Knowledge, attitudes, and practices of seasonal influenza vaccination in postpartum women, Honduras

Influenza vaccination hesitancy and related factors among pregnant and breastfeeding women: A cross-sectional study

Achieving safe influenza vaccination coverage among pregnant and breastfeeding women is a global health goal due to the potential risks of serious influenza for both mother and child. However, vaccine hesitancy remains a significant barrier to vaccination uptake. Since anxiety represents a determinant in vaccine decision-making, this study aimed to assess influenza vaccination hesitancy and anxiety levels in this population and to explore the association between women's characteristics, their reluctance, and anxiety levels. A multicentre, cross-sectional study was conducted between February and June 2022 using structured phone interviews to assess: (1) socio-demographics and clinical history; (2) anti-flu vaccination status, previous anti-flu vaccination, and Sars-CoV-2 infection history; (3) insights into influenza vaccination during pregnancy; (4) attitudes toward anti-flu vaccination, using the Vaccination Attitudes Examination (VAX) Scale; (5) anxiety levels, measured by the Self-Rating Anxiety Scale (SAS). Among the 387 participants, 22.8% were already vaccinated or expressed willingness to be vaccinated against influenza, and 54% had an anxiety disorder. While anxiety was not significantly associated with vaccine hesitancy, ongoing pregnancy emerged as an independent predictor of anxiety. Higher educational levels, ongoing pregnancy, already being vaccinated or willingness to get vaccinated, and being employed were associated with reduced vaccine hesitancy, while prior SARS-CoV-2 infection with increased hesitancy. Fear of unpredictable events and lack of healthcare professionals' recommendations emerged as reasons for vaccine reluctance. Given the low coverage rates, these findings highlight the need for health services to enhance vaccination efforts and provide clear recommendations to counter misinformation and ensure accurate vaccine safety information.

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.

Knowledge, attitudes, and practices regarding seasonal influenza vaccination during pregnancy in Costa Rica: A mixed-methods study

BACKGROUND

Influenza increases stillbirth risk, morbidity and mortality in pregnant women. Vaccination protects pregnant women against severe disease and indirectly protects their infants, but coverage among pregnant women remains low worldwide. We aimed to describe knowledge, attitudes, and practices (KAP) regarding seasonal influenza vaccination among postpartum women and prenatal care physicians in Costa Rica.

METHODS

We conducted cross-sectional KAP surveys to women one to three days after childbirth at Costa Rican Social Security Fund maternity hospitals, and obstetricians and general practitioners who provided prenatal care in 2017. Principal components analysis, multiple imputation, and logistic regression were used to examine associations between influenza vaccination and demographics, prenatal care, and sources of information-separately for postpartum women and physicians. We also held two focus groups of six healthcare workers each to further describe vaccination KAP.

RESULTS

We surveyed 642 postpartum women and 146 physicians in maternity hospitals in five Costa Rican provinces of whom 85.5 % (95 % CI: 82.6 %-88.0 %) and 57.9 % (95 % CI: 49.6 %-65.7 %) were vaccinated for influenza, respectively. Factors associated with influenza vaccination for postpartum women included tetanus vaccination (aOR: 3.62, 95 % CI: 1.89-6.92); received vaccination recommendations from clinicians during prenatal check-ups (aOR: 3.39, 95 % CI: 2.06-5.59); had other children in household vaccinated for influenza (aOR: 2.25, 95 % CI: 1.08-4.68); and secondary/university education (aOR: 0.15-0.31) with no formal education as reference. For postpartum women, reasons for vaccination were perceived benefits for mother and infant, whereas not being offered vaccines was most cited for non-vaccination. Most prenatal care physicians recommended influenza vaccines during prenatal check-ups but believed vaccination causes flu-like symptoms.

CONCLUSION

Vaccination campaigns and provisions of free vaccines effectively increased knowledge and coverage among women in Costa Rica. To improve access, women should be offered vaccines during prenatal care appointments. Educating healthcare workers about vaccine benefits for themselves and patients is needed to mitigate safety concerns.

Association between risk perception and influenza vaccine hesitancy for children among reproductive women in China during the COVID-19 pandemic: a national online survey

BACKGROUND

In China, the national prevalence of parental influenza vaccine hesitancy (IVH) during the pandemic of coronavirus disease 2019 (COVID-19), and the association between risk perception and parental IVH are still unclear. We aimed to explore the association between risk perception and IVH for children among reproductive women in China, a poorly studied area.

METHODS

From December 14, 2020, to January 31, 2021, we conducted a national anonymous online survey on IVH for children among reproductive women in China. We assessed risk perception including perceived susceptibility, severity, barriers, and benefits using the Health Belief Model and then classified each variable into three groups based on tertiles. Logistic regression models were used to calculate the adjusted odds ratio (aOR) of risk perception related to vaccine hesitancy after controlling for sociodemographic characteristics, health status, and knowledge of influenza, among other factors. Additionally, subgroup analysis was performed.

RESULTS

Among 3,011 reproductive women, 9.13% reported IVH. In multivariable models, vaccine hesitancy was associated with low perceived susceptibility (aOR = 2.55, 95% CI: 1.79-3.65), higher perceived barriers (moderate: aOR = 1.47, 95% CI: 1.04-2.08; high: aOR = 2.20, 95% CI: 1.47-3.30), and low perceived benefit (moderate: aOR = 1.40, 95% CI: 1.03-1.92; low: aOR = 2.10, 95% CI: 1.43-3.07). Subgroup analysis showed that vaccine hesitancy was more likely to occur among women with high perceived barriers aged < 30 years compared with those older than 30 years (P for difference = 0.041) and among women with moderate perceived benefit who had never conceived compared with those had a history of pregnancy (P for difference = 0.048).

CONCLUSIONS

Nearly one in 10 reproductive women was hesitant about influenza vaccination for their children during the COVID-19 pandemic. To mitigate vaccine hesitancy, our findings highlight a need for tailored public health measures to increase perceived disease susceptibility and vaccine benefit and decrease perceived barriers. Furthermore, the effect of high perceived barriers and moderate perceived benefit on vaccine hesitancy was higher among younger women and women who had never conceived.

Knowledge, attitudes, and practices for the use of seasonal influenza vaccination, healthcare workers, Costa Rica

INTRODUCTION

Annual seasonal influenza vaccination in healthcare workers prevents nosocomial transmission to patients, coworkers, and visitors, and reduces absenteeism. This study aimed to describe knowledge, attitudes, and practices (KAP) of seasonal influenza vaccine among public healthcare workers attending patients in Costa Rica.

METHODOLOGY

We conducted a cross-sectional survey of healthcare personnel attending patients in public hospitals in 2017-2018. Frequency distributions of demographics, vaccination KAP, sources of information, clinical manifestations and reasons for non-vaccination were reported. Logistic regression was used to analyze associations between exposures of interest (demographics, sources of information, knowledge, attitudes towards vaccination) and self-reported influenza vaccination.

RESULTS

We surveyed 747 healthcare workers in 2017-2018. Of 706 participants who knew their vaccination status, 55.7% were vaccinated for seasonal influenza. Only 20.7% of participants knew the influenza vaccine was an inactivated virus, and 94.6% believed the vaccine causes flu-like symptoms. Factors associated with current influenza vaccination were vaccination in previous year (aOR: 8.13; 95% CI: 5.65-11.71) and believed influenza vaccination may be harmful (aOR: 0.62; 95% CI: 0.44-0.89). Reasons for non-vaccination included fear of adverse effects and access limitations.

CONCLUSIONS

Suboptimal influenza vaccination among healthcare workers may be attributed to misconceptions about the vaccine and limited engagement strategies focusing on healthcare workers. Appropriate interventions are needed to increase healthcare worker vaccination rates and improve their knowledge and beneficence, which would improve patient safety in hospitals.