Quality statement 4: Vaccination
Pregnant women are offered vaccinations at routine antenatal appointments. [new 2023]
The influenza (flu) and pertussis (whooping cough) vaccines for pregnant women are included in the NHS complete routine immunisation schedule. Chapter 14a of the UK Health Security Agency's Green Book recommends pregnant women have the COVID-19 vaccine. Offering pregnant women suitable vaccinations at antenatal appointments if they are eligible to have them provides them with an opportunity to immunise them and their baby against these infectious diseases. It also increases overall uptake of vaccination.
The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.
Evidence of local arrangements to ensure that healthcare professionals receive training to discuss and offer vaccinations to pregnant women.
Data source: Data from information recorded locally, for example, staff training records.
a) Proportion of eligible women who had the seasonal flu vaccination during pregnancy.
Numerator – the number in the denominator who had the seasonal flu vaccination during pregnancy.
Denominator – the number of pregnant women eligible for seasonal flu vaccination.
Data source: NHS Digital's Maternity Services Data Set includes data on vaccination (immunisation) carried out by maternity services. The UK Health Security Agency provides national data on seasonal flu vaccine uptake in pregnant women. Seasonal flu vaccine uptake data by GP patients by ethnicity is available for NHS commissioning regions. Take-up data for pregnant women disaggregated by ethnicity is available.
b) Proportion of eligible women who had a pertussis vaccination during pregnancy.
Numerator – the number in the denominator who had a pertussis vaccination during pregnancy.
Denominator – the number of pregnant women eligible for pertussis vaccination.
Data source: NHS Digital's Maternity Services Data Set includes data on vaccination (immunisation) carried out by maternity services. The UK Health Security Agency provides monthly prenatal pertussis coverage estimates in pregnant women in England by local teams, integrated care systems, and NHS England regions. This uses information submitted by antenatal and other services offering vaccinations to pregnant women through their registration with a GP.
c) The proportion of eligible women who had a COVID-19 vaccine during pregnancy.
Numerator – the number in the denominator who had a COVID-19 vaccine during pregnancy.
Denominator – the number of pregnant women eligible for a COVID-19 vaccine.
Data source: NHS Digital's Maternity Services Data Set includes data on vaccination (immunisation) carried out by maternity services. The UK Health Security Agency provides COVID-19 vaccine surveillance reports which includes data on coverage among pregnant women, including the number of doses by time of delivery and the timing of administration (trimester). Take-up data disaggregated by ethnicity and deprivation quintile are available.
a) Rates of hospitalisation and intensive care unit admission in pregnant women because of flu.
Data source: Rates of hospital admissions (per 100,000 in England) are collected from submissions from NHS acute trusts through the Severe Acute Respiratory Infection (SARI) Watch surveillance system, which forms part of the UK Health Security Agency's surveillance of influenza and other seasonal respiratory viruses (and from the 2020 to 2021 season, COVID-19). Data disaggregated by age ranges and region are available.
b) Incidence of pertussis.
Data source: The UK Health Security Agency provides quarterly and annual statistics on national incidence based on laboratory-confirmed cases (per 100,000 of the population in England) including within different age groups (including incidence in infants and children of various ages).
c) Rates of hospital admission in pregnant women because of COVID-19.
Data source: Rates of hospital admissions (per 100,000 in England) are collected from submissions from NHS acute trusts through the SARI Watch surveillance system, which forms part of the UK Health Security Agency's surveillance of influenza and other seasonal respiratory viruses (and from the 2020 to 2021 season, COVID-19). Data disaggregated by age ranges, sex, ethnicity and region are available. Experimental statistics on the incidence of COVID-19 hospital admissions (per 100,000 infections) by pregnancy and vaccination status are available from the Office for National Statistics.
Service providers (maternity services) ensure that systems are in place to train healthcare professionals to check a pregnant woman's eligibility for vaccinations and administer vaccines during the booking appointment and other routine antenatal appointments. This is in line with Public Health England's national minimum standards and core curriculum for immunisation training for registered healthcare practitioners. They ensure that appointments have enough time for discussion, so healthcare professionals can identify and address any concerns, gain informed consent, administer the vaccine and complete documentation. Providers have protocols to ensure that if staff cannot give the vaccination during the appointment, they signpost women to vaccination services, drop-in clinics or their GP practice.
Healthcare professionals (such as midwives) check the pregnant woman's eligibility for vaccinations and provide evidence-based, consistent information about vaccinations. Healthcare professionals identify and discuss any concerns the pregnant woman has, using information and websites to guide discussion, and obtain informed consent. They ensure that they offer flu, pertussis and COVID-19 vaccinations to eligible pregnant women at the appropriate routine antenatal appointment. They complete documentation after giving vaccination. If they cannot give the vaccination during the appointment, they signpost pregnant women to vaccination services, drop-in clinics or their GP practice.
Commissioners (integrated care systems) ensure that they commission antenatal services that check eligibility for vaccinations and offer them to pregnant women at routine antenatal appointments. Commissioners monitor take-up (coverage) of flu, pertussis and COVID-19 vaccination among pregnant women and monitor data relevant to health inequalities. They take action to address identified inequalities and improve access and uptake.
Pregnant women have a discussion with their midwife at routine antenatal appointments about any vaccinations they may need. They are given the opportunity to discuss any concerns they have about vaccinations. If they are eligible for vaccinations, they are offered them at the appropriate antenatal appointment or they are referred to a service that can give them vaccinations.
Vaccine uptake in the general population. NICE guideline NG218 (2022), recommendations 1.2.9, 1.2.17 and 1.3.15
Antenatal care. NICE guideline NG201 (2021), recommendation 1.3.8
Flu vaccination: increasing uptake. NICE guideline NG103 (2018), recommendations 1.2.3, 1.3.1, 1.4.8 and 1.4.9
Pregnant women should be given information that they can easily access and understand themselves or with support, so they can communicate effectively with healthcare services. Clear language should be used, and the content and delivery of information should be tailored to individual needs and preferences. It should be accessible to people who do not speak or read English, and it should be culturally appropriate. Pregnant women should have access to an interpreter, link worker or advocate if needed. Interpreters, link workers or advocates should not be a member of the woman's family, her legal guardian or her partner, and they should communicate with the woman in her preferred language.
It is important for providers to make reasonable adjustments to support pregnant women with a physical, sensory, cognitive or learning disability. For example, independent British Sign Language interpreting services may be needed. Healthcare professionals may need to plan longer appointments to enable pregnant women (and her partner, if applicable) to raise concerns, confirm correct understanding of information given and how it relates to them, and to ask questions.
For people with additional needs related to a disability, impairment or sensory loss, information should be provided as set out in NHS England's Accessible Information Standard or the equivalent standards for the devolved nations.
Services should ensure that healthcare professionals have access to resources and training which enable them to develop cultural sensitivity to help address variation in uptake of vaccination by women from different ethnic family backgrounds. [Adapted from NICE's guideline on antenatal care, recommendation 1.1.1; NICE's guideline on pregnancy and complex social factors, recommendations 1.3.10 and 1.3.11; NICE's guideline on vaccine uptake in the general population, recommendation 1.3.4 and expert opinion]