Potential use of Western Australia’s mandatory Midwives Notification System for routinely monitoring antenatal vaccine coverage.

Despite the maternal and infant health benefits of antenatal vaccines and availability of government-funded vaccination programs, Australia does not have a national system for routinely monitoring antenatal vaccination coverage. We evaluated the potential use of Western Australia’s mandatory Midwives Notification System (MNS) as a tool for routinely monitoring antenatal vaccination coverage. Two hundred and sixty-eight women who gave birth to a live infant between August and October 2016 participated in a telephone survey of vaccines received in their most recent pregnancy. For women who reported receiving influenza and/or pertussis vaccine and whose vaccination status was documented by their vaccine provider, MNS vaccination data were compared with the vaccine provider’s record as the ‘gold standard.’ For women who reported receiving no vaccines, MNS vaccination data were compared with self-reported information. Influenza and pertussis vaccination status was complete (i.e. documented as either vaccinated or not vaccinated) for 66% and 63% of women, respectively. Sensitivity of MNS influenza vaccination data was 65.7% (95% CI 56.0-74.2%) and specificity was 53.0% (95% CI 42.4-63.4%). Sensitivity of MNS pertussis vaccination data was 62.5% (95% CI 53.3-70.9%) and specificity was 40.4% (95% CI 27.6-54.7%). There was no difference between vaccinated and unvaccinated women in the proportion of MNS records with missing or unknown vaccination information. When considering only MNS records with complete vaccination information, the sensitivity of the MNS influenza vaccination field was 91.8% (95% CI 83.0-96.9%) and the sensitivity of the MNS pertussis vaccination field was 88.0% (95% CI 76.7-95.5%). Due to the high proportion of records with missing or unknown vaccination status, we observed low sensitivity and specificity of antenatal vaccination data in the MNS. However, given we did not observe differential ascertainment by vaccination status, MNS records with complete information may be reliable data source for routinely monitoring antenatal vaccine coverage.

Regan AK ，Effler PV ，Thomson C ，Mak DB ... -  《-》

Antenatal influenza and pertussis vaccination in Western Australia: a cross-sectional survey of vaccine uptake and influencing factors.

Mak DB ，Regan AK ，Vo DT ，Effler PV ... -  《BMC Pregnancy and Childbirth》

Antenatal influenza and pertussis vaccine uptake among Aboriginal mothers in Western Australia.

Antenatal influenza and pertussis vaccination prevent serious disease in mothers and infants. Aboriginal individuals are at increased risk of infection yet little is known about vaccine coverage among Aboriginal mothers. To estimate the uptake of influenza and pertussis vaccination among pregnant Aboriginal women in Western Australia and identify barriers and enablers to vaccination. Four hundred Aboriginal women, aged ≥18 years, who gave birth to a live infant between April and October 2015, were randomly selected and invited to participate in telephone interviews. Of the 387 women who did not decline, 178 had a functioning phone number and 100 completed the survey. Analyses were weighted by maternal residence. During pregnancy the majority of Aboriginal mothers were recommended influenza (66%; unweighted, 65/96 = 68%) and pertussis (65%; unweighted, 62/94 = 66%) vaccines, with 62% (unweighted, 56/94 = 56%) and 63% (unweighted, 60/93 = 65%) receiving the vaccinations, respectively. Almost all vaccinated women (98%) reported wanting to protect their baby as the reason for immunisation. Rural mothers were more likely than metropolitan mothers to have been vaccinated against influenza (odds ratio (OR) 4.1, 95% CI 1.7-10.2) and pertussis (OR 3.1, 95% CI 1.2-7.6). Recommendation by a healthcare provider was strongly associated with vaccine uptake (influenza: OR 15.6, 95% CI 4.9-49.5; pertussis: OR 13.3, 95% CI 4.6-38.0). Vaccination uptake among Western Australian Aboriginal mothers is comparable with rates reported for non-Aboriginal populations worldwide. Provider recommendation is the single most important factor associated with vaccination uptake, underlining the importance of integrating vaccination into routine antenatal care.

Lotter K ，Regan AK ，Thomas T ，Effler PV ，Mak DB ... -  《-》

Influenza and pertussis vaccine coverage in pregnancy in Australia, 2016-2021.

Vaccination in pregnancy is the best strategy to reduce complications from influenza or pertussis infection in infants who are too young to be protected directly from vaccination. Pregnant women are also at risk of influenza complications preventable through antenatal vaccination. Both vaccines are funded under the National Immunisation Program for pregnant women in Australia, but coverage is not routinely reported nationally. We reviewed all reported Australian maternal influenza and pertussis vaccine coverage data for the period 2016-2021, to identify gaps and information needs. Maternal influenza vaccine coverage was suboptimal at < 58% for 2016-2018, with higher coverage of 62-75% reported in two states (Victoria and Western Australia) for 2019-2021. Maternal pertussis vaccine coverage from 2016 was generally higher than for influenza at > 70%, with the highest jurisdictional coverage of 89% reported in Western Australia in 2020. Vaccination rates were often suboptimal among First Nations pregnant women and up to 20% lower than among non-First Nations Australian women; while data were limited, coverage was low among culturally and linguistically diverse women and among women of lower socio-economic status. Jurisdictional perinatal data collections were the best source of information on antenatal vaccine coverage but were only available for a minority of the population; a nationally consistent systematic approach is lacking. Timely and comprehensive data are needed to provide feedback to improve maternal vaccination coverage, particularly among groups with higher risk and/or low uptake, and as new vaccines are recommended, including COVID-19 vaccination.

McRae JE ，McHugh L ，King C ，Beard FH ，Blyth CC ，Danchin MH ，Giles ML ，Mohammed H ，Wood N ，Macartney K ... -  《-》

'Links2HealthierBubs' cohort study: protocol for a record linkage study on the safety, uptake and effectiveness of influenza and pertussis vaccines among pregnant Australian women.

Pregnant women and infants are at risk of severe influenza and pertussis infection. Inactivated influenza vaccine (IIV) and diphtheria-tetanus-acellular pertussis vaccine (dTpa) are recommended during pregnancy to protect both mothers and infants. In Australia, uptake is not routinely monitored but coverage appears sub-optimal. Evidence on the safety of combined antenatal IIV and dTpa is fragmented or deficient, and there remain knowledge gaps of population-level vaccine effectiveness. We aim to establish a large, population-based, multi-jurisdictional cohort of mother-infant pairs to measure the uptake, safety and effectiveness of antenatal IIV and dTpa vaccines in three Australian jurisdictions. This is a first step toward assessing the impact of antenatal vaccination programmes in Australia, which can then inform government policy with respect to future strategies in national vaccination programmes. METHODS AND ANALYSIS: 'Links2HealthierBubs' is an observational, population-based, retrospective cohort study established through probabilistic record linkage of administrative health data. The cohort includes births between 2012 and 2017 (~607 605 mother-infant pairs) in jurisdictions with population-level antenatal vaccination and health outcome data (Western Australia, Queensland and the Northern Territory). Perinatal data will be the reference frame to identify the cohort. Jurisdictional vaccination registers will identify antenatal vaccination status and the gestational timing of vaccination. Information on maternal, fetal and child health outcomes will be obtained from hospitalisation and emergency department records, notifiable diseases databases, developmental anomalies databases, birth and mortality registers. Ethical approval was obtained from the Western Australian Department of Health, Curtin University, the Menzies School of Health Research, the Royal Brisbane and Women's Hospital, and the West Australian Aboriginal Health Ethics Committees. Research findings will be disseminated in peer-reviewed journals, at scientific meetings, and may be incorporated into communication materials for public health agencies and the public.

Sarna M ，Andrews R ，Moore H ，Binks MJ ，McHugh L ，Pereira GF ，Blyth CC ，Van Buynder P ，Lust K ，Effler P ，Lambert SB ，Omer SB ，Mak DB ，Snelling T ，D'Antoine HA ，McIntyre P ，de Klerk N ，Foo D ，Regan AK ... -  《BMJ Open》