© 2012, KAISER PERMANENTE CENTER FOR HEALTH RESEARCH
A Descriptive Study of Vaccinations Occurring During Pregnancy
Allison Naleway, Rachel Gold, Michelle Henninger, Samantha Kurosky, Karen Riedlinger (Kaiser Permanente Center for Health Research)James Nordin, Elyse Kharbanda (HealthPartners Research Foundation)James Donahue (Marshfield Clinic Research Foundation)Eric Weintraub (Centers for Disease Control and Prevention)
HMORN Annual Meeting, Seattle, April 2012
© 2012, KAISER PERMANENTE CENTER FOR HEALTH RESEARCH
Background/Aims
Trivalent influenza vaccine (TIV) is the only vaccine recommended by the Advisory Committee on Immunization Practices (ACIP) for routine administration during pregnancy.
The ACIP categorizes the remaining vaccines as: Should be considered if otherwise indicated (e.g., TD/DT, HepB) Contraindicated (e.g., MMR, Varicella, LAIV, Rubella) Special/conditional recommendations (e.g., HepA, TDAP/TDAP/DTP) or
no recommendations (Hib) The aim of this study was to describe rates of
vaccination during pregnancy within the Vaccine Safety Datalink population, 2002-2006.
© 2012, KAISER PERMANENTE CENTER FOR HEALTH RESEARCH
Vaccine Safety Datalink
Collaboration between CDC, AHIP, and 10 managed care organizations
Epidemiologic studies of vaccine safety using large, standardized datasets
Datasets include demographics, enrollment, diagnoses, procedures, vaccinations
Supplemented with vital statistics data (births, deaths), Census data
© 2012, KAISER PERMANENTE CENTER FOR HEALTH RESEARCH
Vaccine Safety Datalink
© 2012, KAISER PERMANENTE CENTER FOR HEALTH RESEARCH
Methods
7 participating sites: Group Health Cooperative; Health Partners; Marshfield Clinic; and Kaiser Permanente Northwest, Northern California, Southern California, and Colorado
Using the VSD Pregnancy Episode Algorithm (PEA), we identified all pregnancies ending in 2002-2006, including live births, spontaneous and elective terminations, and other birth outcomes.
Then we identified all occurrences of vaccinations given during the same time period
Vaccines were stratified into four categories based on ACIP recommendations
All apparent cases of inadvertent vaccination during pregnancy were chart reviewed, up to 100 cases per site.
© 2012, KAISER PERMANENTE CENTER FOR HEALTH RESEARCH
Results: Recommended vaccines
We identified 595,929 pregnancies and 68,839 vaccinations
As expected, the most commonly administered vaccine was TIV, which is recommended during pregnancy: 58,683 doses (98.47 doses per 1,000 pregnancies) More likely to be administered in 2nd and 3rd trimesters
1st trimester rate: 22 per 1,000 2nd trimester rate: 52 per 1,000 3rd trimester rate: 46 per 1,000
© 2012, KAISER PERMANENTE CENTER FOR HEALTH RESEARCH
Results: Consider if indicated vaccinesTotal doses Rate per 1,000
pregnancies
Tetanus-diphtheria (TD/DT) 3,960 6.65
Hepatitis B 2,567 4.31
Meningococcal 192 0.32
Rabies 24 0.04
Category total 6,743 11.32
© 2012, KAISER PERMANENTE CENTER FOR HEALTH RESEARCH
Results: Consider if indicated vaccines (incidence rates per 1,000 pregnancies)
1st trimester
2nd trimester
3rd trimester
Tetanus-diphtheria (TD/DT)
4.11 2.03 1.23
Hepatitis B 3.03 1.09 0.55
Meningococcal 0.25 0.07 0.03
Rabies 0.03 0.01 0.01
Category total 7.42 3.20 1.82
© 2012, KAISER PERMANENTE CENTER FOR HEALTH RESEARCH
Results: Contraindicated vaccines
Total doses Rate per 1,000 pregnancies
MMR 380 0.64
Varicella 291 0.49
Influenza (LAIV) 116 0.19
Rubella 92 0.15
Category total 882 1.48
© 2012, KAISER PERMANENTE CENTER FOR HEALTH RESEARCH
Results: Contraindicated vaccines (incidence rates per 1,000 pregnancies)
1st trimester
2nd trimester
3rd trimester
MMR 0.48 0.09 0.12
Varicella 0.35 0.11 0.07
Influenza (LAIV) 0.15 0.02 0.03
Rubella 0.04 0 0.14
Category total 1.02 0.22 0.36
© 2012, KAISER PERMANENTE CENTER FOR HEALTH RESEARCH
Conclusions
TIV, which is recommended during pregnancy, was the most commonly administered vaccine in the VSD study population
MMR, varicella, and LAIV were the most commonly administered contraindicated vaccines
With the exception of TIV, all other vaccines were more likely to be administered during the 1st trimester of pregnancy, suggesting that vaccines may have been given when either the woman and/or provider were unaware of pregnancy
Given that some women received contraindicated vaccines during later pregnancy, clearer recommendations and improved provider education may be warranted
© 2012, KAISER PERMANENTE CENTER FOR HEALTH RESEARCH
Acknowledgements
CDC Julianne Gee Eric Weintraub Natalie McCarthy
Group Health Cooperative Lisa Jackson Patti Benson
KP Northwest Jill Mesa Eresha Bluth
KP Northern California Nicola Klein Roger Baxter Pat Ross
KP Southern California Craig Cheetham Lina Sy
KP Colorado Simon Hambidge JoAnn Shoup
Health Partners Jim Nordin Elyse Kharbanda Gabriela Vazquez-Benitez Leslie Kuckler
Marshfield Clinic James Donahue Stephanie Irving
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