Study Finds Low Vaccination Rates Among Pregnant Women With HIV

Despite recommendations for routine prenatal care, pregnant women living with HIV (PLHIV) are receiving routine vaccinations at alarmingly low rates, according to a study published in JAMA Network Open.

“Given the paucity of data on the topic of routine vaccination in PLHIV, our objective was to estimate the prevalence of and identify factors associated with receiving influenza and/or [tetanus, diphtheria, and acellular pertussis (Tdap)] vaccinations among pregnant PLHIV participating in a large multisite prospective cohort in the United States,” explained Saba Berhie, MD, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine in Chicago, Illinois, and Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Brigham and Women’s Hospital in Boston, Massachusetts, and coauthors.

Based on data from 310 pregnancies among 278 women, only about one-third of these pregnancies involved receipt of recommended vaccines.
Specifically, the Tdap vaccine was administered in just 32.6% of pregnancies, while the influenza vaccine was given in 31.6% of cases. Even more concerning, only 22.6% of pregnancies involved receipt of both recommended vaccines.

These rates fall far short of the recommendations set by the American College of Obstetricians and Gynecologists (ACOG) and the US Centers for Disease Control and Prevention (CDC). Both organizations stress the importance of these vaccines for protecting both mother and child during pregnancy and early infancy.
The study also identified several factors associated with lower vaccination rates. Vaccination rates were particularly low among younger, multiparous individuals, and those with perinatally-acquired HIV. For example, the adjusted risk ratio (aRR) for influenza vaccination among multiparous PLHIV was 0.57 compared to nulliparous PLHIV.

Additionally, Tdap vaccination was more likely in pregnancies during 2016-2017 than in earlier years, with an aRR of 1.88. However, PLHIV with perinatally-acquired HIV were less likely to receive Tdap, though this finding did not reach statistical significance.

“Clinicians, researchers, and public health systems must identify and evaluate the impact of innovative and impactful strategies, including improved patient-facing messaging, as the current approach is unsuccessful at achieving the clinical and public health goals of widespread antenatal vaccination,” concluded the study authors.

Reference
Berhie S, Kacanek D, Lee J, et al. Routine vaccination during pregnancy among people living with HIV in the United States. JAMA Netw Open. 2024;7(5):e249531. doi:10.1001/jamanetworkopen.2024.9531