Abstract
Objective
Influenza and tetanus toxoid reduced diphtheria toxoid, and acellular pertussis (Tdap)
are safe and effective vaccines that are recommended in pregnancy. Despite this, significant
vaccine hesitancy exists in pregnancy. However, impact of the coronavirus disease
2019 (COVID-19) pandemic on vaccine hesitancy is not well understood. Thus, we sought
to describe impact of the COVID-19 pandemic on influenza and Tdap vaccination rates
in pregnant patients.
Study Design
Retrospective cohort study of patients delivering at single academic center from October
1, 2017 to August 31, 2021. Patients with missing vaccine data or delivering before
28 weeks (Tdap range) excluded. Patients delivering pre-COVID (October 1, 2017–August
31, 2019) compared with those delivering mid-COVID (October 1, 2020–August 31, 2021).
Primary outcomes were vaccination rates for Tdap and influenza. Secondary outcome
was rate of dual vaccination (receiving both) and variation by race/ethnicity. Chi-square
tests and logistic regression were used to test for changes in vaccination rates.
Results
Of 8,650 unique patient pregnancies, 5,925(68.5%) occurred pre-COVID. Median patient
age (30 years) and gestational age at delivery (39 weeks) not clinically different
between groups. Patients in mid-COVID group had lower numbers of government-assisted
insurance (47.3%) and higher non-Hispanic Black compared with pre-COVID (31.5%). The
rate of influenza vaccination decreased 8.2 percentage points from pre-COVID to mid-COVID
(69.9 vs. 61.7%, p < 0.001). Tdap vaccination rates also decreased, although less-so (88.5 vs. 85.1%,
p < 0.001). The rate of patients receiving both vaccines during pregnancy decreased
from 66.0 to 58.4% (p < 0.001). Significant decreases in influenza vaccination rates mid-COVID versus pre-COVID
was seen in all race–ethnicity groups except non-Hispanic White patients. For Tdap
vaccinations, the effect of COVID on the odds of receiving Tdap did not differ across
race–ethnicity groups.
Conclusion
Rates of influenza, Tdap, and dual vaccination in pregnancy dropped significantly
during the COVID-19 pandemic. For influenza, these were most pronounced in all race–ethnicities
included with exception of non-Hispanic White. These data emphasize the importance
of continued counseling and education on vaccinations in pregnancy and raise important
questions regarding vaccine access and patient hesitancy during pandemic-mediated
prenatal care.
Key Points
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Influenza vaccination decreased with COVID-19.
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Tdap vaccination decreased with COVID-19.
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Decrease in flu vaccination in most race–ethnicity groups.
Keywords
vaccination - influenza - Tdap - COVID-19
