US govt data shows 62% of pregnant black women not vaccinated for flu, pertussis

Low trust levels among black adults for vaccines, doctors

By Rohan Gupta
Published: Friday 11 October 2019

A sample survey conducted by United States Centre for Disease Control and Prevention (CDC) for its latest Morbidity and Mortality Weekly Report found that 62 per cent of black, non-Hispanic pregnant women in the United States (US) were not vaccinated for influenza and pertussis.

This was the lowest among all major ethnicities in US. Black, non-Hispanic women also received the lowest offers or referrals for vaccinations (69 per cent). And among those who received it, the lowest percentage (46.6 per cent) actually ended up getting vaccinated.

Compared to this cultural group, other ethnicities showed vaccination rates higher by at least 19 percentage points in the case of influenza and at least 13 percentage points for Tetanus, diphtheria, and pertussis (Tdap).

Hispanic pregnant women came second in line in the case of vaccination rates — Influenza (57 per cent) and Tdap (51.45 per cent).

Studies on the general population showed that black adults had lower trust levels in influenza vaccines, in their doctors and in CDC-provided data compared to white adults, which could possibly explain the low vaccination rates among black, non-Hispanic women, the report said.

The survey showed that more than 30 per cent of pregnant women in the US who were offered or referred for influenza or pertussis vaccinations by their health care providers, remain unvaccinated.

Data presented in the report showed that 73.3 per cent of the survey respondents reported an offer or referral for influenza vaccinations while 76 per cent did so in case of Tdap. Among these, only 65.7 per cent received influenza vaccines while 70.5 per cent received Tdap.

A woman carries a higher risk of influenza hospitalisation when she is pregnant. Along with that, infants below six months of age have reported higher incidence of influenza-associated hospitalisation and the highest influenza-associated mortality rate among children, the report said.

Even pertussis morbidity and mortality rates are higher among children below one year of age. The report cited a 2014 Guttmacher Institute article, saying that approximately nine per cent of all US women aged between 15-44 years are pregnant at any given time each year. Pregnant women in the same group account for 24-34 per cent of influenza-associated hospitalisations.

The report said that influenza and Tdap vaccinations can reduce the risk of influenza and pertussis among pregnant women and their infants. Vaccinations to pregnant women can be provided trans-placentally, who, in turn, can transfer passive immunity against influenza and pertussis to their infants for the few initial months.

Studies cited find the influenza vaccines to reduce the risk of influenza-associated hospitalisations among pregnant women by 40 per cent. Maternal vaccinations were shown to reduce influenza-related hospitalisation risk among infants below six years, by an average of 72 per cent.

Narratives surrounding anti-vaccination have recently picked up globally, and specifically in the US. So much so that the World Health Organization (WHO) included vaccine hesitancy in its list of 10 global health threats to be tackled in 2019.

The CDC survey provides data on the reasons why women are not getting their influenza and Tdap vaccinations even after offers and referrals. The primary reason reported by women for not taking influenza vaccines was the belief that the vaccine was not effective (17.6 per cent).

Not knowing that vaccines were needed for each pregnancy was the major reason for remaining unvaccinated in the case of Tdap (37.9 per cent). The second-most reported reason for both the vaccines was the fear of safety risks to their infants (influenza = 15.9 per cent, Tdap = 17.1 per cent).

The report mentioned that better vaccination coverage could reduce disease burden. And a pro-active step taken by health care providers in vaccine referrals and offers could help increase vaccination coverage among pregnant women.

Data was collected using an internet panel survey conducted between March 27-April 8, 2019, among women aged 18-49 years who reported being pregnant anytime since August 1, 2018. Sample size for influenza vaccine coverage was 2,097 while it was 817 in the case of Tdap vaccines.

The report also listed some limitations such as vaccination data may over- or under-estimate the true coverage owing to the self-reporting nature of the survey. Along with that, the respondents excluded from the Tdap coverage analysis differed in demographic features from those included.

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