GP's Current Practice and Attitudes towards Pertussis Vaccination during Pregnancy

Problem

BackgroundInfants less than 3months of age have a disproportionately higher morbidity and mortality from pertussis infection. Prior to their first vaccination, infants depend solely on passive maternal antibodies for protection against pertussis. Vaccination of women during pregnancy is a safe and effective way to protect these infants. The National Immunisation Advisory Committee in Ireland recommend routine vaccination during each pregnancy. A recommendation from a doctor is a key factor in influencing a pregnant woman’s decision to receive a vaccination. There is a paucity of research exploring the current practice and attitudes of General Practitioners (GPs) in Ireland to antenatal pertussis vaccination.AimThe aim of the study was to evaluate the current practice and attitudes of General Practitioners in Ireland to antenatal pertussis vaccination.

Approach

Design and SettingAn embedded mixed method design was used. The target population were GPs in the West of Ireland. Ethical approval was granted from the Irish College of General Practitioners.MethodAn anonymous questionnaire, containing both quantitative and qualitative responses, was posted to 268 GPs in the West of Ireland, registered in the Irish Medical Directory 2015 – 2016. Quantitative data was analysed used Excel. Results were described using means, percentage responses and Chi square tests. Qualitative information was transcribed into a Microsoft Word document, coded and analysed thematically. Qualitative and quantitative data was merged for further interpretation.

Findings

ResultsThe response rate was 41% (n=109). 54% of GPs (n=59) routinely recommend the pertussis vaccine to pregnant women. 81% (n = 48) of GPs who routinely recommend the vaccine felt it was safe in pregnancy, compared to only 29% (n = 14) of GPs who do not recommend the vaccine (p = 0.0001). Over 80% of participants believed further education, a national media campaign and a recommendation in antenatal notes would help to increase uptake. 51% of GPs felt the vaccine should be administered in secondary care. Qualitative analysis uncovered three main themes; current practice, safety and isolation. Reoccurring subthemes within current practice included a limited experience of the disease in infants and patient autonomy. The theme of isolation incorporated two subthemes, GPs felt a lack of support from the Health Service Executive (HSE) and a lack of support from secondary care. Within the theme of safety, three subthemes emerged, the necessity to protect the baby from pertussis infection, the lack of long term safety data regarding the vaccine and a fear of litigation.

Consequences

ConclusionThe study revealed that 54% of GPs in the West of Ireland are recommending pertussis vaccination in pregnancy. The study highlighted that more safety data, longitudinal studies, funding from the Health Service Executive and consistent support from secondary care may help to increase pertussis vaccination uptake in pregnancy