Transcript: Vital Signs – Maternal Vaccination

MODERATOR (Benjamin Haynes):
Thank you, Rebecca, and thank you all for joining us today for the release of a new CDC Vital Signs. This month’s Vital Signs is about the importance of vaccinations for pregnant women. We are joined today by CDC’s Principal Deputy Director, Dr. Anne Schuchat, to discuss what CDC has learned about the rates of flu and Tdap (Whooping cough) vaccination among pregnant women and why this is a great concern. We also have Dr. Amanda Cohn, Acting Chief Medical Officer, Vaccine Policy, Preparedness, and Global Health here to respond to questions. I’d like to turn the call over now to Dr. Schuchat.

Dr. Schuchat:
Thanks so much to everyone joining us today. To discuss CDC’s Vital Signs report. CDC works 24/7 to protect the safety, health, and security of Americans. In our Vital Signs report each month we focus on the latest data about a critical health issue facing our nation, and what can be done about it. Today, we are stressing the importance of two safe and effective vaccines for pregnant women—and the risks to both women and their babies when these vaccines are not given during pregnancy. Influenza and pertussis – or whooping cough – are serious infections that can be deadly for babies, especially those who are too young to be vaccinated directly.
Today’s report shows that babies under 6 months old have the highest incidence of influenza-associated hospitalizations among children. Complications from influenza among infants include pneumonia, dehydration, and swelling of the brain called encephalopathy. Infants under 6 months also have the highest risk of dying from influenza among children.
Women who are pregnant are more than twice as likely to be hospitalized if they develop influenza compared with similar aged women. During influenza seasons between 2010 and 2018, women who were pregnant accounted for 24% to 34% of influenza-associated hospitalizations among women 15-44 years old, though only around 9% of women in this age group are pregnant.
For infants who get whooping cough, the disease can be life threatening. More than half of infants under 12 months who are hospitalized for pertussis are under 2 months and out of all the deaths reported for whooping cough in all ages nearly 70% occur in babies less than 2 months old. When infants get whooping cough they are usually very sick and have difficulty breathing, eating, drinking, or sleeping. Parents may see their baby gasping for air and even turning blue while coughing from lack of oxygen.

Today’s Vital Signs also includes data collected from pregnant women during the Spring of 2019. Only one in three pregnant women or 35% received both flu and Tdap or whooping cough vaccinations. Just over half – or 54% – of pregnant women received a flu shot during the 2018–2019 flu season. Findings were similar for Tdap, with only 55% of pregnant women receiving the vaccination during pregnancy. But as I said, only 35% received both influenza and Tdap vaccines. These data come from a CDC survey of nearly 2,100 women, ages 18 to 49, who were pregnant any time between August 2018 and April 2019. So they represent what happened during last years flu vaccination season.
We also found that about three-fourths of pregnant women said their health care provider either offered to vaccinate them or gave them a referral to get flu or Tdap vaccine. Yet, even among these women who received a recommendation, nearly one-third did not get vaccinated against influenza or whooping cough. Among those who did not get vaccinated, the most frequent reasons women reported for not getting a flu shot were concerns about effectiveness and safety at around 18%. The main reason cited for not getting Tdap shot was not knowing that the vaccination is needed during each pregnancy at about 38%. Many women thought because they previously received Tdap it was not needed again during the current pregnancy, but we’ve actually been recommending that women get Tdap shots during each pregnancy since 2012.

Our data suggest a need to get the word out that Tdap – the whooping cough vaccine – is needed during every pregnancy. The report also suggests there is room for improving communication between clinicians and women who are pregnant. Studies over the past several years have demonstrated important findings about the effectiveness of both influenza and Tdap vaccines during pregnancy. A flu shot reduces a pregnant woman’s risk of hospitalization from influenza by an average of 40%; it also reduces the risk of her baby being hospitalized for influenza by about 72%. Tdap vaccines given in the third trimester are 78% effective in preventing cases of whooping cough and more than 90% effective in keeping babies less than 2 months old out of the hospital for complications from whooping cough. High-quality scientific studies consistently demonstrate that getting vaccinated while pregnant is safe and effective in preventing influenza and whooping cough in both women and their babies.

We encourage health care providers to make sure that vaccine recommendations are part of standard prenatal care. It’s important to explain the benefits of vaccination and the risks of not getting vaccinated. CDC and our partners including the American College of Obstetricians and Gynecologists have many resources available to help do this, and to answer any questions or concerns patients or their clinical caregivers may have.
Vaccinating pregnant women is the best way to prevent influenza and whooping cough. CDC recommends that during each pregnancy, pregnant women get flu vaccine during any trimester. We recommend Tdap vaccines be given early in their third trimester (which is at 27 weeks gestation or later).

It has been proven repeatedly that these vaccinations are safe for pregnant women and their developing babies, and effective in preventing serious complications from influenza and whooping cough. When pregnant women get flu vaccine and Tdap they pass protective antibodies to their developing babies, keeping them safe from influenza and whooping cough during the first few months of life. Vaccination also reduces the pregnant women’s own risk from these diseases.

Flu shots have been given to millions of pregnant women over many years. There is a large body of scientific studies that supports the safety of flu vaccine in pregnant women and their babies. The Tdap vaccine is also very safe. Getting Tdap during pregnancy does not put pregnant women at risk for pregnancy complications like low birth weight or preterm delivery. To continue the protection that babies receive from their mothers who were vaccinated during pregnancy, CDC recommends the first dose of childhood whooping cough vaccine be given when an infant is 2 months old. We recommend the the first dose of flu vaccine once the baby is at least 6 months old.

No baby should suffer or die from influenza or whooping cough because of a missed opportunity for the child’s mother to be vaccinated while she was pregnant. And women have enough issues to address when they are pregnant without going through a difficult hospitalization if they come down with influenza. I hope that knowing about the risk of these infections during pregnancy and early in a baby’s life, as well as the safety and effectiveness of receiving these vaccines during pregnancy, will motivate more women who are pregnant to protect themselves and their babies. And right now is a great time for pregnant and anyone else 6 months of age or over to get the flu vaccine. Thank you for your attention. And Operator, we are ready for questions, please.

Operator (Rebecca): So we will now began our question and answer section. If you would like to ask a question press * 1 from your phone, unmute your line, and record your name and company clearly when prompted. If you would like to withdraw your question press *2. One moment while we wait for questions to queue.

Janel Miller; Healio: Yes, thank you for taking my call and having this call with us. Can you provide some suggestions on how clinicians can get conversations started? With there patients, because I know you know there is a lot of vaccine hesitancy out there. So how can clinicians get the conversation started with their patients about these vaccines and the importance of them. Thank you.

Dr. Schuchat: Thank you. Yes, clinicians caring for women that are pregnant have a huge role in helping women understand the risks and benefits and the value of vaccines. A lot of women are worried about taking any extra medicine or getting shots during pregnancy and clinicians can let them know about the large data available showing the safety of the vaccines as well as the effectiveness. And we also think it’s important to let people know about the risk of not vaccinating. Clinicians who give a strong recommendation can have a higher level of uptake in the women that they are talking to. But it is really important for clinicians to begin by listening to women. Asking “Can I answer your questions?”. “What are the concerns that you’ve had?” We find that when a clinician validates a patient’s concerns and really shows that they are listening, they can build trust and respect.

So in general we think understand where a woman is coming from, what the questions she has, listen respectfully and non-judgmentally, and then provide the basis of a recommendation on your personal experience, your strong medical experience, and perhaps whether you have gotten vaccinated yourself while pregnant. Or your partner may have as well. Next question.

Rebecca: Our next question comes from Molly Walker your line is now open.

Molly Walker; Medpage Today: Hi! Thank you for taking my question. It sort of build on the other one. When you say 75% of clinicians are actually recommending the flu shot and the Tdap and 3 quarters. So what, so is this a communication problem? Is this something their not recommending it strongly enough? Do clinicians need to change how they communicate? Is this suggesting this is something, an error that clinicians need to change how they communicate to their patients? If so many are offering it and so few are taking it?

Dr. Schuchat: We are learning a lot about improved communication between clinicians and patients. And in pregnancy one thing we suggest is to begin the conversations early. So it may not even be flu season or it may not be that third trimester yet, but if you start talking early in the pregnancy about the things that you will be looking forward to and also can provide information for women to read between appointments by the time it is flu season and the vaccines are available or it is that third trimester they are prepared to make a good choice. We certainly know that when the clinicians are able to vaccinate right in the office there is a higher uptake then when they have to refer outward. And we know that pharmacists and others, work places are also offering vaccines but that strong recommendation from a clinician is important and I think a lot of consumers want to check and make sure that they are making the best decisions to keep themselves healthy and their kids healthy. And so have time to learn about this can be helpful. We actually think it is important o talk about the child’s vaccination during pregnancy and help parents prepare for what’s to come after the child is born. But CDC and the American Academy of Pediatrics have a lot of materials available for clinicians to help with those conversations; Scripts and tips on how to talk about things, what the facts are, about the side effects and risks and benefits. So we think there is room for improvement but certainly most clinicians who make a strong recommendation and are able to offer the vaccines right in the office are seeing a higher uptake of vaccines. Next question.

Rebecca: As a remind if you would like to ask a question please press *1 from your phone, unmute your line, and record your name and company clearly when prompted. One moment while we wait for further questions.

Dr. Schuchat: Thanks operator. Let me just conclude by saying the time to get vaccinated is now. Influenza vaccines are available all around the country and we strongly recommend everyone 6 months of age and over get vaccinated. If you are pregnant or you are a clinician who is caring for women that are pregnant, remind them about the serious risks that influenza and whooping cough can have during pregnancy or to the very young infant and that’s a chance for you to get vaccinated as well. Thanks everybody for participating today.

Benjamin Haynes: Thank you, Dr. Schuchat and Dr. Cohn for joining us today, and to all the reporters, thank you for your participation. For follow-up questions, please call the CDC Press Office at 404-639-3286 or send an email to media@cdc.gov. This concludes our call.

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