A vaccine against whooping cough free, but limited access

Un vaccin contre la coqueluche gratuit, mais d’accès limité

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Vaccinating pregnant women between the 26th and 32nd week of pregnancy, can protect the infant in early life. It takes four weeks for immunity to develop.

The pertussis vaccine may be recommended, and free for pregnant women for nearly a year in Quebec, only 29% of mothers-to-be have received, learned the Duty. Not to cause alarm, experts propose to simplify the access to the vaccination of patients.

“Obstetricians and family physicians prescribe the vaccine, but don’t have it in their office. Pregnant women should make an appointment at the CLSC. But the CLSC does not seem ready now to welcome this new wave of patients, ” falling leaves Bruce Tapiero, a pediatrician and chief of infectious diseases at CHU Sainte-Justine.

Following a recommendation by the Committee on the’immunisation du Québec (CIQ), the vaccine against whooping cough — a contagious infection of the lungs and respiratory tract — is since June 2018 available systematically and free of charge to expectant mothers to protect their child.

Compared to a cold, persistent accompanied by strong paroxysms of cough in adults, whooping cough is especially dangerous for children under the age of one year and may cause brain damage or even death. In Quebec, where the disease must be reported, every year there are between 240 and 1600 cases.

Vaccinating pregnant women between the 26th and 32nd week of pregnancy, so can help protect the infant in early life, because they cannot be vaccinated at two months, and that it takes four weeks to develop immunity.

But only 18 736 pregnant women, be 29.4 %, have taken advantage of the program between 1 June 2018 and 28 February 2019, according to the ministry of Health and social Services. “We have to be careful, because there may be a delay in data input, which results in an underestimation of the vaccination coverage real,” says the ministry.

Limited choice

In the eyes of Bruce Tapiero, this low is a result of the lack of choice offered to pregnant women when it comes to the time to get vaccinated. Followed by family physicians, obstetricians, gynecologists, or midwives, mothers-to-be are sent out in a CLSC or a pharmacy to receive the injection against the disease. “Lead the way, this is the risk that the person forgets or it is difficult to make an appointment quickly,” worries Mr. Tapiero.

Citing a study published in September 2018 in the Journal of the canadian medical Association , to which he has worked, the pediatrician points out that only 10 % of the CLSC of the province, provide on-site visits with a nurse for pregnant women in their second and third trimesters.

“We give the prescription to the patients and asked at the next appointment if they have had the vaccine. They insist if this is not done. But you can’t take them by the hand to bring the person to be vaccinated “, lance from his side, Fabien Simard, president of the Association of obstetricians and gynecologists of Quebec.

For Caroline Quach, paediatrician, microbiologist-infectiologist at the CHU Sainte-Justine, obstetricians, and family physicians should just think to vaccinate their patients during a consultation. His colleague, Bruce Tapiero, suggests that the pertussis vaccine is administered at the same time as the test for high blood sugar between the 24th and 28th weeks of pregnancy.

Solutions that should soon be tested, according to Nicholas Brousseau, who is a member of the IQC, and participated in the writing of the provincial document recommending a new strategy of vaccination against pertussis. A pilot project should begin within a month or two to assess which model to offer of vaccination for pregnant women would be the most effective. Four regions were selected to assess the different possibilities : Montréal, Québec, Montérégie and Mauricie. “In a place, the women will be referred to the CLSC ; otherwise, they will be vaccinated in their clinic follow-up of pregnancy. In a third region, you will be asked to obstetricians to vaccinate, and in the last, we will give the vaccine at the same time as the test of diabetes, ” says Mr. Brousseau.

“It is not the first to do this, the United States recommend the vaccine against whooping cough for pregnant women since 2011 and England, since 2012, among others. They started with a rate of vaccination that is comparable to ours. And after a year or two, it is mounted at about 50-60 % “, he reports. England, which has integrated the vaccination of mothers-to-be in the medical follow-up, was even able to reach a vaccination coverage of nearly 80 %.

But in the meantime, a work of awareness-raising and information remains to be done, because some women are still unaware that this vaccine is recommended and free of charge. Pregnant 32 weeks, Noémie has never been informed by her midwife that she could protect her child from whooping cough. “As I have heard about the vaccine, I have discussed it with her… She just [replied] that it was really new, and that his team had not yet positioned itself on the issue,” she says.

Contacted by The Duty, the Order of midwives of Quebec has not taken a decision on the subject.

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