Research and analysis

Prenatal pertussis vaccination coverage in England from January to March 2024, and annual coverage for 2023 to 2024

Updated 10 October 2024

Applies to England

Main points

This report evaluates prenatal pertussis vaccine coverage for women who delivered in the January to March 2024 quarter and estimates annual coverage for the 2023 to 2024 financial year.

The main findings were that:

• vaccine coverage was 58.6% in the 2023/24 financial year, compared to 60.7% in 2022/23, 64.7% in 2021/22 and 67.8% in 2020/21

• pertussis vaccine coverage in pregnant women during the fourth quarter of the 2023/24 financial year was 59.8% in January, 58.9% in February and 58.9% in March

• the mean coverage for the quarter was 59.2%, which was 1.0 percentage point lower than the mean coverage for the same quarter in the 2022/23 financial year

• prenatal pertussis vaccine coverage by Integrated Care Board (ICB) ranged from 24.0% (North Central London, February 2024) to 83.1% (Derby and Derbyshire, January 2024)

• prenatal pertussis coverage (%) for 2023/24 was the highest in White British women (66.8%) and lowest in Black or Black British Caribbean women (29.9%)

• coverage was lowest in the London NHS commissioning region; but the region with the largest decline over the last year – 11.9% – was the South West

Background

This report presents data for pertussis vaccine coverage in pregnant women in England for the period January to March 2024, updating the report for October to December 2023 published in April (1); it also presents annual coverage data for the whole of the 2022/23 financial year.

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

General practice 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 commissioning groups (CCGs) have been omitted due to changes in NHS geographies over time and the abolition of CCGs from 1 July 2022.

Annual vaccine coverage for England was calculated by summing the 12 monthly numerators and denominators for the financial year (April 2023 to March 2024). This is different from reports showing annual data on, and prior to, the 2018 to 2019 financial year, where a separate annual extraction (based on the same coding specification) was used to report the annual coverage.

For ethnicity, monthly data was collated for the annual period and coverage calculated by ethnic group according to ONS 2011 census categories. For the ethnicity analysis in this report, we excluded those registered patients without an ethnicity code. In total, we excluded 64,959 of the total 458,615 (14.2%) women recorded as having delivered in 2023/2024. Coverage in excluded women was 54.8% (35,589 out of 64,959)

Participation and data quality

All GP IT suppliers provided data for the January to March 2023 period. National GP practice participation was at 99.0% (January 2024), 98.6% (February 2024) and 98.5% (March 2024).

Results

Monthly pertussis vaccine coverage ranged across the quarter from 58.9%, in February and March, to 59.8% in January, with mean coverage for the quarter at 59.2% (Table 1, Figure 1), see data tables. During this quarter, prenatal pertussis vaccine coverage by Integrated Care Board (ICB) ranged from 24.0% (North Central London, February 2024) to 83.1% (Derby and Derbyshire, January 2024) (Table 1).

When compared with data from the 2022/23 financial year, national coverage was 1.0 percentage point lower in January 2024, 1.6 percentage points lower in February 2024 and 0.4 of a percentage point lower in March 2024. Mean coverage for this quarter was 1.0 percentage point lower than the national coverage reported for the same quarter in the 2022/23 financial year, and 4.7 percentage points lower than the same period in the 2021/22 financial year, representing an ongoing decline in coverage since June 2020 (Figure 2).

The annual vaccine coverage for the 2023/24 financial year was 58.6%. This is 2.1 percentage points lower than the 2022/23 financial year and 6.1 percentage points lower than the 2020/21 financial year.

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

ICB code	ICB name	January 2024	February 2024	March 2024	January to March 2024
QE1	Lancashire and South Cumbria	63.3	60.9	62.9	62.1
QF7	South Yorkshire	68.2	69.6	63.5	68.9
QGH	Herefordshire and Worcestershire	65.7	63.0	60.8	64.4
QH8	Mid and South Essex	66.3	63.8	67.0	65.1
QHG	Bedfordshire, Luton, and Milton Keynes	64.3	61.3	59.5	62.8
QHL	Birmingham and Solihull	50.5	49.5	50.1	50.0
QHM	North East and North Cumbria	61.5	59.0	59.8	60.3
QJ2	Derby and Derbyshire	83.1	78.5	79.2	80.8
QJG	Suffolk and North East Essex	59.7	63.8	61.6	61.8
QJK	Devon	70.5	70.9	67.4	70.7
QJM	Lincolnshire	60.3	60.5	58.6	60.4
QK1	Leicester, Leicestershire and Rutland	60.9	60.3	56.8	60.6
QKK	South East London	48.7	48.7	49.0	48.7
QKS	Kent and Medway	64.4	64.7	66.3	64.6
QM7	Hertfordshire and West Essex	65.9	67.0	62.8	66.5
QMF	North East London	32.2	31.9	34.5	32.1
QMJ	North Central London	25.7	24.0	25.0	24.9
QMM	Norfolk and Waveney	78.2	74.3	78.0	76.3
QNC	Staffordshire and Stoke-on-Trent	62.8	66.2	64.2	64.5
QNQ	Frimley	59.1	54.1	58.5	56.6
QNX	Sussex	54.7	60.7	68.5	57.7
QOC	Shropshire, Telford and Wrekin	77.6	78.2	73.4	77.9
QOP	Greater Manchester	53.8	51.9	51.5	52.9
QOQ	Humber and North Yorkshire	71.6	74.7	71.3	73.2
QOX	Bath and North East Somerset, Swindon and Wiltshire	49.2	48.7	50.0	49.0
QPM	Northamptonshire	55.8	51.3	52.0	53.6
QR1	Gloucestershire	67.4	64.2	66.6	65.8
QRL	Hampshire and Isle of Wight	69.7	73.8	68.6	71.8
QRV	North West London	39.5	42.7	43.5	41.1
QSL	Somerset	68.7	59.5	62.1	64.1
QT1	Nottingham and Nottinghamshire	63.5	69.6	66.6	66.6
QT6	Cornwall and Isles of Scilly	54.1	52.1	48.7	53.1
QU9	Buckinghamshire, Oxfordshire, and Berkshire West	69.1	66.1	69.8	67.6
QUA	Black Country	59.8	57.2	56.8	58.5
QUE	Cambridgeshire and Peterborough	67.1	64.3	64.0	65.7
QUY	Bristol, North Somerset, and South Gloucestershire	60.7	55.7	42.7	58.2
QVV	Dorset	67.9	70.2	64.7	69.1
QWE	South West London	46.4	46.9	52.0	46.7
QWO	West Yorkshire	68.0	65.3	68.1	66.7
QWU	Coventry and Warwickshire	62.5	60.2	60.9	61.4
QXU	Surrey Heartlands	72.8	69.3	69.7	71.1
QYG	Cheshire and Merseyside	65.7	66.0	61.7	65.9
Total		59.8	58.9	58.9	59.4

Ethnicity

Annual Prenatal pertussis coverage (%) for 2023 to 2024 varied by ethnic group and was the highest in White British (66.8%) and Chinese women (66%) (Table 2)

Coverage was the lowest in Black or Black British women (36.6%) and Black or Black British Caribbean (29.9%) (Table 2)

Table 2. Annual pertussis vaccination coverage (%) across ethnicity groups, April 2023 to March 2024

Ethnicity Group	Coverage (%)
White British	66.8
Chinese	66.0
Mixed - White and Asian	58.3
White Irish	57.7
Mixed - Any other mixed background	48.0
Mixed - White and Black African	46.2
Asian or Asian British - Pakistani	45.5
White - Any other White background	43.9
Mixed - White and Black Caribbean	43.4
Asian or Asian British - Bangladeshi	42.7
Black or Black British - African	42.1
Black or Black British - Any other Black background	36.6
Black or Black British - Caribbean	29.9

Figure 1. Monthly pertussis vaccination coverage (%) in pregnant women (England), 2016 to 2024

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

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

Discussion

This report evaluates pertussis vaccine coverage data for women who delivered in the period January to March 2024 quarterly data) and between 1 April 2023 and 31 March 2024 (annual data).

Overall, monthly prenatal pertussis vaccine coverage in the fourth quarter of financial year 2023/24 went from 59.8% in January to 58.9% in February, and to 58.9% in March 2024. From January to March 2024, the difference in mean coverage between the highest and lowest ICB was 56.0 percentage points. Vaccine coverage was 58.6% in the 2023/24 financial year, compared to 60.7% in 2022/23, 64.7% in 2021/22 and 67.8% in 2020/21.

Annual ethnicity prenatal pertussis coverage (%) for 2023/24 was the highest in White British (66.8%) and lowest in Black or Black British Caribbean (29.9%).

Limitations associated with the data presented in this report may explain 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 (10). and delivery are often scanned or archived, rather than coded in an extractable format. Furthermore, a comparison of this denominator data with national data on live births (11) indicates that in 2021, this data represented about 71% of the population of pregnant women.

Continued support in the delivery of this important programme has been sought from:

• service providers (GP practices and maternity units)
• screening and immunisation teams
• health protection teams (HPTs)

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. Maternity units not offering pertussis vaccines to pregnant women should continue to discuss its importance, make use of available resources (12), 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. UKHSA (2024). ‘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. NHS England (2020). Preparedness letter for general practice: 14 April 2020

11. Royal College of Nursing (2020). Immunisation

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

13. PHE (2016). ‘Pertussis vaccination programme for pregnant women: vaccine coverage estimates in England, April 2016 to September 2016.’ Health Protection Report: volume 10 number 41

14. UKHSA (2023). ‘Laboratory confirmed cases of pertussis in England: April to June 2022.’ Health Protection Report: volume 17 number 3

15. 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

16. Office for National Statistics (2022). Provisional births in England and Wales

17. UKHSA (2022). ‘Pregnancy: How to help protect you and your baby’