Research and analysis

Prenatal pertussis vaccination coverage in England from April to June 2023

Updated 4 April 2024

Applies to England

Main points

This quarterly report evaluates prenatal pertussis vaccine coverage for women who delivered in the April to June 2023 quarter who were eligible for the prenatal pertussis vaccine from 16 weeks of pregnancy onwards.

The main findings were that:

• pertussis vaccine coverage in pregnant women for the first quarter of the 2023 to 2024 financial year was 58.7% in April, 58.1% in May and 57.5% in June

• the mean coverage for the quarter was 58.1%, which was 2.7 percentage points lower than the mean coverage for the same quarter in the 2022 to 2023 financial year

• the mean coverage for the quarter was also 6.4 percentage points lower than the mean coverage for the same quarter in the 2021 to 2022 financial year

• this observed decline in coverage has largely been driven by a decrease in London NHS Commissioning Region but is also reflected in other regions, particularly the North West and the Midlands

Background

This report presents pertussis vaccine coverage in pregnant women in England for the period April to June 2023, updating previous data reported for January to March 2023 (1).

Following increased pertussis activity in all age groups, including infants under 3 months of age, and the declaration of a national pertussis outbreak in April 2012 (2), the pertussis vaccine has been offered to pregnant women since 1 October 2012 (3). The prenatal pertussis vaccination programme aims to minimise disease, hospitalisation and deaths in young infants, through the intra-uterine transfer of maternal antibodies, until they can be actively protected by the routine infant programme with the first dose of pertussis vaccine scheduled at 8 weeks of age (4).

In June 2014, the Joint Committee on Vaccination and Immunisation (JCVI) advised it should continue for a further 5 years (5). In February 2016, the JCVI considered new evidence demonstrating that vaccination earlier in pregnancy would increase opportunities during pregnancy for vaccination, without detrimentally affecting the protection afforded to the infant (6, 7). Based on this, JCVI advised that vaccination could be offered from gestational week 16, although for operational reasons vaccination should ideally be offered from around 20 weeks, on or after the foetal anomaly scan (8).

This advice was implemented from April 2016 as was offering the vaccine through general practice as well as some maternity services. In 2019, following the JCVI recommendation, the prenatal pertussis vaccine became a routine programme in England (9).

Methods

GP level pertussis vaccine coverage data is automatically uploaded via participating GP IT suppliers to the ImmForm website each month. ImmForm data is validated and analysed by the UK Health Security Agency (UKHSA) to check data completeness, identify and query any anomalous data and describe epidemiological trends. Since April and May 2016 (implementation date varied by GP IT supplier), the following monthly data has been collected:

• denominator: number of women who delivered in the survey month, excluding miscarriages and stillbirths, regardless of gestational age
• numerator: number of women receiving pertussis vaccination between week 16 of pregnancy and delivery

For accurate denominators to be extracted from GP IT systems by the automated survey and precise coverage estimates to be calculated, it is important that the medical records of all women who have given birth have the following fields completed:

• the date of delivery
• the date of receipt of a pertussis-containing vaccine at or after week 16 of pregnancy, regardless of the setting where the vaccine was administered
• where relevant, fields indicating stillbirth or miscarriage

Coverage by former local teams and NHS commissioning regions (based on the 2019 NHS England configurations) is also included, for comparison, in the data tables associated with this report.

Integrated Care Boards (ICBs) have been omitted due to changes in NHS geographies over time and the abolition of CCGs from 1 July 2022.

Participation and data quality

All GP IT suppliers provided data for the April to June 2023 period. National GP practice participation was at 98.4% (April 2023), 96.8% (May 2023) and 93.3% (June 2023).

Results

Monthly pertussis vaccine coverage ranged across the quarter from 58.7% in April to 58.1% in May and 57.5% in June, with mean coverage for the quarter at 58.1% (Table 1, Figure 1), see data tables. During this quarter, prenatal pertussis vaccine coverage by ICB ranged from 76.7% (Derby and Derbyshire, April to June 2023) to 76.7% (North Central London, April to June 2023) (Table 1).

When compared with data from the 2022 to 2023 financial year, national coverage was 2.8 percentage points lower in April, 2.3 percentage points lower in May and 2.0 percentage points lower in June. Mean coverage for this quarter was 2.4 percentage points lower compared to national coverage reported for the same quarter in the 2021 to 2022 financial year. Coverage in quarter 1 (April to June 2023) was the lowest measured since April 2016 when the new IT specification was implemented (Figure 1) (10).

Coverage by former local teams and NHS commissioning regions (based on the 2019 NHS England configurations) are also included in the data tables for trend comparisons.

In the London NHS commissioning region there has been a steep decline in coverage since June 2019. Coverage in London dropped 19.5 percentage points between June 2019, when coverage was 56.7%, and June 2023, when coverage was 37.2% (Figure 2).

Table 1. Monthly pertussis vaccination coverage (%) in pregnant women by ICB in England, April to June 2023

ICB code	ICB name	April 2023	May 2023	June 2023	April to June 2023
QE1	Lancashire and South Cumbria	56.5	56.8	56.7	56.7
QF7	South Yorkshire	66.4	65.2	63.3	64.9
QGH	Herefordshire and Worcestershire	69.1	65.8	70.2	68.5
QH8	Mid and South Essex	63.0	59.4	60.6	61.0
QHG	Bedfordshire, Luton, and Milton Keynes	59.7	58.8	57.7	58.7
QHL	Birmingham and Solihull	42.3	40.6	42.4	41.8
QHM	North East and North Cumbria	59.9	56.3	56.3	57.5
QJ2	Derby and Derbyshire	76.5	77.3	76.4	76.7
QJG	Suffolk and North East Essex	63.8	62.2	59.5	61.8
QJK	Devon	65.9	67.3	70.5	67.8
QJM	Lincolnshire	60.2	54.8	58.4	57.8
QK1	Leicester, Leicestershire and Rutland	61.0	55.3	54.6	56.9
QKK	South East London	48.4	50.0	46.8	48.4
QKS	Kent and Medway	65.3	63.9	62.1	63.8
QM7	Hertfordshire and West Essex	66.3	62.8	64.3	64.5
QMF	North East London	31.1	30.0	29.5	30.2
QMJ	North Central London	30.0	28.5	27.9	28.9
QMM	Norfolk and Waveney	75.6	75.8	74.2	75.2
QNC	Staffordshire and Stoke-on-Trent	56.3	54.7	56.8	56.0
QNQ	Frimley	5.07	59.3	50.6	55.6
QNX	Sussex	70.0	68.4	70.3	69.6
QOC	Shropshire, Telford and Wrekin	75.0	74.6	73.8	74.5
QOP	Greater Manchester	48.7	48.8	46.2	47.9
QOQ	Humber and North Yorkshire	71.2	70.7	69.7	70.6
QOX	Bath and North East Somerset, Swindon and Wiltshire	69.3	68.5	58.8	65.4
QPM	Northamptonshire	50.3	52.6	50.2	51.0
QR1	Gloucestershire	61.9	59.2	58.5	59.8
QRL	Hampshire and Isle of Wight	70.6	71.4	69.3	70.4
QRV	North West London	41.5	35.1	33.9	36.9
QSL	Somerset	72.3	64.3	67.2	68.3
QT1	Nottingham and Nottinghamshire	63.1	62.0	62.2	62.4
QT6	Cornwall and Isles of Scilly	67.2	67.6	64.0	66.4
QU9	Buckinghamshire, Oxfordshire, and Berkshire West	69.1	70.8	73.5	71.1
QUA	Black Country	47.9	48.8	50.4	49.0
QUE	Cambridgeshire and Peterborough	62.7	59.1	59.9	60.6
QUY	Bristol, North Somerset, and South Gloucestershire	74.8	72.1	71.8	73.1
QVV	Dorset	68.3	64.9	68.8	67.3
QWE	South West London	50.2	52.1	50.7	51.0
QWO	West Yorkshire	64.0	64.2	65.1	64.4
QWU	Coventry and Warwickshire	62.6	57.8	59.4	60.1
QXU	Surrey Heartlands	70.8	73.0	75.3	72.9
QYG	Cheshire and Merseyside	56.6	57.7	59.3	57.8
Total		58.7	58.1	57.5	58.1

Figure 1. Monthly pertussis vaccination coverage (%) in pregnant women (England), 2016 to 2023

Figure 2. Monthly pertussis vaccination coverage (%) in pregnant women by NHS commissioning region, April 2019 to June 2023 [Note 1]

Note 1: Data from the smallest IT supplier was excluded between November to December 2019.

Discussion

The number of confirmed cases in infants under 3 months, who are targeted by the maternal immunisation programme, continues to remain extremely low with no confirmed cases between July and September 2022 compared to 0, 1 and 29 cases in the same quarter in 2021, 2020 and 2019, respectively (11). It continues to be important to encourage women to be immunised against pertussis at the optimal time during pregnancy in order to protect their babies from birth as levels of disease are likely to increase following the lifting of COVID-19 control measures.

This first quarterly report evaluates pertussis vaccine coverage data for women who delivered in the April to June 2023 quarter.

Overall, monthly prenatal pertussis vaccine coverage in the first quarter of financial year 2022 to 2023 went from 58.7% in April to 58.1% in May, and to 57.5% in June 2023; the difference between the highest and lowest ICB was 47.9 percentage points.

Coverage in the London NHS commissioning region has declined substantially since June 2019, falling 19.5 percentage points by June 2022 to 37.2%.

Limitations to the data presented in this report may explain the some of the observed variability in coverage at the local level and over time. First, completeness of data is reliant on the recording of delivery dates in the mother’s medical records and a recent study in England suggests that maternity notes regarding pregnancy and delivery are often scanned or archived, rather than coded in an extractable format (12). Furthermore, a comparison of this denominator data with national data on live births (13) indicates that, in 2021, this data represented about 73% of the population of pregnant women.

Continued support in the delivery of this important programme has been sought from service providers (GP practices and maternity units).

Screening and Immunisation Teams and HPTs should continue to update service providers on the current epidemiology of the disease and the need to maintain and improve coverage achieved thus far.

If coverage, and ultimately the impact of the programme itself, is to be accurately monitored, it is essential that GPs and practice nurses continue to ensure that vaccination and date of delivery are recorded in the patient’s GP record. In areas that have commissioned maternity units to offer pertussis vaccines in pregnancy, it is important that providers ensure doses of vaccines given to individual women are also communicated to the woman’s GP. Maternity units not offering pertussis vaccines to pregnant women should continue to discuss its importance, make use of available resources on GOV.UK, and signpost women to their GP to receive the vaccine.

GPs, practice nurses, obstetricians and midwives should continue to encourage pregnant women to receive the pertussis vaccine – ideally between weeks 20 and 32 of their pregnancy (but up to term) – so as to optimise protection for their babies from birth (8).

References

1. ‘Prenatal pertussis vaccination coverage in England from January to March 2023 and annual coverage for 2022 to 2023’. Health Protection Report: volume 17, number 5

2. ‘Pertussis in England and Wales continues to increase’. Health Protection Report volume 6, number 15.

3. DHSC (2012). Pregnant women to be offered whooping cough vaccination

4. UKHSA. ‘Complete routine immunisation schedule’

5. JCVI (2014). Minute of the meeting on 4 June 2014

6. Eberhardt CS, Blanchard-Rohner G, Lemaitre B, Boukrid M, Combescure C, Othenin-Girard V and others (2016). ‘Maternal immunization earlier in pregnancy maximizes antibody transfer and expected infant seropositivity against pertussis’. Clinical Infectious Diseases: volume 62, pages 829 to 836

7. JCVI (2016). Minute of the meeting on 3 February 2016

8. UKHSA (2016). The Green Book, chapter 24: Pertussis

9. JCVI (2019). Minute of the meeting on 5 June 2019

10. PHE (2016). ‘Pertussis vaccination programme for pregnant women: vaccine coverage estimates in England, April 2016 to September 2016.’ Health Protection Report: volume 10 number 41

11. UKHSA (2023). ‘Laboratory confirmed cases of pertussis in England: April to June 2022.’ Health Protection Report: volume 17 number 3

12. Llamas A, Amirthalingam G, Andrews N, and Edelstein M (2020). ‘Delivering prenatal pertussis vaccine through maternity services in England: what is the impact on vaccine coverage?’ Vaccine: volume 38, issue 33, pages 5,332 to 5,336

13. Office for National Statistics (2022). Births in England and Wales