Department of Obstetrics, Gynecology and Reproductive Sciences, Larner College of Medicine, University of Vermont, Burlington, VT, United States.
Department of Medical Biostatistics, Larner College of Medicine, University of Vermont, Burlington, VT, United States.
Vaccine. 2019 Feb 21;37(9):1188-1193. doi: 10.1016/j.vaccine.2019.01.001. Epub 2019 Jan 18.
The Advisory Committee on Immunization Practices (ACIP) has focused on maternal Tdap immunization as an important means to protect neonates from pertussis infections. There is little published data on provider and/or clinic characteristics as predictors of maternal Tdap uptake. This study examined differences in maternal Tdap coverage in women delivering at a single academic institution, but cared for prenatally in different clinical settings, in 2013, 2014, and 2015. Additionally, the accuracy and utilization of Vermont's immunization information system (IIS) was assessed.
This was a retrospective, multiple time-point cross-sectional analysis of annual maternal Tdap coverage in women delivering at a single academic institution in the 3 years following a fundamental change in national maternal Tdap vaccination guidelines. Tdap administration was examined across different obstetric groups using chart review and data from the state's IIS.
All obstetric care groups except the resident-staffed clinic significantly increased maternal Tdap coverage in 2014, compared to 2013 coverage, with no further increase in 2015. In contrast, there was no increase in maternal Tdap coverage in 2014 in the resident-staffed clinics, but then a statistically significant increase in 2015. Overall Tdap coverage in 2014 was 80.4%, with variation in Tdap coverage between clinics types. In the subset of women who were cared for by the University-based groups, there was significant variation in Tdap coverage between clinics, despite racial homogeneity, which persisted after adjustment for maternal age and insurance type. The state's IIS was found to be highly accurate, using individual chart review as the "gold standard."
While we demonstrated high maternal Tdap coverage in women delivering at our institution, differences in clinic type and provider training appeared to impact immunization rates, as well as how quickly evolving national recommendations were adopted. Additionally, the fidelity of the state's IIS data was verified.
免疫实践咨询委员会（ACIP）一直专注于母亲 Tdap 免疫接种，将其作为保护新生儿免受百日咳感染的重要手段。关于提供者和/或诊所特征作为母亲 Tdap 接种率预测因素的相关数据较少。本研究于 2013 年、2014 年和 2015 年，在一家学术机构分娩但在不同临床环境中接受产前护理的女性中，调查了母亲 Tdap 覆盖率的差异。此外，还评估了佛蒙特州免疫信息系统（IIS）的准确性和使用情况。
这是一项回顾性、多时间点的横断面分析，研究了在国家母亲 Tdap 疫苗接种指南发生根本性变化后的 3 年内，在一家学术机构分娩的女性每年的母亲 Tdap 覆盖率。通过病历回顾和该州 IIS 中的数据，检查了不同产科群体中的 Tdap 管理情况。
与 2013 年相比，除居民员工诊所外，所有产科护理群体在 2014 年的母亲 Tdap 覆盖率均显著增加，而 2015 年则没有进一步增加。相比之下，居民员工诊所的母亲 Tdap 覆盖率在 2014 年没有增加，但在 2015 年则显著增加。2014 年 Tdap 总覆盖率为 80.4%，不同诊所类型之间 Tdap 覆盖率存在差异。在由大学为基础的群体护理的女性亚组中，尽管种族同质化，但诊所之间的 Tdap 覆盖率存在显著差异，这种差异在调整了母亲年龄和保险类型后仍然存在。该州的 IIS 被发现具有高度准确性，将个体病历审查作为“金标准”。
尽管我们在我院分娩的女性中观察到高的母亲 Tdap 覆盖率，但诊所类型和提供者培训的差异似乎影响了免疫接种率，以及国家推荐的更新速度。此外，还验证了该州 IIS 数据的准确性。
