Vaccination in Pregnancy, 2022–23: Coverage Low, Hesitancy Rising

Flu, Tdap and COVID-19 vaccines can protect pregnant women and their babies from serious respiratory illness. Yet in the 2022–23 season, about half of pregnant women in a CDC survey had not had a flu shot or Tdap, only about a quarter had both, and three in four had not had a bivalent COVID-19 booster. More women than before said they were very hesitant about the vaccines.

What ACIP recommends in pregnancy

• Flu vaccine for everyone who is or might be pregnant during flu season, at any point in pregnancy.
• Tdap in every pregnancy, preferably early in weeks 27–36.
• COVID-19 vaccine for everyone 6 months and older, including pregnant women.

Coverage, 2022–23

An internet panel survey from March 28 to April 16, 2023, reached 2,349 women aged 18 to 49 who had been pregnant since August 1, 2022.

Flu coverage was more than 10 points lower than in 2019–20, part of a decline since the pandemic began. Tdap coverage rose about 10 points from the year before, back to its 2019–20 and 2020–21 levels.

What made a difference

A provider's offer. Among women whose provider offered the flu vaccine or referred them for it, 61.4 percent were vaccinated, against 22.7 percent of those who got a recommendation without an offer and 10.8 percent of those who got no recommendation. Tdap coverage was 69.1 percent with an offer or referral. Coverage was lower among women in rural areas (flu) and with public insurance (flu and Tdap), and lower among Black women, who have been less likely to receive an offer or referral.

Hesitancy is growing

How hesitant pregnant women were about flu and Tdap vaccines, 2019–20 through 2022–23. Credit: CDC, Morbidity and Mortality Weekly Report.

Hesitancy was higher among Black women than white women. Women who received a provider recommendation were less hesitant — and hesitant women were more likely to be vaccinated when a provider offered or referred them.

What helps

Every pregnant woman, in every racial and ethnic group, should get a provider's recommendation along with an offer or referral, and culturally relevant conversations about vaccines. CDC has resources to help providers explain why a vaccine is right for each patient, and the American College of Obstetricians and Gynecologists offers an immunization toolkit.

Limits

The sample was not a probability sample and may not represent all pregnant women; vaccination was self-reported; some groups were too small to analyze; and nearly 13 percent of women did not know their Tdap status, so true Tdap coverage could be 6–7 points higher or lower.

Sources

Based on "Influenza, Tdap, and COVID-19 Vaccination Coverage and Hesitancy Among Pregnant Women — United States, April 2023," by Hilda Razzaghi and colleagues, Morbidity and Mortality Weekly Report, Centers for Disease Control and Prevention; a work of the United States government in the public domain.