Incidence rates of influenza illness during pregnancy in Suzhou, China, 2015-2018

Reliability and validity study of the "5Cs" hesitancy scale for maternal influenza vaccination among pregnant and postpartum women

BACKGROUND

Maternal influenza vaccine hesitancy plays a vital role in the low rates of vaccination. However, instruments to appropriately assess perinatal influenza vaccine hesitancy are unavailable. This study aimed to develop the Maternal Influenza Vaccine Hesitancy Scale based on the 5C vaccination hesitancy scale, containing the subscales of confidence, complacency, constraints, calculative, and collective responsibility, and to provide a preliminary overview of the current hesitancy on maternal influenza vaccination in China.

METHODS

A cross-sectional survey, from January to March 2024, was carried out among 2035 pregnant and postpartum women from nine provincial-level administrative divisions representing eastern, central, western, and northeastern areas of China. Reliability was evaluated by internal consistency reliability and split-half reliability, and a Cronbach's alpha coefficient > 0.7 was considered acceptable. Construct validity was assessed using confirmatory factor analysis (CFA), with good model fit defined as root mean square error of approximation (RMSEA) < 0.100, normed fit index (NFI) > 0.9, comparative fit index (CFI) > 0.9, and Tucker-Lewis index (TLI) > 0.9.

RESULTS

Confirmatory factor analysis results supported the five-factor structure of the scale (RMESA = 0.098, CFI = 0.921, TLI = 0.903, NFI = 0.918). The Cronbach's alpha coefficients for the scale as well as the subscales ranged from 0.802 to 0.958. Among five subscales, collective responsibility (2.73 ± 0.63) scored highest, while complacency (2.16 ± 0.69) and constraints (2.17 ± 0.69) were the lowest.

CONCLUSIONS

The Maternal Influenza Vaccine Hesitancy Scale developed in this study is a reliable and valid instrument to measure the influenza vaccine hesitancy of pregnant and postpartum women. It is recommended that interventions including health education and improving the access to the vaccination service be carried out to reduce the maternal influenza vaccination hesitancy.

Laboratory-Confirmed Influenza Hospitalizations During Pregnancy or the Early Postpartum Period - Suzhou City, Jiangsu Province, China, 2018-2023

What is already known about this topic?

Pregnancy is associated with increased risk for severe illness and complications attributable to influenza infection. Information about the incidence of influenza hospitalization among pregnant and early postpartum women in China is limited.

What is added by this report?

Population-based data from a large city in southern China estimated the annual influenza hospitalization rate to be 2.1 per 1,000 live births. Among hospitalized pregnant and postpartum women with influenza, 86% were admitted to obstetrics rather than respiratory medicine wards; fewer than one third received antiviral treatment. Influenza vaccination coverage among hospitalized pregnant and postpartum women with influenza was <0.1%.

What are the implications for public health practice?

Increasing vaccination coverage among pregnant women can reduce influenza-associated morbidity. Raising awareness about early detection, treatment, and infection control of influenza in obstetrics wards is needed to reduce the adverse impact of influenza on pregnant women.

Laboratory-Confirmed Influenza Hospitalizations During Pregnancy or the Early Postpartum Period - Suzhou City, Jiangsu Province, China, 2018-2023

Pregnancy is associated with increased risk for severe illness and complications associated with influenza infection. Insufficient knowledge about the risk for influenza among pregnant women and their health care providers in China is an important barrier to increasing influenza vaccination coverage and treating influenza and its complications among pregnant women. Improved influenza incidence estimates might promote wider vaccine acceptance and higher vaccination coverage. In Suzhou, active population-based surveillance during October 2018-September 2023 estimated that the annual rate of hospitalization for acute respiratory or febrile illness (ARFI) among women who were pregnant or <2 weeks postpartum was 11.1 per 1,000 live births; the annual rate of laboratory-confirmed influenza-associated ARFI (influenza ARFI) hospitalization in this group was 2.1 per 1,000 live births. A majority of hospitalized pregnant or early postpartum patients with ARFI (82.6%; 2,588 of 3,133) or influenza ARFI (85.5%; 423 of 495) were admitted to obstetrics wards rather than respiratory medicine wards. Only one (0.03%) pregnant or postpartum ARFI patient had received influenza vaccination, and 31.3% of pregnant or postpartum women hospitalized for influenza ARFI received antiviral treatment; the lowest percentage of hospitalized women with influenza ARFI who received antiviral treatment was among women admitted to obstetrics and gynecology wards (29.6% and 23.1%, respectively), compared with 54.1% of those admitted to a respiratory medicine ward. These findings highlight the risk for influenza and its associated complications among pregnant and postpartum women, the low rates of influenza vaccination among pregnant women, and of antiviral treatment of women with ARFI admitted to obstetrics and gynecology wards. Increasing awareness of the prevalence of influenza ARFI among pregnant women, the use of empiric antiviral treatment for ARFI, and the infection control in obstetrics wards during influenza seasons might help reduce influenza-associated morbidity among pregnant and postpartum women.

SARS-CoV-2 seroprevalence around the world: an updated systematic review and meta-analysis

BACKGROUND

Covid-19 has been one of the major concerns around the world in the last 2 years. One of the challenges of this disease has been to determine its prevalence. Conflicting results of the serology test in Covid explored the need for an updated meta-analysis on this issue. Thus, this systematic review aimed to estimate the prevalence of global SARS-CoV-2 serology in different populations and geographical areas.

METHODS

To identify studies evaluating the seroprevalence of SARS-CoV-2, a comprehensive literature search was performed from international databases, including Medline (PubMed), Web of Sciences, Scopus, EMBASE, and CINHAL.

RESULTS

In this meta-analysis, the results showed that SARS-CoV-2 seroprevalence is between 3 and 15% worldwide. In Eastern Mediterranean, the pooled estimate of seroprevalence SARS-CoV-2 was 15% (CI 95% 5-29%), and in Africa, the pooled estimate was 6% (CI 95% 1-13%). In America, the pooled estimate was 8% (CI 95% 6-11%), and in Europe, the pooled estimate was 5% (CI 95% 4-6%). Also the last region, Western Pacific, the pooled estimate was 3% (CI 95% 2-4%). Besides, we analyzed three of these areas separately. This analysis estimated the prevalence in subgroups such as study population, diagnostic methods, sampling methods, time, perspective, and type of the study.

CONCLUSION

The present meta-analysis showed that the seroprevalence of SARS-CoV-2 has been between 3 and 15% worldwide. Even considering the low estimate of this rate and the increasing vaccination in the world, many people are still susceptible to SARS-CoV-2.

Comprehensive Overview of Vaccination during Pregnancy in Europe

Vaccinations during pregnancy can protect the mother from several infections, thus blocking vertical transmission. Furthermore, through passive antibody transfer, the newborn can be protected against some infections in the first months of life until their own vaccination regimen is initiated and completed at the appropriate age. Pregnancy can be considered a high-risk condition that increases vulnerability to infectious diseases with potentially unfavorable evolution. We present the current knowledge on vaccination during pregnancy in Europe as a useful information source for different health workers involved in prenatal care. Many European countries implement vaccination policies specifically designed for pregnant women, but there is great heterogeneity among programs. Recommendations on vaccination during pregnancy must be based on current high-quality scientific data. The decisions must be made for each individual case, depending on the associated conditions or special circumstances, with a concomitant assessment of the potential benefits and risks to both the pregnant patient and the fetus. Many vaccines are well-tolerated in pregnant women, with no clinically meaningful injection site reactions, systemic symptoms, or vaccine-related serious adverse events.