[Iskander] Hello.
I'm Dr. John Iskandar.
Welcome to CDC Beyond the Data.
I'm here today with Dr. Denise Jamison, chair of gynecology
and obstetrics at the Emory University School of Medicine.
Welcome. [Jamieson] Thank you very much.
I'm delighted to be here.
[Iskander] Our topic for this month's Grand Rounds is maternal
immunization, and I wonder
if you could just start us off with the basics.
What are the vaccines recommended during pregnancy?
[Jamieson] So there are two vaccines
that are recommended during pregnancy.
One is influenza vaccine which is the same vaccine
that everybody should be getting during the flu season,
and the other vaccine is the Tdap vaccine.
Tdap is a newer vaccine,
and it helps protect babies once they're born against pertussis.
And we strongly recommend
that pregnant women receive both of these vaccines.
[Iskander] So those are very important recommendations.
What do we know about the benefits
of pregnant women receiving those two vaccines?
[Jamieson] We know that if pregnant women have influenza,
they can get quite sick, severely ill, and so,
it's really important
that pregnant women get vaccinated against influenza.
And we've been making that recommendation as obstetricians,
gynecologists for many decades.
The Tdap vaccine, which I mentioned is a bit
of a newer vaccine, is really primarily aimed at trying
to protect babies once they're born and when they're too young
to be immunized against pertussis.
And so, we recommend both of those during pregnancy.
[Iskander] Yeah, and I think many of our reviewers may know
that pertussis in that early infancy period can be a
life-threatening an even fatal illness.
[Jamieson] Yes, it can be very severe, and what we used to try
to do is immunize those around the baby
to protect the baby and cocoon the baby.
And what we found was it didn't work all that well,
and so a number of years ago we changed our approach
and now vaccinate the pregnant mother.
And that provides protection for the infant.
So, it's a different strategy, and it's worked quite well.
[Iskander] So what can you tell us in brief
about the numerous safety studies that have been done
about use of these vaccines during pregnancy?
[Jamieson] So we know more about influenza vaccine and pregnancy
than we know about any other vaccine.
We have many decades of evidence showing that the vaccine is safe
in pregnancy, and that's why we recommended it.
Tdap is a newer vaccine, but there's a history of safety data
around that vaccine as well.
So overall, what I tell my pregnant patients is
that it's important to be vaccinated,
the vaccines are safe, and it can really make a difference.
[Iskander] That's a very important
and powerful clinical message.
So as a public health and clinical community,
how are we doing at giving these important vaccines
to pregnant women?
[Jamieson] Well, we're not doing as well as we could be.
So, just to give you perspective,
during the pandemic influenza,
vaccine rates increased by about three-fold.
So, it went from about 15% to about 50%.
And, really since then, a decade later,
we still really haven't made a big impact
on increasing vaccination rates, and there's still about half
of pregnant women who don't get vaccinated.
We do slightly better with Tdap but only slightly.
It's a little more than half
of pregnant women get vaccinated for just Tdap.
So, if you look at the whole picture, we really have a lot
of room for improvement in both vaccines during pregnancy.
[Iskander] So Dr. Jamison, you've been recognized
by the American College of Obstetrics and Gynecology
as an immunization champion.
Can you tell us a little bit about what you
and your team have done at Grady Hospital in Atlanta
to improve immunization rates?
[Jamieson] Of course.
In our clinic, we have a lot of things in place that sort
of make giving the vaccine easy and sort of routine.
So, we have the vaccine in clinic.
It's stocked in our clinic
so that the nurse can easily give it
without the patient having to go to a different place.
We have standing orders, so that there's not an extra step
that the physician needs to do in order to give the vaccine.
We have a policy where we train and retrain all our providers
to universally recommend the vaccine
to everybody during flu season and then we also train
and retrain in terms of the Tdap as well.
And then this past season we did sort of more than we usually do.
Those of the things that we usually do because we wanted
to see if we could increase the vaccination coverage
above the 50%.
We're right at about the national average.
About half of our patients received the vaccine, and so,
with the medical student in conjunction
with medical students and public health students who have a lot
of energy and a lot of great ideas,
we did a lot for the clinic.
So, we had stickers that they designed.
We had weekly celebrations and reminders, so in the middle
of the day between the morning and the afternoon clinic
on Fridays we had a little celebration
that usually involved food.
And we would make a presentation to the Emory
and Morehouse resident who had the most patients vaccinated the
previous week.
We recognized the medical assistant and nurses
who were acting as champions and really had great enthusiasm
around the vaccines in the vaccine campaign.
We had pizza parties with, you know, cakes that were decorated
with little cartoon vaccines.
Again, I did not design them because I'm not that creative,
but it's amazing what great ideas students come up with.
And there was a lot of energy.
We did an education campaign around immunization week,
so a lot of energy and enthusiasm went
into supporting the staff and the faculty and physicians
and the students in promoting vaccines.
And I think it was infectious.
I think it also rubbed off on our patients, and so,
we're hoping to do something similar this season.
[Iskander] So it's fascinating because of this combination
of some of the traditional sort of more technical approaches
to increasing vaccinates with a lot of a big layer
of what we've come
to be realizing are these very important sort
of soft skills on top of them.
So, for providers looking
to increase their maternal immunization rates or people
in public health looking to promote maternal immunization,
are there some good websites or resources that they can turn to?
[Jamieson] Yes, ACOG has a really nice toolkit
on maternal immunization and resources that are available.
They give you patient education materials, give you information
about how to stock and code for immunization in your practice,
so a lot of really helpful handy materials that can be used
if you're interested in either starting to vaccinate
in your practice or increasing your vaccination rates
within your practice.
[Iskander] Wonderful.
So we'll provide that contact information
for the American College of Obstetrics
and Gynecology to our listeners.
Again, thank you very much for joining us today Dr. Jamison.
[Jamieson] Thanks so much.
It was great to be here.
[Iskander] Please join us next time for Beyond the Data.