Expected challenges of implementing universal pertussis vaccination during pregnancy in Quebec: a cross-sectional survey.
Expected challenges of implementing universal pertussis vaccination during pregnancy in Quebec: a cross-sectional survey.
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DOI：
10.9778/cmajo.20180040
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发表时间：
2018-07-01
期刊：
影响因子：
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通讯作者：
Dube, Eve
中科院分区：
文献类型：
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作者：
Brousseau, Nicholas;Gagnon, Dominique;Dube, Eve
背景：加拿大最近推荐所有孕妇接种含百日咳（破伤风、白喉、百日咳[Tdap]）的无细胞疫苗，理想情况是在妊娠27至32周之间。本研究旨在描述魁北克现有的产前护理模式，并确定在多大程度上可以将母亲接种百日咳疫苗纳入该模式。方法：在魁北克，卫生保健是围绕当地社区服务中心（LCSCs）组织的，服务于特定的地理区域。对于158家LCSCs（占全省LCSCs的98.1%）中的每一家，我们邀请了1名参与产前护理的护士或管理人员参与一项基于网络的横断面调查。根据使用人口普查数据确定的城市化水平，记录了产前保健访问结构和将产妇Tdap疫苗接种纳入现有模型的可能性，并进行了比较。结果：127例LCSCs完成问卷调查，有效率80.4%。只有13个（10.2%）和14个（11.0%）LCSCs分别为大多数妊娠中期和晚期的孕妇提供护士的现场访问。农村LCSCs在妊娠晚期对孕妇进行现场访问的比例明显高于城市LCSCs(13[18%]对1 [2%])（p = 0.003）。在至少50个LCSC服务区（39.4%），大多数提供产前护理的医疗诊所不提供疫苗。解释：鉴于魁北克省目前的情况，实施普遍的产妇百白破疫苗接种可能具有挑战性，这可能导致孕妇疫苗覆盖率达不到最佳水平。由于加拿大其他省份可能面临类似的问题，优先考虑的是评估基于省份的实施模式，以制定在加拿大各地提供产妇百白破疫苗接种的有效方法。
BACKGROUND: Vaccination of all pregnant women with an acellular pertussis-containing vaccine (tetanus, diphtheria, pertussis [Tdap]) was recently recommended in Canada, ideally between 27 and 32 weeks of gestation. This study aimed to describe the existing model of prenatal care in Quebec and determine to what extent maternal vaccination against pertussis could be integrated into this model.METHODS: In Quebec, health care is organized around Local Community Service Centres (LCSCs) that serve specific geographic areas. For each of 158 LCSCs (98.1% of LCSCs in the province), we invited 1 nurse or manager involved in prenatal care to participate in a cross-sectional Web-based survey. The structure of prenatal care visits and potential integration of maternal Tdap vaccination into the existing model were documented and compared according to urbanization level, determined with the use of census data.RESULTS: A completed survey was obtained for 127 LCSCs (response rate 80.4%). Only 13 (10.2%) and 14 (11.0%) LCSCs offered on-site visits with a nurse for the majority of pregnant women during the second and third trimesters, respectively. A significantly higher proportion of rural LCSCs than urban LCSCs offered on-site visits to pregnant women in the third trimester (13 [18%] v. 1 [2%]) (p = 0.003). In at least 50 LCSC service areas (39.4%), vaccines were not available in most medical clinics offering prenatal care.INTERPRETATION: Given the current situation in Quebec, implementing universal maternal Tdap vaccination may be challenging, which may result in suboptimal vaccine coverage among pregnant women. As other Canadian provinces may face similar issues, a priority will be to evaluate province-based implementation models to develop efficient ways to provide maternal Tdap vaccination across Canada.