Research and analysis

Prenatal pertussis vaccination coverage in England from October to December 2022

Updated 4 April 2024

Applies to England

Main points

This quarterly report evaluates pertussis coverage for women who delivered in the October to December 2022 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 third quarter of the 2022 to 2023 financial year was 61.7% in October, 61.2% in November and 61.4% in December

• the mean coverage for the quarter was 61.4%, which was 3.9 percentage points lower than the mean coverage for the same quarter in the 2021 to 2022 financial year

• the mean coverage for the quarter was also 6.6 percentage points lower than the mean coverage for the same quarter in the 2020 to 2021 financial year

• this observed decline in coverage has largely been driven by a decrease in London NHS Commissioning Region which had coverage that was 11.5 percentage points lower in December 2022 as compared to December 2020

• coverage in London has continued to fall behind, now being 29 percentage points lower than the region with the highest coverage (North East and Yorkshire)

Introduction

This report presents pertussis vaccine coverage in pregnant women in England for the period October to December 2022, updating previous data reported for July to September 2022 (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 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 and 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 and 12).

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 in the denominator 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 data tables associated with this report for comparison.

Clinical commissioning groups (CCGs) 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 October to December 2022 period. National GP practice participation was at 96.6% (October 2022), 97.5% (November 2022) and 81.0% (December 2022) (Table 1).

Results

Monthly pertussis vaccine coverage ranged across the quarter from 61.2% in November to 61.7% in October, with mean coverage for the quarter at 61.4% (Table 1, Figure 1, see data tables). During this quarter, prenatal pertussis vaccine coverage by ICB ranged from 27.4% (North Central London, October and December 2022) to 81.0% (Derby and Derbyshire, December 2022) (Table 1).

When compared with data from the 2021 to 2022 financial year, national coverage was 4.0 percentage points lower in October, 3.7 percentage points lower in November and 4.0 percentage points lower in December. Mean coverage for this quarter was 6.6 percentage points lower compared to national coverage reported for the same quarter in the 2020 to 2021 financial year. Coverage in quarter 2 (July and September 2022) was the lowest measured since April 2016 when the new IT specification was implemented (Figure 1) (13). Coverage in quarter 3 (October to December 2022) was slightly higher than quarter 2 but still lower than previous years.

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

In London NHS commissioning region there has been a steep decline in coverage since December 2019. Coverage in London has dropped 23.1 percentage points from December 2019 when coverage was 60.9% to December 2022 when coverage was 39.6% (Figure 2).

Table 1. Monthly pertussis vaccination coverage (%) in pregnant women by ICB in England, October to December 2022

ICB code	ICB name	October 2022	November 2022	December 2022	October to December 2022
QE1	Lancashire and South Cumbria	62.9	58.6	60.3	60.6
QF7	South Yorkshire	71.9	74.6	69.2	71.9
QGH	Herefordshire and Worcestershire	64	67.7	67.9	66.4
QH8	Mid and South Essex	65.2	64.8	65.4	65.2
QHG	Bedfordshire, Luton, and Milton Keynes	61.2	58.6	59	59.6
QHL	Birmingham and Solihull	45.7	48.1	45.1	46.3
QHM	North East and North Cumbria	63.2	63.4	64.2	63.5
QJ2	Derby and Derbyshire	76.8	75.4	81	77.7
QJG	Suffolk and North East Essex	67.4	68.6	68.2	68.1
QJK	Devon	70.9	64.3	66.5	67.3
QJM	Lincolnshire	68.1	69	63.5	66.9
QK1	Leicester, Leicestershire and Rutland	56.8	54.8	57.9	56.4
QKK	South East London	49.8	48.6	49	49.2
QKS	Kent and Medway	66.3	64.9	65.6	65.6
QM7	Hertfordshire and West Essex	65.3	65.7	65.2	65.4
QMF	North East London	36	35.3	35	35.5
QMJ	North Central London	27.4	29	27.4	27.9
QMM	Norfolk and Waveney	73.1	78.3	77.9	76.2
QNC	Staffordshire and Stoke-on-Trent	59.8	58	56.2	58.2
QNQ	Frimley	58.9	60.6	59.9	59.7
QNX	Sussex	69.9	70.6	68.2	69.6
QOC	Shropshire, Telford and Wrekin	73.9	73.8	75.9	74.4
QOP	Greater Manchester	55.5	53.6	53.5	54.2
QOQ	Humber and North Yorkshire	78.2	75.7	74	76
QOX	Bath and North East Somerset, Swindon and Wiltshire	75.1	71.2	71.8	72.7
QPM	Northamptonshire	58.7	55.3	55.8	56.7
QR1	Gloucestershire	65.3	66.4	65.9	65.9
QRL	Hampshire and Isle of Wight	70	70	72.5	70.7
QRV	North West London	41.7	39.5	39.3	40.2
QSL	Somerset	72.3	72.1	73.1	72.5
QT1	Nottingham and Nottinghamshire	66.8	69.4	68.6	68.3
QT6	Cornwall and Isles of Scilly	57.8	58.3	58.4	58.1
QU9	Buckinghamshire, Oxfordshire, and Berkshire West	69.7	73.1	74.8	72.4
QUA	Black Country	51.6	50.6	46.2	49.5
QUE	Cambridgeshire and Peterborough	58.3	61.6	60.5	60.1
QUY	Bristol, North Somerset, and South Gloucestershire	71.6	70.4	72.1	71.3
QVV	Dorset	73.3	73.1	67.1	71.1
QWE	South West London	53	55.5	50.4	53.2
QWO	West Yorkshire	68.7	66.3	68.6	67.9
QWU	Coventry and Warwickshire	60.6	58.2	59.3	59.4
QXU	Surrey Heartlands	68.8	67.4	70.7	68.9
QYG	Cheshire and Merseyside	62.4	60.5	61.7	61.5
Total		61.7	61.2	61.4	61.4

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 December 2022

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 one confirmed case between April and June 2022 compared to 13 and 23 cases in the same quarter in 2021, 2020 and 2019, respectively (14). 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 easing of COVID-19 control measures.

This third quarterly report evaluates pertussis vaccine coverage for women who delivered in the October to December 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 in previous years.

Overall, monthly prenatal pertussis vaccine coverage in the third quarter of 2022 to 2023 went from 61.7% in November to 61.2% in December. From October to December 2022, the difference in mean coverage between the highest and lowest ICB was 49.1 percentage points.

Coverage in the London NHS commissioning region has declined substantially since December 2019, falling 21.3 percentage points by December 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 this 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
• health protection teams (HPTs)

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 (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. UKHSA (2022). Prenatal pertussis vaccination coverage in England from July to September 2022. Health Protection Report: volume 17, number 2

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

4. UKHSA (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. UKHSA (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 (2023). ‘Laboratory confirmed cases of pertussis in England: April to June 2022.’ Health Protection Report: volume 16 number 12

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. UKHSA (2022). Pregnancy: How to help protect you and your baby