In this mixed-methods implementation study, routine immunization and family planning services were integrated across health facilities and community sites across two rural districts in Malawi, Dowa and Ntchisi. The total number of women accessing family planning services during the study period increased by 14% while DPT immunization rates for children remained consistent. In interviews, parents and providers found the integration of family planning and immunization services to be feasible and beneficial, indicating a win-win for both services.
Pertussis
The introduction of the dTpa vaccine for pregnant women in Brazil reduced pertussis hospitalizations in infants
In response to an increase in pertussis cases beginning in 2010, Brazil introduced dTpa vaccine into the national immunization schedule for pregnant women in 2013. In the pre-maternal vaccination period (2011–2013), the average annual incidence of pertussis hospitalizations in children under 1 year old was 98.3/100,000 and in the post-maternal vaccination period (2015–2017) the average was 65.9/100,000, a decline of 32.9%.
Children with critical pertussis have lower scores in language, cognitive, and motor development, highlighting the importance of immunization
More than one-third of children under one year of age in a US study, admitted to a pediatric intensive care unit for critical pertussis had significantly abnormal scores on the Mullen Scales of Early Learning, especially in the area of language development. These children also had a significantly lower mean score for all areas of the test, including cognitive and motor development. This indicates the need for routine neuro-development screening of child survivors of critical pertussis.
The Mullen Scales of Early Learning assesses cognitive and motor development [Gross Motor, Visual Reception, Fine Motor, Expressive Language, and Receptive Language] in children. The Mullen test is generally used for evaluating intellectual development and readiness for school.
Vaccinating pregnant women with Tdap vaccine protects infants from pertussis and provides additional protection in their first year
A large study in California involving nearly 150,000 newborns found that vaccinating pregnant women with the Tdap vaccine provided 91% protection against pertussis infection among infants under 2 months of age and 88% protection before the infants had any vaccinations. The study also showed that vaccinating mothers during their pregnancy did not reduce the effectiveness of infant vaccination but that maternal Tdap vaccination provided additional protection to the infants through their first year of life.
Adding dTpa vaccination for pregnant women in Australia would prevent thousands of pertussis hospitalizations each year
A study in Australia estimated that adding dTpa vaccination for pregnant women to the current pertussis immunization program for children would prevent an additional 8,800 symptomatic pertussis cases (mostly unreported) and 146 hospitalizations each year in all ages, including infants and their mothers, as well as one death every 22 months. The study found maternal pertussis vaccination to be cost-effective.
Note: The formulation used in this study is abbreviated dTpa.
Vaccinating pregnant women with dTpa vaccine greatly reduces severe pertussis in infants
A case-control study in the state of New South Wales, Australia estimated that vaccination of pregnant women with the dTpa vaccine at 28-32 weeks of pregnancy was highly effective in preventing severe pertussis in infants less than 6 months of age — with a vaccine efficacy rate of 94% against pertussis hospitalizations — and 69% effective in preventing the disease of any severity in infants less than 3 months old.
Note: The formulation used in this study is abbreviated dTpa.
Vaccinating pregnant women with Tdap vaccine in Brazil was 83% effective in preventing pertussis in infants
In a case-control study in the state of São Paulo, Brazil, vaccination of pregnant women with Tdap vaccine was 83% effective in preventing pertussis in their infants less than 2 months of age — before their first dose of DPT — and 81% effective after controlling for household income and mother’s age.
Maternal pertussis vaccination in Argentina reduced pertussis incidence in infants under 2 months by half
In Argentina, more than 50% of deaths due to pertussis occurred in infants younger than 2 months of age — too young to be vaccinated in the country. The impact of maternal pertussis vaccination in protecting their infants against the disease reduced the incidence of pertussis in infants less than 2 months old by half, when comparing states with high and low maternal vaccination rates.
Vaccinating pregnant women against pertussis greatly reduces the risk of the disease in infants and infant deaths
Vaccinating pregnant women against pertussis at least one week before delivery was found to be 91% effective in preventing the disease in infants <3 months old and 95% effective in preventing infant deaths in a study conducted in England over a 3-year period following the introduction of dTap-IPV vaccine for pregnant women. Of the 37 deaths from pertussis in infants that occurred in England from 2009 to 2015, 32 (86%) were in infants <2 months of age, highlighting the vulnerability of very young infants to severe pertussis. All but 2 of the deaths in <2 month olds were in children whose mothers hadn’t been vaccinated against pertussis during their pregnancy, while in the 2 other cases, the vaccination occurred too late in the pregnancy (<10 days before the birth).
Immunization during pregnancy protects against serious illnesses and improves pregnancy outcomes
Pregnant women are at particularly high risk of serious illness and death from a variety of bacterial and viral diseases, such as influenza, pneumococcal pneumonia, and Group B strep, for which vaccines exist or are in development. Vaccine-preventable diseases in pregnancy are associated with adverse pregnancy outcomes such as spontaneous abortion, congenital anomalies, preterm birth, and low birth weight.