Two vaccines are recommended in pregnancy, for the mother and for the infant
who is too young to be vaccinated: **influenza vaccine at any point in the
pregnancy**, and Tdap during each pregnancy, ideally in **gestational weeks
27–36**.
For the 2019–20 season:
| Influenza vaccine | 61.2% — up 7.5 points on 2018–19 |
| Tdap | 56.6% — similar to 2018–19 |
| Both | 40.3% |
The single biggest difference
| Coverage | |
|---|---|
| Women who received a provider offer or referral | influenza 75.2% · Tdap 72.7% |
| Overall | influenza 61.2% · Tdap 56.6% |
About fifteen percentage points, from whether the clinician raised it.
That reframes the whole subject. This is usually discussed as a question of
what pregnant women believe about vaccines; the largest measured lever is
whether anybody offered.
Which does not close the gap
Influenza coverage rose sharply in the groups that were furthest behind:
| 2019–20 | Change | |
|---|---|---|
| Black women | 52.7% | +14.7 points |
| Hispanic women | 67.2% | +9.9 |
| Other races | 69.6% | +7.9 |
| White women | 60.6% | no change |
Hispanic women overtook white women. Black women remained lowest.
Tdap went the other way:
| 2019–20 | |
|---|---|
| White women | 65.5% |
| Other races | 54.0% |
| Black women | 38.8% |
| Hispanic women | 35.8% — down on the previous season |
Two vaccines, offered at the same appointments, to the same women, with
opposite patterns — which means the explanation is not a general attitude to
vaccination.
And the sentence that rules out the easy fix:
**Racial/ethnic disparities in influenza vaccination coverage decreased but
persisted, even among women who received a provider offer or referral for
vaccination.**
Being offered helps everyone and does not equalise anyone. Hence the
recommendation's two halves: consistent provider offers or referrals, **in
combination with conversations culturally and linguistically tailored for
patients of all races and ethnicities.** The offer is necessary; what is said
around it is what differs.
What the numbers rest on
An internet panel survey, 2–14 April 2020. Of 18,314 women screened,
2,515 eligible and 2,268 completed (cooperation rate 90.2%), weighted
to the age, race/ethnicity and geographic distribution of US pregnant women.
Influenza analysis: 1,841 women pregnant at any point during October
2019–January 2020. Tdap analysis: 463 women with a live birth by the survey
date — a smaller group by design, because Tdap's recommended window falls late
in pregnancy. 69 of 532 (12.9%) were excluded for not knowing whether or
when they had received it.
Source: Centers for Disease Control and Prevention, MMWR.
许可协议： CC0 1.0（公有领域） · 改编自 www.cdc.gov
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