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Sienicka A, Pisula A, Pawlik KK, Dobrowolska-Redo A, Kacperczyk-Bartnik J, Romejko-Wolniewicz E. The Obstetrician's Role in Pregnant Women's Decision-Making Process Regarding Influenza and COVID-19 Vaccination. Vaccines (Basel) 2023; 11:1608. [PMID: 37897010 PMCID: PMC10610802 DOI: 10.3390/vaccines11101608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 10/14/2023] [Accepted: 10/16/2023] [Indexed: 10/29/2023] Open
Abstract
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.
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Affiliation(s)
- Agnieszka Sienicka
- Students’ Scientific Group Affiliated to 2nd Department of Obstetrics and Gynecology, Medical University of Warsaw, 00-315 Warsaw, Poland; (A.S.); (K.K.P.)
| | - Agata Pisula
- Students’ Scientific Group Affiliated to 2nd Department of Obstetrics and Gynecology, Medical University of Warsaw, 00-315 Warsaw, Poland; (A.S.); (K.K.P.)
| | - Katarzyna Karina Pawlik
- Students’ Scientific Group Affiliated to 2nd Department of Obstetrics and Gynecology, Medical University of Warsaw, 00-315 Warsaw, Poland; (A.S.); (K.K.P.)
| | - Agnieszka Dobrowolska-Redo
- 2nd Department of Obstetrics and Gynecology, Medical University of Warsaw, 00-315 Warsaw, Poland; (A.D.-R.); (J.K.-B.); (E.R.-W.)
| | - Joanna Kacperczyk-Bartnik
- 2nd Department of Obstetrics and Gynecology, Medical University of Warsaw, 00-315 Warsaw, Poland; (A.D.-R.); (J.K.-B.); (E.R.-W.)
| | - Ewa Romejko-Wolniewicz
- 2nd Department of Obstetrics and Gynecology, Medical University of Warsaw, 00-315 Warsaw, Poland; (A.D.-R.); (J.K.-B.); (E.R.-W.)
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Andraweera PH, Wang B, Danchin M, Blyth C, Vlaev I, Ong J, Dodd J, Couper J, Sullivan TR, Karnon J, Spurrier N, Cusack M, Mordaunt D, Simatos D, Dekker G, Carlson S, Tuckerman J, Wood N, Whop L, Marshall HS. Randomised controlled trials of behavioural nudges delivered through text messages to increase influenza and COVID-19 vaccines among pregnant women (the EPIC study): study protocol. Trials 2023; 24:454. [PMID: 37438776 DOI: 10.1186/s13063-023-07485-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 06/28/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Influenza and COVID-19 infections during pregnancy may have serious adverse consequences for women as well as their infants. However, uptake of influenza and COVID-19 vaccines during pregnancy remains suboptimal. This study aims to assess the effectiveness of a multi-component nudge intervention to improve influenza and COVID-19 vaccine uptake among pregnant women. METHODS Pregnant women who receive antenatal care at five tertiary hospitals in South Australia, Western Australia and Victoria will be recruited to two separate randomised controlled trials (RCTs). Women will be eligible for the COVID-19 RCT is they have received two or less doses of a COVID-19 vaccine. Women will be eligible for the influenza RCT if they have not received the 2023 seasonal influenza vaccine. Vaccination status at all stages of the trial will be confirmed by the Australian Immunisation Register (AIR). Participants will be randomised (1:1) to standard care or intervention group (n = 1038 for each RCT). The nudge intervention in each RCT will comprise three SMS text message reminders with links to short educational videos from obstetricians, pregnant women and midwives and vaccine safety information. The primary outcome is at least one dose of a COVID-19 or influenza vaccine during pregnancy, as applicable. Logistic regression will compare the proportion vaccinated between groups. The effect of treatment will be described using odds ratio with a 95% CI. DISCUSSION Behavioural nudges that facilitate individual choices within a complex context have been successfully used in other disciplines to stir preferred behaviour towards better health choices. If our text-based nudges prove to be successful in improving influenza and COVID-19 vaccine uptake among pregnant women, they can easily be implemented at a national level. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT05613751. Registered on November 14, 2022.
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Affiliation(s)
- Prabha H Andraweera
- Vaccinology and Immunology Research Trials Unit, Women's and Children's Hospital, SA Health, Adelaide, South Australia, Australia
- Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Bing Wang
- Vaccinology and Immunology Research Trials Unit, Women's and Children's Hospital, SA Health, Adelaide, South Australia, Australia
- Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Margie Danchin
- The Royal Children's Hospital, Melbourne, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Christopher Blyth
- Perth Children's Hospital, Perth, Western Australia, Australia
- Department of Paediatrics, The University of Western Australia, Perth, Western Australia, Australia
| | - Ivo Vlaev
- School of Business, Warwick University, Warwick, UK
| | - Jason Ong
- School of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jodie Dodd
- Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Women's and Babies Division, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Jennifer Couper
- Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Division of Paediatrics, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Thomas R Sullivan
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Jonathan Karnon
- Discipline of Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Nicola Spurrier
- Discipline of Paediatrics, Flinders University, Adelaide, South Australia, Australia
- SA Health, South Australian Government, Adelaide, South Australia, Australia
| | - Michael Cusack
- SA Health, South Australian Government, Adelaide, South Australia, Australia
| | - Dylan Mordaunt
- Discipline of Paediatrics, Flinders University, Adelaide, South Australia, Australia
| | - Dimi Simatos
- Discipline of Paediatrics, Lyell McEwin Hospital, Elizabeth Vale, South Australia, Australia
| | - Gus Dekker
- Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Discipline of Women's Health, Lyell McEwin Hospital, Elizabeth Vale, South Australia, Australia
| | - Samantha Carlson
- Department of Paediatrics, The University of Western Australia, Perth, Western Australia, Australia
| | - Jane Tuckerman
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Nicholas Wood
- Discipline of Paediatrics, University of Sydney, Sydney, New South Wales, Australia
- Children's Hospital Westmead, Sydney, New South Wales, Australia
| | - Lisa Whop
- Discipline of Public Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Helen S Marshall
- Vaccinology and Immunology Research Trials Unit, Women's and Children's Hospital, SA Health, Adelaide, South Australia, Australia.
- Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia.
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia.
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McHugh L, Regan AK, Sarna M, Moore HC, Van Buynder P, Pereira G, Blyth CC, Lust K, Andrews RM, Crooks K, Massey P, Binks MJ. Inequity of antenatal influenza and pertussis vaccine coverage in Australia: the Links2HealthierBubs record linkage cohort study, 2012-2017. BMC Pregnancy Childbirth 2023; 23:314. [PMID: 37150828 PMCID: PMC10164451 DOI: 10.1186/s12884-023-05574-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 04/04/2023] [Indexed: 05/09/2023] Open
Abstract
BACKGROUND Pregnancy and early infancy are increased risk periods for severe adverse effects of respiratory infections. Aboriginal and/or Torres Strait Islander (respectfully referred to as First Nations) women and children in Australia bear a disproportionately higher burden of respiratory diseases compared to non-Indigenous women and infants. Influenza vaccines and whooping cough (pertussis) vaccines are recommended and free in every Australian pregnancy to combat these infections. We aimed to assess the equity of influenza and/or pertussis vaccination in pregnancy for three priority groups in Australia: First Nations women; women from culturally and linguistically diverse (CALD) backgrounds; and women living in remote areas or socio-economic disadvantage. METHODS We conducted individual record linkage of Perinatal Data Collections with immunisation registers/databases between 2012 and 2017. Analysis included generalised linear mixed model, log-binomial regression with a random intercept for the unique maternal identifier to account for clustering, presented as prevalence ratios (PR) and 95% compatibility intervals (95%CI). RESULTS There were 445,590 individual women in the final cohort. Compared with other Australian women (n = 322,848), First Nations women (n = 29,181) were less likely to have received both recommended antenatal vaccines (PR 0.69, 95% CI 0.67-0.71) whereas women from CALD backgrounds (n = 93,561) were more likely to have (PR 1.16, 95% CI 1.10-1.13). Women living in remote areas were less likely to have received both vaccines (PR 0.75, 95% CI 0.72-0.78), and women living in the highest areas of advantage were more likely to have received both vaccines (PR 1.44, 95% CI 1.40-1.48). CONCLUSIONS Compared to other groups, First Nations Australian families, those living in remote areas and/or families from lower socio-economic backgrounds did not receive recommended vaccinations during pregnancy that are the benchmark of equitable healthcare. Addressing these barriers must remain a core priority for Australian health care systems and vaccine providers. An extension of this cohort is necessary to reassess these study findings.
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Affiliation(s)
- Lisa McHugh
- School of Public Health, Division of Medicine, University of Queensland, Brisbane, Qld, 4001, Australia.
| | - Annette K Regan
- Curtin School of Population Health, Curtin University, Perth, WA, Australia
- School of Nursing and Health Professions, University of San Francisco, San Francisco, CA, USA
- Wesfarmers Centre for Vaccines & Infectious Diseases, Telethon Kids Institute, Perth, WA, Australia
| | - Mohinder Sarna
- Curtin School of Population Health, Curtin University, Perth, WA, Australia
- Wesfarmers Centre for Vaccines & Infectious Diseases, Telethon Kids Institute, Perth, WA, Australia
| | - Hannah C Moore
- Curtin School of Population Health, Curtin University, Perth, WA, Australia
- Wesfarmers Centre for Vaccines & Infectious Diseases, Telethon Kids Institute, Perth, WA, Australia
| | - Paul Van Buynder
- School of Medicine and Dentistry, Griffith University, Southport, QLD, Australia
| | - Gavin Pereira
- Curtin School of Population Health, Curtin University, Perth, WA, Australia
- enAble Institute, Curtin University, Perth, WA, Australia
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Christopher C Blyth
- Wesfarmers Centre for Vaccines & Infectious Diseases, Telethon Kids Institute, Perth, WA, Australia
- School of Medicine, The University of Western Australia, Perth, WA, Australia
- Department of Paediatric Infectious Diseases, Perth Children's Hospital, Perth, WA, Australia
- Department of Microbiology, PathWest Laboratory Medicine, Perth, WA, Australia
| | - Karin Lust
- Women's and Newborn Service, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
- Department of Medicine, The University of Queensland, Brisbane Queensland, Australia
| | - Ross M Andrews
- Australian National University Canberra, Canberra, Australia
| | - Kristy Crooks
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Peter Massey
- College of Medicine and Dentistry, James Cook University, Queensland, Australia
| | - Michael J Binks
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
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Dahlen HG, Homer C, Boyle J, Lequertier B, Kildea S, Agho KE. Vaccine intention and hesitancy among Australian women who are currently pregnant or have recently given birth: the Birth in the Time of COVID-19 (BITTOC) national online survey. BMJ Open 2023; 13:e063632. [PMID: 37041048 PMCID: PMC10111185 DOI: 10.1136/bmjopen-2022-063632] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/13/2023] Open
Abstract
OBJECTIVE To examine the prevalence of COVID-19 vaccination, and factors associated with vaccination intention and hesitancy in pregnant and postnatal women in Australia. DESIGN AND SETTING A national online survey was conducted over 6 months between 31 August 2021 and 1 March 2022 and responses to vaccination status were categorised as: 'vaccinated', 'vaccine intended' and 'vaccine hesitant'. The data were weighted to reflect the proportion of women of reproductive age. Potential confounding variables were examined using multinomial logistic regression analyses, and all comparisons were made against vaccinated pregnant and postnatal women. PARTICIPANTS 2140 women responded to the survey (838 pregnant; 1302 recently post partum). RESULTS Amongst pregnant women, 586 (69.9%) were vaccinated, 166 (19.8%) indicated intention and 86 (10.3%) were hesitant. In postnatal women, this was 1060 (81.4%), 143 (11.0%) and 99 (7.6%), respectively. Only 52 (6.2%) of pregnant women stated never wanting a COVID-19 vaccine. Vaccine hesitancy increased over time, and for pregnant women was associated with: living in a state other than New South Wales (NSW) (Adjusted Relative Risk (ARR) 2.77, 95%CI: 1.68-4.56 for vaccine intention and ARR=3.31, 95%CI: 1.52-7.20 for vaccine hesitancy), younger age <30 years, not having a university education, income <80K AUD, gestation <28 weeks, having no pregnancy risk factors, and being less satisfied with life (ARR=2.20, 95%CI: 1.04-4.65 for vaccine intention and ARR=2.53, 95%CI: 1.02-6.25 for vaccine hesitancy) . For postnatal women: living in a state other than NSW or Victoria, income <80K AUD and having private obstetric care (ARR=2.06, 95%CI: 1.23-3.46) were significantly associated with vaccine hesitancy. CONCLUSIONS Around 1 in 10 pregnant women and just over 1 in 13 postnatal women reported vaccine hesitancy in this Australian survey, and hesitancy was higher in the latter 3-month period. Tailored messages to younger mothers and those from lower-middle socioeconomic groups, alongside advice from midwives and obstetricians, could help to reduce hesitancy among pregnant and postnatal women. Financial incentives may help to facilitate COVID-19 vaccine uptake. A real-time surveillance system and additional pregnancy fields added to the Australian immunisation register would support the safety monitoring of multiple vaccines in pregnancy and may build confidence.
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Affiliation(s)
- Hannah G Dahlen
- School of Nursing and Midwifery, Western Sydney University, Penrith South, New South Wales, Australia
| | - Caroline Homer
- Burnet Institute, Melbourne, Victoria, Australia
- Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Jacqueline Boyle
- School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Belinda Lequertier
- Molly Wardaguga Research Centre, Charles Darwin University College of Nursing & Midwifery, Casuarina, Northern Territory, Australia
| | - Sue Kildea
- Molly Wardaguga Research Centre, Charles Darwin University College of Nursing & Midwifery, Casuarina, Northern Territory, Australia
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Mchugh L, Van Buynder P, Sarna M, Andrews RM, Moore HC, Binks MJ, Pereira G, Blyth CC, Lust K, Foo D, Regan AK. Timing and temporal trends of influenza and pertussis vaccinations during pregnancy in three Australian jurisdictions: The Links2HealthierBubs population-based linked cohort study, 2012-2017. Aust N Z J Obstet Gynaecol 2023; 63:27-33. [PMID: 35696340 PMCID: PMC10952684 DOI: 10.1111/ajo.13548] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 05/09/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Antenatal inactivated influenza (IIV) and pertussis-containing vaccines (dTpa) offer protection against severe respiratory infections for pregnant women and infants <6 months of age. Both vaccines are recommended in pregnancy; however, little is known about temporal or jurisdictional trends and predictors of uptake. AIMS To identify gaps and predictors of IIV and/or dTpa vaccinations in Australian pregnancies from 2012 to 2017. MATERIALS AND METHODS We conducted a probabilistically linked, multi-jurisdictional population-based cohort study, drawing from perinatal data collections and immunisation databases. We used a generalised linear mixed model with a random effect term to account for clustering of multiple pregnancies within mothers, to calculate vaccination uptake, and identify predictors of uptake by maternal demographic, pregnancy, and health characteristics. RESULTS Of 591 868 unique pregnancies, IIV uptake was 15%, dTpa 27% and 12% received both vaccines. Pertussis vaccinations in First Nations pregnancies were 20% lower than non-Indigenous pregnancies; dTpa was strongly associated with IIV uptake (risk ratio (RR): 8.60, 95% CI 8.48-8.73). This trend was temporally and jurisdictionally consistent. First Nations women were more likely to have had IIV in pregnancy before the introduction of dTpa in the pregnancy program: (RR: 1.48, 95% CI 1.40-1.57), but less likely after dTpa implementation (RR: 0.78, 95% CI 0.76-0.80). CONCLUSIONS Inequity in vaccine uptake between First Nations and non-Indigenous pregnancies, and dismal rates of vaccination in pregnancy overall need urgent review, particularly before the next influenza pandemic or pertussis outbreak. If antenatal dTpa is driving IIV uptake, changes in antenatal healthcare practices are needed to ensure vaccines are offered equitably and optimally to protect against infection.
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Affiliation(s)
- Lisa Mchugh
- School of Public HealthUniversity of QueenslandBrisbaneQueenslandAustralia
| | - Paul Van Buynder
- School of Medicine and DentistryGriffith UniversitySouthportQueenslandAustralia
| | - Mohinder Sarna
- Curtin School of Population HealthCurtin UniversityPerthWestern AustraliaAustralia
- Wesfarmers Centre for Vaccines & Infectious DiseasesTelethon Kids InstitutePerthWestern AustraliaAustralia
| | - Ross M. Andrews
- Australian National UniversityCanberraAustralian Capital TerritoryAustralia
| | - Hannah C. Moore
- Curtin School of Population HealthCurtin UniversityPerthWestern AustraliaAustralia
- Wesfarmers Centre for Vaccines & Infectious DiseasesTelethon Kids InstitutePerthWestern AustraliaAustralia
| | - Michael J. Binks
- Menzies School of Health ResearchDarwinNorthern TerritoryAustralia
| | - Gavin Pereira
- Curtin School of Population HealthCurtin UniversityPerthWestern AustraliaAustralia
- Wesfarmers Centre for Vaccines & Infectious DiseasesTelethon Kids InstitutePerthWestern AustraliaAustralia
- enAble InstituteCurtin UniversityPerthWestern AustraliaAustralia
- Centre for Fertility and Health (CeFH)Norwegian Institute of Public HealthOsloNorway
| | - Christopher C. Blyth
- Wesfarmers Centre for Vaccines & Infectious DiseasesTelethon Kids InstitutePerthWestern AustraliaAustralia
- School of MedicineThe University of Western AustraliaPerthWestern AustraliaAustralia
- Department of Paediatric Infectious DiseasesPerth Children's HospitalPerthWestern AustraliaAustralia
- Department of MicrobiologyPathWest Laboratory MedicinePerthWestern AustraliaAustralia
| | - Karin Lust
- Women's and Newborn ServiceRoyal Brisbane and Women's HospitalBrisbaneQueenslandAustralia
- Department of MedicineThe University of QueenslandBrisbaneQueenslandAustralia
| | - Damien Foo
- Curtin School of Population HealthCurtin UniversityPerthWestern AustraliaAustralia
- Wesfarmers Centre for Vaccines & Infectious DiseasesTelethon Kids InstitutePerthWestern AustraliaAustralia
| | - Annette K. Regan
- Curtin School of Population HealthCurtin UniversityPerthWestern AustraliaAustralia
- Wesfarmers Centre for Vaccines & Infectious DiseasesTelethon Kids InstitutePerthWestern AustraliaAustralia
- School of Nursing and Health ProfessionsUniversity of San FranciscoSan FranciscoCaliforniaUSA
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Hebballi NB, Parker T, Garcia EI, Ferguson DM, Lesser S, Tsao K, Broussard M, Wootton SH. Pertussis and influenza immunization: perceived attitude and decision of postpartum patients. BMC Pregnancy Childbirth 2022; 22:975. [PMID: 36577947 PMCID: PMC9795743 DOI: 10.1186/s12884-022-05296-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 12/08/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Vaccination of pregnant patients with tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) and influenza vaccine during influenza season can reduce maternal and fetal morbidity and mortality; nevertheless, vaccination rates remain suboptimal in this patient population. To investigate the effect of a brief educational counseling session on maternal Tdap and influenza vaccination and determine factors influencing women's decision in regards to receiving Tdap and or influenza vaccine during their pregnancy. METHODS A face-to-face semi-structured cross-sectional survey was administered to postpartum patients on their anticipated day of discharge (June 11-August 21, 2018). A brief educational counseling session about maternal pertussis and Tdap vaccine was provided to interested patients after which the Tdap vaccine was offered to eligible patients who did not receive it during their pregnancy or upon hospital admission. Medical records were reviewed to determine if surveyed patients were vaccinated prior to discharge. RESULTS Two hundred postpartum patients were surveyed on their day of anticipated discharge. Of those who were surveyed, 103 (51.5%) had received Tdap and 80 (40.0%) had received influenza vaccinations prior to hospitalization. Among immunized patients, the common facilitators were doctor's recommendation (Tdap: 68, 54.4%; influenza: 3, 6.0%), to protect their baby (Tdap: 57, 45.6%; influenza: 17, 34.0%) and for self-protection (Tdap: 17, 13.6%; Influenza: 17, 34.0%). Of the 119 participants who had not received either Tdap or influenza vaccine prior to the survey, the barriers cited were that the vaccine was not offered by the provider (Tdap: 36, 52.2%; influenza: 29, 27.6%), belief that vaccination was unnecessary (Tdap: 5, 7.2%; influenza: 9, 8.5%), safety concerns for baby (Tdap: 4, 5.8%; influenza: 2, 1.9%). Of 97 patients who were not immunized with Tdap prior to admission but were eligible to receive vaccine, 24 (25%) were vaccinated prior to survey as part of routine hospital-based screening and vaccination program, 29 (38.2%) after our survey. CONCLUSION Interventions to educate pregnant patients about the benefits of vaccination for their baby, addressing patient safety concerns, and vaccine administration in obstetricians' offices may significantly improve maternal vaccination rates.
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Affiliation(s)
- Nutan B. Hebballi
- grid.267308.80000 0000 9206 2401Department of Pediatric Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, 6410 Fannin St., Suite 471, Houston, TX 77030 USA
| | - Tayler Parker
- grid.267308.80000 0000 9206 2401Department of Internal Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX USA
| | - Elisa I. Garcia
- grid.267308.80000 0000 9206 2401Department of Pediatric Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, 6410 Fannin St., Suite 471, Houston, TX 77030 USA
| | - Dalya M. Ferguson
- grid.267308.80000 0000 9206 2401Department of Pediatric Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, 6410 Fannin St., Suite 471, Houston, TX 77030 USA
| | - Susan Lesser
- grid.267308.80000 0000 9206 2401Department of Pediatric Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, 6410 Fannin St., Suite 471, Houston, TX 77030 USA
| | - KuoJen Tsao
- grid.267308.80000 0000 9206 2401Department of Pediatric Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, 6410 Fannin St., Suite 471, Houston, TX 77030 USA ,grid.430695.d0000 0004 0444 5322Children’s Memorial Hermann Hospital, Houston, TX USA
| | - Maryam Broussard
- grid.267308.80000 0000 9206 2401Department of Pediatric Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, 6410 Fannin St., Suite 471, Houston, TX 77030 USA
| | - Susan H. Wootton
- grid.430695.d0000 0004 0444 5322Children’s Memorial Hermann Hospital, Houston, TX USA ,grid.267308.80000 0000 9206 2401Department of Pediatrics, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX USA
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Homer CSE, Javid N, Wilton K, Bradfield Z. Vaccination in pregnancy: The role of the midwife. Front Glob Womens Health 2022; 3:929173. [PMID: 36353468 PMCID: PMC9637860 DOI: 10.3389/fgwh.2022.929173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 10/07/2022] [Indexed: 11/14/2022] Open
Abstract
Midwives are the front-line workers providing maternity care for women in many countries. The role of the midwife includes providing information about, and recommendations for, maternal vaccination in pregnancy and for the baby in the postnatal period. Vaccinations recommended in pregnancy include those to prevent influenza, pertussis, tetanus and now COVID-19. Vaccinations for the newborn baby include hepatitis B. Healthcare professionals play an important role in influencing decision-making around vaccination and midwives are key in supporting vaccination uptake. Midwives are strong influencer in women's decisions around vaccination for themselves and their babies. The COVID-19 vaccination programs have shone a light on vaccination in pregnancy especially as SARS-COV-2 infection has significant adverse effects in pregnancy. COVID-19 vaccination has been shown to be safe and effective in pregnancy. Despite this, there is vaccine hesitancy from pregnant women in many countries. Midwives play a unique role in the provision of care to women and families but they need specific support and information regarding vaccination in pregnancy. Targeted education, supportive mentoring and supervision and opportunities to lead innovative ways of ensuring vaccine access is logistically easy and possible are all needed. This Commentary outlines the key vaccinations recommended in pregnancy including COVID-19 vaccination and highlights some strategies to scale-up vaccination programs in pregnancy with a particular focus on the role of midwives.
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Affiliation(s)
- Caroline S. E. Homer
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC, Australia,Faculty of Health, Universityof Technology Sydney, Sydney, NSW, Australia,Correspondence: Caroline S. E. Homer
| | - Nasrin Javid
- Faculty of Health, Universityof Technology Sydney, Sydney, NSW, Australia,Nursing and Midwifery Research Alliance, South West Sydney Local Health District, Liverpool, NSW, Australia
| | - Kellie Wilton
- Australian College of Midwives, Canberra, ACT, Australia
| | - Zoe Bradfield
- Faculty of Health Sciences, King Edward Memorial Hospital and Curtin University, Perth, WA, Australia
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El-Heneidy A, Grimwood K, Lambert SB, Sarna M, Ware RS. Association between vaccination status, symptom identification and healthcare use: Implications for test negative design observational studies. Vaccine 2022; 40:1918-1923. [PMID: 35216842 DOI: 10.1016/j.vaccine.2022.02.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 12/10/2021] [Accepted: 02/09/2022] [Indexed: 11/16/2022]
Abstract
AIM To test the internal validity of the test-negative design (TND) by investigating associations between maternal influenza vaccination, and new virus detection episodes (VDEs), acute respiratory illness, and healthcare visits in their children. METHODS Eighty-five children from a birth cohort provided daily symptoms, weekly nasal swabs, and healthcare use data until age 2-years. Effect estimates are summarised as incidence rate ratios (IRR). RESULTS There was no association between maternal vaccination and VDEs in children (IRR = 1.1; 95 %CI = 0.9-1.2). Influenza-vaccinated mothers were more likely than unvaccinated mothers to both report, and seek healthcare for, acute lower respiratory illness in their children, IRR = 2.4; 95 %CI = 1.2-4.8 and IRR = 2.2; 95 %CI = 1.1-4.3, respectively. CONCLUSION A key assumption of the TND, that healthcare seeking behaviour for conditions of the same severity is not associated with vaccine receipt, did not hold. Further studies of the performance of the TND in different populations are required to confirm its validity.
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Affiliation(s)
- Asmaa El-Heneidy
- School of Medicine and Dentistry and Menzies Health Institute Queensland, Griffith University, Parklands Drive, Gold Coast, QLD 4222, Australia.
| | - Keith Grimwood
- School of Medicine and Dentistry and Menzies Health Institute Queensland, Griffith University, Parklands Drive, Gold Coast, QLD 4222, Australia; Departments of Paediatrics and Infectious Diseases, Gold Coast Health, Gold Coast, QLD 4215, Australia.
| | - Stephen B Lambert
- Child Health Research Centre, The University of Queensland, South Brisbane, QLD 4101, Australia.
| | - Mohinder Sarna
- Curtin School of Population Health, Curtin University, Bentley, WA 6102, Australia; Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, WA 6009, Australia.
| | - Robert S Ware
- School of Medicine and Dentistry and Menzies Health Institute Queensland, Griffith University, Parklands Drive, Gold Coast, QLD 4222, Australia.
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