Understanding factors influencing vaccination acceptance during pregnancy globally: A literature review

Attitudes towards vaccination against COVID-19 during pregnancy and its determinants among people of reproductive age

The attitudes of reproductive-age individuals toward COVID-19 vaccination during pregnancy are still not well understood. We aimed to explore the attitudes toward COVID-19 vaccines during pregnancy and the determinants among the Chinese reproductive-age population. An anonymous cross-sectional study was conducted in China from July 4 to August 11, 2023. Structured questionnaires on vaccine hesitancy during pregnancy, socio-demographic characteristics, behavior characteristics, health-related factors, and mental health status were sent online to reproductive-age individuals (both males and females). Among 2966 participants of reproductive age, 86.9% exhibited significant hesitancy toward receiving the COVID-19 vaccine during pregnancy. Participants of older age (30-34: aOR = 1.71, 95% CI: 1.62-2.52; 35-39: aOR = 1.72, 95% CI: 1.11-2.66), nonsmokers (aOR = 1.42, 95% CI: 1.07-1.89), with a longer duration since their last COVID-19 vaccination (aOR = 2.37, 95% CI: 1.20-4.70), and exhibiting marked pandemic fatigue (moderate: aOR = 1.98, 95% CI: 1.56-2.52; high: aOR = 3.49, 95% CI: 2.41-5.05) were prone to refuse COVID-19 vaccines during pregnancy. The presence of generalized anxiety disorder may push the vaccination (aOR = 0.75, 95% CI: 0.57-0.99). The top three reasons for hesitation were concerns about the adverse health effects of vaccines on pregnant women (77.72%), fetuses (72.13%), and newborns/infants (58.77%), respectively. Therefore, under the context of the existing circumstances and the WHO's encouragement, this study provides data support for possible future policy changes and emphasizes the importance of public health strategies.

A qualitative exploration of Australian women's vaccination experiences and information needs for routine, COVID-19 and respiratory syncytial virus vaccines in pregnancy

PROBLEM

New maternal vaccine introduction may affect pregnant women's information needs and decision-making processes.

BACKGROUND

The number of vaccines available to pregnant women in Australia has doubled with the introduction of the COVID-19 vaccine during the pandemic and recent approval of respiratory syncytial virus (RSV) vaccine.

AIM

This study explored the maternal vaccine experiences and evolving information needs of Australian pregnant women during and since the pandemic.

METHODS

This qualitative study recruited participants through social media and a Melbourne public antenatal clinic. Eligible women were either pregnant mid-pandemic (gave birth May 2021-April 2022) or pregnant post-pandemic during the study period (June 2023-March 2024). Online interviews exploring information-seeking and decision-making practices for influenza, pertussis, COVID-19, and maternal RSV vaccines were inductively thematically analysed.

FINDINGS

We interviewed twenty-two women with different levels of vaccine acceptance, identifying four themes: (i) "Full mother mode" to protect the baby - perceived disease risk influenced vaccine decision-making; (ii) "Fear of the unknown and comfort of the familiar" - testing and safety data on known vaccines provided confidence. More information was needed for the new RSV vaccine due to less familiarity; (iii) Whatever the provider says, "she's the professional" - providers' recommendations and personal vaccine decisions provided reassurance; (iv) "I want time to learn about it" - women preferred consistent information early in pregnancy for unhurried decision-making.

CONCLUSION

Information about new maternal vaccines like RSV should be provided early in pregnancy, emphasising vaccine testing rigour, effectiveness and safety for the baby. Consistent recommendations across providers are essential.

Analysis of key factors and equity in influenza vaccination among Chinese adults-evidence from a large national cross-sectional survey

Introduction

Influenza is prevalent globally, leading to severe morbidity and mortality. Vaccination remains a critical strategy for influenza prevention. Although previous studies in China have primarily focused on influenza vaccination among children, limited research has addressed the key determinants and equity issues concerning adult influenza vaccination.The purpose of this study was to investigate the key factors influencing influenza vaccination and its equity among Chinese adults.

Methods

The study uses data from the 2021 Chinese General Social Survey (CGSS) (N = 2695).Initially, differences in influenza vaccination among adults with various baseline characteristics were analyzed using the chi-square test. Subsequently, the importance of influencing factors was assessed through a random forest model, with LASSO used for variable selection. Following this, weighted logistic regression analysis was applied to quantify the significant influencing factors. Finally, the concentration index was employed to identify and determine the contribution of important variables to influenza vaccination.

Results

The influenza vaccination rate among Chinese adults is low (6.75%). Key factors identified as influencing adult vaccination include government trust, physician trust, income, aging concerns, health insurance, age, education, and health status. These factors not only have independent effects but also interact to influence vaccination behavior. Regarding individual effects, government trust, physician trust, income, and aging concerns showed positive associations with vaccination rates. Conversely, health insurance status, age, educational attainment, and health status demonstrated negative associations. Regarding the interaction terms, there were positive associations between health insurance and government trust, education and government trust, health and physician trust, government trust, as well as education level and age with the target variables. In contrast, interactions between income and health insurance, as well as income and physician trust negatively influenced vaccination rates. The concentration index for adult influenza vaccination was 0.092. There was inequity in vaccination, with the distribution of vaccinations being skewed toward higher-income individuals. Decomposition analysis further revealed that the primary contributors to vaccination inequity, in descending order of magnitude, were income (32.6%), government trust (9.1%), education (8.7%), age (8.2%), and aging concerns (2.6%).

Discussion

This is the first study to leverage a large micro-survey database in China to analyze the key factors affecting adult influenza vaccination and its equity. By providing new evidence on influenza vaccination among Chinese adults, the findings may inform the optimization of adult immunization policies. To further increase influenza vaccination rates and promote equity among Chinese adults, future policy improvements could consider emphasizing the role of trust in vaccination uptake, subsidizing vaccination costs, and fully utilizing comprehensive intervention strategies to enhance adult influenza vaccination coverage and equity.

Socio-economic contextual determinants and behavioral changes during pregnancy: evidence from the "MAMI-MED" cohort

BACKGROUND

Pregnancy is a period marked by significant physiological and psychological changes in women and increased fetal nutritional requirements, necessitating maternal adaptation and behavior modifications. Clinicians and health institutions recommend pregnant women engage in healthy practices, such as smoking and alcohol cessation, folic acid consumption, vaccinations, and the like. As behavioral changes in general, the individual's conduct during pregnancy is also influenced not only by personal socio-economic status but also by the socio-economic conditions of the individual's area of residence. This mechanism is recognized by the social epidemiological approach and relates to the concept of neighborhood effect on individual health-related choices. Leveraging such considerations, the work aims to explore the association between selected behaviors recommended by clinicians during pregnancy and specific contextual variables in the residential areas where pregnant women live.

METHODS

Data from the "MAMI-MED" cohort, recruiting pregnant women during the first prenatal visit at a hospital in Catania (Italy), were analyzed. The cohort provides a valuable resource for investigating the relationship between various exposures during pregnancy and the health outcomes of both mothers and infants. Geocoding techniques were employed to link individual-level data to selected contextual variables related to education, income, unemployment, and housing costs in the participants' residential areas. Mann-Whitney test, Kruskal-Wallis tests, logistic regressions and mixtures of regressions models with concomitant variables are implemented 1) to investigate the associations between contextual covariates and individual responses, 2) to assess the presence of latent sub-groups of the population reacting differently to the same contextual factors.

RESULTS

The results of Mann-Whitney and Kruskal-Wallis tests, and logistic regressions indicated that neighborhood's socio-economic characteristics, such as educational level and unemployment rate, are associated with women's behaviors during pregnancy, smoking cessation in particular. Results from the logistic regression for BMI showed that obese and overweight individuals tend to live in neighborhoods where the percentage of individuals holding at least a bachelor's degree is comparatively lower. A mixture of regressions predicting individual BMI detected the presence of two latent groups in the population under analysis. The main finding seems to suggest that people living in worse socio-economic environments have a higher sensitivity to changes in education conditions, with respect to individuals living in better-off neighborhoods.

CONCLUSIONS

These findings highlight the importance of considering social and contextual dimensions in understanding and promoting healthy behaviors during pregnancy.

Examining the hesitations of pregnant women towards COVID-19 vaccines during the pandemic: A mixed methods approach

BACKGROUND

Various reasons stemming from direct vaccine concerns, individual factors, and sociocultural and environmental factors contribute to vaccine hesitancy among pregnant women regarding COVID-19 vaccines.

AIMS

The study described and compare pregnant women's perspectives on COVID-19 vaccination during the pandemic and to identify barriers and facilitators.

FINDINGS

A mixed-methods research design was adopted to integrate quantitative and qualitative descriptive methods. At a state hospital in the western region of Turkey, 249 pregnant women attending the maternity clinic from March to August 2022 were surveyed using questionnaires, and in-depth individual interviews were conducted with 17 of them. The interview topics were based on the participants' perceptions and attitudes toward COVID-19 vaccines. A mixed-methods research design was adopted, using quantitative purposive sampling to describe and compare their COVID-19 vaccination status and qualitative purposive sampling to identify their hesitations regarding COVID-19 vaccines, analyzed through content analysis. Reporting followed the GRAMMS guidelines.

DISCUSSION

Sixty-six percent of pregnant women had not received the COVID-19 vaccine. Those with advanced age, lower education levels, and lower income exhibited higher levels of vaccine hesitancy. The hesitations of pregnant women toward COVID-19 vaccines revealed three main themes: direct vaccine-related hesitation, hesitation arising from individual factors, and hesitation stemming from socio-cultural and environmental factors.

CONCLUSION

Vaccine hesitancy, which emerged during the COVID-19 pandemic, was a significant cause for concern. This hesitancy was explained by three main themes: vaccine hesitancy arising from the vaccine itself, vaccine hesitancy due to individual factors, and vaccine hesitancy stemming from socio-cultural and environmental factors. Additionally, sub-themes such as perceptions related to the management of the vaccination program, personal and infant-related risk-benefit assessments, the influence of anti-vaccine activists on social media, and political factors were also identified as playing a significant role in vaccine hesitancy.

An exploration of women's decision-making processes around accepting or declining vaccinations in pregnancy: A qualitative descriptive study

OBJECTIVE

To explore women's perceptions and experiences of accepting or declining vaccinations in pregnancy, and to identify factors that influence vaccination uptake.

DESIGN

A qualitative descriptive interview-based study.

SETTING

The maternity unit of a rural hospital in the Republic of Ireland.

PARTICIPANTS

A purposive sample of eight women who were pregnant, aged 18 and over, who were receiving antenatal care through the public healthcare system. Half of the participants accepted vaccinations, while the other half declined, reflecting varying levels of vaccine hesitancy.

METHODS

Semi structured interviews (n=8) were conducted between July 2022 and August 2022 and analysed using thematic analysis.

FINDINGS

The study offers insight into women's decision-making processes on vaccinations in pregnancy. Five main themes were identified (1). Maternal Instincts in the Shadow of Uncertainty, (2). Lack of Balanced Information, (3). Misinformation: Difficult to Ignore, (4). Navigating Fear and Social Pressures, (5). Perceived Benefits Outweighing Risk.

KEY CONCLUSIONS

The decision-making process around vaccination in pregnancy is complex and multifaceted, influenced by various factors that can either hinder or promote uptake rates. Participants expressed complex emotions, associated fears and anxieties, and highlighted the necessity for more balanced and transparent dialogues with healthcare professionals. They emphasised the need for the dissemination of high-quality objective evidence from health authorities. This, they felt, would help facilitate genuine informed decision making, and ease the burden of feelings of uncertainty.

IMPLICATIONS FOR PRACTICE

The provision of balanced, reliable, evidence-based information made available through multiple sources, alongside open and non-judgemental conversations with healthcare professionals is essential to support women in making informed decisions. Consequently, healthcare professionals require education and training to effectively communicate vaccination information clearly, empathetically, and in a way that is tailored to individual needs.

Factors that influence vaccination communication during pregnancy: provider and patient perspectives using the theoretical domains framework

INTRODUCTION

Vaccination during pregnancy is recommended but uptake is low and evidence on the topic is limited.

AIMS

This study aimed to identify the drivers of current behavior and barriers to change for health care practitioners (HCPs) and pregnant patients in Canada.

METHODS

This study is an in-depth qualitative investigation of the factors influencing HCPs' vaccination communication during pregnancy, as well as factors influencing pregnant patients' vaccination uptake in Canada using the Theoretical Domains Framework. Three data sources were used: (1) perinatal HCP interviews before COVID-19; (2) perinatal HCP interviews regarding vaccine communication after COVID-19; and (3) survey of pregnant or lactating women after COVID-19.

RESULTS

Forty-seven interviews and 169 participant responses were included. Perinatal HCPs reported limited information on vaccine communication or difficulty keeping up-to-date ( Environmental context and resources ; Knowledge; Beliefs about capabilities ). HCPs lacked confidence and struggled with lack of training to address vaccine hesitancy without alienating patients ( Beliefs about capabilities; Skills ). Pregnant or lactating women struggled with the amount of information they felt was imposed on them, had concerns about the perceived negative consequences of vaccination, and felt pressure to understand what was best for them and their babies ( Knowledge; Beliefs about consequences; Social influences ).

CONCLUSIONS

Our study provides a theory-based approach to identify influencing factors that can be mapped to theory-based intervention components, improving the likelihood of intervention effectiveness. The study is the first step in adapting an existing intervention to improve vaccine communication during pregnancy, ultimately, increasing vaccination uptake.

SPANISH ABSTRACT

http://links.lww.com/IJEBH/A260.

The Tdap Vaccination in Pregnancy: Results of a Healthy Equity Audit on Coverage Trends and Their Determinants in the Reggio Emilia Province (Italy)

Background/Objectives: The Italian National Plan for Vaccine Prevention 2017-2019 recommended tetanus, diphtheria, and acellular pertussis vaccines (Tdap) for pregnant women, irrespectively of their immunization history. This study aims to describe the coverage rate trends for Tdap vaccination in pregnancy and evaluate the differences by socioeconomic status. Methods: This is a retrospective analysis within a health equity audit of the Local Health Authority of Reggio Emilia on vaccination in pregnancy from 2018 (a local vaccination campaign) to 2023. All women residents in our area who gave birth during that period were included and linked to the electronic Registry of Immunization Service. The vaccination coverage in pregnant women was analyzed over time and stratified by pregnant women's sociodemographic and obstetric characteristics. Results: The coverage of Tdap in pregnant women of the Province of Reggio Emilia increased from 15.9% in 2018 to 53.9% in 2023. The coverage was higher among Italians, women with higher educational levels (aPR 1.49 (CI95%1.41-1.57)), within 31-35 years of age (aPR 1.37 (CI95% 1.28-1.46)), occupied, nulliparous (aPR multiparous vs nulliparous: 0.76 (0.74; 0.78)), and followed in the private sector (aPR 1.07 (1.03-1.11)). Inequalities in coverage increased during the study period for women assisted in the private sector, while decreased or remained stable for women assisted in the context of public services. Conclusions: The vaccination promotion campaign in Reggio Emilia helped increase Tdap coverage in pregnancy from 16 to 53%. Nevertheless, the coverage rates of the most disadvantaged women are still several points lower than the average.

Pregnant women's choices for preventing respiratory syncytial virus (RSV)

INTRODUCTION

Respiratory syncytial virus (RSV) is the leading cause of bronchiolitis and pneumonia in infants and can lead to severe respiratory distress, especially in very young infants. No specific treatments exist for RSV. However, new preventative strategies have become available including RSV vaccine for pregnant women and monoclonal antibody for infants. This study aimed to identify and understand barriers and facilitators to the uptake of a new RSV vaccine in pregnant women and determine their underlying choices for a maternal RSV immunisation program. Additionally, the study investigated choice for maternal vaccination or administration of a long-lasting monoclonal antibody to infants.

METHODS

Eligible participants were pregnant women residing in Australia and aged 18 years or older. Focus group discussions and individual online interviews were conducted and data were analysed using a thematic analysis approach.

RESULTS

A total of 34 pregnant women participated in online focus group discussions or interviews, with an average age of 34 years. The identified themes were categorised into four overarching domains: 1) motivators for vaccinating during pregnancy to safeguard their babies and prevent severe diseases, 2) barriers to vaccination including vaccine safety concerns, uncertainties regarding vaccine effectiveness, and vaccine hesitancy arising from COVID-19 vaccination experiences, 3) preferred vaccination promotion strategies, including constant reminders/prompts, personalised messages, campaign focusing on serious outcomes and using diverse/lay languages, recommendations from local obstetricians and health authorities, 4) clear vaccine recommendation policies and a preference for maternal immunisation over infant immunisation.

CONCLUSIONS

The maternal RSV vaccination was generally welcomed and preferred by pregnant women in our study comparing to other strategies. Preferences for RSV program promotion included diversity in languages, "nudge" reminders, and recommendations from healthcare providers.

Association between Perceived Ethnic Discrimination and Receipt of COVID-19 Vaccine in Pregnancy or Postpartum

BACKGROUND

Although the COVID-19 vaccination has been shown to be safe and effective during pregnancy, pregnant and postpartum populations continue to experience higher rates of vaccine hesitancy than the general population. The experience of discrimination is associated with vaccine hesitancy, but this association has not yet been examined within a pregnant population, which is a particularly vulnerable group for adverse COVID-19 outcomes.

METHODS

Pregnant individuals receiving prenatal care at a Midwestern academic institution were approached between June 2021 and March 2022 to complete a web-based discrimination questionnaire. The validated survey- the Brief Perceived Ethnic Discrimination Questionnaire - Community Version (BPEDQ-CV) - measures perceived interpersonal racial and ethnic discrimination through four domains, with questions rated on a five-point Likert scale ranging from "never" to "very often". All four domains were summarized in a lifetime discrimination score ranging from 1 to 5. The primary outcome was receipt of COVID-19 vaccination in pregnancy or within the first 180 days postpartum. A multivariate logistic regression model was used to examine the association between "lifetime discrimination score" and COVID-19 vaccination.

RESULTS

Of the 274 pregnant individuals who met inclusion criteria for this analysis, 211 (77.0%) received the COVID-19 vaccine and 63 (23.0%) declined. For each domain of BPEDQ-CV, and for the combined score of lifetime discrimination, a higher score was associated with a higher rate of declining the COVID-19 vaccine. After adjusting for potential cofounders, each unit increase in lifetime exposure to perceived discrimination was associated with 1.25 higher odds of not receiving the COVID-19 vaccine during pregnancy or within in the first 180 days postpartum (aOR 1.25, 95% CI 1.01 - 1.55).

CONCLUSION

We found that higher lifetime exposure to perceived discrimination was associated with higher risk of declining COVID-19 vaccination during pregnancy and within six months postpartum.

Prevalence of Mpox Vaccine Acceptance Among Students: A Systematic Review and Meta-Analysis

BACKGROUND

Mpox, formerly known as monkeypox, is a re-emerging viral disease. Vaccine acceptance is crucial for preventing its spread. This systematic review and meta-analysis assessed the acceptance of the Mpox vaccine among student populations.

METHODS

We searched electronic databases, including PubMed, Web of Science, and Embase, up to 14 September 2024. The studies included were observational, such as cross-sectional and cohort studies, and specifically assessed vaccine acceptance for Mpox vaccines among students. R version 4.4 was used to perform the meta-analysis, and sensitivity analyses were conducted to assess the robustness of the findings. The publication bias was evaluated using Doi plots.

RESULTS

Of the 143 studies initially identified, eight studies were included in the final analysis, comprising a total of 16,129 participants. The overall vaccine acceptance rate was 58.6%, with considerable variability across studies (I2 = 100%). The sensitivity analyses indicated that acceptance rates ranged between 45% and 70%. The Doi plot demonstrated the presence of moderate publication bias.

CONCLUSION

This systematic review and meta-analysis shows moderate acceptance of the Mpox vaccine among students. Future studies should investigate the factors influencing vaccine acceptance and design targeted strategies to improve coverage, which will be essential for controlling Mpox and ensuring successful vaccination campaigns.

Vaccine Confidence During Pregnancy and the Impact of the COVID-19 Pandemic: A Wide Variety of Views Across the European Union

BACKGROUND

There is a wide variety of vaccination programs during pregnancy implemented in different European Union (EU) countries. The recent coronavirus disease 2019 (COVID-19) pandemic emphasized the need for efficient interventions to increase vaccine confidence during pregnancy since pregnant women were less likely to accept COVID-19 vaccination compared with nonpregnant women. This survey investigated the influence of the COVID-19 pandemic on vaccine confidence during pregnancy in 11 European countries.

METHODS

An online survey with questions on maternal vaccine confidence was distributed in 10 EU countries between March 29 and April 6, 2022. Via convenience sampling, 25 eligible participants per country were recruited. Subsequently, the survey was distributed in Flanders (Belgium) between October 14 and 26, 2022, delivering 480 eligible respondents. All participants were either pregnant or gave birth in the last 2 years.

RESULTS

Across all countries, vaccine confidence during pregnancy was found to be lower than vaccine confidence in general. Safety concerns were indicated as the most important reason to refuse vaccination during pregnancy. Participants with higher education and who were above 30 years old showed more confidence toward vaccination during pregnancy. A total of 15% of the participants indicated that the COVID-19 pandemic negatively impacted their confidence toward vaccines.

CONCLUSIONS

Vaccine confidence during pregnancy varies widely across the EU. However, across all surveyed countries, vaccine confidence during pregnancy is lower than vaccine confidence in general, and safety concerns appear to be the main driver of this. The COVID-19 pandemic negatively impacted the view on vaccination in a significant proportion of participants, indicating that vaccine implementation in a next pandemic should be tackled differently.

Sociodemographic Factors Associated With Established and Novel Antenatal Vaccination Uptake in a Cohort of Pregnant Women in Uganda

INTRODUCTION

Vaccination is a key strategy to safeguard the health of pregnant women and newborns. Although vaccine acceptance is often higher in low- and middle-income countries, the COVID-19 pandemic has highlighted increasing vaccine hesitancy. Vaccine hesitancy, specifically in pregnant women, must be understood to increase uptake. We used data from a Ugandan pregnancy registry study to examine sociodemographic factors linked to uptake of vaccines (tetanus toxoid and later COVID-19) in pregnancy.

METHODS

Pregnant women were recruited in Kampala, Uganda, as part of the PREPARE (Prevention of invasive Group B Streptococcus disease in young infants: a pathway for the evaluation & licensure of an investigational maternal GBS vaccine) study from September 1, 2020 until February 24, 2022. Demographic, socioeconomic and obstetric data were collected alongside COVID-19 and tetanus vaccination.

RESULTS

One thousand five hundred sixty-eight participants were included: 151 (10%) were unvaccinated, 11 (1%) received COVID-19 vaccine only, 1230 (78%) received a tetanus vaccine only and 176 (11%) received both. Lower vaccination rates were seen in participants attending fewer than 4 antenatal care episodes (P < 0.001), and those with higher parity (P = 0.036). Higher vaccination rates were seen with a managerial or professional occupation or higher maternal education level, but paternal occupation was not significantly associated with maternal vaccination. Parish vaccination rates varied from 0% to 100%, with 49 (29%) of parishes showing a vaccination rate <90%.

CONCLUSIONS

This study highlights antenatal care as a key route for health promotion, and the stark difference in uptake between new and established antenatal vaccines. Further qualitative studies should investigate effective interventions to establish the safety and benefit of newer maternal vaccines across all demographic groups.

Provider Determinants of Maternal Influenza and Pertussis Vaccination Uptake in South Australia in a Tertiary Healthcare Setting

Background: In Australia, maternal influenza and pertussis vaccinations have been recommended for every pregnancy since 2010 and 2015, respectively. Aims: This study aimed to determine maternal influenza and pertussis vaccine uptake in South Australia and assess factors associated with vaccine uptake among pregnant women. Methods: This retrospective cohort study collected data from the South Australian Pregnancy Record (SAPR) or other medical records of women who delivered at the Women's and Children's Hospital from 2016 to 2018. Results: Of 2230 complete records, 53.5% received influenza vaccination and 66.5% pertussis vaccination. Maternal vaccine uptake significantly increased from 2016 to 2018: influenza 43.1-61.6%; pertussis 58.7-71.6%. Healthcare provider discussions with pregnant women about maternal vaccines more than doubled the likelihood of influenza (AOR 2.74, 95% CI: 2.21-3.39) and pertussis vaccine uptake (AOR 2.22, 95% CI: 1.77-2.78). Lower vaccine uptake was observed among women attending midwifery clinics (influenza: AOR 0.72, 95% CI: 0.58-0.90; pertussis: AOR 0.67, 95% CI: 0.54-0.84) or private maternity care (influenza: AOR 0.51, 95% CI: 0.34-0.77; pertussis: AOR 0.40, 95% CI: 0.27-0.60). Shared antenatal care increased the uptake of influenza (AOR 1.51, 95% CI: 1.12-2.04) and pertussis (AOR 1.39, 95% CI: 1.00-1.91). Additional adjustment for SAPR versions did not appreciably change the results, although attending private practice was no longer significantly associated with lower vaccine uptake. Conclusions: Maternal vaccine uptake varies depending on the antenatal care provider. This study identifies opportunities to improve vaccination access during pregnancy and emphasizes the need for targeted strategies to address provider-related barriers.

Structural equation modeling to evaluate the adult vaccine hesitancy scale for vaccines recommended during pregnancy

INTRODUCTION

Acceptance of recommended vaccines is lower among pregnant people compared to non-pregnant adults, yet no tool has specifically measured prenatal vaccine hesitancy. We evaluated the performance of an existing adult Vaccine Hesitancy Scale (aVHS) in measuring vaccine hesitancy toward routinely recommended prenatal vaccines.

METHODS

Between December 2021 and April 2022, we conducted a cross-sectional national online survey with 917 US postpartum adults 18-49 years old who had given birth in the past six months. Vaccine hesitancy was measured using the aVHS, a 10-item scale previously validated among the adult general population. Scores range from 10 to 50, with higher scores indicating greater vaccine hesitancy. Structural equation modeling (SEM) with weighted least squares means and variances adjusted (WLSMV) estimator was used to assess the fit of the aVHS structure. Construct validity was assessed by examining the correlation between the aVHS score and the self-reported receipt of recommended prenatal vaccines.

RESULTS

SEM indicated acceptable fit (RMSEA: 0.098; CFI: 0.983; TLI: 0.978; SRMR: 0.040) of the data to the two-factor model: (1) lack of vaccine confidence, and (2) perceived vaccine risks. For the paths from the two factors to the vaccine acceptance, lack of vaccine confidence was significantly correlated with influenza vaccine acceptance (β = -0.41, p < 0.001) and COVID-19 vaccine acceptance (β = -0.64, p < 0.001), while perceived vaccine risk was significantly linked with Tdap vaccine acceptance (β = -0.57, p < 0.001) and influenza vaccine acceptance (β = -0.25, p < 0.001). Additionally, pregnant people with higher aVHS scores were less likely to receive recommended prenatal vaccines.

DISCUSSION

Although the aVHS offered acceptable measurement of prenatal vaccine hesitancy, a scale that measures pregnancy-specific concerns may offer more tailored measurement for this unique population.

Attitude to RSV Vaccination Among a Cohort of Pregnant Women in Jordan: A Cross-Sectional Survey Study

Background and Aims

The recently approved maternal vaccination against respiratory syncytial virus (RSV) can reduce its burden among infants. However, vaccine hesitancy/resistance can undermine the beneficial impact of RSV vaccination. The aim of this study was to assess the willingness of pregnant women in Jordan to receive RSV vaccination and its associated determinants.

Methods

Face-to-face interviews were conducted in obstetrics/gynecology clinics in the Central, Northern, and Southern regions of Jordan during January-February 2024, using a convenience sampling approach. Attitude to RSV vaccination was assessed using the previously validated ABCDEF scale.

Results

A total of 404 pregnant women participated in the study with a mean age of 30.1 ± 6.2 years. A majority of the participants showed willingness to receive RSV vaccination (n = 313, 77.5%), with hesitancy among 25 participants (6.2%), and resistance among 66 participants (16.3%). Variables that were significantly associated with a higher RSV vaccine acceptance in multivariate analysis were: age < 30 years (adjusted odds ratio (aOR): 2.45, p = 0.010), undergraduates (aOR: 3.27, p = 0.026), being a healthcare worker (aOR: 4.50, p = 0.036), and the history of previous COVID-19/influenza vaccine uptake (aOR: 2.47, p = 0.045). Two out of the six ABCDEF constructs were significantly associated with RSV vaccine acceptance, namely the "Advice" construct (aOR: 10.38, p < 0.001) and the "Fear" construct (aOR: 21.49, p < 0.001).

Conclusion

This study highlighted the complex nature of attitude towards maternal RSV vaccination among pregnant women. The study showed the role of demographic variables, prior vaccination experience, trust in credible health institutions and vaccine safety, and the fear of RSV disease consequences in infants in shaping maternal attitude to RSV vaccination. Addressing these factors can help to effectively promote RSV vaccine uptake among pregnant women, subsequently helping to protect infants from the significant RSV disease burden.

Exploring parental perspectives: Maternal RSV vaccination versus infant RSV monoclonal antibody

Respiratory Syncytial Virus poses a significant global public health threat, particularly affecting infants aged less than one year of age. Recently, two forms of passive immunization against infant RSV have been developed and brought to market; nirsevimab a long-acting monoclonal antibody (mAb) and RSV-PreF, a maternal RSV vaccine. The acceptability and uptake of these products will play a pivotal role in determining the success of any national immunization strategy aimed at safeguarding infants from RSV. It is crucial at this time to reflect on the factors that influence parental decisions surrounding immunization to facilitate more informed discussions, enhance healthcare communication, and contribute to the design of effective RSV prevention strategies that resonate with the concerns and aspirations of parents worldwide.

Efficacy of vaccination during pregnancy in reducing the risk of SARS-CoV-2 infection in infants younger than 12 months. Puglia (Italy), 2021-23

This retrospective cohort study evaluated the effectiveness of maternal vaccination against COVID-19 in reducing the risk of SARS-CoV-2 infection in infants younger than 12 months. The study, conducted at the "Policlinico" University Hospital of Bari, included 3346 newborns and their mothers. The study explored the degree of protection offered by maternal vaccination depending on the timing, type, and trimester of vaccination, also taking into account the mother's history of infection. We compared the incidence rate of infection between children of vaccinated and unvaccinated mothers; the values were 10.2% and 18.1%, respectively, and the difference was statistically significant. The overall effectiveness of the vaccine against the infection was 45%. Further analysis revealed increasing efficacy as the doses of vaccine administered to the mother increased and in case of a previous history of maternal infection. Dual immune stimulation (vaccination and natural infection) was 83% effective in preventing infection among newborns. The multivariable models confirmed the protective effect of vaccination with all types of vaccines used. The analysis of infection's incidence in newborns revealed an interesting temporal trend, with increasing incidence with time, suggesting a possible correlation with the persistence of maternal antibodies or with the gradual weaning. The results on the protective capacity of vaccines are in line with the global literature. Strengths of study include sample size, robust methodology, and multivariate analyses. Institutions could intensify awareness campaigns to encourage both pregnant women and all those who would like to become pregnant to receive SARS-CoV-2 vaccination.

Facilitators and barriers to maternal immunization and strategies to improve uptake in low-income and lower-middle income countries: A systematic review

Maternal immunization (MI) is an emerging strategy to combat infant mortality in low-income (LIC) and lower-middle income countries (LMIC). We conducted a systematic review to identify the facilitators and barriers to MI and strategies that improve uptake in LICs and LMICs. We searched PubMed, Cochrane Library, and Scopus for quantitative, qualitative, and mixed-methods studies published in English from January 1, 2011, to October 31, 2021, from all LICs and LMICs. Data was appraised using the Mixed Methods Appraisal Tool. 55 studies were included. The major barriers were low knowledge and concern of vaccine safety among pregnant women and healthcare providers (HCP). HCP's recommendation, maternal knowledge, vaccine confidence and ≥4 antenatal care (ANC) visits facilitated uptake. The key strategies encompassed health financing, reminders, intersectoral coordination, integration, community engagement, capacity building, and education. Community-based delivery models were effective. Tailored programs are needed to improve ANC access, and educate pregnant women and HCPs.

Trends in influenza vaccination and its determinants among pregnant French women between 2015 and 2020: A single-center study

In 2016, only 7% of French women had received an influenza vaccination during their pregnancy. In this vaccine-averse country, the possibility of reaching the rates of 50% observed in other countries remains unknown. To measure the rate of influenza vaccination in a French university maternity. To study its evolution and determinants over the last 5 years. Single-center observational study of all women who gave birth during March 2020 in this maternity. Comparison with rates observed in 2015 in the same conditions. Of the 337 women included in the study, 202 received a vaccination during pregnancy (59.9%). After logistic regression, the factors significantly associated with achieving vaccination were the offer of vaccination during pregnancy, odds ratio (ORa) 26.2 [7.0; 98.2]; previous vaccination, ORa 20.3 [9.6; 42.6]; high education level, ORa 2.9 [1.3; 6.2]; delivery of a CERFA government reimbursement form, ORa 2.5 [1.3; 4.8]; a vaccination offer made by a general practitioner, ORa 2.1 [1.0; 4.4] and not by a hospital midwife, ORa 0.3 [0.1; 0.6]. The rate of vaccination increased from 35% to 59.9% between 2015 and 2020 (p < .001), with a significant increase in the offer of vaccination during pregnancy (+14.6%) - especially by a general practitioner (+17.2%) - and in the rate of women with earlier vaccination (+13.6%). In France, vaccination rates above 50% are possible at a center level. A proposal of vaccination during pregnancy - especially by the general practitioner - seems to be a determining factor in this development.

Number of tetanus toxoid injections before birth and associated factors among pregnant women in low and middle income countries: Negative binomial poisson regression

BACKGROUND

In low- and middle-income countries where vaccination rates are low, tetanus is still an important threat to public health. Although maternal and neonatal tetanus remains a major global health concern, its magnitude and determinates are not well studied. Therefore, this study aimed to assess the number of tetanus toxoid injections and associated factors among pregnant women in low- and middle-income countries.

METHODS

Data from the most recent Demographic and Health Surveys, which covered 60 low- and middle-income countries from 2010 to 2022, was used for secondary data analysis. The study included a total of 118,704 pregnant women. A statistical software package, STATA 14, was used to analyze the data. A negative binomial regression of a cross-sectional study was carried out. Factors associated with the number of tetanus vaccinations were declared significant at a p-value of < 0.05. The incidence rate ratio and confidence interval were used to interpret the results. A model with the smallest Akaike Information Criterion and Bayesian Information Criterion values and the highest log likelihood was considered the best-fit model for this study.

RESULTS

In low- and middle-income countries, 26.0% of pregnant women took at least two doses of the tetanus toxoid vaccine. Factors such as maternal education, primary (IRR = 1.22, 95% CI: 1.17, 1.26), secondary (IRR = 1.19, 95% CI: 1.15, 1.23), higher (IRR = 1.16, 95% CI: 1.12, 1.20), employment (IRR = 1.11, 95% CI: 1.09, 1.13), 1-3 ANC visits (IRR = 2.49, 95% CI: 2.41, 2.57), ≥4 visits (IRR = 2.94, 95% CI: 2.84, 3.03), wealth index (IRR = 1.06; 95% CI: 11.04, 1.08), ≥birth order (IRR = 1.04, 95% CI: 1.02, 1.27), distance to health facility (IRR = 1.02, 95% CI: 1.00, 1.03), and health insurance coverage (IRR = 1.08; 95% CI: 1.06, 1.10) had a significant association with the number of tetanus vaccinations among pregnant women.

CONCLUSIONS AND RECOMMENDATIONS

This study concludes that the number of tetanus toxoid vaccinations among pregnant women in low- and middle-income countries is low. In the negative binomial model, the frequency of tetanus vaccinations has a significant association with maternal employment, educational status, wealth index, antenatal care visits, birth order, distance from a health facility, and health insurance. Therefore, the ministries of health in low and middle-income countries should give attention to those women who had no antenatal care visits and women from poor wealth quantiles while designing policies and strategies.

'It has been the hardest decision of my life': a mixed-methods study of pregnant women's COVID-19 vaccination hesitancy

OBJECTIVE

To explore psychological factors influencing decision-making regarding COVID-19 vaccination among pregnant women.

DESIGN

Cross-sectional mixed-methods online survey comprising sociodemographic factors, health beliefs, trust and anticipated regret, and open-ended qualitative questions. Pregnant respondents living in the UK or Ireland (n = 191) completed the online survey during June and July 2021.

MAIN OUTCOME MEASURES

Intention to vaccinate against COVID-19 during pregnancy, with response options yes (vaccine accepting), no (vaccine resistant), unsure (vaccine hesitant). Qualitative questions about perceived benefits and risks of COVID-19 vaccination during pregnancy.

RESULTS

Multivariate analysis of correlates of vaccine hesitancy and resistance revealed independent associations for perceived barriers to the COVID-19 vaccine, anticipated regret, and social influences. Most respondents described making a decision regarding COVID-19 vaccination in the absence of satisfactory information or guidance from a health care professional. Vaccine hesitant and resistant respondents reported significantly greater barriers to the COVID-19 vaccination than vaccine accepting respondents. Concerns about the vaccine focussed on the speed of its development and roll-out and lack of evidence regarding its safe use in pregnancy.

CONCLUSION

Participants who did not intend to be vaccinated against COVID-19 in pregnancy focused on vaccine fears as opposed to virus fears. Results indicate that pregnant women need balanced vaccine information and unequivocal health care provider recommendation to aid maternal vaccination decision-making.

Understanding the barriers and enablers to participation in vaccine trials in a pregnant population from diverse ethnic background in an inner-city UK hospital

BACKGROUND

Vaccination during pregnancy is an important healthcare intervention for safeguarding the health of the mother and their infants. Ethnic disparities in recruitment to vaccine research studies during pregnancy potentially contribute to health inequalities. The aim of the current study was to explore the barriers and enablers influencing the willingness of pregnant women from ethnic minority backgrounds to participate in vaccine research studies.

METHODS AND FINDINGS

Semi-structured qualitative online interviews were conducted with 23 pregnant women from diverse ethnic backgrounds in the UK. Interviews were transcribed verbatim, and thematically analysed. Our findings suggest that participants perceived vaccines and vaccine research, in principle, to be beneficial to the individual and to society, and understood the value of vaccination in mitigating severity of disease and protecting the health of mothers and their infants. Apprehension over the safety of vaccination in pregnancy was common and reduced willingness to participate. For those that decided to participate in vaccine trials in pregnancy, this was seen as an act of solidarity, a way to contribute to a collective responsibility for the public health of the community. Personal and community connections and representation-seeing people from their own communities represented in in the recruitment process shapped decisions about vaccine trial participating. Trust and mistrust in health systems, shaped by past experiences of interacting with healthcare professionals were likely to inform whether they would consider participating. Practical considerations such as excessive time commitments related to study procedures, travel and organising childcare were barrier to participation. The level of invasiveness of trial procedures were also a concern, although increased monitoring during the trial was seen as a potential benefit, mitigating some safety concerns.

CONCLUSIONS

Our study reinforcing previously identified barriers to vaccine participation among pregnant women from diverse ethnic communities. This study underlines the need to develop tailored interventions that focus on fostering trust with the aid of community engagement to understand cultural contexts, establishing authentic representation, and address practical considerations, to contribute to enhancing vaccine trial participation in pregnancy in those from diverse ethnic communities.

Leveraging seasonal influenza health worker vaccination programmes for COVID-19 vaccine Introduction: A global qualitative analysis

BACKGROUND

Health worker vaccination programmes can help to safeguard both health workers (HWs) and their patients and enhance vaccine uptake more broadly in local communities and society. This study's objective was to increase global understanding of how existing HW vaccination programmes were leveraged for emergency COVID-19 vaccine introduction.

METHODS

This qualitative study included 13 in-depth group interviews with 38 key informants with expertise in vaccine programme implementation from eleven countries in five WHO regions: Albania, Armenia, Bhutan, Lao PDR, Maldives, Mongolia, Oman, Timor Leste, the United Kingdom, Vietnam, and Zimbabwe in addition to WHO regional focal points from all six regions. These interviews were transcribed, coded, and thematically analyzed. Key informants reviewed the initial results and validated the key findings.

RESULTS

Informants characterized key components of both routine and seasonal influenza vaccination programmes that were leveraged for the emergency vaccination of HWs during the COVID-19 pandemic. We identified a set of cross-cutting factors that were used for COVID-19 vaccine roll out: 1) pre-existing occupational health policies, 2) adequate human resources, 3) well-functioning data information systems and vaccine delivery platforms, and 4) established communication channels. Across the eleven countries and six regions interviewed, the ability to adapt existing influenza or other health worker vaccination infrastructure was beneficial for their pandemic response.

CONCLUSIONS

Our findings suggest a strong justification for enhanced investment in vaccination of health workers, particularly against seasonal influenza, through country-wide programmes as a foundation for pandemic preparedness and response.

Insights into maternal pertussis vaccination counselling: a qualitative study on perspectives and experiences among midwives and gynaecologists in the Netherlands

BACKGROUND

Healthcare professionals (HCPs) play a significant role in the decision-making process of pregnant women on maternal vaccinations. Whereas a high proportion of HCPs discuss maternal vaccinations with pregnant women, confidence in discussing maternal vaccinations is lacking and HCPs experience inadequate training to discuss maternal vaccinations with pregnant women. Furthermore, different practical barriers might influence the consultation process, such as lack of time. More studies on the barriers, as well as facilitators, to discussing maternal vaccinations is needed and will help us to better understand and support HCPs in discussing maternal vaccinations.

METHODS

This qualitative study involved semi-structured interviews with fourteen HCPs working as midwives or gynaecologists in the Netherlands. An integrated theoretical approach was used to inform data collection and analysis. Thematic analysis was conducted using inductive and deductive approaches. This study followed the COnsolidated criteria for REporting Qualitative research (COREQ) guidelines.

RESULTS

The thematic analysis of the data pointed to the following five themes of HCP counselling: the consultation process, attitude, perceived norm, perceived control and improvement ideas. Most HCPs follow a similar approach in maternal pertussis vaccination consultations, beginning by assessing clients' understanding, providing basic information, and addressing questions. However, consultation timing and prioritization vary among HCPs. Challenges in consultations include client requests for clear advice, with HCPs trained to remain neutral, emphasizing client autonomy in decision-making. Most HCPs acknowledge the importance of their consultations in informing pregnant women about maternal pertussis vaccination.

CONCLUSIONS

This study offers a confirmation of the awareness of the pivotal role of HCPs in informing pregnant women about the maternal pertussis vaccination. HCPs stress the importance of neutral counselling, enabling pregnant women to make well-informed decisions independently. Because of upcoming vaccine hesitancy nowadays, HCPs must be equipped with the knowledge and confidence to navigate difficult conversations. Continuous education and training might help to increase HCPs' confidence in handling difficult consultations. Additionally, making the information materials for pregnant women available in multiple languages and incorporating more visuals to enhance comprehension could support HCPs in reaching a broader group of pregnant women.

Risk factors related to the SARS-CoV-2 vaccine additional doses hesitancy among pregnant and non-pregnant people of reproductive age and partners: A Brazilian cross-sectional study

OBJECTIVE

The aim of this study was to assess the predictors of acceptance and hesitancy of additional doses of any SARS-CoV-2 (COVID-19) vaccine among pregnant or recently pregnant and non-pregnant people of reproductive age and partners in Brazil.

METHODS

We conducted an online cross-sectional study from June 2022 to April 2023 and invited women and partners between 18 and 49 years old to participate. We employed a snowball strategy to reach all potential eligible participants. Our primary outcome was the acceptance rate of the COVID-19 booster vaccine. We estimated the frequency and percentage for the three groups and compared categorical variables using the Chi-square test. Moreover, bivariate, backward stepwise regression, and subgroup analyses were performed to evaluate risk factors and predictors of COVID-19 vaccine booster hesitancy. We reported the effect size as OR with a 95% CI.

RESULTS

We included 1487 participants, and among them, 334 (22.5%) were pregnant or recently pregnant people, 905 (60.8%) were non-pregnant people, and 247 (16.6%) were male partners. Pregnant and recently pregnant people showed greater hesitancy for the COVID-19 vaccine booster than non-pregnant people (28% vs 15%, P < 0.001) and male partners (28% vs 16%, P < 0.001). Non-pregnant women accepted the COVID-19 vaccine more often than pregnant or recently pregnant people (OR 1.75; 95% CI: 1.13-2.70). The associated factors to the reduced COVID-19 vaccine booster acceptance were family income between US$ 566-945.00 (54%), evangelic religion (65%), concern about vaccine safety (80%) and perceived common vaccine importance (93%).

CONCLUSION

Pregnant people were more hesitant than non-pregnant people to accept the COVID-19 booster vaccine. Family income, religious beliefs, vaccine safety concerns, and perceived common vaccine importance were significant barriers to accepting COVID-19 booster vaccines. The impact of these factors was more evident among pregnant or recently pregnant people, emphasizing the harmful effect of misinformation among this vulnerable population.

Factors Influencing COVID-19 Vaccine Hesitancy in Pregnant and Breastfeeding/Puerperium Women: A Cross-Sectional Study

Vaccination among pregnant and breastfeeding women is critical for protecting this vulnerable population and their children. COVID-19 vaccination is recommended both during pregnancy and breastfeeding; however, we still do not fully understand the determinants that influence hesitancy towards COVID-19 vaccination. This study aimed to identify the determinants of vaccine hesitancy in pregnant and breastfeeding, puerperium women. A multicenter, cross-sectional study, involving 435 pregnant and breastfeeding women, was conducted. Vaccination hesitancy was evaluated by administering the Vaccination Attitudes (VAX) Scale and the Zung Anxiety Self-Assessment Scale (SAS) was adopted to measure anxiety levels. Overall, 14% of the participants reported that they did not receive the COVID-19 vaccine, and 78.3% received their first dose during pregnancy or while breastfeeding. The descriptive statistics for the VAX scale showed a total mean score of 3.35 (±1.6), and 75% of participants reported an anxiety index equal to or lower than the threshold. Vaccine hesitancy increased as "adverse events after vaccination" increased (p < 0.01), while SAS levels positively correlated with the participants' mean age (p < 0.05). Investigating the factors influencing vaccine hesitancy enables the development of targeted health policies and SARS-CoV-2 vaccination programs.

Short term Outcomes of COVID-19 Vaccines Among Lactating Mother and Child Dyads in Bangladesh: A Multi-centre, Cross-sectional Study

INTRODUCTION

The aims of the study are to: (1) determine the short-term reactogenicity of WHO-approved COVID-19 vaccines (i.e., Pfizer-BioNTech, Moderna, Sinovac, Oxford-AstraZeneca, Johnson and Johnson, Covaxin) amongst lactating women and their children, and 2) evaluate lactation-related outcomes following the same vaccines in Bangladesh.

METHODS

This was a multi-centre, self-reported, cross-sectional study of lactating woman-child dyads in Bangladesh. Demographics, past medical history, breastfeeding history and clinical outcomes of lactating woman-child dyads at least 7 days after the last dose of vaccine were determined through a structured questionnaire.

RESULTS

There were 750 participants from four centres. The mean age of lactating women and children surveyed were 27.6 (SD ± 4.6) years and 10.3 (SD ± 6.7) months, respectively. Majority (81.2%; 608 of 750) received 2 doses of COVID-19 vaccinations while lactating. Almost all (99.9%; 749 of 750) vaccinated lactating women surveyed reported no change in human milk supply. More than half of the participants (56.9%; 373 of 656) reported no symptoms after both doses of COVID-19 vaccines. There were no serious adverse events such as anaphylaxis or hospital admission. Majority of the lactating women (98.9%; 742 of 750) reported that the children whom they breastfed had no symptoms such as fever or cough.

DISCUSSION

This large study of lactating woman-child dyads in Bangladesh, who received a diverse range of WHO-approved COVID-19 vaccines, showed no serious short-term adverse effects.

Vaccination: Adherence and Hesitancy among Pregnant Women for COVID-19, Pertussis, and Influenza Vaccines

In the realm of antenatal care, vaccinations serve as a cornerstone, crucial for safeguarding the health of both the mother and the fetus, while also extending protection to the newborn against communicable diseases. Nevertheless, vaccine adherence among pregnant women remains very low. The aim of our study was to evaluate the uptake of vaccines (influence, pertussis, and COVID-19) among women during pregnancy and to understand pregnant women's knowledge of vaccines and the diseases they protect against. The purpose was to investigate the reasons why pregnant women chose not to be vaccinated and to develop effective strategies for informing them about the importance of vaccination for both maternal and fetal safety. A prospective observational study was conducted in the Department of Obstetrics and Gynaecology, "Ospedale Santa Maria della Misericordia" in Udine, from 1 December 2021 to 30 June 2022. During this period, a self-completed paper questionnaire was administered to women at the end of pregnancy or during the puerperium. A total of 161 questionnaires were collected. Higher educational level was found to be significantly associated with influenza vaccination uptake (p = 0.037, OR = 2.18, 95% CI 1.05-4.51). Similarly, for pertussis vaccination, adherence was mainly associated with higher educational level (p = 0.014, OR = 2.83, 95% CI 1.24-6.47), but also with Italian nationality (p = 0.003, OR = 3.36, 95% CI 1.56-8.43) and pregnancy attended by a midwife or private gynecologist (p = 0.028, OR = 0.39, 95% CI 0.17-0.90). Regarding the COVID-19 vaccine, the only factor positively influencing uptake was Italian nationality (p = 0.044, OR = 2.66, 95% CI 1.03-6.91). Women's fear that vaccines would endanger the fetus appeared to be the most important reason for refusing vaccinations. Simultaneously, patients also exhibited a desire to receive more information about maternal vaccination, particularly from their general physician or gynecologist. For this reason, it is imperative to enhance maternal vaccination counselling, making it a routine step in prenatal care from the first antenatal visit until the postpartum period.

Estimating COVID-19 vaccine acceptance in pregnant and lactating women: a cross-sectional study in Lebanon

BACKGROUND

The COVID-19 pandemic highlights vaccination's critical role in reducing morbidity and mortality, depending on public attitude. This study aims to identify the estimates of COVID-19 vaccine acceptance in pregnant and lactating women, as well as associated potential factors.

METHODS

A cross-sectional study was conducted between August and September 2021, through an online survey and with a paper survey distributed in gynecology and pediatric clinics. Pregnant and breastfeeding women aged 18 years and above were recruited. The attitude scale was created specifically for evaluating attitudes towards the COVID-19 vaccine.

RESULTS

In total, 207 women participated, with 132 breastfeeding, 74 pregnant and 1 experiencing both conditions. Of these, one hundred and twenty women (58%) considered themselves at risk for COVID-19 infection. In addition, 51.7% (n = 107) of women expressed the intent to receive the vaccine once available. A multivariable linear regression was conducted taking the COVID-19 vaccination attitude scale as a dependent variable. The results revealed an R-squared value of 0.558, indicating that approximately 55.8% of the variance in the attitude scale was accounted for by the included predictors. The results showed that preventive measures (ß=2.25, 95% Confidence Interval (CI) [1.02; 3.48], p < 0.001), preference for vaccines made in Europe and America (ß=1.23; 95% CI [0.69-1.77], p < 0.001), protect yourself for getting sick (ß=4.22, 95% Confidence Interval (CI) [2.83; 5.61], p < 0.001) and belief in the importance of vaccination for themselves and their baby (ß=3.49; 95% CI [2.01; 4.98], p < 0.001) were associated with a positive attitude towards vaccination. Conversely, experiencing a previous bad reaction to a vaccine (ß= -1.35; 95% CI [0.85-1.85], p < 0.001) and concerns regarding COVID-19 vaccine safety (ß= -4.09; 95% CI [-5.98; -2.21], p < 0.001) were associated with a negative attitude towards vaccination.

CONCLUSION

Our findings reveal that COVID-19 vaccine acceptability among pregnant and breastfeeding women, amidst the pandemic was insufficient to meet community immunity. The identified reasons for vaccine reluctance, notably concerns about safety for both personal health and the health of their pregnancy or newborns, along with insufficient information about the vaccine, underscore the pressing need to address these factors to improve immunization rates.

National vaccination policies for health workers - A cross-sectional global overview

BACKGROUND

Immunization is essential for safeguarding health workers from vaccine-preventable diseases (VPDs) that they may encounter at work; however, information about the prevalence and scope of national policies that protect health workers through vaccination is limited. Understanding the global landscape of health worker immunization programmes can help direct resources, assist decision-making and foster partnerships as nations consider strategies for increasing vaccination uptake among health workers.

METHODS

A one-time supplementary survey was distributed to World Health Organization (WHO) Member States using the WHO/United Nations Children's Fund (UNICEF) Joint Reporting Form on Immunization (JRF). Respondents described their 2020 national vaccination policies for health workers - detailing VPD policies and characterising technical and funding support, monitoring and evaluation activities and provisions for vaccinating health workers in emergencies.

RESULTS

A total of 53 % (103/194) Member States responded and described health worker policies: 51 had a national policy for vaccinating health workers; 10 reported plans to introduce a national policy within 5 years; 20 had subnational/institutional policies; 22 had no policy for vaccinating health workers. Most national policies were integrated with occupational health and safety policies (67 %) and included public and private providers (82 %). Hepatitis B, seasonal influenza and measles were most frequently included in policies. Countries both with and without national vaccination policies reported monitoring and reporting vaccine uptake (43 countries), promoting vaccination (53 countries) and assessing vaccine demand, uptake or reasons for undervaccination (25 countries) among health workers. Mechanisms for introducing a vaccine for health workers in an emergency existed in 62 countries.

CONCLUSION

National policies for vaccinating health workers were complex and context specific with regional and income-level variations. Opportunities exist for developing and strengthening national health worker immunization programmes. Existing health worker immunization programmes might provide a foothold on which broader health worker vaccination policies can be built and strengthened.

Social determinants of health and vaccine uptake in pregnancy: Disparities in a diverse, predominately foreign-born population

OBJECTIVE

To identify discrepancies in influenza, Tdap, and COVID-19 vaccine uptake and offer rates among pregnant individuals across various social determinants of health including race, ethnicity, foreign-born status, education level, and health insurance coverage, highlighting potential interventions to improve vaccine uptake in pregnancy.

METHODS

An IRB-approved cross-sectional survey was conducted on the postpartum floor of a large urban hospital in South Florida. Between July to September 2021, 359 participants consented and answered questions on their demographics, social background, and influenza, Tdap, and COVID-19 vaccine history.

RESULTS

Most participants identified as White (67.7 %), Hispanic (67.4 %), and foreign-born (68.5 %) with an average age of 29.7 ± 6 years. There was a significant difference in mean vaccine between White (1.3) and Black individuals (0.9, p = 0.002). Mean uptake was significantly higher in foreign-born individuals (1.3) compared to US-born (0.9, p < 0.001). Mean uptake was significantly higher for those with graduate (1.7) and college (1.4) degrees compared to those with a high school degree (1.0) or less than high school (1.0, p < 0.0001).

CONCLUSION

Significant differences in the uptake and offer rates of influenza, Tdap, and COVID-19 vaccines were observed across a variety of social determinants including educational attainment, employment, insurance, and median income of the zip code of primary residence.

Prevalence and correlates of tetanus toxoid uptake among women in sub-Saharan Africa: Multilevel analysis of demographic and health survey data

BACKGROUND

Tetanus toxoid vaccination is one of the most effective and protective measures against tetanus deaths among mothers and their newborns. We examined the prevalence and correlates of tetanus toxoid uptake among women in sub-Saharan African (SSA).

MATERIALS AND METHODS

We analysed pooled data from the Demographic and Health Surveys (DHS) of 32 countries in SSA conducted from 2010 to 2020. We included 223,594 women with a history of childbirth before the survey. Percentages were used to present the prevalence of tetanus toxoid vaccine uptake among the women. We examined the correlates of tetanus toxoid uptake using a multilevel binary logistic regression.

RESULTS

The overall prevalence of tetanus toxoid uptake was 51.5%, which ranged from 27.5% in Zambia to 79.2% in Liberia. Women age, education level, current working status, parity, antenatal care visits, mass media exposure, wealth index, and place of residence were the factors associated with the uptake of tetanus toxoid among the women.

CONCLUSION

Uptake of tetanus toxoid vaccination among the women in SSA was low. Maternal age, education, current working status, parity, antenatal care visits, exposure to mass media, and wealth status influence tetanus toxoid uptake among women. Our findings suggest that health sector stakeholders in SSA must implement interventions that encourage pregnant women to have at least four antenatal care visits. Also, health policymakers in SSA could ensure that the tetanus toxoid vaccine is free or covered under national health insurance to make it easier for women from poorer households to have access to it when necessary.

A scoping review of the reasons for and approaches to non-uptake of pertussis and influenza vaccinations in pregnant women in the United Kingdom and Ireland

BACKGROUND

Pertussis and influenza cause significant morbidity and mortality in pregnancy and the neonatal period. Maternal vaccination in pregnancy would reduce harm, but low vaccine uptake is a concern. This scoping review aimed to understand the reasons for, and approaches, to non-uptake of pertussis and influenza vaccinations in pregnant women in the UK and Ireland.

METHODS

The inclusion criteria of this scoping review consist of pregnant women who avail of pertussis and influenza vaccines in the UK and Ireland. MEDLINE, EMBASE, Web of Science and CINAHL databases were searched in June 2021 and updated in October 2022. Searches were limited to English language reports published after 2011. We followed the Joanna Briggs Institute guidance on scoping reviews. Data were extracted and charted.

RESULTS

Five themes emerged from the literature. Acceptability, as well as organisational and awareness issues, were overarching themes regarding reasons for and approaches to non-uptake of the vaccines respectively. Other themes included healthcare professional factors, information interpretation and pregnancy-related factors.

CONCLUSIONS

Women need clear, comprehensible information, ideally provided by their healthcare professionals, in a way that is meaningful and addresses their circumstances and risk perceptions. This research will serve as a base for future work that aims behaviour science interventions at the wider pregnant population as well as the target groups that have been identified in this review.

Vaccine hesitancy among nursing and midwifery undergraduate students in Switzerland: protocol for an online national study

Background

Vaccine hesitancy is a persistent challenge in public health, exacerbated by the proliferation of anti-vaccine sentiments facilitated by social networks. The COVID-19 pandemic has underscored the importance of addressing vaccine hesitancy, designated by the WHO as a top global health threat. This study explores vaccine hesitancy among nursing and midwifery undergraduate students in Switzerland-a cohort crucial to public health given their future roles as healthcare professionals-with a particular emphasis on the HPV vaccine, which exhibits lower confidence levels compared to other vaccines.

Methods

This study will employ an online questionnaire distributed to nursing and midwifery undergraduate students from various healthcare universities. The questionnaire will collect data on vaccine hesitancy (general confidence in vaccines and specifically in the HPV vaccine), HPV vaccine coverage, socio-demographics, likelihood to recommend vaccines to patients, perception of vaccination education and interest in complementary medicine.

Conclusion

The study's findings will contribute to our understanding of vaccine hesitancy among nursing and midwifery undergraduate students, providing insights that can inform targeted interventions and education strategies to bolster vaccine confidence among future healthcare professionals, thereby enhancing public health efforts.

COVID-19 vaccine eligibility of pregnant and lactating women in Bangladesh: Gap between policy and policy interpretation among policymakers and healthcare workers

SARS-CoV-2 infection in pregnancy is associated with a greater risk of maternal and newborn morbidity and maternal death. Bangladesh confirmed its first COVID-19 case in March of 2020, and vaccination rollout started in January of 2021. In Bangladesh, pregnant women are allowed to receive COVID-19 vaccines during pregnancy with qualifications while lactating women are permitted to receive COVID-19 vaccines with no qualifications as of October 2021. There is limited evidence on how vaccine policies are disseminated, interpreted, and implemented from the national level to the community level in Bangladesh. We conducted in-depth interviews from April-August 2022 with policymakers and healthcare workers in Bangladesh to understand how different stakeholders understood and implemented COVID-19 vaccination policies related to pregnant and lactating women. We interviewed policymakers at three levels: national, divisional, and district, and interviewed healthcare workers from one one urban and three rural communities within one division. We found a gap between policies related to COVID-19 vaccination for pregnant and lactating women and policy interpretation among policymakers and healthcare workers. Policymakers and healthcare workers' perceptions differed related to policy dissemination, attitudes toward policies related to pregnant and lactating women, and eligibility of pregnant and lactating women. Our findings indicate the need for effective dissemination of and understanding of policies. Within the context of vaccine uptake and vaccine acceptance, policymakers play a critical role as they are charged with developing and disseminating policy related to vaccine eligibility. Healthcare workers rely on timely and accurate communication related to vaccine eligibility, including populations, timing, and locations. Efforts are needed to narrow the policy and policy implementation gap as doing so is crucial to controlling vaccine preventable disease.

Racial and ethnic disparities in influenza vaccination coverage among pregnant women in the United States: The contribution of vaccine-related attitudes

OBJECTIVE

Racial and ethnic disparities in influenza vaccination coverage among pregnant women in the United States have been documented. This study assessed the contribution of vaccine-related attitudes to coverage disparities.

METHODS

Surveys were conducted following the 2019-2020 and 2020-2021 influenza seasons in a US research network. Using electronic health record data to identify pregnant women, random samples were selected for surveying; non-Hispanic Black women and influenza-unvaccinated women were oversampled. Regression-based decomposition analyses were used to assess the contribution of vaccine-related attitudes to racial and ethnic differences in influenza vaccination. Data were combined across survey years, and analyses were weighted and accounted for survey design.

RESULTS

Survey response rate was 41.2% (721 of 1748) for 2019-2020 and 39.3% (706 of 1798) for 2020-2021. Self-reported influenza vaccination was higher among non-Hispanic White respondents (79.4% coverage, 95% CI 73.1%-85.7%) than Hispanic (66.2% coverage, 95% CI 52.5%-79.9%) and non-Hispanic Black (55.8% coverage, 95% CI 50.2%-61.4%) respondents. For all racial and ethnic groups, a high proportion (generally >80%) reported being seen for care, recommended for influenza vaccination, and offered vaccination. In decomposition analyses, vaccine-related attitudes (e.g., worry about vaccination causing influenza; concern about vaccine safety and effectiveness) explained a statistically significant portion of the observed racial and ethnic disparities in vaccination. Maternal age, education, and health status were not significant contributors after controlling for vaccine-related attitudes.

CONCLUSIONS

In a setting with relatively high influenza vaccination coverage among pregnant women, racial and ethnic disparities in coverage were identified. Vaccine-related attitudes were associated with the disparities observed.

Maternal pertussis vaccination behavior: Psychosocial, attitudinal and organizational factors

BACKGROUND

In December 2019, the maternal pertussis vaccination (MPV) became part of the Dutch National Immunization Program. This study aims to study MPV behavior and associated psychosocial, attitudinal and organizational factors of pertussis vaccination behavior during pregnancy in the Netherlands.

METHODS

We conducted a cross-sectional survey among pregnant women and recent mothers, up to six months post-partum. The primary outcome measure of this study was MPV behavior. Associations between psychosocial, attitudinal and organizational factors and MPV behavior were assessed using univariate and multivariate binary logistic regression analysis.

RESULTS

In total 1348 participants filled out the questionnaire, including 1282 (95.1%) MPV acceptors and 66 (4.9%) MPV refusers. The most important factors associated with MPV behavior were: attitude (aOR: 10.19; 95%CI: 4.30-24.16), outcome expectations (aOR: 8.94; 95%CI: 3.60-22.21), omission bias (aOR: 0.11; 95%CI: 0.02-0.59) and physical accessibility (aOR: 7.44; 95%CI: 3.37-16.46).

CONCLUSION

Pregnant women make their decision about the MPV primarily based on attitudinal and psychosocial factors, such as outcome expectations and attitude. A combination and variation of different messages, about the advantages (effectiveness) and disadvantages (side effects) of maternal vaccination, can be used in reaching pregnant women with a positive and negative attitude about the MPV. In addition, strategies to increase MPV uptake should not only focus on providing information, but also decrease experienced practical barriers, such as poor physical accessibility, in people that are intended to receive the MPV but are not getting vaccinated.

The Obstetrician's Role in Pregnant Women's Decision-Making Process Regarding Influenza and COVID-19 Vaccination

Pregnant women are considered to be a population vulnerable to influenza and COVID-19 infections, and the latest guidelines consistently recommend that they receive influenza and COVID-19 vaccinations. A cross-sectional questionnaire-based study was conducted among pregnant women in Poland to determine which factors have the greatest impact on their decision to vaccinate against influenza and COVID-19. A total of 515 pregnant women participated in the study. Among them, 38.4% (n = 198) demonstrated a positive attitude toward influenza vaccination, and 64.3% (n = 331) demonstrated a positive attitude toward COVID-19 vaccination. Logistic regression analysis revealed that the strongest influence on positive attitudes toward COVID-19 vaccination is having it recommended by an obstetrician-gynecologist (OR = 2.439, p = 0.025). The obstetrician-gynecologist's recommendation to vaccinate against influenza also significantly influences the decision to vaccinate (OR = 5.323). The study results also show a strong correlation between the obstetrician-gynecologist as a source of information on influenza and vaccination and participants' positive attitudes toward vaccination (OR = 4.163). Obstetricians have a significant influence on pregnant women's decisions regarding vaccinations. Further recommendations to vaccinate and awareness-raising among obstetricians may be needed to increase the vaccination rate of pregnant women in Poland.

Examining spatial variation for immunisation coverage in pregnant women: A nationwide and geospatial retrospective cohort study in Aotearoa New Zealand

BACKGROUND

Maternal influenza and pertussis immunisation is crucial for protecting mothers during pregnancy and their babies in the first weeks of life against severe disease. We examined geospatial variation in maternal immunisation coverage among pregnant women in Aotearoa New Zealand and its health equity implications.

METHOD

We constructed a retrospective cohort including all pregnant women who delivered between 01 January 2013 and 31 December 2020 using administrative health datasets. Our outcomes were receipt of influenza or pertussis vaccine in any one of three relevant national databases (e.g. National Immunisation Register, Proclaims, or Pharmaceutical collection) during the eligible pregnancy.

RESULTS

Data from our retrospective cohort study show significant regional variation in maternal immunisation coverage for both influenza and pertussis from 2013 to 2020. Maximal coverage was around 50% in the best performing regions, which means that half of the women who were pregnant (183,737 women) were not protected. In addition, we found significant spatio-temporal variation and clustering of immunisation coverage. Our findings are interactively available to explore here: https://geohealthlab.shinyapps.io/hapumama/ CONCLUSION: Our study is one of the first to examine spatial variation in maternal vaccination coverage in pregnant women at a national level over space and time. This provides powerful tools to measure the impact of interventions to improve coverage at national and regional levels, with specific reference to inequities between ethnic groups, likely applicable to similar settings internationally.

Covid-19 vaccination during pregnancy: A mixed-methods study of attitudes in a sample of Italian women and the role of health professionals' communication

OBJECTIVES

We examined Italian pregnant women's attitudes about the diphtheria, tetanus, and pertussis (DTP) vaccine, seasonal influenza, and Covid-19 vaccines, healthcare professionals' (HP) communication, reasons and potential predictors for non-adherence.

METHODS

From August 2021 to January 2022, we carried out a cross-sectional study in Italy using an online self-administered questionnaire addressed to women of age and pregnant, designed using LimeSurvey and disseminated through social media. Questions explored vaccination attitude/perceptions, satisfaction, and trust in HPs' information. Thematic analysis of free-text responses was performed using MaxQDA 2022. Statistical analyses were performed using STATA.

RESULTS

1594 responses were obtained. 52% of women hesitated to be vaccinated against Covid-19 while pregnant. Information received by HPs was deemed incomplete by 56% of participants, unclear by 52%, and untrustworthy by 46%; 49% felt unsupported in their decision-making process. This variable was one predictor of vaccine hesitancy together with concern about vaccine safety in the multivariate model. The analysis of open-ended questions revealed a pervasive feeling of dissatisfaction.

CONCLUSION

The perceived lack of adequate communication and support by HPs affected pregnant women's decision-making process on Covid-19 vaccination.

PRACTICE IMPLICATIONS

HPs need to understand and communicate the importance of vaccination during pregnancy, learning to better tailor their messages.

Factors Affecting COVID-19 Vaccine Acceptance among Pregnant Women: A Cross Sectional Study from Abha City, Saudi Arabia

Background: Pregnant women can get infected with COVID-19 with serious sequelae to them and their fetus. Concerns about COVID-19 vaccination safety to mothers and babies, and doubts about its effectiveness, have hindered vaccine acceptance throughout the COVID-19 crisis. The objective of the current investigation was to estimate COVID-19 acceptance rates among pregnant women in Abha city, Aseer region, Saudi Arabia, and determine its clinical and demographic correlates. Method: Descriptive questionnaire-based cross-sectional survey of a sample of pregnant women attending regular antenatal care services in Abha. We used backward stepwise multiple logistic regression analysis to evaluate the predictability of vaccine acceptance in terms of baseline clinical and demographic factors. Results: The survey included 572 pregnant women. The prevalence of acceptance of COVID-19 vaccine was high (93.7%; 95%CI: 91.7-95.7%). University graduates and women with a later gestational age were more likely to accept vaccination (OR = 6.120, p = 0.009), (t = 2.163, p = 0.036), respectively. Confidence in vaccine safety was associated with better acceptance (OR = 3.431, p = 0.001). Conclusions: The acceptance rate for vaccination among pregnant women in Abha, Saudi Arabia, is higher compared to international rate. However, our results indicate that confidence in vaccine safety was associated with better acceptance. Hence, vaccine safety was the overarching predictor for harboring positive attitudes towards it. Public health policies should capitalize on such positive attitudes and aim for total coverage of pregnant women with COVID-19 vaccination including booster dosages.

Risk of Miscarriage in Relation to Seasonal Influenza Vaccination Before or During Pregnancy

OBJECTIVE

To evaluate the association between seasonal influenza vaccination and miscarriage using data from an ongoing, prospective cohort study.

METHODS

We analyzed 2013-2022 data from PRESTO (Pregnancy Study Online), a prospective prepregnancy cohort study of female pregnancy planners and their male partners in the United States and Canada. Female participants completed a baseline questionnaire and then follow-up questionnaires every 8 weeks until pregnancy, during early and late pregnancy, and during the postpartum period. Vaccine information was self-reported on all questionnaires. Miscarriage was identified from self-reported information during follow-up. Male partners were invited to complete a baseline questionnaire only. We used Cox proportional hazard models to estimate the hazard ratio (HR) and 95% CI for the association between vaccination less than 3 months before pregnancy detection through the 19th week of pregnancy and miscarriage, with gestational weeks as the time scale. We modeled vaccination as a time-varying exposure and used propensity-score fine stratification to control for confounding from seasonal and female partner factors.

RESULTS

Of 6,946 pregnancies, 23.3% of female partners reported exposure to influenza vaccine before or during pregnancy: 3.2% during pregnancy (gestational age 4-19 weeks) and 20.1% during the 3 months before pregnancy detection. The miscarriage rate was 16.2% in unvaccinated and 17.0% among vaccinated participants. Compared with no vaccine exposure, influenza vaccination was not associated with increased rate of miscarriage when administered before (HR 0.99, 95% CI 0.81-1.20) or during (HR 0.83, 95% CI 0.47-1.47) pregnancy. Of the 1,135 couples with male partner vaccination data available, 10.8% reported vaccination less than 3 months before pregnancy. The HR for the association between male partner vaccination and miscarriage was 1.17 (95% CI 0.73-1.90).

CONCLUSION

Influenza vaccination before or during pregnancy was not associated with miscarriage.

Increasing Vaccine Uptake during Pregnancy by Using Prenatal Education Classes: An Effective Tool for Health Communication and Promotion

Childbirth education classes represent an antenatal tool for supporting pregnant women and couples in increasing knowledge on pregnancy, delivery, breastfeeding, and newborn care. The aim of this study was to investigate the impact of an additional lesson during the prenatal course regarding the advantage of vaccination to mitigation of maternal anxiety. An observational study was designed that included participants in childbirth education classes and compared courses enhanced by the extra lesson on vaccination during pregnancy versus those who did not receive it. Assessment of the impact of prenatal educational on vaccination was measured by using validated questionnaires (State-Trait Anxiety Inventory, STAI; Perceived Stress Scale, PSS; World Health Organization- Five Well-Being Index, WHO-5). A total of 145 pregnant women participated to the investigation by answering to the online survey. Of them, 33 patients (22.8%) belonged to the course without a lesson on vaccine, while 112 (77.2%) participated to online prenatal education that included an additional meeting on the usefulness of getting vaccinated during pregnancy. No statistical differences were found between study groups in terms of demographics and perinatal outcomes. Participants in the enriched course reported lower basal anxiety levels than those without the vaccine lesson (STAI-State, normal score < 40, 30 vs. 19%, p-value 0.041; STAI-State, mild score 40-50, 78 vs. 67%, p-value 0.037). With reference to the prior two weeks, maternal wellbeing level was improved by the added class (score > 13 as measurement of wellbeing: 62% vs. 80%, p-value < 0.05). Moderate perceived stress assessed by PSS was found in those pregnant women without prenatal education on vaccination (64 vs. 50%, p-value 0.042). The introduction of a lesson regarding vaccination during pregnancy in the program of prenatal education courses improved maternal anxiety levels and wellbeing, in addition to reducing perceived stress.

Resources available for parent-provider vaccine communication in pregnancy in Canada: a scoping review

OBJECTIVE

Vaccination in pregnancy (VIP) is a protective measure for pregnant individuals and their babies. Healthcare provider's (HCP) recommendations are important in promoting VIP. However, a lack of strong recommendations and accessible resources to facilitate communication impact uptake. This study sought to determine the extent of and characterise the resources available for parent-provider vaccine communication in pregnancy in Canada using a behavioural theory-informed approach.

DESIGN

Scoping review.

METHODS

In accordance with the JBI methodology, nine disciplinary and interdisciplinary databases were searched, and a systematic grey literature search was conducted in March and January 2022, respectively. Eligible studies included resources available to HCPs practising in Canada when discussing VIP, and resources tailored to pregnant individuals. Two reviewers piloted a representative sample of published and grey literature using inclusion-exclusion criteria and the Authority, Accuracy, Coverage, Objectivity, Date, Significance guidelines (for grey literature only). Sixty-five published articles and 1079 grey reports were screened for eligibility, of which 19 articles and 166 reports were included, respectively.

RESULTS

From the 19 published literature articles and 166 grey literature reports, 95% were driven by the 'Knowledge' domain of the Theoretical Domains Framework, while n=34 (18%) addressed the 'Skills' domain. Other gaps included a lack of VIP-specific tools to address hesitancy and a lack of information on culturally safe counselling practices.

CONCLUSION

The study suggests a need for resources in Canada to improve VIP communication skills and improve access to vaccination information for HCPs and pregnant individuals. The absence of such resources may hinder VIP uptake.

Sources of COVID-19 Vaccine Promotion for Pregnant and Lactating Women in Bangladesh

COVID-19 vaccines are an effective public health intervention to reduce COVID-19-related morbidity and mortality. Given that pregnant and lactating women have a higher risk of severe COVID-19 complications, it is paramount to understand the factors that inform vaccine decision-making among this population. In this study, we sought to identify facilitators and barriers to COVID-19 vaccine acceptance and vaccine promotion in pregnant and lactating women in Bangladesh. We conducted 40 in-depth interviews with 12 pregnant women, 12 lactating women, and 16 health workers from one urban and four rural communities in Bangladesh. We used a grounded theory approach to identify emerging themes. Our results suggest that health workers and religious leaders played key roles in promoting COVID-19 vaccines in this population. Further, we found that the culture of trust in public health authorities and the existing vaccine infrastructure facilitated vaccine promotion. However, changes in vaccine eligibility and myths and rumors acted as both facilitators and barriers to vaccine promotion within our study. It is crucial that maternal immunization vaccine promotion efforts push pregnant and lactating women toward vaccine acceptance to protect the health of mothers and their babies. Additionally, as new maternal vaccines are developed and licensed, understanding how to best promote vaccines within this group is paramount.

Association between community-level political affiliation and peripartum vaccination

BACKGROUND

Political affiliation has been associated with vaccine uptake, but whether this association holds in pregnancy, when individuals are recommended to receive multiple vaccinations, remains to be studied.

OBJECTIVE

This study aimed to examine the association between community-level political affiliation and vaccinations for tetanus, diphtheria, and pertussis; influenza; and COVID-19 in pregnant and postpartum individuals.

STUDY DESIGN

A survey was conducted about tetanus, diphtheria, and pertussis and influenza vaccinations in early 2021, with a follow-up survey of COVID-19 vaccination among the same individuals at a tertiary care academic medical center in the Midwest. Geocoded residential addresses were linked at the census tract to the Environmental Systems Research Institute 2021 Market Potential Index, which ranks a community in comparison to the US national average. The exposure for this analysis was community-level political affiliation, defined by the Market Potential Index as very conservative, somewhat conservative, centrist, somewhat liberal, and very liberal (reference). The outcomes were self-reported vaccinations for tetanus, diphtheria, and pertussis; influenza; and COVID-19 in the peripartum period. Modified Poisson regression was used and adjusted for age, employment, trimester at assessment, and medical comorbidities.

RESULTS

Of 438 assessed individuals, 37% lived in a community characterized by very liberal political affiliation, 11% as somewhat liberal, 18% as centrist, 12% as somewhat conservative, and 21% as very conservative. Overall, 72% and 58% of individuals reported receiving tetanus, diphtheria, and pertussis and influenza vaccinations, respectively. Of the 279 individuals who responded to the follow-up survey, 53% reported receiving COVID-19 vaccination. Individuals living in a community characterized by very conservative political affiliation were less likely to report vaccinations for tetanus, diphtheria, and pertussis (64% vs 72%; adjusted risk ratio, 0.83; 95% confidence interval, 0.69-0.99); influenza (49% vs 58%; adjusted risk ratio, 0.79; 95% confidence interval, 0.62-1.00); and COVID-19 (35% vs 53%; adjusted risk ratio, 0.65; 95% confidence interval, 0.44-0.96) than those in a community characterized by very liberal political affiliation. Individuals living in a community characterized by centrist political affiliation were less likely to report vaccinations for tetanus, diphtheria, and pertussis (63% vs 72%; adjusted risk ratio, 0.82; 95% confidence interval, 0.68-0.99) and influenza (44% vs 58%; adjusted risk ratio, 0.70; 95% confidence interval, 0.54-0.92) than those in a community characterized by very liberal political affiliation.

CONCLUSION

Compared with pregnant and postpartum individuals living in communities characterized by very liberal political beliefs, those living in communities characterized by very conservative political beliefs were less likely to report vaccinations for tetanus, diphtheria, and pertussis; influenza; and COVID-19, and those in communities characterized by centrist political beliefs were less likely to report vaccinations for tetanus, diphtheria, and pertussis and influenza. Increasing vaccine uptake in the peripartum period may need to consider engaging an individual's broader sociopolitical milieu.

A study of acceptance and hesitation factors towards tetanus, diphtheria, and acellular pertussis (Tdap) and influenza vaccines during pregnancy

Introduction

Vaccination of pregnant women with tetanus, diphtheria, and acellular pertussis (Tdap) and influenza vaccines is desirable to reduce neonatal and maternal morbidity and mortality. However, vaccine coverage rates and acceptance are frequently below recommended rates.

Objectives

To ascertain Tdap and influenza vaccine coverage rates in our population and to study the reasons behind sub-optimal rates.

Method

A survey was submitted to pregnant or in their puerperium women at the University Hospital of São Paulo University. Data were obtained during two consecutive influenza seasons (2017-2018), and vaccination was verified through vaccination chart checking. Respondents were classified according to their status as "Received Tdap" and "Didn't receive Tdap", and as "Know" or "Doesn't know" regarding their awareness of Tdap safety during pregnancy and protective effect on the newborn. Vaccine uptake and personal awareness of vaccination status were compared among these groups for Tdap and influenza vaccines.

Results

In a studied sample of 207 patients (representative of the whole), coverage rates for Tdap and influenza vaccines were respectively 85.5% and 95.2%. Additionally, 84.5% received both vaccines. There was no vaccine refusal for Tdap and only 0.5% for influenza. For either Tdap or influenza vaccines, the main reason for not vaccinating was a lack of knowledge/information. Factors associated with not vaccinating Tdap during pregnancy were lower number of prenatal visits, being unemployed or freelance worker, not being aware of vaccine safety or its benefits for the baby, not being oriented by the doctor to be vaccinated, not being aware of personal vaccination status, and not having been vaccinated for influenza.

Conclusion

While influenza vaccination coverage during pregnancy was ideal, Tdap rates were below recommended values. Significant factors associated with better coverage for Tdap during pregnancy included being employed and not being self-employed, (not yet reported in the Americas) and being aware of personal vaccination status.

"Figuring stuff out myself" - a qualitative study on maternal vaccination in socially and ethnically diverse areas in England

BACKGROUND

Maternal vaccinations against Influenza, Pertussis, and Covid-19 are recommended in the UK, and vaccines against further infections may become available soon. However, many pregnant women, especially in socially and ethnically diverse areas, have low vaccine uptake. Qualitative studies on the reasons and possible solutions are needed that are inclusive of disadvantaged and minority ethnic groups. We therefore aimed to understand the complex interplay between structural and behavioural factors contributing to the low maternal vaccine uptake in socially and ethnically diverse areas in London in the Covid-19 context.

METHODS

In 2022, we conducted semi-structured interviews and a focus group discussion among a purposive sample of 38 pregnant/recently pregnant women and 20 health service providers, including 12 midwives. Participants were recruited in ethnically diverse London boroughs. We followed a critical realist paradigm and used a thematic analysis approach.

RESULTS

The sample included participants who took all, some or none of the maternal vaccines, with some participants unsure whether they had taken or been offered the vaccines. Decision-making was passive or active, with the expectation for pregnant women to do their 'own research'. Participants described various individual, social and contextual influences on their decision-making as they navigated the antenatal care system. Missing or conflicting information from providers meant knowledge gaps were sometimes filled with misinformation from unreliable sources that increased uncertainties and mistrust. Both pregnant women and providers described structural and organisational factors that hindered access to information and vaccinations, including lack of training, time and resources, and shortcomings of health information systems and apps. Some participants described factors that facilitated vaccination uptake and many made recommendations for improvements.

CONCLUSIONS

Our study showed how structural and organisational factors can compound uncertainties around maternal vaccination among socially and ethnically diverse populations. Results highlight the need for more reliable resources, streamlined workflows, improved electronic information systems and training in their use. Roles and responsibilities should be clarified with potential greater involvement of nurses and pharmacists in vaccine provision. Education and communication should consider individual (language/digital) skills and needs for information and reassurance. Further research is needed to co-produce solutions with service users and providers.