Janagaraj Priya Darshene, Gurusamy Pari Shanmuga Raman, Webby Rosalind
Centre for Disease Control (CDC), Tiwi, Northern Territory, Australia.
Department Obstetrics and Gynecology, Top End Health Service, Tiwi, Northern Territory, Australia.
Aust N Z J Obstet Gynaecol. 2019 Jun;59(3):436-443. doi: 10.1111/ajo.12896. Epub 2018 Sep 26.
Assessing gaps in antenatal pertussis vaccination to increase coverage.
Antenatal pertussis vaccination has been proven effective in reducing pertussis disease in infants. Current guidelines recommend maternal pertussis vaccination from 28 weeks gestation. The aim of this study is to determine antenatal pertussis vaccination coverage in the Northern Territory and potential socio-demographic factors affecting uptake, using validated birth and immunisation data.
Cross-sectional population study including all viable births (from 24 weeks gestation) in Northern Territory public hospitals in 2016.
There were 3392 viable delivery episodes in 2016 with 48.9% coverage against maternal pertussis based on current guidelines. Mothers <35 years old were more likely to receive antenatal vaccination (adjusted odds ratio (aOR) = 1.26, CI 1.035-1.52, P = 0.021). Pertussis vaccination coverage for preterm births was low at 0% for extreme, 18.86% for very preterm and 39.8% for moderate preterm births, with an overall coverage of 33.5% for all preterm births. Term births were two times more likely than preterm births to have had mothers receive an antenatal diphtheria toxoid, tetanus toxoid and acellular pertussis vaccine (aOR = 1.957, CI 1.53-2.50, P < 0.001).
A significant proportion (66.5%) of preterm babies are not benefiting from protection against pertussis with the current pertussis vaccination policy from 28 weeks gestation. As timing of birth cannot be predetermined, a review of safety and acceptability of pertussis vaccine administration in the second trimester is needed. Implementation of pertussis vaccination from 20 weeks gestation will provide a wider vaccination period and maximise the protection of all infants including pre-term infants from pertussis.
评估产前百日咳疫苗接种的差距以提高覆盖率。
产前百日咳疫苗接种已被证明可有效降低婴儿百日咳疾病。当前指南建议在妊娠28周起进行孕产妇百日咳疫苗接种。本研究的目的是利用经过验证的出生和免疫数据，确定北领地的产前百日咳疫苗接种覆盖率以及影响疫苗接种率的潜在社会人口学因素。
横断面人群研究，纳入2016年北领地公立医院所有可存活出生（妊娠24周起）的情况。
2016年有3392例可存活分娩，根据当前指南，孕产妇百日咳疫苗接种覆盖率为48.9%。年龄小于35岁的母亲更有可能接受产前疫苗接种（调整优势比（aOR）=1.26，置信区间1.035 - 1.52，P = 0.021）。早产婴儿的百日咳疫苗接种覆盖率较低，极早早产儿为0%，非常早产为18.86%，中度早产为39.8%，所有早产婴儿的总体覆盖率为33.5%。足月儿母亲接受产前白喉类毒素、破伤风类毒素和无细胞百日咳疫苗接种的可能性是早产儿母亲的两倍（aOR = 1.957，置信区间1.53 - 2.50，P < 0.001）。
按照当前从妊娠28周起的百日咳疫苗接种政策，相当比例（66.5%）的早产婴儿无法从百日咳预防保护中受益。由于出生时间无法预先确定，需要重新审视妊娠中期接种百日咳疫苗的安全性和可接受性。从妊娠20周起实施百日咳疫苗接种将提供更广泛的接种期，并最大限度地保护所有婴儿包括早产儿免受百日咳侵害。
