Pertussis is a serious and potentially fatal disease in infants too young for vaccination. Despite a high vaccine coverage in children, pertussis continues to occur in unvaccinated infants in the Kingdom of Saudi Arabia (KSA). Available data supports the use of maternal pertussis immunization for preventing pertussis in young infants. In June 2019, the Saudi Ministry of Health recommended maternal pertussis immunization with combined tetanus-diphtheria-acellular pertussis vaccine (Tdap) during every pregnancy. To understand barriers to maternal immunization and identify strategies to improve maternal immunization, we conducted an online survey in November and December 2020, asking 60 obstetricians/gynecologists about their attitudes to maternal pertussis immunization. Fewer than 50% survey respondents considered maternal immunization as part of their role, and only 47% were aware of the national recommendation. Consequently, the uptake of maternal vaccination in KSA may be sub-optimal. The key barriers that hinder obstetricians/gynecologists from recommending maternal Tdap immunization were the anticipation of patient refusal, and their own need for more information/experience about the disease and the national recommendation. Vaccine availability and supply were important barriers, whereas cost/reimbursement and resource issues were of lesser concern. Disseminating evidence based information to physicians, educating pregnant women and addressing public misconceptions.
Keywords: Maternal vaccination; Saudi Arabia; Tdap vaccine; pertussis; pregnancy; vaccine coverage; vaccine hesitancy.
What is the context?Pertussis (whooping cough) can be life-threatening when it occurs in very young infants.The most effective strategy to prevent whooping cough in young infants is to vaccinate their mothers during the third trimester of pregnancy.Maternal antibodies transferred to the fetus can provide protection against infection until the first routine whooping cough vaccine at 2 or 3 months of age.Maternal pertussis vaccination has been recommended in Saudi Arabia since 2019.What is new?A survey of obstetricians/gynecologists found that almost 50% were unaware of the recommendation, suggesting poor uptake of maternal vaccination.What is the impact?Strategies to improve maternal immunization rates in the Kingdom of Saudi Arabia need to include education of obstetricians/gynecologists, mothers, and the general public about the disease, how it can be prevented, and the benefits and risk of vaccinating versus not vaccinating.