Research and analysis

Prenatal pertussis vaccination coverage in England from July to September 2024

Updated 20 December 2024

Applies to England

Main points

This quarterly report evaluates prenatal pertussis vaccine coverage for women who delivered in the July to September 2024 quarter, the second quarter of the 2024 to 2025 financial year (2024/25). The main findings were that:

• coverage was 62.7% in July, 64.5% in August and 65.9% in September 2024

• coverage was 64.4% across the whole of quarter 2, which was 6.7 percentage points higher than the quarter 2 coverage in the 2023/24 financial year

• coverage by Integrated Care Board (ICB) ranged from 25.6% (North Central London, July 2024) to 84.7% (Shropshire, Telford and Wrekin, September 2024)

• coverage has consistently increased over the past 5 months, since April 2024

• coverage in the London NHS commissioning region has gradually increased from 35.5% in September 2023 to 44.4% in September 2024

• the increase in coverage nationally and in London may be partially explained by improved data flows (see Note 1).

Note 1. A new point of care app developed by NHSE to record vaccination events was introduced in September 2024. The Record a Vaccination service (RAVs) has improved dataflows into general practice, which may partially account for the increase in coverage reported in recent months.

Introduction

This report presents vaccine coverage in pregnant women in England for the period July to September 2024, updating previous report that covered April to June 2024 (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

General practice (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 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 NHS commissioning region (based on the 2019 NHS England configurations), ICB and sub-ICB are reported in the data tables associated with this report.

Participation and data quality

All GP IT suppliers provided data for the months of July to September 2024. National GP practice participation was at 98.1% in July, 98.9% in August and 99.0% in September 2024.

Results

Monthly coverage was 62.7% in July, 64.5% in August and 65.9% in September 2024. Coverage has increased in recent months, having risen by 7 percentage points since April 2024. This increase may be partially explained by improved data flows (see Note 1 above). Overall coverage for quarter 2 was 64.4% (Table 1, Figure 1, see data tables).

During this quarter, coverage by ICB ranged from 25.6% (North Central London, July 2024) to 84.7% (Shropshire, Telford and Wrekin, September 2024) (Table 1). By commissioning region, coverage was highest in the South East (75.4%, September 2024) and lowest in London (41.2%, July 2024). Coverage in London has been gradually increasing and has risen from 35.5% in September 2024 to 44.4% in September 2024, an increase of 8.9 percentage points.

Coverage by NHS commissioning region, ICB and Sub ICB is reported in the data tables associated with this report.

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

ICB code	ICB name	July 2024	August 2024	September 2024
QE1	Lancashire and South Cumbria	66.5	67.9	65.4
QF7	South Yorkshire	67.9	70.7	72.0
QGH	Herefordshire and Worcestershire	68.0	67.1	73.8
QH8	Mid and South Essex	67.4	68.6	72.9
QHG	Bedfordshire, Luton, and Milton Keynes	61.2	63.4	63.5
QHL	Birmingham and Solihull	53.0	55.0	55.9
QHM	North East and North Cumbria	65.1	68.1	66.5
QJ2	Derby and Derbyshire	78.9	79.5	80.3
QJG	Suffolk and North East Essex	60.6	66.7	66.4
QJK	Devon	67.8	74.6	76.
QJM	Lincolnshire	64.6	61.1	67.7
QK1	Leicester, Leicestershire and Rutland	67.6	64.0	67.2
QKK	South East London	47.5	54.0	56.4
QKS	Kent and Medway	68.0	71.6	69.8
QM7	Hertfordshire and West Essex	64.7	65.0	68.5
QMF	North East London	39.0	39.3	39.0
QMJ	North Central London	25.6	26.3	27.5
QMM	Norfolk and Waveney	77.3	79.5	80.5
QNC	Staffordshire and Stoke-on-Trent	61.5	65.6	62.9
QNQ	Frimley	61.9	64.1	69.3
QNX	Sussex	73.9	76.1	76.5
QOC	Shropshire, Telford and Wrekin	83.3	83.0	84.7
QOP	Greater Manchester	55.8	60.0	62.8
QOQ	Humber and North Yorkshire	77.8	77.6	81.9
QOX	Bath and North East Somerset, Swindon and Wiltshire	69.2	74.4	76.3
QPM	Northamptonshire	57.0	51.7	58.2
QR1	Gloucestershire	63.6	67.1	66.2
QRL	Hampshire and Isle of Wight	73.5	75.0	78.8
QRV	North West London	39.9	42.5	42.7
QSL	Somerset	63.8	67.6	71.1
QT1	Nottingham and Nottinghamshire	66.1	65.9	67.3
QT6	Cornwall and Isles of Scilly	69.1	59.3	60.9
QU9	Buckinghamshire, Oxfordshire, and Berkshire West	75.0	74.0	77.5
QUA	Black Country	58.9	61.5	62.4
QUE	Cambridgeshire and Peterborough	64.8	70.0	71.2
QUY	Bristol, North Somerset, and South Gloucestershire	75.9	75.1	78.0
QVV	Dorset	71.9	77.6	75.9
QWE	South West London	53.3	54.1	57.9
QWO	West Yorkshire	72.0	73.2	72.1
QWU	Coventry and Warwickshire	67.2	65.2	64.9
QXU	Surrey Heartlands	76.2	77.1	81.4
QYG	Cheshire and Merseyside	65.4	67.7	68.1
Total		62.7	64.5	65.9

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 September 2024 [Note 1]

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

Discussion

This second quarterly report of the 2024/25 financial year and evaluates pertussis vaccine coverage for women who delivered in the July to September 2024 quarter.

Monthly prenatal pertussis vaccine coverage 62.7% in July 2024, to 64.5% in August 2024 and 65.9% in September 2024. Between July and September 2024, the difference in coverage between the highest and lowest ICB was 59.1 percentage points. Coverage was lowest in the London commissioning region, although this had increased by 8.9% since April 2024.

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. Since September 2024, new processes have been implemented by NHSE to capture vaccinations, including pertussis vaccines given in maternity units. These changes are likely to result in improved data flow into General Practice and therefore, increases seen in reported coverage may be due in part to this, particularly after the start of September.

Pertussis activity has been exceptionally high across England in 2024 following an increase in case numbers from December 2023 to a peak in May 2024. Whilst activity has since declined it remains elevated compared to recent pre-COVID-19 years and maternal vaccination is key to helping protect infants from birth and in their first weeks of life when they are most vulnerable to severe disease requiring hospital care.

Recent cases included 10 deaths of infants who had contracted pertussis between January and October 2024. Calculated maternal vaccine effectiveness against infant death was updated to include these recent deaths and remains very high at around 91% (See ‘Confirmed cases of pertussis in England by month’).

Measures undertaken to raise awareness, alongside the high media profile of these infant deaths, may also have improved recognition of the importance of vaccination in pregnancy amongst the pregnant population and healthcare professionals both supporting and delivering the programme.

If coverage, and ultimately the impact of the programme itself, is to be accurately monitored, GPs and practice nurses must 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, providers must 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