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Ayouni I, Amponsah-Dacosta E, Noll S, Kagina BM, Muloiwa R. Interventions to Improve Knowledge, Attitudes, and Uptake of Recommended Vaccines during Pregnancy and Postpartum: A Scoping Review. Vaccines (Basel) 2023; 11:1733. [PMID: 38140138 PMCID: PMC10747157 DOI: 10.3390/vaccines11121733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 11/02/2023] [Accepted: 11/14/2023] [Indexed: 12/24/2023] Open
Abstract
Tetanus, pertussis, influenza, and COVID-19 vaccines are recommended for the prevention of related morbidity and mortality during pregnancy and postpartum. Despite the established benefits of vaccination for prenatal and postnatal women, maternal vaccination is not universally included in routine antenatal programs, especially in low- and middle-income countries. Furthermore, the uptake of recommended vaccines among pregnant and postpartum women remains below optimum globally. This review aimed to map the evidence on interventions to improve knowledge, attitudes, and uptake of recommended vaccines among pregnant and postpartum women. We conducted a comprehensive and systematic search for relevant literature in PubMed, Scopus, Web of Science, EBSCOhost, and Google Scholar. Overall, 29 studies published between 2010 and 2023 were included in this review. The majority (n = 27) of these studies were from high-income countries. A total of 14 studies focused on the influenza vaccine, 6 on the Tdap vaccine, 8 on both influenza and Tdap vaccines, and only one study on the COVID-19 vaccine. Patient-centered interventions predominated the evidence base (66%), followed by provider-focused (7%), health system-focused (10%), and multilevel interventions (17%). Overall, the effect of these interventions on knowledge, attitudes, and uptake of maternal vaccines was variable.
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Affiliation(s)
- Imen Ayouni
- Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital, University of Cape Town, Cape Town 7700, South Africa;
- Vaccines for Africa Initiative, School of Public Health, Faculty of Health Sciences, University of Cape Town, Cape Town 7935, South Africa; (E.A.-D.); (S.N.); (B.M.K.)
| | - Edina Amponsah-Dacosta
- Vaccines for Africa Initiative, School of Public Health, Faculty of Health Sciences, University of Cape Town, Cape Town 7935, South Africa; (E.A.-D.); (S.N.); (B.M.K.)
| | - Susanne Noll
- Vaccines for Africa Initiative, School of Public Health, Faculty of Health Sciences, University of Cape Town, Cape Town 7935, South Africa; (E.A.-D.); (S.N.); (B.M.K.)
| | - Benjamin M. Kagina
- Vaccines for Africa Initiative, School of Public Health, Faculty of Health Sciences, University of Cape Town, Cape Town 7935, South Africa; (E.A.-D.); (S.N.); (B.M.K.)
| | - Rudzani Muloiwa
- Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital, University of Cape Town, Cape Town 7700, South Africa;
- Vaccines for Africa Initiative, School of Public Health, Faculty of Health Sciences, University of Cape Town, Cape Town 7935, South Africa; (E.A.-D.); (S.N.); (B.M.K.)
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Koyuncu A, Ishizumi A, Daniels D, Jalloh MF, Wallace AS, Prybylski D. The Use of Adaptive Sampling to Reach Disadvantaged Populations for Immunization Programs and Assessments: A Systematic Review. Vaccines (Basel) 2023; 11:vaccines11020424. [PMID: 36851301 PMCID: PMC9961530 DOI: 10.3390/vaccines11020424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 01/25/2023] [Accepted: 02/02/2023] [Indexed: 02/16/2023] Open
Abstract
Vaccines prevent 4-5 million deaths every year, but inequities in vaccine coverage persist among key disadvantaged subpopulations. Under-immunized subpopulations (e.g., migrants, slum residents) may be consistently missed with conventional methods for estimating immunization coverage and assessing vaccination barriers. Adaptive sampling, such as respondent-driven sampling, may offer useful strategies for identifying and collecting data from these subpopulations that are often "hidden" or hard-to-reach. However, use of these adaptive sampling approaches in the field of global immunization has not been systematically documented. We searched PubMed, Scopus, and Embase databases to identify eligible studies published through November 2020 that used an adaptive sampling method to collect immunization-related data. From the eligible studies, we extracted relevant data on their objectives, setting and target population, and sampling methods. We categorized sampling methods and assessed their frequencies. Twenty-three studies met the inclusion criteria out of the 3069 articles screened for eligibility. Peer-driven sampling was the most frequently used adaptive sampling method (57%), followed by geospatial sampling (30%), venue-based sampling (17%), ethnographic mapping (9%), and compact segment sampling (9%). Sixty-one percent of studies were conducted in upper-middle-income or high-income countries. Data on immunization uptake were collected in 65% of studies, and data on knowledge and attitudes about immunizations were collected in 57% of studies. We found limited use of adaptive sampling methods in measuring immunization coverage and understanding determinants of vaccination uptake. The current under-utilization of adaptive sampling approaches leaves much room for improvement in how immunization programs calibrate their strategies to reach "hidden" subpopulations.
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Affiliation(s)
- Aybüke Koyuncu
- Global Immunization Division, Centers for Disease Control and Prevention (CDC), Atlanta, GA 30329, USA
| | - Atsuyoshi Ishizumi
- Global Immunization Division, Centers for Disease Control and Prevention (CDC), Atlanta, GA 30329, USA
| | - Danni Daniels
- Global Immunization Division, Centers for Disease Control and Prevention (CDC), Atlanta, GA 30329, USA
| | - Mohamed F Jalloh
- Global Immunization Division, Centers for Disease Control and Prevention (CDC), Atlanta, GA 30329, USA
| | - Aaron S Wallace
- Global Immunization Division, Centers for Disease Control and Prevention (CDC), Atlanta, GA 30329, USA
| | - Dimitri Prybylski
- Global Immunization Division, Centers for Disease Control and Prevention (CDC), Atlanta, GA 30329, USA
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Smith SE, Sivertsen N, Lines L, De Bellis A. Decision making in vaccine hesitant parents and pregnant women - An integrative review. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2022; 4:100062. [PMID: 38745627 PMCID: PMC11080481 DOI: 10.1016/j.ijnsa.2022.100062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 01/03/2022] [Accepted: 01/14/2022] [Indexed: 12/01/2022] Open
Abstract
Objectives : Vaccine refusal is increasing in Australia and is a major concern in high- and middle-income countries. There is evidence to suggest that some parents, even those who elect to immunise, may be vaccine hesitant with some manipulating the schedule by excluding or delaying some vaccines. The aim of this review was to gain an understanding of factors that influence vaccine decision-making in pregnant women and parents of children. Design : An integrative review approach was used to produce an analysis of existing literature on vaccine decision-making in pregnancy and parents. As the broadest of review methods, an integrative review can include a range of experimental and non-experimental research, thereby ensuring the inclusion of data from multiple perspectives. Data Sources : Online databases were searched for research related to vaccine decision-making in pregnant women and parents. Original and review articles were sought that were published in English between 2015 and 2021. Reviewed articles included qualitative and quantitative studies and systematic reviews. No mixed methods papers were located or excluded from this review. Review methods : The review method was an integrative review informed by Coughlan. Results : Papers from thirteen predominantly high- and middle-income countries were selected for this review. A total of 31 articles fit the inclusion/exclusion criteria, including qualitative, quantitative and review articles. Three main themes were identified including the role of healthcare professionals, vaccine safety concerns and alternative influences. Alternative influences included: social media, friends and family, religion, conspiracy theories and salutogenic parenting. Findings suggest that high levels of anxiety are involved in vaccine decision-making with parents seeking information from multiple sources including healthcare professionals, friends and family and social media. Conclusions : Pregnancy is an ideal time to provide education on both pregnancy and childhood vaccinations. However, some parents reported dissatisfaction in their therapeutic relationships with healthcare professionals. As a result, parents can resort to their own information seeking, in the main via social media which has been linked to vaccine refusal. Additionally, some healthcare professionals report feeling inadequately prepared for the role of immunisation promotion and provision. Parental information seeking from non-traditional sources has been shown to result in the acquisition of misinformation, exposure to conspiracy theories, the inevitable loss of vaccine confidence and subsequent vaccine refusal.
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Affiliation(s)
- Susan E Smith
- Flinders University College of nursing and health science, Australia
| | - Nina Sivertsen
- Flinders University College of nursing and health science, Australia
- Arctic University of Norway, Rural and Remote Arctic Health, Campus Hammersfest
| | - Lauren Lines
- Flinders University College of nursing and health science, Australia
| | - Anita De Bellis
- Flinders University College of nursing and health science, Australia
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Tostrud L, Thelen J, Palatnik A. Models of determinants of COVID-19 vaccine hesitancy in non-pregnant and pregnant population: Review of current literature". Hum Vaccin Immunother 2022; 18:2138047. [PMID: 36345571 DOI: 10.1080/21645515.2022.2138047] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Vaccination has proven to be the most effective tool in controlling the COVID-19 pandemic. While pregnant individuals are considered to be a high-risk population and are more likely to experience adverse effects from COVID-19, vaccination rates among pregnant individuals are significantly lower than in the general population. The Health Belief Model (HBM), Theory of Planned Behavior (TPB), 3C model, 5C model, and 5A model have been used to assess vaccination hesitancy behaviors. In this paper, we review the use of each of these models to address vaccine hesitancy, with a focus on the pregnant population and the COVID-19 vaccine. The HBM, TPB, 3C model, and 5C model have demonstrated great versatility in their ability to evaluate, explain, and modify vaccine hesitancy and behavior. Up to date, the HBM and 3C models appear to be the most effective models to study and address vaccination hesitancy within the pregnant persons.
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Affiliation(s)
- Lauren Tostrud
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Julia Thelen
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Anna Palatnik
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Geoghegan S, Shuster S, Butler KM, Feemster KA. Understanding Barriers and Facilitators to Maternal Immunization: A Systematic Narrative Synthesis of the Published Literature. Matern Child Health J 2022; 26:2198-2209. [PMID: 36173503 PMCID: PMC9521012 DOI: 10.1007/s10995-022-03508-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2022] [Indexed: 11/24/2022]
Abstract
Introduction Vaccines are being developed against Group B Streptococcus and respiratory syncytial virus. These vaccines are designed to be given to pregnant women to protect infants; thus, their success depends on uptake in this population. Maternal immunization programs have struggled to achieve target coverage rates. This systematic narrative synthesis aims to define the most important barriers and facilitators for maternal immunization and to identify priority areas for future research. Methods A search strategy was developed in Medline and adapted according to the requirements of additional search engines. Two reviewers independently reviewed the studies, using pre-specified inclusion and exclusion criteria. Results sections of included studies were coded, and thematic analysis was used to identify prominent themes. Results 321 studies were included in the final review. Most studies came from North America (37%), Europe (26%) or East Asia, Australia and New Zealand (22%). Low-and middle-income countries were under-represented. Five percent of studies came from Sub-Saharan Africa, and 2% came from South Asia. The prominent factors impacting maternal immunization were provider recommendation, perceived risks and benefits of maternal vaccines for the infant, race, birthplace, and access to healthcare. Few studies explored reasons behind racial and socioeconomic disparities in maternal immunization rates. Discussion A strong provider recommendation, equitable access to prenatal care and messaging that focuses on vaccine safety and infant benefits emerged as the key components for optimising vaccine uptake among pregnant women. Research among healthcare providers, minority groups and in low- and-middle-income countries was lacking. In anticipation of the expansion of maternal immunization programmes, focused research is needed to address these gaps and inform a successful public health strategy. Supplementary Information The online version contains supplementary material available at 10.1007/s10995-022-03508-0.
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Affiliation(s)
- Sarah Geoghegan
- Division of Infectious Diseases, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA. .,University College Dublin School of Medicine, Belfield, Dublin 4, Ireland.
| | - Sydney Shuster
- Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Karina M Butler
- University College Dublin School of Medicine, Belfield, Dublin 4, Ireland.,Children's Health Ireland at Crumlin, Dublin 12, Ireland
| | - Kristen A Feemster
- Division of Infectious Diseases, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd., Building 421, Philadelphia, PA, 19104, USA.,Global Medical and Scientific Affairs, Merck Research Laboratories, Merck & Co., Inc, 351 North Sumneytown Pike, Upper Gwynedd, PA, 19454, USA
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de Munter AC, Hautvast JL, Ruijs WL, Henri Spaan D, Hulscher ME, Ruiter RA. Deciding about maternal pertussis vaccination: associations between intention, and needs and values in a vaccine-hesitant religious group. Vaccine 2022; 40:5213-5222. [DOI: 10.1016/j.vaccine.2022.07.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 07/02/2022] [Accepted: 07/20/2022] [Indexed: 10/16/2022]
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de Munter AC, Ruijs WLM, Ruiter RAC, van Nimwegen DJJ, Oerlemans AJM, van Ginkel R, Hulscher MEJL, Hautvast JLA. Decision-making on maternal pertussis vaccination among women in a vaccine-hesitant religious group: Stages and needs. PLoS One 2020; 15:e0242261. [PMID: 33180859 PMCID: PMC7660565 DOI: 10.1371/journal.pone.0242261] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 10/29/2020] [Indexed: 12/03/2022] Open
Abstract
Introduction As of December 2019, pregnant women in the Netherlands are offered pertussis vaccination to protect their newborn infant against pertussis infection. However, the manner in which pregnant women decide about this maternal pertussis vaccination is largely unknown. The aim of this study is to gain insight into the decision-making process regarding maternal pertussis vaccination, and to explore the related needs among the vaccine-hesitant subgroup of orthodox Protestant women. Methods Charmaz’s grounded theory approach was used to develop a decision-making framework. To construct this framework we used an explorative multimethod approach in which in-depth interviews and online focus groups were supplemented by a literature search and research group meetings. This study was carried out in a hypothetical situation since the maternal pertussis vaccination had yet to be implemented in the Dutch immunisation programme at the time of the study. Results Twenty-five orthodox Protestant women participated in an interview, an online focus group, or in both. The findings of this study resulted in a decision-making framework that included three stages of decision-making; an Orientation stage, a value-based Deliberation stage, and Final decision stage. The Orientation stage included the needs for decision-making categorised into Information needs and Conversation needs. Women indicated that -if they were to receive sufficient time for Orientation and Deliberation- they would be able to reach the stage of Final decision. Conclusion The decision-making framework resulting from our findings can be used by health care professionals to provide women with information and consultation in the decision-making process. Future studies should investigate whether the stages of and needs for decision-making can be found across other vaccine-hesitant subgroups and vaccinations.
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Affiliation(s)
- Anne C. de Munter
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Infectious Disease Control, GGD Gelderland-Zuid, Nijmegen, The Netherlands
- * E-mail:
| | - Wilhelmina L. M. Ruijs
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Infectious Disease Control, GGD Gelderland-Zuid, Nijmegen, The Netherlands
| | - Robert A. C. Ruiter
- Department of Work & Social Psychology, Maastricht University, Maastricht, The Netherlands
| | - Dagmar J. J. van Nimwegen
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Infectious Disease Control, GGD Gelderland-Zuid, Nijmegen, The Netherlands
| | - Anke J. M. Oerlemans
- IQ healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Rijk van Ginkel
- “Fruits of Passion; Together Fighting Human Suffering”, Bodegraven, The Netherlands
| | - Marlies E. J. L. Hulscher
- IQ healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jeannine L. A. Hautvast
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
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Kilich E, Dada S, Francis MR, Tazare J, Chico RM, Paterson P, Larson HJ. Factors that influence vaccination decision-making among pregnant women: A systematic review and meta-analysis. PLoS One 2020; 15:e0234827. [PMID: 32645112 PMCID: PMC7347125 DOI: 10.1371/journal.pone.0234827] [Citation(s) in RCA: 92] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 06/02/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The most important factor influencing maternal vaccination uptake is healthcare professional (HCP) recommendation. However, where data are available, one-third of pregnant women remain unvaccinated despite receiving a recommendation. Therefore, it is essential to understand the significance of other factors and distinguish between vaccines administered routinely and during outbreaks. This is the first systematic review and meta-analysis (PROSPERO: CRD 42019118299) to examine the strength of the relationships between identified factors and maternal vaccination uptake. METHODS We searched MEDLINE, Embase Classic & Embase, PsycINFO, CINAHL Plus, Web of Science, IBSS, LILACS, AfricaWideInfo, IMEMR, and Global Health databases for studies reporting factors that influence maternal vaccination. We used random-effects models to calculate pooled odds ratios (OR) of being vaccinated by vaccine type. FINDINGS We screened 17,236 articles and identified 120 studies from 30 countries for inclusion. Of these, 49 studies were eligible for meta-analysis. The odds of receiving a pertussis or influenza vaccination were ten to twelve-times higher among pregnant women who received a recommendation from HCPs. During the 2009 influenza pandemic an HCP recommendation increased the odds of antenatal H1N1 vaccine uptake six times (OR 6.76, 95% CI 3.12-14.64, I2 = 92.00%). Believing there was potential for vaccine-induced harm had a negative influence on seasonal (OR 0.22, 95% CI 0.11-0.44 I2 = 84.00%) and pandemic influenza vaccine uptake (OR 0.16, 95% CI 0.09-0.29, I2 = 89.48%), reducing the odds of being vaccinated five-fold. Combined with our qualitative analysis the relationship between the belief in substantial disease risk and maternal seasonal and pandemic influenza vaccination uptake was limited. CONCLUSIONS The effect of an HCP recommendation during an outbreak, whilst still powerful, may be muted by other factors. This requires further research, particularly when vaccines are novel. Public health campaigns which centre on the protectiveness and safety of a maternal vaccine rather than disease threat alone may prove beneficial.
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Affiliation(s)
- Eliz Kilich
- Department of Infectious Diseases Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Topical Medicine, London, United Kingdom
| | - Sara Dada
- Department of Infectious Diseases Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Topical Medicine, London, United Kingdom
| | - Mark R. Francis
- Department of Infectious Diseases Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Topical Medicine, London, United Kingdom
| | - John Tazare
- Department of Medical Statistics, Faculty of Epidemiology and Population Health, London School of Hygiene & Topical Medicine, London, United Kingdom
| | - R. Matthew Chico
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Topical Medicine, London, United Kingdom
| | - Pauline Paterson
- Department of Infectious Diseases Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Topical Medicine, London, United Kingdom
| | - Heidi J. Larson
- Department of Infectious Diseases Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Topical Medicine, London, United Kingdom
- Institute of Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America
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Yakut N, Soysal S, Soysal A, Bakir M. Knowledge and acceptance of influenza and pertussis vaccinations among pregnant women of low socioeconomic status in Turkey. Hum Vaccin Immunother 2019; 16:1101-1108. [PMID: 31687874 DOI: 10.1080/21645515.2019.1689082] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Pregnant women and infants are at relatively high risk for influenza- and pertussis-related morbidity and mortality. Vaccination is the most important prevention strategy for both diseases. We evaluated knowledge and acceptance of influenza and pertussis vaccinations among pregnant women. We performed a cross-sectional survey of 465 pregnant women receiving prenatal care at the obstetric outpatient clinic in a tertiary medical center in Turkey between November 2015 and May 2016. We used a questionnaire investigating the knowledge of pertussis and influenza to evaluate potential influences on the acceptance or rejection of pertussis or influenza vaccinations. The acceptance rates of pertussis and influenza vaccinations were 11.2% and 19.8%, respectively. Maternal age, education level, employment status, number of gestations, and gestational age did not affect the rate of acceptance of these vaccinations. On the other hand, pregnant women who had a history of vaccination during their adolescence and in previous pregnancies were significantly more likely to accept pertussis vaccination. Knowledge about the risks of pertussis and influenza diseases for pregnant women and their children has a significant effect on vaccination acceptance. Even in low socioeconomic status groups, a recommendation for vaccinations by the primary obstetrician was significantly predictive of acceptance of both pertussis and influenza vaccination. This study revealed that the acceptance rates of pertussis and influenza vaccination among pregnant women are very low in Turkey. Healthcare worker recommendations and increased awareness about pertussis and influenza morbidity and mortality in pregnant women and infants are essential to improve the rates of vaccination acceptance during pregnancy.
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Affiliation(s)
- Nurhayat Yakut
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Marmara University Medical Faculty, Istanbul, Turkey
| | - Sunullah Soysal
- Department of Obstetrics and Gynecology, Marmara University Medical Faculty, Istanbul, Turkey
| | - Ahmet Soysal
- Clinics of Pediatrics, Atasehir Memorial Hospital, Istanbul, Turkey
| | - Mustafa Bakir
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Marmara University Medical Faculty, Istanbul, Turkey
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Krishnaswamy S, Lambach P, Giles ML. Key considerations for successful implementation of maternal immunization programs in low and middle income countries. Hum Vaccin Immunother 2019; 15:942-950. [PMID: 30676250 PMCID: PMC6605837 DOI: 10.1080/21645515.2018.1564433] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The Maternal Neonatal Tetanus Elimination program is proof of concept for the feasibility and potential for maternal immunization to reduce neonatal mortality particularly in low and middle-income countries. Introduction of any additional vaccine into the antenatal space, such as Influenza and Pertussis, and potentially Respiratory Syncytial Virus and Group B Streptococcus vaccines in the future, requires strengthening of antenatal care and immunization services. Successful implementation also requires robust disease surveillance in pregnant women and neonates and active surveillance for adverse events following immunization to monitor the impact and ensure the safe use of the vaccine. This review outlines five key elements essential for successful implementation of a maternal immunization program focusing particularly on low and middle-income countries. These include; relevant considerations in supporting a decision to undertake a maternal immunization program including knowledge of local disease epidemiology, involvement of the consumer, healthcare provider recommendation, equitable access to maternal vaccination, and systems for disease surveillance, program evaluation and safety monitoring.
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Affiliation(s)
- Sushena Krishnaswamy
- a The Ritchie Centre, Department of Obstetrics and Gynaecology , Monash University , Clayton , Australia
| | - Philipp Lambach
- b Initiative for Vaccine Research , World Health Organization , Geneva , Switzerland
| | - Michelle L Giles
- a The Ritchie Centre, Department of Obstetrics and Gynaecology , Monash University , Clayton , Australia
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