Research and analysis

Prenatal pertussis vaccination coverage in England from April to June 2024

Updated 10 October 2024

Applies to England

Main points

This quarterly report evaluates prenatal pertussis vaccine coverage for women who delivered in the April to June 2024 quarter who were eligible for the prenatal pertussis vaccine from 16 weeks of pregnancy onwards.

The main findings were that:

• pertussis vaccine coverage in pregnant women for the first quarter of the 2024 to 2025 financial year (2024/25) was 58.9% in April, 59.0% in May and 60.9% in June

• the mean coverage for the quarter was 59.6%, which was 1.5 percentage points higher than the mean coverage for the same quarter in 2023/24 and was the first quarterly increase in coverage since quarter 4 of 2019/20

• prenatal pertussis vaccine coverage by Integrated Care Board (ICB) ranged from 23.2% (North Central London, June 2024) to 79.8% (Shropshire, Telford and Wrekin, June 2024)

• despite an increase in coverage this quarter, there has been an 8.1.% decline in coverage compared to the peak coverage in the same reporting quarter of 2016/17

• Although coverage in the London NHS commissioning region has increased to 41.3% (June 2024), this remains well below the peak coverage of 60.9% achieved in December 2019

Introduction

This report presents vaccine coverage in pregnant women in England for the period April to June 2024, updating previous data reported for January to March (1).

The pertussis vaccine has been offered to pregnant women since 1 October 2012 (2) following a period of increased pertussis activity in all age groups, including infants under 3 months of age, and the declaration of a national pertussis outbreak in April 2012 (3).

In June 2014, the Joint Committee on Vaccination and Immunisation (JCVI) advised it should continue for a further 5 years (4). In February 2016, the JCVI considered new evidence demonstrating that vaccination earlier in pregnancy would increase opportunities during pregnancy for vaccination, without detrimentally affecting the protection afforded to the infant (5, 6). Based on this, JCVI advised that vaccination could be offered from gestational week 16, although for operational reasons vaccination should ideally be offered from around 20 weeks, on or after the foetal anomaly scan (7).

This advice was implemented from April 2016 as was offering the vaccine through general practice as well as some maternity services. In 2019, following the JCVI recommendation, the prenatal pertussis vaccine became a routine programme in England (8).

The prenatal pertussis vaccination programme aims to minimise disease, hospitalisation and deaths in young infants through the intra-uterine transfer of maternal antibodies, until they can be actively protected by the routine infant programme with the first dose of pertussis vaccine scheduled at 8 weeks of age (9).

Methods

GP level pertussis vaccine coverage data is automatically uploaded via participating GP IT suppliers to the ImmForm website each month. ImmForm data is validated and analysed by the UK Health Security Agency (UKHSA) to check data completeness, identify and query any anomalous data and describe epidemiological trends. Since April and May 2016 (implementation date varied by GP IT supplier), the following monthly data has been collected:

• denominator: number of women who delivered in the survey month, excluding miscarriages and stillbirths, regardless of gestational age
• numerator: number of women receiving pertussis vaccination between week 16 of pregnancy and delivery

For accurate denominators to be extracted from GP IT systems by the automated survey and precise coverage estimates to be calculated, it is important that the medical records of all women who have given birth have the following fields completed:

• the date of delivery
• the date of receipt of a pertussis-containing vaccine at or after week 16 of pregnancy, regardless of the setting where the vaccine was administered
• where relevant, fields indicating stillbirth or miscarriage

Coverage by former local teams and NHS commissioning regions (based on the 2019 NHS England configurations) is also included, for comparison, in the data tables associated with this report.

Clinical Commissiing Groups (CCGs) have been omitted due to changes in NHS geographies over time and the abolition of CCGs from 1 July 2022.

Participation and data quality

All GP IT suppliers provided data for the months of April to June 2024. National GP practice participation was at 98.2% (April 2024), 98.4% (May 2024) and 98.2% (June 2024).

Results

Monthly pertussis vaccine coverage across the quarter showed that 58.9% was recorded in April, 59.0% in May and 60.9% in June, with mean coverage for the quarter at 59.6% (Table 1, Figure 1), see data tables. During this quarter, prenatal pertussis vaccine coverage by ICB ranged from 23.2% (North Central London, June 2024) to 79.8% (Shropshire, Telford and Wrekin, June 2024) (Table 1).

When comparing change in percentage from the 2023/24 financial year, national coverage was 0.2% higher in April and 0.9% higher in May. Coverage in June 2024 was higher by 3.4 percentage points compared to June 2023/24 financial year and higher by 1.4 percentage points than in the June 2022/23 financial year.

Coverage by former local teams and NHS commissioning regions (based on the 2019 NHS England configurations) are also included in the data tables for trend comparisons.

Although coverage in the London NHS commissioning region increased to 41.3% (June 2024), this remains well below the peak coverage of 60.9% in December 2019 (Figure 2).

Table 1. Monthly pertussis vaccination coverage (%) in pregnant women by ICB in England, April to June 2024

ICB code	ICB name	April 2024	May 2024	June 2024
QE1	Lancashire and South Cumbria	62.2	62.6	61.7
QF7	South Yorkshire	65.4	64	66.9
QGH	Herefordshire and Worcestershire	56.2	58.2	64.2
QH8	Mid and South Essex	63.0	63.4	65.4
QHG	Bedfordshire, Luton, and Milton Keynes	59.2	58.6	57.1
QHL	Birmingham and Solihull	49.8	49.3	50.0
QHM	North East and North Cumbria	57.5	59.3	61.2
QJ2	Derby and Derbyshire	79.4	77.3	78.7
QJG	Suffolk and North East Essex	58.5	53.4	56.6
QJK	Devon	69.1	68.8	69.5
QJM	Lincolnshire	60.4	52.6	64.0
QK1	Leicester, Leicestershire and Rutland	48.5	46.7	48.7
QKK	South East London	56.1	56.5	60.4
QKS	Kent and Medway	65.7	65.4	66.9
QM7	Hertfordshire and West Essex	63.4	62.2	63.4
QMF	North East London	37.3	35.7	40.0
QMJ	North Central London	23.3	25.5	23.2
QMM	Norfolk and Waveney	75.6	77.2	79.6
QNC	Staffordshire and Stoke-on-Trent	64.5	63.5	65.8
QNQ	Frimley	58.2	59.5	61.6
QNX	Sussex	68.0	69.3	70.4
QOC	Shropshire, Telford and Wrekin	74.6	76.6	79.8
QOP	Greater Manchester	49.5	50.9	51.9
QOQ	Humber and North Yorkshire	70.8	73.9	75.5
QOX	Bath and North East Somerset, Swindon and Wiltshire	52.8	56.0	61.7
QPM	Northamptonshire	52.8	50.9	50.9
QR1	Gloucestershire	63.8	63.4	64.2
QRL	Hampshire and Isle of Wight	69.0	71.5	71.3
QRV	North West London	39.3	40.3	41.4
QSL	Somerset	58.2	60.6	66.3
QT1	Nottingham and Nottinghamshire	67.9	63.9	65.8
QT6	Cornwall and Isles of Scilly	52.8	58.2	52.7
QU9	Buckinghamshire, Oxfordshire, and Berkshire West	71.4	69.5	72.4
QUA	Black Country	59.9	59.7	59.4
QUE	Cambridgeshire and Peterborough	68.0	60.5	66.2
QUY	Bristol, North Somerset, and South Gloucestershire	58.1	67.4	73.6
QVV	Dorset	63.9	68.0	71.5
QWE	South West London	49.1	52.3	50.6
QWO	West Yorkshire	65.5	64.8	68.2
QWU	Coventry and Warwickshire	65.4	62.6	63.4
QXU	Surrey Heartlands	71.5	71.0	73.3
QYG	Cheshire and Merseyside	63.3	63.9	66.1
Total		58.9	59.0	60.9

Figure 1. Monthly pertussis vaccination coverage (%) in pregnant women (England), 2017 to 2024

Figure 2. Monthly pertussis vaccination coverage (%) in pregnant women by NHS commissioning region, April 2019 to June 2024 [Note 1]

Note 1. Data from the smallest IT supplier was excluded between November and December 2019.

Discussion

This first quarterly report of 2024/25 evaluates pertussis vaccine coverage data for women who delivered in the April to June 2024 quarter.

Overall, monthly prenatal pertussis vaccine coverage for the first quarter of 2024/25 went from 58.9% in April, to 59.0% in May and to 60.9% in June; the difference between the highest and lowest ICB was 54.5 percentage points.

Although coverage in the London NHS commissioning region has increased to 41.3% (June 2024), this remains well below the peak coverage of 60.9% reached in December 2019.

Limitations to the data presented in this report may explain the some of the observed variability in coverage at the local level and over time. First, completeness of data is reliant on the recording of delivery dates in the mother’s medical records and a recent study in England suggests that maternity notes regarding pregnancy (12) and delivery are often scanned or archived, rather than coded in an extractable format (10). Furthermore, a comparison of this denominator data with national data on live births (11) indicates that, in 2022, this data represented about 73% of the population of pregnant women. Recent improvements in the capture of pertussis vaccine events delivered in maternity units may result in improvements in coverage, but these will not start to be visible in these reports until data becomes available for women delivering after September 2024.

Continued support in the delivery of this important programme has been sought from service providers (GP practices and maternity units).

Screening and Immunisation Teams and HPTs should continue to update service providers on the current epidemiology of the disease and the need to maintain and improve coverage achieved thus far.

If coverage, and ultimately the impact of the programme itself, is to be accurately monitored, it is essential that GPs and practice nurses continue to ensure that vaccination and date of delivery are recorded in the patient’s GP record. In areas that have commissioned maternity units to offer pertussis vaccines in pregnancy, it is important that providers ensure doses of vaccines given to individual women are also communicated to the woman’s GP where these are not captured in automated systems. Maternity units not offering pertussis vaccines to pregnant women should continue to discuss its importance, make use of available resources (13) and signpost women to their GP to receive the vaccine.

GPs, practice nurses, obstetricians and midwives should continue to encourage pregnant women to receive the pertussis vaccine – ideally between weeks 20 and 32 of their pregnancy (but up to term) – so as to optimise protection for their babies from birth (7).

References

1. ‘Prenatal pertussis vaccination coverage in England from October to December 2023’. Health Protection Report: volume 18, number 3

2. DHSC (2012). Pregnant women to be offered whooping cough vaccination

3. A national “level 3” incident had been declared in April 2012 in response to the ongoing increased pertussis activity. A level 3 incident is the third of 5 levels of alert under the UKHSA’s Incident Reporting and Information System (IERP) according to which public health threats are classified and information flow to the relevant outbreak control team is coordinated; a level 3 incident is defined as one where the public health impact is significant across regional boundaries or nationally.

4. JCVI (2014). Minute of the meeting on 4 June 2014

5. Eberhardt CS, Blanchard-Rohner G, Lemaitre B, Boukrid M, Combescure C, Othenin-Girard V and others (2016). ‘Maternal immunization earlier in pregnancy maximizes antibody transfer and expected infant seropositivity against pertussis’. Clinical Infectious Diseases: volume 62, pages 829 to 836

6. JCVI (2016). Minute of the meeting on 3 February 2016

7. UKHSA. The Green Book, chapter 24: Pertussis

8. JCVI (2019). Minute of the meeting on 5 June 2019

9. UKHSA. ‘Complete routine immunisation schedule’

10. Llamas A, Amirthalingam G, Andrews N, and Edelstein M (2020). ‘Delivering prenatal pertussis vaccine through maternity services in England: what is the impact on vaccine coverage?’ Vaccine: volume 38, issue 33, pages 5,332 to 5,336

11. Office for National Statistics (2022). Births in England and Wales

12. PHE (2020). Vaccine update: World Immunisation Week

13. UKHSA (2022). Pregnancy: How to help protect yourself and your baby