{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T11:44:28Z","timestamp":1793187868604,"version":"4.5.0"},"reference-count":30,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2025,2,27]],"date-time":"2025-02-27T00:00:00Z","timestamp":1740614400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Vaccines"],"abstract":"<jats:p>Background\/Objectives: The Italian National Plan for Vaccine Prevention 2017\u20132019 recommended tetanus, diphtheria, and acellular pertussis vaccines (Tdap) for pregnant women, irrespectively of their immunization history. This study aims to describe the coverage rate trends for Tdap vaccination in pregnancy and evaluate the differences by socioeconomic status. Methods: This is a retrospective analysis within a health equity audit of the Local Health Authority of Reggio Emilia on vaccination in pregnancy from 2018 (a local vaccination campaign) to 2023. All women residents in our area who gave birth during that period were included and linked to the electronic Registry of Immunization Service. The vaccination coverage in pregnant women was analyzed over time and stratified by pregnant women\u2019s sociodemographic and obstetric characteristics. Results: The coverage of Tdap in pregnant women of the Province of Reggio Emilia increased from 15.9% in 2018 to 53.9% in 2023. The coverage was higher among Italians, women with higher educational levels (aPR 1.49 (CI95%1.41\u20131.57)), within 31\u201335 years of age (aPR 1.37 (CI95% 1.28\u20131.46)), occupied, nulliparous (aPR multiparous vs nulliparous: 0.76 (0.74; 0.78)), and followed in the private sector (aPR 1.07 (1.03\u20131.11)). Inequalities in coverage increased during the study period for women assisted in the private sector, while decreased or remained stable for women assisted in the context of public services. Conclusions: The vaccination promotion campaign in Reggio Emilia helped increase Tdap coverage in pregnancy from 16 to 53%. Nevertheless, the coverage rates of the most disadvantaged women are still several points lower than the average.<\/jats:p>","DOI":"10.3390\/vaccines13030251","type":"journal-article","created":{"date-parts":[[2025,2,28]],"date-time":"2025-02-28T02:48:37Z","timestamp":1740710917000},"page":"251","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["The Tdap Vaccination in Pregnancy: Results of a Healthy Equity Audit on Coverage Trends and Their Determinants in the Reggio Emilia Province (Italy)"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6773-5931","authenticated-orcid":false,"given":"Laura","family":"Bonvicini","sequence":"first","affiliation":[{"name":"Epidemiology Unit, Azienda Unit\u00e0 Sanitaria Locale-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7380-0576","authenticated-orcid":false,"given":"Filomena Giulia","family":"Sileo","sequence":"additional","affiliation":[{"name":"Prenatal Medicine Unit, Obstetrics and Gynecology Unit, Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, 41121 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benedetta","family":"Riboldi","sequence":"additional","affiliation":[{"name":"Azienda Unit\u00e0 Sanitaria Locale-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eufemia","family":"Bisaccia","sequence":"additional","affiliation":[{"name":"Public Health Unit, Azienda Unit\u00e0 Sanitaria Locale-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Tamelli","sequence":"additional","affiliation":[{"name":"Public Health Unit, Azienda Unit\u00e0 Sanitaria Locale-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniela","family":"Bertani","sequence":"additional","affiliation":[{"name":"Salute Donna, Azienda Unit\u00e0 Sanitaria Locale-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia","family":"Cilloni","sequence":"additional","affiliation":[{"name":"Public Health Unit, Azienda Unit\u00e0 Sanitaria Locale-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7632-1271","authenticated-orcid":false,"given":"Luca","family":"Ghirotto","sequence":"additional","affiliation":[{"name":"Qualitative Research Unit, Azienda Unit\u00e0 Sanitaria Locale-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9703-2460","authenticated-orcid":false,"given":"Paolo","family":"Giorgi Rossi","sequence":"additional","affiliation":[{"name":"Epidemiology Unit, Azienda Unit\u00e0 Sanitaria Locale-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,2,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1016\/j.bpobgyn.2021.03.007","article-title":"Uptake of vaccination in pregnancy","volume":"76","author":"Sebghati","year":"2021","journal-title":"Best Pract. Res. Clin. Obstet. Gynaecol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"S16","DOI":"10.1016\/j.jcpa.2007.04.006","article-title":"The Influence of Maternal Immunization on Infant Immune Responses","volume":"137","author":"Englund","year":"2007","journal-title":"J. Comp. Pathol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"362","DOI":"10.1016\/S0140-6736(14)60236-1","article-title":"Maternal and neonatal tetanus","volume":"385","author":"Thwaites","year":"2015","journal-title":"Lancet Lond. Engl."},{"key":"ref_4","unstructured":"(2023, May 19). WHO. Available online: https:\/\/www.who.int\/initiatives\/maternal-and-neonatal-tetanus-elimination-(mnte)."},{"key":"ref_5","unstructured":"Centers for Disease Control and Prevention (CDC) (2013). Updated recommendations for use of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap) in pregnant women\u2013Advisory Committee on Immunization Practices (ACIP), 2012. MMWR Morb. Mortal. Wkly. Rep., 62, 131\u2013135."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"(2017). Committee Opinion No. 718: Update on Immunization and Pregnancy: Tetanus, Diphtheria, and Pertussis Vaccination. Obstet. Gynecol., 130, e153\u2013e157.","DOI":"10.1097\/AOG.0000000000002301"},{"key":"ref_7","unstructured":"GOV.UK [Internet] (2024, September 18). Pertussis (Whooping Cough) Vaccination Programme for Pregnant Women: Information for Healthcare Practitioners, Available online: https:\/\/www.gov.uk\/government\/publications\/vaccination-against-pertussis-whooping-cough-for-pregnant-women\/pertussis-whooping-cough-vaccination-programme-for-pregnant-women."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2555","DOI":"10.1016\/j.vaccine.2021.03.069","article-title":"Clinical repercussions in pertussis infants post-Tdpa vaccination of pregnant woman: An immunization success?","volume":"39","author":"Baptista","year":"2021","journal-title":"Vaccine"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e01207","DOI":"10.1016\/j.heliyon.2019.e01207","article-title":"Effectiveness of dTpa vaccination during pregnancy in preventing whooping cough in infants under 3 months of age. Bizkaia, Basque Country, Spain","volume":"5","author":"Uriarte","year":"2019","journal-title":"Heliyon"},{"key":"ref_10","first-page":"1","article-title":"Childhood vaccine coverage in Italy after the new law on mandatory immunization","volume":"30","author":"Signorelli","year":"2018","journal-title":"Ann. Ig. Med. Prev. E Comunit\u00e0"},{"key":"ref_11","unstructured":"Ministero della Salute (2024, September 18). Piano Nazionale Prevenzione Vaccinale [Internet], Available online: https:\/\/www.salute.gov.it\/portale\/vaccinazioni\/dettaglioContenutiVaccinazioni.jsp?lingua=italiano&id=4828&area=vaccinazioni&menu=vuoto."},{"key":"ref_12","unstructured":"(2024, September 18). Piano Nazionale Prevenzione Vaccinale 2017 [Internet], Available online: https:\/\/www.salute.gov.it\/imgs\/C_17_pubblicazioni_2571_allegato.pdf."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"820","DOI":"10.1002\/ijc.33601","article-title":"Cumulative COVID-19 incidence, mortality and prognosis in cancer survivors: A population-based study in Reggio Emilia, Northern Italy","volume":"149","author":"Mangone","year":"2021","journal-title":"Int. J. Cancer"},{"key":"ref_14","unstructured":"(2024, October 10). Regione Emilia Romagna [Internet]. Available online: https:\/\/www.regione.emilia-romagna.it\/sicurezza-nei-luoghi-di-lavoro\/coordinamento-prevenzione-vigilanza\/strumenti-sicurezza\/piano-regionale-della-prevenzione."},{"key":"ref_15","unstructured":"Ministero della Salute (2024, October 10). Certificato di assistenza al parto (CeDAP). Analisi dell\u2019evento nascita-Anno 2020 [Internet], Available online: https:\/\/www.salute.gov.it\/portale\/donna\/dettaglioPubblicazioniDonna.jsp?lingua=italiano&id=3149."},{"key":"ref_16","unstructured":"World Health Organization (WHO) (2018). WHO Recommendations on Antenatal Care for a Positive Pregnancy Experience: Summary, WHO."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1016\/j.ejogrb.2020.02.007","article-title":"Barriers and facilitators regarding influenza and pertussis maternal vaccination uptake: A multi-center survey of pregnant women in Italy","volume":"247","author":"Vilca","year":"2020","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1016\/j.ejogrb.2024.02.019","article-title":"Interventional study to improve pertussis and influenza vaccination uptake in pregnant women","volume":"295","author":"Cremer","year":"2024","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1360","DOI":"10.4161\/hv.25525","article-title":"Approaches to the vaccination of pregnant women: Experience from Stockport, UK, with prenatal influenza","volume":"9","author":"Baxter","year":"2013","journal-title":"Hum. Vaccines Immunother."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"879","DOI":"10.1080\/21645515.2015.1130193","article-title":"Knowledge, attitudes, beliefs, and behaviors of pregnant women approached to participate in a Tdap maternal immunization randomized, controlled trial","volume":"12","author":"MacDougall","year":"2016","journal-title":"Hum. Vaccines Immunother."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"6420","DOI":"10.1016\/j.vaccine.2015.08.046","article-title":"Understanding factors influencing vaccination acceptance during pregnancy globally: A literature review","volume":"33","author":"Wilson","year":"2015","journal-title":"Vaccine"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"5785","DOI":"10.1016\/j.vaccine.2016.09.055","article-title":"Maternal pertussis and influenza immunization coverage and attitude of health care workers towards these recommendations in Flanders, Belgium","volume":"34","author":"Maertens","year":"2016","journal-title":"Vaccine"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1016\/j.ejogrb.2019.10.012","article-title":"Routine immunizations during pregnancy, doctors\u2019 compliance and patient hesitancy: A two stage study on vaccination uptake","volume":"243","author":"Psarris","year":"2019","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Qiu, X., Bailey, H., and Thorne, C. (2021). Barriers and Facilitators Associated with Vaccine Acceptance and Uptake Among Pregnant Women in High Income Countries: A Mini-Review. Front. Immunol., 12.","DOI":"10.3389\/fimmu.2021.626717"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"436","DOI":"10.1016\/j.ajic.2016.11.025","article-title":"Despite awareness of recommendations, why do health care workers not immunize pregnant women?","volume":"45","author":"Hayek","year":"2017","journal-title":"Am. J. Infect. Control"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Bonito, B., Balzi, D., Boccalini, S., Bonanni, P., Mereu, G., Santini, M.G., and Bechini, A. (2021). Descriptive Observational Study of Tdap Vaccination Adhesion in Pregnant Women in the Florentine Area (Tuscany, Italy) in 2019 and 2020. Vaccines, 9.","DOI":"10.3390\/vaccines9090955"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1591","DOI":"10.1080\/21645515.2018.1445455","article-title":"Understanding the barriers to uptake of antenatal vaccination by women from culturally and linguistically diverse backgrounds: A cross-sectional study","volume":"14","author":"Krishnaswamy","year":"2018","journal-title":"Hum. Vaccines Immunother."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e016189","DOI":"10.1136\/bmjopen-2017-016189","article-title":"Association between mothers\u2019 screening uptake and daughters\u2019 HPV vaccination: A quasi-experimental study on the effect of an active invitation campaign","volume":"7","author":"Venturelli","year":"2017","journal-title":"BMJ Open"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1177\/1529100618760521","article-title":"Increasing Vaccination: Putting Psychological Science into Action","volume":"18","author":"Brewer","year":"2017","journal-title":"Psychol. Sci. Public Interest"},{"key":"ref_30","unstructured":"European Centre for Disease Prevention and Control (2025, January 10). Increase of pertussis cases in the EU\/EEA, 8 May 2024. Stockholm: ECDC. Available online: https:\/\/www.ecdc.europa.eu\/en\/publications-data\/increase-pertussis-cases-eueea."}],"container-title":["Vaccines"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-393X\/13\/3\/251\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T16:43:51Z","timestamp":1760028231000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-393X\/13\/3\/251"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,27]]},"references-count":30,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2025,3]]}},"alternative-id":["vaccines13030251"],"URL":"https:\/\/doi.org\/10.3390\/vaccines13030251","relation":{},"ISSN":["2076-393X"],"issn-type":[{"value":"2076-393X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2,27]]}}}