Lessons learnt from the implementation of maternal immunization programs in England

Maternal immunization is increasingly being recognized as an important platform for the prevention of severe maternal and infant morbidity and mortality from vaccine preventable diseases. Since the 1980s, the widespread use of tetanus toxoid vaccines for pregnant women in developing countries has had a major impact on the burden of neonatal tetanus, with WHO estimating a 94% global reduction in newborn tetanus deaths. More recently, many developed countries have recommended influenza and pertussis vaccines for pregnant women. Despite the wealth of evidence supporting the significant morbidity and mortality associated with influenza infection for pregnant women and for both influenza and pertussis in young infants, these programs have been implemented with varying degrees of success. In this paper, we describe the experience of the implementation of the influenza and pertussis vaccination programs for pregnant women in England and consider some of the key factors that have impacted on the coverage achieved across the country.