Research and analysis

Pertussis vaccination programme for pregnant women update: vaccine coverage in England, April to June 2022

Updated 4 April 2024

Applies to England

Main points

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

• pertussis vaccine coverage in pregnant women for the first quarter of the 2022 to 2023 financial year was 61.5% in April, 60.4% in May and 59.5% in June

• the mean coverage for the quarter was 60.6%, 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 8.9 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 15.2 percentage points lower in June 2022 as compared to June 2020

Introduction

This report presents pertussis vaccine coverage in pregnant women in England for the period April to June 2022, updating previous data reported for January to March 2022 (1).

Methods

General practice (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.

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

Completeness and data quality

All GP IT suppliers provided data for the April to June 2022 period. National GP practice participation was at 93.4% (April 2022), 97.1% (May 2022) and 67.9% (June 2022).

Results

Monthly pertussis vaccine coverage ranged across the quarter from 59.5% in June to 61.5% in April, with mean coverage for the quarter at 60.6% (Table 1, Figure 1, see the data tables associated with this report. During this quarter, prenatal pertussis vaccine coverage by Sustainability and Transformation Plan (STP) ranged from 20.6% (North London Partners in Health and Care, June 2022) to 78.0% (Humber, Coast and Vale, April 2022) (Table 1).

When compared with data from the 2021 to 2022 financial year national coverage was 4.5 percentage points lower in April, 2.8 percentage points lower in May and 4.8 percentage points lower in June. Mean coverage for this quarter was 8.9 percentage points lower compared to national coverage reported for the same quarter in the 2020 to 2021 financial year. Coverage between April and June 2022 was the lowest measured since April 2016 when the new IT specification was implemented (Figure 1) (2).

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 23.3 percentage points from December 2019 when coverage was 60.9% to June 2022 when coverage was 37.6% (Figure 2). No increases in coverage were reported by region compared to the previous year.

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

STP Code	STP Name	April 2022	May 2022	June 2022	April to June 2022
QE1	Healthier Lancashire and South Cumbria	58.4	58.0	59.6	58.4
QF7	South Yorkshire and Bassetlaw	67.8	68.4	67.0	67.8
QGH	Herefordshire and Worcestershire	63.4	66.4	48.7	63.6
QF7	South Yorkshire and Bassetlaw	67.8	68.4	67.0	67.8
QGH	Herefordshire and Worcestershire	63.4	66.4	48.7	63.6
QH8	Mid and South Essex	66.8	64.4	62.6	64.6
QHG	Bedfordshire, Luton, and Milton Keynes	62.2	59.6	59.2	60.3
QHL	Birmingham and Solihull	49.4	48.1	42.9	47.3
QHM	Cumbria and North East	69.4	68.5	67.4	68.6
QJ2	Joined Up Care Derbyshire	71.7	77.8	76.8	75.3
QJG	Suffolk and North East Essex	70.0	67.6	64.7	67.6
QJK	Devon	65.9	65.8	63.2	65.2
QJM	Lincolnshire	66.5	65.1	65.3	65.6
QK1	Leicester, Leicestershire and Rutland	64.3	60.7	54.1	60.0
QKK	Our Healthier South East London	51.1	47.9	40.2	48.3
QKS	Kent and Medway	67.5	66.3	57.5	65.9
QM7	Hertfordshire and West Essex	63.1	64.2	62.0	63.3
QMF	East London Health and Care Partnership	37.2	36.0	26.0	35.6
QMJ	North London Partners in Health and Care	31.4	29.5	20.6	29.1
QMM	Norfolk and Waveney Health and Care Partnership	69.0	67.6	71.4	69.3
QNC	Staffordshire and Stoke on Trent	63.7	61.2	64.6	62.6
QNQ	Frimley Health and Care ICS	57.5	57.3	38.4	54.9
QNX	Sussex and East Surrey	71.9	68.2	67.4	69.3
QOC	Shropshire and Telford and Wrekin	75.6	75.3	58.1	74.2
QOP	Greater Manchester Health and Social Care Partnership	59.3	56.8	53.7	57.2
QOQ	Humber, Coast, and Vale	78.0	74.5	75.6	76.0
QOX	Bath and North East Somerset, Swindon and Wiltshire	76.0	70.9	73.2	73.3
QPM	Northamptonshire	53.0	51.8	46.4	50.6
QR1	Gloucestershire	62.1	61.6	68.3	63.6
QRL	Hampshire and The Isle of Wight	63.6	65.6	66.9	65.0
QRV	North West London Health and Care Partnership	46.3	42.9	42.8	44.1
QSL	Somerset	69.3	70.1	59.2	69.0
QT1	Nottingham and Nottinghamshire Health and Care	65.1	67.4	61.3	64.7
QT6	Cornwall and The Isles of Scilly Health & Social Care Partnership	44.8	40.1	32.0	39.5
QU9	Buckinghamshire, Oxfordshire, and Berkshire West	72.6	70.1	63.1	70.6
QUA	The Black Country and West Birmingham	50.9	52.2	42.6	49.6
QUE	Cambridgeshire and Peterborough	63.7	59.8	59.6	61.1
QUY	Bristol, North Somerset, and South Gloucestershire	68.8	69.5	48.6	68.1
QVV	Dorset	75.9	76.7	74.6	75.7
QWE	South West London Health and Care Partnership	52.3	52.0	45.2	51.3
QWO	West Yorkshire and Harrogate Health and Care Partnership	68.1	69.1	67.7	68.4
QWU	Coventry and Warwickshire	63.7	59.1	45.7	59.0
QXU	Surrey Heartlands Health and Care Partnership	70.0	68.2	60.5	68.1
QYG	Cheshire and Merseyside	57.8	57.1	52.1	56.5
TOTAL		61.5	60.4	59.5	60.6

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

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 9 confirmed cases between January and March 2022 compared to 0 and 16 cases in the same quarter in 2021 and 2020 respectively (3). 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 quarterly report report evaluates pertussis vaccine coverage for women who delivered in the April to June 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 any previous quarter since April 2016.

Overall, monthly prenatal pertussis vaccine coverage in the first quarter of 2021 to 2022 went from 61.5% in April to 60.4% in May and to 59.5% in June. Between April to June 2022, the difference between the highest and lowest STP coverage month was 46.9 percentage points.

Coverage in the London NHS Commissioning Region has declined substantially since June 2020, falling 15.2 percentage points by June 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 (4). Furthermore, a comparison of denominator data with national data on live births (5) indicates that in 2021, this data represented about 71% of recorded live births.

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 mechanisms exist to update patients GP records with vaccination and date of delivery. 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 (6), 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 (7) and prenatal pertussis vaccinations should be maintained throughout the COVID-19 pandemic (8, 9, 10).

References

1. PHE (2022). ‘Pertussis vaccination coverage for pregnant women in England, January to March and annual coverage 2021 to 2022’. Health Protection Report volume 16, number 8.

2. 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

3. UKHSA (2022). ‘Laboratory confirmed cases of pertussis in England: January to March 2022’. Health Protection Report: volume 16 number 11

4. 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

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

6. PHE (2017). ‘Pregnancy: How to help protect you and your baby’.

7. PHE (2016). The Green Book, chapter 24: Pertussis.

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

9. Royal College of Nursing (2020). Immunisation.

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