Routine Vaccination During Pregnancy Among People Living With HIV in the United States
Authors: Berhie Saba , Kacanek Deborah , Lee Jessica , Jao Jennifer , Powis Kathleen , Salomon Liz , Siddiqui Danish , Yee Lynn M. ,   Pediatric HIV/AIDS Cohort Study, D'Angelo Jessica , Ann Sanders Margarent , Kathleen Malle , Paul Mary , Eser-Jose Ruth , McMullen-Jackson Chivon , Harris Lynnette , Purswani Murli , Mirza Baig Mahoobullah , Villegas Alma , Alvarado Marvin , Robinson Lisa-Gaye , Cooley Jawara Dia , Blood James , Garvie Patricia , Borkowsky William , Deygoo Nagamah , Lewis Jennifer , Dieudonne Arry , Bettica Linda , Johnson Juliette , Suroweic Karen , Knapp Katherine , Russell-Bell Jamie , Wilkins Megan , Love Stephanie , Rosario Nicolas , Angeli-Nieves Lourdes , Olivera Vivian , Kohlhoff Stephan , Dennie Ava , Kaye Jean , Wallier Jenny , Craig Karen , Van Dyke Russell , Sirois Patricia , Hutto Cecelia , Hickman Paige , Huldtquist Julie , Marullo Dan , Spector Stephen A. , Figueroa Veronica , Loughran Megan , Nichols Sharon , McFarland Elizabeth , Kwon Christine , Glenny Carrie , Englund Jennifer , Rathore Mobeen , Mahmoudi Saniyyah , El-Hassan Sarah , Tejan Jamilah , Hayani Karen , Richardson Lourdes , Smith Renee , Miller Alina , Scott Gwendolyn , Gil Garcia Gustavo , Fernandez Gabriel , Cuadra Anai , Frederick Toni , Davtyan Mariam , Morales-Avendano Guadalupe , Rodriguez Zoe M. , Torres Lizmarie , Scalley Nydia 
Published: May 2024

Importance

Pregnancy represents a window of opportunity for vaccination due to established maternal and fetal benefits of vaccination. Little is known about receipt of routinely recommended vaccines in pregnancy, specifically tetanus, diphtheria, plus acellular pertussis (Tdap) and influenza, among pregnant people living with HIV (PLHIV).

Objective

To estimate prevalence of vaccination receipt among pregnant people with HIV (PLHIV) and identify demographic and clinical characteristics associated with vaccination.

Design, Setting, and Participants

This multicenter cohort study included women participating in Women’s Health Study (WHS) of the Surveillance Monitoring for ART Toxicities (SMARTT) Study of the Pediatric HIV/AIDS Cohort Study. The network has been enrolling pregnant PLHIV at 22 US sites since 2007. Participants for this study enrolled between December 2017 and July 2019. Data analysis was conducted from October 2021 to March 2022.

Exposure

Data on vaccination in pregnancy were collected through medical record abstraction.

Main Outcomes and Measures

Vaccination receipt was defined as Tdap vaccination received at less than 36 weeks’ gestation and influenza vaccination at any gestational age, based on current guidelines. Log-binomial and modified Poisson regression models with generalized estimating equations were fit to identify factors associated with successful receipt of (1) Tdap, (2) influenza, and (3) both vaccinations.

Results

A total of 310 pregnancies among 278 people participating in the WHS were included (mean [SD] age, 29.5 [6.1] years; 220 [71%] Black, 77 [25%] Hispanic, and 77 [25%] race and ethnicity other than Black; 64 [21%] with perinatally acquired HIV). Less than one-third of pregnancies were vaccinated as recommended (Tdap, 32.6% [95% CI, 27.4%-38.1%]; influenza, 31.6% [95% CI, 26.5%-37.1%]; both, 22.6% [95% CI, 18.0%-27.6%]). People living with perinatally acquired HIV, those who did not identify as Black, or those who were multiparous had adjusted risk ratios (aRRs) less than 1, while older PLHIV had aRRs greater than 1, but these differences did not reach statistical significance (perinatally acquired HIV: adjusted risk ratio [aRR], 0.46; 95% CI, 0.21-1.02; race other than Black: aRR, 0.53; 95% CI, 0.26-1.08; multiparous: aRR, 0.59; 95% CI, 0.35-1.00; age 24-29 years: aRR, 2.03; 95% CI, 0.92-4.48).

Conclusions and Relevance

In this diverse, multicenter cohort of pregnant PLHIV, receipt of recommended vaccinations was low. Identifying and addressing barriers to vaccination receipt is urgently needed for pregnant people with HIV.