Brousseau Nicholas, Gagnon Dominique, Vivion Maryline, Poliquin Vanessa, Boucoiran Isabelle, Tapiéro Bruce, Dubé Eve
Institut national de santé publique du Québec (Brousseau, Gagnon, Vivion, Dubé); Université Laval (Brousseau, Vivion, Dubé), Québec, Que.; Department of Obstetrics, Gynecology and Reproductive Sciences (Poliquin), University of Manitoba, Winnipeg, Man.; Centre hospitalier universitaire Sainte-Justine (Boucoiran, Tapiéro), Montréal, Que.
CMAJ Open. 2018 Sep 20;6(3):E391-E397. doi: 10.9778/cmajo.20180040. Print 2018 Jul-Sep.
Vaccination of all pregnant women with an acellular pertussis-containing vaccine (tetanus, diphtheria, pertussis [Tdap]) was recently recommended in Canada, ideally between 27 and 32 weeks of gestation. This study aimed to describe the existing model of prenatal care in Quebec and determine to what extent maternal vaccination against pertussis could be integrated into this model.
In Quebec, health care is organized around Local Community Service Centres (LCSCs) that serve specific geographic areas. For each of 158 LCSCs (98.1% of LCSCs in the province), we invited 1 nurse or manager involved in prenatal care to participate in a cross-sectional Web-based survey. The structure of prenatal care visits and potential integration of maternal Tdap vaccination into the existing model were documented and compared according to urbanization level, determined with the use of census data.
A completed survey was obtained for 127 LCSCs (response rate 80.4%). Only 13 (10.2%) and 14 (11.0%) LCSCs offered on-site visits with a nurse for the majority of pregnant women during the second and third trimesters, respectively. A significantly higher proportion of rural LCSCs than urban LCSCs offered on-site visits to pregnant women in the third trimester (13 [18%] v. 1 [2%]) ( = 0.003). In at least 50 LCSC service areas (39.4%), vaccines were not available in most medical clinics offering prenatal care.
Given the current situation in Quebec, implementing universal maternal Tdap vaccination may be challenging, which may result in suboptimal vaccine coverage among pregnant women. As other Canadian provinces may face similar issues, a priority will be to evaluate province-based implementation models to develop efficient ways to provide maternal Tdap vaccination across Canada.
加拿大最近建议所有孕妇接种含无细胞百日咳疫苗（破伤风、白喉、百日咳[Tdap]），理想接种时间为妊娠27至32周。本研究旨在描述魁北克现有的产前护理模式，并确定孕妇百日咳疫苗接种可在多大程度上纳入该模式。
在魁北克，医疗保健围绕服务特定地理区域的地方社区服务中心（LCSC）组织。对于158个LCSC中的每一个（占该省LCSC的98.1%），我们邀请1名参与产前护理的护士或管理人员参加基于网络的横断面调查。根据使用人口普查数据确定的城市化水平，记录并比较产前检查的结构以及孕妇Tdap疫苗接种纳入现有模式的可能性。
共获得127个LCSC的完整调查结果（回复率80.4%）。分别只有13个（10.2%）和14个（11.0%）LCSC在孕中期和孕晚期为大多数孕妇提供护士上门服务。农村LCSC在孕晚期为孕妇提供上门服务的比例显著高于城市LCSC（13个[18%]对1个[2%]）（P = 0.003）。在至少50个LCSC服务区（39.4%），大多数提供产前护理的医疗诊所没有疫苗。
鉴于魁北克的现状，实施普遍的孕妇Tdap疫苗接种可能具有挑战性，这可能导致孕妇疫苗接种覆盖率不理想。由于加拿大其他省份可能面临类似问题，当务之急是评估基于省份的实施模式，以制定在加拿大全国提供孕妇Tdap疫苗接种的有效方法。
