Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Challenges to Improve Tdap Immunization Rates

Heliyon; 2018 May 25; Mehrotra, et al

Barriers such as insurance reimbursement and financial concerns for specialty practices can outweigh the perceived benefits of Tdap immunization; however, structural support for Tdap vaccine administration in obstetrician-gynecologist practices and continuing medical education may help overcome these barriers. Researchers conducted interviews with a sample of 24 obstetrician-gynecologists with the goal to inform new strategies to increase uptake of the Tdap vaccine among pregnant women in order to reduce pertussis-related morbidity and mortality in infants. They found:

  • The majority of physicians stated they believed that the Tdap vaccine was important and effective due to the transfer of pertussis antibodies from the mother to the fetus.
  • Most physicians indicated that they recommended the vaccine to patients during pregnancy, but not all reported administering it on site because it was not stocked at their practice.
  • Implementation challenges for physician included insurance reimbursement and patient refusal.
  • Physicians recognized the benefits associated with Tdap vaccination during pregnancy.


Mehrotra A, Fisher AK, Mullen J, et al. Provider insight on surmounting specialty practice challenges to improve Tdap immunization rates among pregnant women. Heliyon. 2018;4(5):e00636. doi:10.1016/j.heliyon.2018.e00636.


Over the last 15 years, there have been a lot of changes with regard to the use of the Tdap vaccination. A large number of these changes have occurred in how we administer this vaccination in the perinatal time period. The current recommendation has us giving this vaccine during every pregnancy to pregnant mothers in the last part of their pregnancy. This study clearly showed that obstetricians felt that this was a worthwhile endeavor. Clearly issues such as insurance coverage and patient refusal might be out of the hands of the clinician, however, it seems imperative that our OB colleagues should keep this vaccine in their office for administration if we hope to improve coverage of our pregnant patients and, in turn, their newborn babies. —John Russell, MD