Pertussis infection (whooping cough) has been increasing across populations in recent years. Infants less than 3 months old are most at risk of serious disease. Greta Hayward, Consultant Midwife in the Immunisation Division at the UK Health Security Agency (UKHSA), shares recent data and highlights the importance of the midwives’ role in the promotion of the maternal vaccination programme to protect infants from pertussis.
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I am a consultant midwife in the Immunisation Division at the UK Health Security Agency (UKHSA) with over 35 years of midwifery experience. The consultant midwife role was created in recognition of the increasing portfolio of immunisation programmes targeted at pregnant women and neonates. I provide expert clinical input to national public health programmes, aiming to balance the demands of seasonal and year-round immunisation programmes against the challenges faced by local services and frontline staff.
I firmly believe that vaccination is the single most effective way to protect pregnant women and their babies against infectious diseases and reduce harm from vaccine-preventable diseases such as pertussis, influenza, COVID-19 and Respiratory Syncytial Virus (RSV). The role of midwives in advocating for vaccination during pregnancy cannot be overstated. Not only does vaccination directly protect women against diseases that can be more serious in pregnancy, but they also protect unborn babies against the effects of serious disease in the mother. Maternal vaccines generate antibodies in the mother which cross the placenta and passively protect infants against diseases that can be very serious in the first few weeks of life.
Most of you will have seen or heard about recent increases in pertussis (whooping cough) across the country in all age groups, after a prolonged period of unusually low disease levels following measures to stop the spread of COVID-19. The main aims of the maternal and infant vaccination programmes are to protect young babies from this disease. This is because babies are most at risk of severe disease, usually require hospital treatment and, unfortunately, sometimes babies with pertussis will die. The latest UK Health Security Agency (UKHSA) data shows that, in England, pertussis cases rose across the first 5 months of 2024 to peak in May and continue to remain at very high levels in June. There were 328 infants aged under 3 months with confirmed pertussis between January and June 2024, whilst there were 188 cases in the same period in 2012 which was our last outbreak year.
Maternal vaccination is the only way that babies can be protected against pertussis from the day they are born until they are old enough to have their own vaccines as part of the routine childhood immunisation schedule. The pertussis vaccination programme for pregnant women commenced on 1 October 2012 in response to the increase in pertussis infection at that time.
In the 12 years prior to the introduction of maternal pertussis vaccination in October 2012, 63 deaths occurred in babies aged under one year with confirmed pertussis. Since the introduction of pertussis vaccination in pregnancy, from 2013 to the end of June 2024, there have been 30 deaths in babies with confirmed pertussis who were all too young to be fully protected by infant vaccination. Of the 30 infants that died, 24 had mothers who were not vaccinated in pregnancy. Studies on timing of maternal pertussis vaccination in England have shown that having vaccine in pregnancy is very effective (around 90%) at preventing pertussis disease and hospitalisation, and infant death. Vaccinating in pregnancy offers the best protection against severe pertussis disease in young babies.
The number of women receiving a pertussis-containing vaccine has fallen in recent years in England. Maternal vaccine uptake fell from 74.7% in December 2017 to 58.9% in March 2024. This means many pregnant women are not receiving a vaccine to protect their infant at a time when the number of cases of pertussis is very high. Vaccine acceptability and trust remains high amongst pregnant women; the reasons for the decline in uptake are not clear but likely to be due to multiple factors.
Midwives are asked to ensure that appropriate measures are in place to optimise uptake of pertussis-containing vaccine for pregnant women. This includes ensuring vaccine is easily accessible, ensuring that they are informed and confident so they are able to answer any questions women may have, and providing information resources so that women can access further information if they wish to, for example providing the leaflets and displaying the poster available at Whooping cough: vaccination in pregnancy programme resources – GOV.UK (www.gov.uk)
Women can be vaccinated against pertussis any time in pregnancy from 16 weeks gestation until the point at which they give birth. However, it is best to give the maternal pertussis vaccine between 20-32 weeks gestation to ensure the mother has enough time to optimally respond to the vaccine and for her antibodies to be transferred to the baby across the placenta. Ideally, the vaccine is given around the time of the 18-20-week fetal anomaly scan. Giving it at this time means that, even if a baby is born prematurely, they are likely to have some protection. When women are vaccinated only days before giving birth, this has been found to be less effective in protecting their baby. Those who miss the vaccine whilst pregnant can receive the vaccine for up to 8 weeks after they give birth, until their baby is old enough to get their first childhood dose. This will not give the baby maternal antibodies but can help protect the mother from getting pertussis infection, thereby reducing the risk of exposure for their baby. The vaccine should be given in every pregnancy.
Timely vaccination with the infant doses at 8, 12 and 16 weeks is then very important to continue protection in all babies during their early years until they can have their pre-school booster three years later.
Midwives play a crucial role in discussing vaccinations with parents and caregivers. We know from National surveys on attitudes to vaccination that health care professionals are the most trusted source of information on vaccines and that receiving information on vaccination from a healthcare professional is the best way to support pregnant women. Through the trusting relationships that midwives build with pregnant women, they play a vital role in boosting vaccine confidence and in securing the success of the maternal vaccination programmes.
UKHSA provide resources to support healthcare professionals in having these conversations. Information for healthcare practitioners guidance available on the UKHSA pertussis immunisation programmes collection is recommended reading for midwives administering or providing advice about the maternal pertussis programme. It includes the vaccination programme recommendations, contraindications, precautions and examples of scenarios or questions that staff may experience when vaccinating pregnant women. Resources which midwives can share with pregnant women to support maternal vaccination can be found on the Health Publications page.
Pregnant women trust their midwife and your role in supporting them to receive their maternal pertussis vaccination, and in encouraging women to ensure their babies start their primary immunisations at 8 weeks of age, is key to achieving longer-term protection against pertussis and in ensuring babies receive the best start in life.
If you would like to learn more about pertussis, the UKHSA webinar on pertussis – Google Drive is available to view.
Greta Hayward, RN, RM, MPH
Consultant Midwife, Immunisation Division, UKHSA
August 2024