The Centers for Disease Control and Prevention’s immunization quality improvement program may improve the uptake of maternal immunizations in the obstetric care setting, according to results of a study presented at IDWeek 2019, held from October 2 to 6 in Washington, DC.

For all pregnant women and for every pregnancy, it is recommended that patients receive both the influenza and tetanus-diphtheria acellular pertussis (Tdap) vaccines. However, vaccine uptake remains suboptimal and quality improvement models in obstetrics practices are needed to improve their vaccination delivery programs. To this end, the CDC developed the AFIX program, which consists of 4 components: Assessment, Feedback, Incentives, and Exchange. The AFIX program is a quality improvement program with the goal of increasing vaccination of children and adolescents with all Advisory Committee on Immunization Practices-recommended vaccines by improving immunization delivery practices at the provider level and reducing missed opportunities to vaccinate. In primary care settings, the CDC’s AFIX program has been effective in increasing vaccination uptake. Therefore, this study adapted to and evaluated the CDC’s AFIX program in the obstetrical setting (AFIX-OB).

In total, 11 obstetric practices were included: 5 in Georgia and 6 in Colorado. These practices were urban in setting, with the majority of the patients carrying private insurance and being either African American or white. At each practice, an average of 40 charts were randomly reviewed pre- and postintervention. All 4 of the AFIX program components were addressed. At the Assessment phase, baseline immunization rates and vaccine administration practices were collected. At the Feedback phase, baseline immunization rates were shared and quality improvement practices were implemented via feedback given by study staff. At the Incentive phase, providers were incentivized with receiving continuing medical education and maintenance of certification part IV credit. At the Exchange phase, a postintervention meeting was held with providers and staff at each practice to exchange results of practice-wide vaccine rates after 6 months.

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Results suggested that in obstetric practice settings, the CDC’s AFIX program is effective at increasing vaccination uptake. For the influenza vaccine, baseline practice-level immunization rates ranged from 10% to 82.9% and 9 practices either maintained or increased their influenza vaccine acceptance; final rates ranged from 32.5% to 85.0% after the 6-month follow-up period, and 4 of these practices had statistically significant increases (P <.05). ‘

For Tdap, baseline practice-level immunization rates ranged from 12.5% to 97.6% and all 11 practices saw improvements in their Tdap vaccine acceptance with final rates ranging from 25% to 100%; 3 of these practices had statistically significant improvements (P <.05).

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Overall, the researchers concluded that, “The AFIX-OB model provides a promising intervention to improve maternal immunization uptake that can be administered widely but still be tailored to the needs of individual clinics.”

Disclosure: One author declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of this author’s disclosures.


OLeary ST, Ellingson M, Spina C, et al. Improving uptake of maternal immunizations in the obstetric care setting through an adaptation of the CDC’s immunization quality improvement program (AFIX). Presented at: IDWeek 2019; October 2-6, 2019; Washington, DC. Poster 2735.