Lakhasly

ABSTRACT
Pertussis is a serious and potentially fatal disease in infants too young for vaccination. Despite
a high vaccine coverage in children, pertussis continues to occur in unvaccinated infants in the
Kingdom of Saudi Arabia (KSA). Available data supports the use of maternal pertussis immunization
for preventing pertussis in young infants. In June 2019, the Saudi Ministry of Health recommended
maternal pertussis immunization with combined tetanus-diphtheria-acellular pertussis vaccine
(Tdap) during every pregnancy. To understand barriers to maternal immunization and identify
strategies to improve maternal immunization, we conducted an online survey in November and
December 2020, asking 60 obstetricians/gynecologists about their attitudes to maternal pertussis
immunization. Fewer than 50% survey respondents considered maternal immunization as part of
their role, and only 47% were aware of the national recommendation. Consequently, the uptake of
maternal vaccination in KSA may be sub-optimal. The key barriers that hinder obstetricians/
gynecologists from recommending maternal Tdap immunization were the anticipation of patient
refusal, and their own need for more information/experience about the disease and the national
recommendation. Vaccine availability and supply were important barriers, whereas cost/reimbursement
and resource issues were of lesser concern. Disseminating evidence based information to
physicians, educating pregnant women and addressing public misconceptions.
PLAIN LANGUAGE SUMMARY
What is the context?
● Pertussis (whooping cough) can be life-threatening when it occurs in very young infants.
● The most effective strategy to prevent whooping cough in young infants is to vaccinate their mothers
during the third trimester of pregnancy.
● Maternal antibodies transferred to the fetus can provide protection against infection until the first
routine whooping cough vaccine at 2 or 3 months of age.
● Maternal pertussis vaccination has been recommended in Saudi Arabia since 2019.
What is new?
● A survey of obstetricians/gynecologists found that almost 50% were unaware of the recommendation,
suggesting poor uptake of maternal vaccination.
What is the impact?
● Strategies to improve maternal immunization rates in the Kingdom of Saudi Arabia need to include
education of obstetricians/gynecologists, mothers, and the general public about the disease, how it
can be prevented, and the benefits and risk of vaccinating versus not vaccinating