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Impact of Maternal Immunization on Pertussis Prevention among Newborns in Nigeria

Abstract

Pertussis remains an important public health concern among infants, particularly newborns who are too young to have completed their routine childhood immunization schedules. Severe pertussis infection in early infancy may result in prolonged coughing, pneumonia, feeding difficulties, apnea, hospitalization, and death. Maternal immunization during pregnancy provides an opportunity to protect newborns through the transfer of maternal antibodies across the placenta, thereby providing passive protection during the early period of life before infants can develop full protection through their own vaccination. In Nigeria, challenges including limited maternal immunization coverage, inadequate awareness of vaccination during pregnancy, concerns about vaccine safety, inconsistent access to antenatal care, vaccine availability, and missed opportunities for vaccination may affect the effectiveness of maternal immunization programmes. Against this background, this study investigates the impact of maternal immunization on pertussis prevention among newborns in Nigeria. The study will be anchored on the Health Belief Model, Social Ecological Model, and Health Systems Framework. The Health Belief Model explains how pregnant women's perceptions of susceptibility to pertussis, perceived severity of infant infection, perceived benefits of maternal immunization, perceived barriers, and cues to action may influence vaccine uptake during pregnancy. The Social Ecological Model emphasizes the influence of individual, family, healthcare, community, and broader policy factors on maternal vaccination and newborn health. The Health Systems Framework emphasizes antenatal service delivery, health workforce, vaccine availability, health information, financing, governance, and accessibility as essential components of effective maternal immunization programmes. Collectively, these theoretical perspectives provide a suitable framework for explaining how maternal immunization may contribute to pertussis prevention among newborns in Nigeria. The study will adopt a quantitative analytical cohort or quasi-experimental research design. The study population will comprise pregnant women receiving antenatal care in selected healthcare facilities in Nigeria and their newborns. A multistage sampling technique will be used to select states, local government areas, healthcare facilities, antenatal clinics, pregnant women, and eligible mother-newborn pairs. Maternal immunization will be assessed using indicators such as receipt of pertussis-containing vaccine during pregnancy, gestational age at vaccination, vaccination timing, vaccination status, antenatal care attendance, and documentation of maternal vaccination. Pertussis prevention among newborns will be assessed using indicators such as laboratory-confirmed pertussis where diagnostic testing is available, suspected pertussis cases, pertussis-related hospitalization, severe respiratory symptoms, neonatal or early-infant pertussis-related complications, and other appropriate clinical outcomes during the defined follow-up period. Where feasible, maternal and newborn health records may also be used to assess vaccination history and infant health outcomes. Data will be collected using structured questionnaires, antenatal care records, maternal immunization registers, immunization cards, delivery records, newborn medical records, hospital admission records, laboratory reports, and relevant surveillance databases. Descriptive statistics will be used to summarize maternal and newborn characteristics, vaccination coverage, timing of vaccination, and pertussis-related outcomes. Inferential statistical techniques, including chi-square tests, t-tests, correlation analysis, and logistic or multiple regression analysis where appropriate, will be used to determine the impact of maternal immunization on pertussis prevention among newborns. Where a cohort design is adopted, pertussis-related outcomes among newborns whose mothers received maternal immunization during pregnancy may be compared with outcomes among newborns whose mothers did not receive the vaccine, with relevant potential confounding factors appropriately controlled. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that maternal immunization has a significant positive impact on pertussis prevention among newborns in Nigeria. Newborns whose mothers received an appropriate pertussis-containing vaccine during pregnancy are expected to have a lower risk of pertussis infection and severe pertussis-related outcomes during the early months of life than newborns whose mothers were not immunized during pregnancy. Maternal vaccination is also expected to provide an important period of passive protection before infants become eligible for or complete their own routine immunization. However, inadequate maternal vaccination coverage, late or missed antenatal care, limited vaccine availability, concerns about vaccination during pregnancy, inadequate healthcare worker recommendation, and poor documentation may reduce the effectiveness of maternal immunization programmes. The study therefore expects improved access to maternal immunization, strengthened antenatal vaccination services, effective vaccine communication, and timely vaccination during pregnancy to contribute significantly to pertussis prevention among newborns in Nigeria. The study is expected to contribute to the literature on maternal immunization, pertussis prevention, newborn health, vaccine-preventable diseases, antenatal care, passive immunity, immunization programmes, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Primary Health Care Development Agency, Nigeria Centre for Disease Control and Prevention, state ministries of health, healthcare facilities, maternal and child health programmes, immunization programme managers, obstetricians, midwives, paediatricians, development partners, and policymakers regarding strategies for strengthening maternal vaccination. The study will also provide evidence-based recommendations for integrating maternal immunization into antenatal care, improving vaccine availability and accessibility, strengthening healthcare worker recommendations, increasing awareness of maternal vaccination, improving vaccination documentation and monitoring, addressing concerns about vaccination during pregnancy, and strengthening maternal and newborn immunization programmes for improved pertussis prevention across Nigeria.

Keywords: Maternal immunization, pertussis prevention, newborns, pregnancy, maternal vaccination, passive immunity, antenatal care, vaccine-preventable diseases, infant health, Nigeria, public health.