@article {LiE56, author = {Yinan Li and Nicholas Brousseau and Maryse Guay and {\`E}ve Dub{\'e} and Zineb Laghdir and Isabelle Boucoiran and Bruce Tapi{\'e}ro and Caroline Quach}, title = {Coverage for pertussis vaccination during pregnancy with 4 models of vaccine delivery: a quasiexperimental, multicentre observational study}, volume = {10}, number = {1}, pages = {E56--E63}, year = {2022}, doi = {10.9778/cmajo.20210011}, publisher = {Canadian Medical Association Open Access Journal}, abstract = {Background: Vaccination of pregnant people with a vaccine containing acellular pertussis (tetanus{\textendash}diphtheria{\textendash}acellular pertussis [Tdap]) has been recommended in Canada since 2018, and the evaluation of delivery models for efficient maternal Tdap administration is a priority for the Quebec Ministry of Health. We implemented 3 vaccine delivery models, in addition to the existing standard of practice model, and compared the vaccine coverage achieved by the 4 models in Quebec.Methods: In this quasiexperimental, multicentre observational study, we recruited pregnant people at less than 21 weeks{\textquoteright} gestation in 4 Quebec regions from April to October 2019. We compared 4 vaccine delivery models: local community service centres (centre local de services communautaires [CLSCs], baseline), family medicine groups (FMGs), obstetrics clinic and the oral glucose challenge test (OGCT). In addition to the CLSCs, 3 FMGs, 1 obstetric clinic and a hospital-based OGCT screening program participated. We determined vaccination status from a self-reported questionnaire, the Quebec Immunization Registry or medical charts. We compared model-specific (for participants recruited to a model and subsequently vaccinated within that model) and overall vaccine coverage (considering all vaccine delivery pathways) and used logistic regression to adjust for sociodemographic variables.Results: Overall, 946 of 1000 recruited pregnant people were eligible for analyses. Vaccination via the FMGs achieved the highest model-specific vaccine coverage (67.8\%, 95\% confidence interval [CI] 60.5\%{\textendash}74.4\%), but coverage was not significantly different from the CLSCs (63.8\%, 95\% CI 57.6\%{\textendash}69.6\%). For overall vaccine coverage, the FMG (86.5\%, 95\% CI 80.6\%{\textendash}90.9\%) and obstetrics models (85.9\%, 95\% CI 80.9\%{\textendash}89.7\%) achieved significantly higher vaccine coverage than the CLSCs (66.3\%, 95\% CI 60.1\%{\textendash}71.9\%). The OGCT model did not improve overall vaccine coverage (61.8\%, 95\% CI 56.1\%{\textendash}67.2\%).Interpretation: Compared with CLSCs, overall vaccine coverage was higher when Tdap was offered in FMGs or an obstetrics clinic providing prenatal care. Health professionals involved in pregnancy follow-up recommending and offering the vaccine may be a key factor in optimizing vaccine coverage.}, URL = {https://www.cmajopen.ca/content/10/1/E56}, eprint = {https://www.cmajopen.ca/content/10/1/E56.full.pdf}, journal = {Canadian Medical Association Open Access Journal} }