Too Few Women Receive Influenza and Tdap Vaccines During Pregnancy, CDC Says

Pregnant woman receiving a vaccine.
Pregnant woman receiving a vaccine.
Only 1 in 3 mothers-to-be receive both influenza and Tdap vaccines, according to a CDC report.

The Centers for Disease Control and Prevention (CDC) recommends the influenza vaccine for women before or during pregnancy, depending on if the pregnancy occurs in flu season. The CDC also recommends that pregnant women receive the tetanus, diphtheria, and pertussis (Tdap) vaccine between 27 and 36 weeks.1 Despite these recommendations, only 1 in 3 mothers-to-be receive both vaccines, according to a CDC Vital Signs report.2

Researchers Survey Expecting Mothers

Women who are pregnant are 2.4 times more likely to be hospitalized for influenza than women who are not.3 In addition, infants accounted for 88.8% of pertussis-related deaths in the United States between 2000 and 2016.4

With these risks in mind, researchers set out to determine how many expecting mothers follow CDC guidelines by undergoing vaccination against the flu and whooping cough. They conducted an internet survey of women aged 18 to 49 years who had been pregnant at any point since August 1, 2018 (the survey was conducted from March 27, 2019, to April 8, 2019). Of 2097 women who reported a pregnancy between October 2018 and January 2019, 53.7% had received the influenza vaccine. Of 817 women who knew their Tdap vaccination status during pregnancy, 54.9% had received the vaccine. Just 34.8% of respondents had received both influenza and Tdap vaccines.2

Vaccine Offers and Refusals

The majority of respondents reported that their healthcare provider had offered to administer the vaccine or make a referral (73.3% for influenza and 76% for Tdap). Of those who received an offer or referral, approximately two-thirds underwent vaccination (65.7% for influenza and 70.5% for Tdap).

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Offers and referrals for influenza vaccination were less common depending on certain factors:

  • Education level (college degree or less)
  • Insurance status (uninsured)
  • Geographic location (living in the south)
  • Economic status (living below the poverty level)
  • Medical history (no other high-risk medical conditions)
  • Healthcare utilization (10 or fewer healthcare visits since July 2018)

Likewise, offers and referrals for Tdap vaccination were less common depending on certain factors:

  • Age (35 to 49 years)
  • Employment status (employed)
  • Education level (very or poorly educated)

Barriers to Vaccination

Among women who refused the influenza vaccine, efficacy (17.6%) and safety concerns for the infant (15.9%) were most often cited as reasons for refusal. A similar percentage of women (17.1%) had concerns about the safety of the Tdap vaccine. The most common reason for Tdap refusal was not knowing the vaccine is necessary for each pregnancy (37.9%).

Reducing Disease Burden

“These findings highlight influenza and pertussis disease burden among pregnant women and infants and vaccination coverage among pregnant women in the United States and suggest that disease burden could be reduced by improving vaccination coverage,” the researchers concluded. “Starting maternal vaccination discussions with patients early in pregnancy can offer providers multiple opportunities to share information tailored to individual patients’ needs and address vaccination-related concerns.”


  1. Maternal vaccines: part of a healthy pregnancy. Centers for Disease Control and Prevention. Reviewed August 5, 2016. Accessed November 15, 2019.
  2. Lindley MC, Kahn KE, Bardenheier BH, et al. Vital signs: burden and prevention of influenza and pertussis among pregnant women and infants – United States. MMWR Morb Mortal Wkly Rep. 2019;68(40):885-892.
  3. Mertz D, Geraci J, Winkup J, Gessner BD, Ortiz JR, Loeb M. Pregnancy as a risk factor for severe outcomes from influenza virus infection: a systematic review and meta-analysis of observational studies. Vaccine. 2017;35(4):521-528.
  4. Skoff TH, Hadler S, Hariri S. The epidemiology of nationally reported pertussis in the United States, 2000-2016. Clin Infect Dis. 2019;68(10):1634-1640.