Research and analysis

Pertussis vaccination coverage for pregnant women in England, January to March and annual coverage 2021 to 2022

Updated 4 April 2024

Applies to England

Main points

This quarterly report evaluates pertussis coverage for women who delivered in the January to March 2022 quarter and the annual period from April 2021 to March 2022 who were eligible for the prenatal pertussis vaccine from 16 weeks of pregnancy onwards. The main findings were:

• the mean coverage for the quarter was 64.0%, which was 2.8 percentage points lower than the mean coverage for the same quarter in the 2020 to 2021 financial year
• the mean coverage in 2021 to 2022 was also 8.3 percentage points lower than the mean coverage for the same quarter in the 2019 to 2020 financial year
• the annual vaccine coverage for the financial year 2021 to 2022 was 64.7%, which was 3.1 percentage points lower compared to the 2020 to 2021 financial year and 5.8% percentage points lower compared to the 2019 to 2020 financial year when it was 70.5%
• this observed decline in coverage has largely been driven by a decrease in London NHS Commissioning Region which had coverage that was 12.9 percentage points lower in March 2022 as compared to March 2020

Introduction

This report presents pertussis vaccine coverage in pregnant women in England for the period January to March 2022, updating previous data reported for October to December 2021 (1). Annual coverage for the 2021 to 2022 financial year is also presented.

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 intrauterine 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).

In response to the coronavirus (COVID-19) pandemic, nationwide social distancing measures were initiated from 23 March 2020. To minimise disruptions, guidance to continue routine vaccination programmes with priority given to time sensitive vaccines, such as prenatal pertussis vaccines, were outlined by NHS England at the beginning of the pandemic (10).

In addition, the Royal College of Nursing published guidance on the management of immunisation clinics, and the then Public Health England (PHE) produced resources promoting immunisations to pregnant women and young families (11, 12).

Methods

GP-level pertussis vaccine coverage data is automatically uploaded via participating GP IT suppliers to the ImmForm (ImmForm is the system used by UKHSA to record vaccine coverage data for some immunisation programmes and to provide vaccine ordering facilities for the NHS. 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 in the attached data tables for comparison.

CCGs have been omitted due to changes in NHS geographies over time and the abolition of CCGs from 1 July 2022.

Annual vaccine coverage for England was calculated by summing the 12 monthly numerators and denominators for the financial year (April 2021 to March 2022). This is different from reports showing annual data on and prior to the 2018 to 2019 financial year, where a separate annual extraction (based on the same coding specification) was used to report the annual coverage.

Participation and data quality

All GP IT suppliers provided data for the January to March 2022 period. National GP practice participation was at 96.3% (January 2022), 96.7% (February 2022) and 96.9% (March 2022).

Results

Monthly pertussis vaccine coverage ranged across the quarter from 63.4% in March to 64.3% in January, with mean coverage for the quarter at 64.0% (Table 1, Figure 1, see data tables). During this quarter, prenatal pertussis vaccine coverage by Sustainability and Transformation Plan (STP) ranged from 30.9% (Cornwall and the Isles of Scilly Health and Social Care partnership STP, January 2022) to 82.9% (Shropshire and Telford and Wrekin, January 2022) (Table 1).

Monthly national coverage this quarter was between 1.6 percentage points lower in February to 3.6 percentage points lower in January, compared to monthly national coverage reported for the same quarter in the 2020 to 2021 financial year. Mean coverage for this quarter was 8.3 percentage points lower compared to national coverage reported in the same quarter in the 2019 to 2020 financial year. Coverage between January and March 2022 was the lowest measured since April 2016 when the new IT specification was implemented (Figure 1) (13).

The annual vaccine coverage for the financial year 2021 to 2022 was 64.7%, which was 3.1 percentage points lower compared to the 2020 to 2021 financial year and 5.8% percentage points lower compared to the 2019 to 2020 financial year when it was 70.5%.

Coverage by former Local Teams and NHS commissioning regions (based on the 2019 NHS England configurations) are also included in the attached data tables for trend comparisons. In London NHS Commissioning Region there has been a steep decline in coverage since December 2019. Coverage has dropped 15.6 percentage points from December 2019 when coverage was 60.9% to March 2022 when coverage was 45.3% (Figure 2).

Table 1. Monthly pertussis vaccination coverage (%) in pregnant women by STP: England, January to March 2022

STP Code	STP Name	January 2022	February 2022	March 2022
QE1	Healthier Lancashire and South Cumbria	61.0	58.9	59.4
QF7	South Yorkshire and Bassetlaw	69.6	71.7	71.4
QGH	Herefordshire and Worcestershire	66.8	64.6	64.2
QH8	Mid and South Essex	65.9	67.6	66.2
QHG	Bedfordshire, Luton, and Milton Keynes	63.6	63.6	62.2
QHL	Birmingham and Solihull	52.8	53.5	50.8
QHM	Cumbria and North East	71.6	71.6	70.7
QJ2	Joined Up Care Derbyshire	76.3	76.4	71.6
QJG	Suffolk and North East Essex	70.5	71.6	69.9
QJK	Devon	69.5	63.0	65.2
QJM	Lincolnshire	65.4	68.4	66.3
QK1	Leicester, Leicestershire and Rutland	65.0	64.1	60.0
QKK	Our Healthier South East London	53.4	49.8	55.5
QKS	Kent and Medway	71.3	73.6	72.1
QM7	Hertfordshire and West Essex	68.7	66.9	64.6
QMF	East London Health and Care Partnership	37.2	39.4	36.9
QMJ	North London Partners in Health and Care	32.1	32.3	33.0
QMM	Norfolk and Waveney Health and Care Partnership	76.8	78.8	71.7
QNC	Staffordshire and Stoke on Trent	58.0	58.7	63.7
QNQ	Frimley Health and Care ICS	64.2	65.1	65.7
QNX	Sussex and East Surrey	71.4	70.7	69.9
QOC	Shropshire and Telford and Wrekin	82.9	79.9	79.3
QOP	Greater Manchester Health and Social Care Partnership	61.5	58.5	59.0
QOQ	Humber, Coast, and Vale	77.9	78.3	74.4
QOX	Bath and North East Somerset, Swindon and Wiltshire	76.0	76.5	75.6
QPM	Northamptonshire	50.4	52.3	57.6
QR1	Gloucestershire	65.1	65.3	64.7
QRL	Hampshire and The Isle of Wight	74.8	73.2	68.0
QRV	North West London Health and Care Partnership	44.8	46.5	46.8
QSL	Somerset	71.7	74.4	67.5
QT1	Nottingham and Nottinghamshire Health and Care	65.0	64.9	65.9
QT6	Cornwall and The Isles of Scilly Health & Social Care Partnership	30.9	34.4	35.2
QU9	Buckinghamshire, Oxfordshire, and Berkshire West	75.4	75.4	75.3
QUA	The Black Country and West Birmingham	56.9	56.2	57.4
QUE	Cambridgeshire and Peterborough	69.0	69.6	63.2
QUY	Bristol, North Somerset, and South Gloucestershire	72.3	75.2	75.0
QVV	Dorset	77.2	72.5	78.2
QWE	South West London Health and Care Partnership	53.5	52.6	55.2
QWO	West Yorkshire and Harrogate Health and Care Partnership	71.6	71.7	69.6
QWU	Coventry and Warwickshire	65.1	64.4	66.0
QXU	Surrey Heartlands Health and Care Partnership	74.0	73.5	69.4
QYG	Cheshire and Merseyside	61.7	61.5	63.7
Total	Total	64.3	64.2	63.4

Figure 1. Monthly pertussis vaccination coverage (%) in pregnant women (England), 2016 to 2022

Figure 2. Monthly pertussis vaccination coverage (%) in pregnant women by NHS commissioning region, April 2019 to March 2022*

• Data from the smallest IT supplier was excluded between August to September 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 1 confirmed case between October and December 2021 compared to 0 and 19 cases in the same quarter in 2020 and 2019 respectively (14). Whilst overall pertussis activity has declined since measures to control the spread of COVID-19 were introduced, 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.

This quarterly report evaluates pertussis vaccine coverage for women who delivered in the January to March 2022 quarter. The continuation of the COVID-19 pandemic and its impact on healthcare services has possibly resulted in vaccine coverage this quarter being lower than any previous quarter since April 2016.

Overall, monthly prenatal pertussis vaccine coverage in the fourth quarter of 2021 to 2022 went from 64.3% in January to 64.2% in February and to 63.4% in March 2021. Between January to March 2022, the difference between the highest and lowest STP coverage month was 52.0 percentage points.

Coverage in the London NHS Commissioning Region has declined substantially since March 2020, falling 12.9 percentage points by March 2022. Sharing learning across the country, including those measures that have been successful in mitigating the impact of social distancing, may help address any gaps in coverage for future cohorts of pregnant women.

Limitations to the data presented in this report may explain 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 (15). Furthermore, a comparison of these denominator data with national data on live births (16) indicates that in 2021, this data represented about 71% 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 Health Protection Teams. Screening and Immunisation Teams 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 (17), and signpost the woman to her 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) to optimise protection for their babies from birth (8) and prenatal pertussis vaccinations should be maintained throughout the COVID-19 pandemic (10, 11, 12).

References

1. PHE (2021). ‘Pertussis vaccination programme for pregnant women update vaccine. coverage in England, April to July 2021.’ Health Protection Report volume 15, number 14

2. PHE (2012). A level 3 incident is the third of 5 levels of alert under the PHE’s Incident Reporting and Information System (IERP) according to which public health threats are classified and information flow to the relevant outbreak control team is coordinated. A level 3 incident is defined as one where the public health impact is significant across regional boundaries or nationally. An IERP level 3 incident was declared in April 2012 in response to the ongoing increased pertussis activity.

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

4. PHE (2018). ‘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. PHE (2016). The Green Book, chapter 24: Pertussis

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

10. NHS England (2020). Preparedness letter for general practice: 14 April 2020

11. Royal College of Nursing (2020). Immunisation

12. PHE (2020). Vaccine update: World Immunisation Week

13. PHE (2016). Pertussis vaccination programme for pregnant women: vaccine coverage estimates in England, April 2016 to September 2016

14. UKHSA (2022). ‘Laboratory confirmed cases of pertussis in England: October to December 2021.’ Health Protection Report: volume 16 number 6

15. 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

16. Office for National Statistics (2022) Provisional births in England and Wales

17. PHE (2017). Pregnancy: How to help protect you and your baby