Prenatal Immunization Status (PRS-E)

The percentage of deliveries in the measurement period in which women received influenza and tetanus, diphtheria toxoids and acellular pertussis (Tdap) vaccinations.

Why it Matters

The Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) recommends influenza and tetanus, diphtheria and acellular pertussis (Tdap) vaccines for pregnant women to protect them and their infants from serious illness and death. 1 Pregnant women are at higher risk for hospitalizations and death from influenza than other populations because changes in physiology and immune function predispose them to severe disease and worse outcomes from infections. 2 Infants are also highly susceptible to influenza and pertussis. The transfer of antibodies from an immunized mother to her fetus is the primary means of protecting infants after birth. 3, 4, 5 Improving prenatal vaccination is critical, as approximately half of pregnant women do not receive these recommended vaccines. 6, 7

*Developed with support from the Department of Health and Human Services (DHHS), Office of the Assistant Secretary for Health (OASH), National Vaccine Program Office (NVPO).

Results – National Averages

Prenatal Immunization Status - Influenza

Measure YearCommerical HMOCommercial PPOMedicaid HMO

Prenatal Immunization Status - Tdap

Measure YearCommerical HMOCommercial PPOMedicaid HMO

Prenatal Immunization Status - Combination

Measure YearCommerical HMOCommercial PPOMedicaid HMO

NCQA published a special report summarizing HEDIS measurement year 2020 results for eight measures that leverage electronic clinical data, including this measure. This report can be found here:


  1. Freedman M.S., Hunter P., Ault K., Kroger A. 2020. “Advisory Committee on Immunization Practices Recommended Immunization Schedule for Adults Aged 19 Years or Older — United States, 2020.” MMWR Morb Mortal Wkly Rep 2020;69:133–135. DOI:
  2. Yudin, M. 2014. “Risk management of seasonal influenza during pregnancy: current perspectives.” Int J Womens Health 6: 681–9.
  3. Jamieson, D.J., D.M. Kissin, C.B. Bridges, S.A. Rasmussen. 2012. “Benefits of influenza immunization during pregnancy for pregnant women.” AMJ Obstet Gynecol. 207(3 Suppl):S17–20.
  4. Furuta, M., et al 2017. “Efficacy and safety of pertussis vaccination for pregnant women – a systematic review of randomised controlled trials and observational studies.” BMC Pregnancy and Childbirth. 17:390.
  5. Winter, K., S. Nickell, M. Powell, K. Harriman. 2017. “Effectiveness of Prenatal Versus Postpartum Tetanus, Diphtheria, and Acellular Pertussis Immunization in Preventing Infant Pertussis.” Clinical Infectious Diseases. 64 (1): 3-8. doi: 10.1093/cid/ciw634.
  6. Ahluwalia, I., H. Ding, D. D’Angelo, K. Shealy, J. Singleton, J. Liang, K. Rosenberg. 2015. “Tetanus, Diphtheria, Pertussis Immunization Coverage Before, During, and After Pregnancy—16 States and New York City, 2011.” MMWR Morb Mortal Wkly Rep. 64(19);522–6.
  7. Ding, H., C.L. Black, S. Ball, et al. 2015. “Influenza immunization coverage among pregnant women—United States, 2014–15 influenza season.” MMWR Morb Mortal Wkly Rep. 64(36);1000–5.
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