By Tamara Mathias

(Reuters Health) -

Pregnant women who rely on state-administered Medicaid health insurance programs are far less likely to receive recommended vaccines that could protect them and their babies, compared to those with private coverage, a study from Florida suggests.

Researchers at the University of Florida analyzed vaccination data from 341 adult women randomly selected from nearly 7,000 whose healthcare costs were covered by Medicaid or private insurance and who gave birth between from 2016 through 2018.

The study found that 68.6% of pregnant women with private insurance received a vaccine called Tdap that protects against tetanus, diptheria and pertussis (whooping cough), compared to just 13.4% of those on Medicaid.

Further, 70.4% of pregnant women with private insurance received their flu shot, versus just about half that number for those reliant on Medicaid.

The Advisory Committee on Immunization Practices, which falls under the U.S. Centers for Disease Control and Prevention (CDC), recommends that all women receive the tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine and a regular influenza vaccine during pregnancy.

But Medicaid programs, which differ from state to state, do not necessarily cover these vaccines, often forcing women from low-income families to pay out of pocket, said senior study author Dr. Lindsay Thompson of the University of Florida in Gainesville.

While flu shots are often available for free at local supermarkets or clinics, the Tdap vaccine averages about $71 without discounts.

Vaccinations for pregnant women not only help reduce their risk of illness but also offer protection to their babies. New mothers can also pass on some protection via breastfeeding.

The antibodies that newborns inherit from their mothers play a key role in fighting off infection until they are old enough for their own vaccinations.

Newborns can typically only receive their first vaccine against pertussis at 2 months of age and need to be at least 6 months old to get their first flu shot, Thompson said.

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Interestingly, the study documented a change in statistics when the recommended vaccines were offered free of charge to women who had just delivered at the University of Florida Health Shands Hospital in Gainsesville.

Tdap vaccination rates among women using Medicaid surged to 51.7% immediately after giving birth, while influenza vaccination rates rose to 43.5%.

"(The data suggest) that Medicaid-insured women might receive the Tdap and influenza vaccines as recommended during pregnancy if cost barriers were removed," the study authors write in the CDC's Morbidity and Mortality Weekly Report.

"I was surprised to see such a dramatic increase," Thompson told Reuters Health in a phone interview.

"Getting the vaccine postpartum is second best because there will be a time between getting the vaccine and when the mom can make protective antibodies, as it takes a few weeks... But getting the vaccine then is basically better than never getting the booster."

In February 2019, the Medicaid program in Florida changed its policy to cover the flu vaccine as an expanded benefit for people over 21, including pregnant women. However, the Tdap vaccine remains unreimbursed.

"I'm hopeful that these data will help our state and other states consider Tdap, which is absolutely recommended with each pregnancy," Thompson said.

Sarah Gordon, an assistant professor of health law, policy and management at Boston University noted there may be political or administrative issues motivating decisions on what merits Medicaid coverage, given the "robust scientific evidence" on the vaccinations studied.

"From a public health perspective, covering Tdap and influenza vaccinations for pregnant women is a total win," said Gordon, who was not involved in the study. "The vaccinations are low cost, and they offer important protective benefits for mothers and their infants during vulnerable life stages."





SOURCE: https://bit.ly/2UvN7BR MMWR, online January 24, 2020.