Pregnant Women’s Perception of Risk With Use of the H1N1 Vaccine

The Rate of Influenza Vaccination after Face-to-Face Interview in Pregnancy

PURPOSE

Most societies recommend routine influenza vaccine to all pregnant women. In Turkey, the Ministry of Health provides the influenza vaccine free of charge to pregnant women during the second and third trimesters. Pregnant women may not be willing to accept vaccination despite their knowledge and attitudes. We aimed to investigate the rate and determining factors of influenza vaccine acceptance after receipt of face-to-face information.

METHODS

Pregnant women were informed about the benefits of the influenza vaccine and asked if they would get the vaccine.

RESULTS

A total of 353 Turkish women were involved, and 191 (54.1%) accepted influenza vaccination. There was no statistically significant difference in terms of maternal age, body mass index, gravida, number of children, socioeconomic status, smoking and occupation between groups. Women in the third trimester had lower vaccination rates compared to first- and second-trimester pregnancies (35.7% vs. 67.7-64.2%). Women with at least a university degree also had lower vaccine uptake rates (58.1% vs. 59.5-36.8%). While 82.2% of women who accepted vaccination believed the benefit of the vaccine to the baby, the rate was 54.9% in the non-vaccinated group. The most common reason for refusal was the belief that influenza was not a serious disease. Vaccination uptake was higher especially for women who understood the benefits of the influenza vaccine for the baby (OR=3.79, 95%Cl=2.34-6.14).

CONCLUSION

Women who had enough information, who had a lower education level, who had a previous history of influenza infection, and who had decided to have their babies vaccinated were more likely to accept influenza vaccine.

Psychological impact of infectious disease outbreaks on pregnant women: rapid evidence review

Objectives

Infectious disease outbreaks can be distressing for everyone, especially those deemed to be particularly vulnerable such as pregnant women, who have been named a high-risk group in the current COVID-19 pandemic. This paper aimed to summarise existing literature on the psychological impact of infectious disease outbreaks on women who were pregnant at the time of the outbreak.

Study design

The design of this study is a rapid review.

Methods

Five databases were searched for relevant literature, and main findings were extracted.

Results

Thirteen articles were included in the review. The following themes were identified: negative emotional states; living with uncertainty; concerns about infection; concerns about and uptake of prophylaxis or treatment; disrupted routines; non-pharmaceutical protective behaviours; social support; financial and occupational concerns; disrupted expectations of birth, prenatal care and postnatal care and sources of information.

Conclusions

Pregnant women have unique needs during infectious disease outbreaks and could benefit from up-to-date, consistent information and guidance; appropriate support and advice from healthcare professionals, particularly with regards to the risks and benefits of prophylaxis and treatment; virtual support groups and designating locations or staff specifically for pregnant women.

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Pregnant women may be particularly susceptible to distress during pandemics.

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Infection fears and prophylaxis concerns may exacerbate distress.

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Disrupted routines, financial concerns and uncertainty are also stressors.

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Disrupted expectations of birth and related healthcare may be distressing.

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Pregnant women may benefit from clear information/guidance and support groups.

Factors that influence vaccination decision-making among pregnant women: A systematic review and meta-analysis

BACKGROUND

The most important factor influencing maternal vaccination uptake is healthcare professional (HCP) recommendation. However, where data are available, one-third of pregnant women remain unvaccinated despite receiving a recommendation. Therefore, it is essential to understand the significance of other factors and distinguish between vaccines administered routinely and during outbreaks. This is the first systematic review and meta-analysis (PROSPERO: CRD 42019118299) to examine the strength of the relationships between identified factors and maternal vaccination uptake.

METHODS

We searched MEDLINE, Embase Classic & Embase, PsycINFO, CINAHL Plus, Web of Science, IBSS, LILACS, AfricaWideInfo, IMEMR, and Global Health databases for studies reporting factors that influence maternal vaccination. We used random-effects models to calculate pooled odds ratios (OR) of being vaccinated by vaccine type.

FINDINGS

We screened 17,236 articles and identified 120 studies from 30 countries for inclusion. Of these, 49 studies were eligible for meta-analysis. The odds of receiving a pertussis or influenza vaccination were ten to twelve-times higher among pregnant women who received a recommendation from HCPs. During the 2009 influenza pandemic an HCP recommendation increased the odds of antenatal H1N1 vaccine uptake six times (OR 6.76, 95% CI 3.12-14.64, I2 = 92.00%). Believing there was potential for vaccine-induced harm had a negative influence on seasonal (OR 0.22, 95% CI 0.11-0.44 I2 = 84.00%) and pandemic influenza vaccine uptake (OR 0.16, 95% CI 0.09-0.29, I2 = 89.48%), reducing the odds of being vaccinated five-fold. Combined with our qualitative analysis the relationship between the belief in substantial disease risk and maternal seasonal and pandemic influenza vaccination uptake was limited.

CONCLUSIONS

The effect of an HCP recommendation during an outbreak, whilst still powerful, may be muted by other factors. This requires further research, particularly when vaccines are novel. Public health campaigns which centre on the protectiveness and safety of a maternal vaccine rather than disease threat alone may prove beneficial.

Does the availability of influenza vaccine at prenatal care visits and of immediate vaccination improve vaccination coverage of pregnant women?

Introduction

Although vaccination against influenza is recommended for pregnant women in France because it exposes them to a risk of death and severe respiratory complications, their vaccination coverage in 2016 was estimated at 7%. This study's principal objective was to assess the association between the availability of influenza vaccination at prenatal care visits and vaccination coverage.

Material and methods

This multicenter survey took place in 3 Paris-area public hospital (AP-HP) maternity wards (A, B, and C). Only maternity ward A offered the vaccine and vaccination without charge at prenatal visits. Data were collected from parturients during 10 days in January 2017 by a self-administered anonymous questionnaire.

Results

Data from 248 women showed overall vaccination coverage of 19.4% (48/248): 35.4% (46/130) in maternity unit A, 2.7% (2/75) in B, and 0% (0/43) in C (P<0.01). After adjustment for socio-demographic characteristics, women at maternity ward A were significantly more likely to be vaccinated than those at B and C (aOR 25.52, 95%CI [5.76–113.10]). Other factors significantly associated with higher vaccination coverage were the mother’s French birth (aOR 2.37 CI [1.03–5.46]) and previous influenza vaccination (aOR 3.13, 95%CI [1.25–7.86]). Vaccinated women generally considered they had received adequate information (aOR 4.15 CI [2.10–8.22]), principally from the professional providing their prenatal care. Nonvaccination was attributed to the absence of an offer of vaccination (81.5%), fear of fetal side effects (59.5%), and inadequate information (51.4%).

Conclusion

Our results show that availability of influenza vaccination, free of charge, at prenatal consultations at the maternity ward increases vaccination coverage significantly.

A Systematic Review of Barriers to Vaccination During Pregnancy in the Canadian Context

OBJECTIVE

Although vaccination in pregnancy has the potential to affect maternal and infant morbidity and mortality dramatically, uptake of recommended vaccinations in pregnancy remains low. The objective of this study was to identify barriers and facilitators of vaccination during pregnancy in Canada.

METHODS

The Medline database and the tables of contents of four relevant Canadian journals were screened to identify all studies that considered barriers and/or facilitators to vaccination during pregnancy, specifically in Canadian settings. Citations were screened, and a narrative synthesis of findings was undertaken given the heterogeneity of study design.

RESULTS

In total, 17 studies met inclusion criteria, most with a focus on the seasonal and pandemic influenza vaccines. Facilitators and barriers were identified at the level of the patient and the provider. At both levels, knowledge was an important facilitator of vaccine acceptance during pregnancy and was notably improved in studies following the 2009 pandemic H1N1 influenza outbreak compared with earlier studies. Vaccine endorsement by a prenatal care provider and clear messages of safety for the fetus emerged as key motivators. Few studies addressed system-level barriers or interventions for improving vaccine uptake during pregnancy in the Canadian setting.

CONCLUSION

Common themes have emerged from the Canadian literature addressing barriers and facilitators of vaccination during pregnancy. However, there is a paucity of literature to suggest strategies to improve the uptake of vaccination during pregnancy in Canadian settings. Further research is urgently needed given the expanding role of vaccination during routine prenatal care.

The swine flu vaccine, public attitudes, and researcher interpretations: a systematic review of qualitative research

BACKGROUND

During pandemics, health authorities may be uncertain about the spread and severity of the disease and the effectiveness and safety of available interventions. This was the case during the swine flu (H1N1) pandemic of 2009-2010, and governments were forced to make decisions despite these uncertainties. While many countries chose to implement wide scale vaccination programmes, few accomplished their vaccination goals. Many research studies aiming to explore barriers and facilitators to vaccine uptake have been conducted in the aftermath of the pandemic, including several qualitative studies.

AIMS

1. To explore public attitudes to the swine flu vaccine in different countries through a review of qualitative primary studies. 2. To describe and discuss the implications drawn by the primary study authors.

METHODS

Systematic review of qualitative research studies, using a broadly comparative cross case-study approach. Study quality was appraised using an adaptation of the Critical Appraisal Skills Programme (CASP) quality assessment tool.

RESULTS

The review indicates that the public had varying opinions about disease risk and prevalence and had concerns about vaccine safety. Most primary study authors concluded that participants were uninformed, and that more information about the disease and the vaccine would have led to an increase in vaccine uptake. We find these conclusions problematic. We suggest instead that people's questions and concerns were legitimate given the uncertainties of the situation at the time and the fact that the authorities did not have the necessary information to convince the public. Our quality assessment of the included studies points to a lack of reflexivity and a lack of information about study context. We suggest that these study weaknesses are tied to primary study authors' lack of acknowledgement of the uncertainties surrounding the disease and the vaccine.

CONCLUSION

While primary study authors suggest that authorities could increase vaccine uptake through increased information, we suggest instead that health authorities should be more transparent in their information and decision-making processes in future pandemic situations.

Risk perception in pregnancy: a concept analysis

AIM

To report an analysis of the concept of risk perception in pregnancy.

BACKGROUND

Pregnant women are increasingly exposed to the view that pregnancy and childbirth are intrinsically dangerous, requiring medical monitoring and management. Societal pressures are applied to women that dictate appropriate behaviours during pregnancy. These changes have resulted in increased perception of risk for pregnant women.

DESIGN

Walker and Avant's method was selected to guide this analysis.

DATA SOURCES

Peer-reviewed articles published in English from CINAHL, Scopus, PubMed and Psychinfo. No date limits were applied.

METHODS

Thematic analysis was conducted on 79 articles. Attributes, antecedents and consequences of the concept were identified.

RESULTS

The attributes of the concept are the possibility of harm to mother or infant and beliefs about the severity of the risk state. The physical condition of pregnancy combined with the cognitive ability to perceive a personal risk state is antecedents. Risk perception in pregnancy influences women's affective state and has an impact on decision-making about pregnancy and childbirth. There are limited empirical referents with which to measure the concept.

CONCLUSION

Women today know more about their developing infant than at any other time in history; however, this has not led to a sense of reassurance. Nurses and midwives have a critical role in assisting pregnant women, and their families make sense of the information they are exposed to. An understanding of the complexities of the concept of risk perception in pregnancy may assist in enabling nurses and midwives to reaffirm the normalcy of pregnancy.

A qualitative study of vaccine acceptability and decision making among pregnant women in Morocco during the A (H1N1) pdm09 pandemic

Vaccination uptake of pregnant women in Morocco during the A (H1N1) pdm09 pandemic was lower than expected. A qualitative study using open-ended questions was developed to explore the main determinants of acceptance and non-acceptance of the monovalent A (H1N1) pdm09 vaccine among pregnant women in Morocco and to identify information sources that influenced their decision-making process. The study sample included 123 vaccinated and unvaccinated pregnant women who were in their second or third trimester between December 2009 and March 2010. They took part in 14 focus group discussions and eight in-depth interviews in the districts of Casablanca and Kenitra. Thematic qualitative analysis identified reasons for vaccine non-acceptance: (1) fear of the monovalent A (H1N1) pdm09 vaccine, (2) belief in an A (H1N1) pdm09 pandemic conspiracy, (3) belief in the inapplicability of the monovalent A (H1N1) pdm09 vaccine to Moroccans, (4) lack of knowledge of the monovalent A (H1N1) pdm09 vaccine, and (5) challenges of vaccination services/logistics. Reasons for vaccine acceptance included: (1) perceived benefits and (2) modeling. Decision-making was strongly influenced by family, community, mass media, religious leaders and health providers suggesting that broad communication efforts should also be used to advocate for vaccination. Meaningful communication for future vaccine campaigns must consider these context-specific findings. As cultural and religious values are shared across many Arab countries, these findings may also provide valuable insights for seasonal influenza vaccine planning in the Middle East and North Africa region at large.

Determinants of uptake of influenza vaccination among pregnant women - a systematic review

BACKGROUND

Pregnant women have the highest priority for seasonal influenza vaccine. However, suboptimal coverage has been repeatedly noted in this population. To improve vaccine uptake, reviewing the determinants of vaccination is of increasing importance.

METHODS

A detailed literature search was performed up to November 30, 2013 to retrieve articles related to uptake of influenza vaccination during pregnancy.

RESULTS

Forty-five research papers were included in the review. Twenty-one studies assessed the coverage of seasonal influenza vaccination, 13 studies assessed coverage of A/H1N1 pandemic vaccination and 11 studies assessed both. Vaccination uptake ranged from 1.7% to 88.4% for seasonal influenza, and from 6.2% to 85.7% for A/H1N1 pandemic influenza. Many pregnant women were unaware that they were at high risk for influenza and its complications during pregnancy. They were also more likely to underestimate the threat of influenza to themselves and their fetus. Moreover, they had substantial concerns about the safety and efficacy of the influenza vaccine during pregnancy. Negative media reports contributed to the perception that influenza vaccination during pregnancy was risky and could result in adverse pregnancy outcomes. Although health care providers' (HCPs) recommendations were consistently associated with vaccine uptake, most did not recommend the vaccine to their pregnant clients.

CONCLUSIONS

Influenza vaccination uptake among pregnant women is suboptimal and HCPs rarely recommend it. Positive vaccination recommendations from HCPs as well as direct access to the vaccine would likely substantially improve vaccination acceptance.

Factors Associated With H1N1 Influenza Vaccine Receipt in a High-Risk Population During the 2009-2010 H1N1 Influenza Pandemic

BACKGROUND

Persons with spinal cord injuries and disorders (SCI/D) are at high risk for respiratory complications from influenza. During pandemic situations, where resources may be scarce, uncertainties may arise in veterans with SCI/D.

OBJECTIVE

To describe concerns, knowledge, and perceptions of information received during the 2009-2010 H1N1 influenza pandemic and to examine variables associated with H1N1 vaccine receipt.

METHODS

In August 2010, a cross-sectional survey was mailed to a national sample of veterans with traumatic and nontraumatic SCI/D.

RESULTS

During the pandemic, 58% of veterans with SCI/D received the H1N1 vaccine. Less than two-thirds of non-H1N1 vaccine recipients indicated intentions to get the next season's influenza vaccine. Being ≥50 years of age and depressed were significantly associated with higher odds of H1N1 vaccination. Being worried about vaccine side effects was associated with lower odds of H1N1 receipt. Compared to individuals who reported receiving an adequate amount of information about the pandemic, those who received too little information had significantly lower odds of receiving the H1N1 vaccine. Those who received accurate/clear information (vs confusing/conflicting) had 2 times greater odds of H1N1 vaccine receipt.

CONCLUSIONS

H1N1 influenza vaccination was low in veterans with SCI/D. Of H1N1 vaccine nonrecipients, only 63% intend to get a seasonal vaccine next season. Providing an adequate amount of accurate and clear information is vital during uncertain times, as was demonstrated by the positive associations with H1N1 vaccination. Information-sharing efforts are needed, so that carry-over effects from the pandemic do not avert future healthy infection prevention behaviors.

Participation of ICUs in critical care pandemic research: a province wide, cross-sectional survey

OBJECTIVE

Little information exists to identify barriers to participation in pandemic research involving critically ill patients. We sought to characterize clinical research activity during the recent influenza A pandemic and to understand the experiences, beliefs, and practices of key stakeholders involved in pandemic research implementation.

DESIGN

Cross-sectional, provincial postal questionnaire.

SETTING

Level III ICUs.

PARTICIPANTS

ICU administrators and research coordinators.

MEASUREMENTS

We used rigorous survey methodology to identify potential respondents and to develop, test, and administer two-related questionnaires.

MAIN RESULTS

We analyzed responses from 39 research coordinators and 139 administrators (response rates: 70.9% and 73.2%, respectively). Compared with non-influenza A studies, influenza A studies were less likely to be randomized trials and most often investigator-initiated and peer-review funded. Whereas both respondent groups felt that pandemic research would be helpful in providing care during future pandemics, research coordinators placed significantly greater importance on their ICU's participation in pandemic research. Both respondent groups expressed a need for rapid approval processes, designated funding for research personnel, adequate funding for start-up and patient screening, preapproved template protocols and consent forms, and clearer guidance regarding co-enrollment. Research coordinators acknowledged a need for alternative consent models to increase their capacity to participate in future pandemic research. More administrators expressed willingness to participate in the next pandemic if the required research resources were made available to them.

CONCLUSIONS

Whereas research personnel and administrators support participation in pandemic ICU research, several modifiable barriers to participation exist. Pandemic research preparedness planning with regulatory bodies and dedicated funding to support research infrastructure, especially in community settings, are required to optimize future pandemic research participation.