a descriptive study of vaccinations occuring during pregnancy henninger

© 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


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.


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


Vaccine Safety Datalink


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.


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


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


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


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


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


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


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

a descriptive study of vaccinations occuring during pregnancy henninger

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