title: Pertussis vaccination coverage among Australian women prior to childbirth in the cocooning era: a two-hospital, cross-sectional survey, 2010 to 2013.
abstract: BACKGROUND
  Recent pertussis epidemics have triggered implementation of cocooning, involving caregiver vaccination to indirectly protecting susceptible infants.
  
  
  OBJECTIVE
  To determine patient, provider and setting factors associated with maternal pertussis booster vaccination (dTpa) within 5-10 years before childbirth.
  
  
  METHODS
  Cross-sectional survey using Health Belief Model constructs among postpartum women in a tertiary referral centre and a private hospital in Sydney, Australia.
  
  
  RESULTS
  Pertussis vaccination was current among 33.7% of the 2483 new mothers (0.5% vaccinated during pregnancy). Women were more likely to be vaccinated if they had heard of 'whooping cough' from a health professional (OR: 2.59, P < 0.001, 95% CI: 1.70-3.95), were recommended the vaccine (OR: 2.48, P < 0.00, 95% CI: 1.55-4.00), perceived pertussis as 'severe' for adults (OR: 1.21, p0.009, 95% CI: 1.05-1.39) and 'common' within their community (OR: 1.38, P < 0.001, 95% CI: 1.18-1.61). They more often agreed that it was their parental responsibility to be vaccinated (OR: 1.61, P = 0.002, 95% CI: 1.19-2.18), and this would help prevent their baby from contracting pertussis (OR: 1.22, P = 0.046, 95% CI: 1.00-1.47). Vaccinated women were less likely to report vaccination barriers: time constraints (OR: 0.75, P < 0.001, 95% CI: 0.66-0.85) and having safety concerns (OR: 0.80, P < 0.001, 95% CI: 0.69-0.92). Additionally, their partners reported three times higher uptake (76% vs 49%; P < 0.001; 95% CI: 2.66-3.85).
  
  
  CONCLUSIONS
  Current pertussis vaccination in only one in every three postpartum participants may indicate insufficient coverage to protect newborns. Practitioners are instrumental in raising awareness and addressing vaccine concerns. Integrating vaccination into routine obstetric care, whether antenatally or postnatally, may minimise barriers.
authors.affiliation: National Centre for Immunisation Research and Survellience, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.
authors.forename: Elizabeth H
authors.initials: EH
authors.lastname: Hayles
authors.affiliation: The School of Public Health, City University of New York, New York, New York, USA.
authors.forename: Spring C
authors.initials: SC
authors.lastname: Cooper
authors.affiliation: Department of Neonatology, Royal North Shore Hospital, Sydney, New South Wales, Australia.
authors.forename: John
authors.initials: J
authors.lastname: Sinn
authors.affiliation: National Centre for Immunisation Research and Survellience, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.
authors.forename: Nick
authors.initials: N
authors.lastname: Wood
authors.affiliation: The School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Julie
authors.initials: J
authors.lastname: Leask
authors.affiliation: Discipline of Paediatric and Child Health, The Children's Hospital at Westead, Sydney, New South Wales, Australia.
authors.forename: Susan Rachel
authors.initials: SR
authors.lastname: Skinner
mesh_terms: D000328:Adult; D001315:Australia; D003430:Cross-Sectional Studies; D022681:Diphtheria-Tetanus-acellular Pertussis Vaccines; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006771:Hospitals, Maternity; D006801:Humans; D032521:Immunity, Herd; D007117:Immunization, Secondary / Q000706:statistics & numerical data*; D049590:Postpartum Period; D011295:Prenatal Care; D011369:Professional-Patient Relations; D011446:Prospective Studies; D012927:Social Control, Informal; D011795:Surveys and Questionnaires; D013997:Time Factors; D014611:Vaccination / Q000706:statistics & numerical data*; D014917:Whooping Cough / Q000517:prevention & control*
chemical_list: D022681:Diphtheria-Tetanus-acellular Pertussis Vaccines
keywords: cocooning; health belief model; maternal vaccination; pertussis booster vaccine; whooping cough