Barriers and Facilitators Associated With Vaccine Acceptance and Uptake Among Pregnant Women in High Income Countries: A Mini-Review

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.

COVID-19 Antiviral Medication Use Among Pregnant and Recently Pregnant US Outpatients

BACKGROUND

Pregnant people are at risk of severe coronavirus disease 2019 (COVID-19) and associated complications. While withholding treatment from pregnant patients is not recommended, little is known about the frequency of antiviral medication use during pregnancy.

METHODS

Using Medicaid and commercial insurance databases, we constructed a national claims-based cohort study of pregnant, recently pregnant, and nonpregnant female patients 18-49 years old with an outpatient diagnosis of COVID-19 between 21 December 2021 and 30 September 2022. Outpatient treatment with a recommended antiviral medication was identified within 5 days of diagnosis, using national drug codes in outpatient prescription drug claims. Propensity score-matched prevalence ratios (PRs) were used to compare antiviral treatment by pregnancy status.

RESULTS

A total of 412 755 publicly and privately insured patients with COVID-19 were identified, including 33 855 currently pregnant, 2460 recently pregnant, and 376 440 nonpregnant female patients; 6.8% had a record of antiviral medication use, including 1.3% of pregnant, 5.4% of recently pregnant, and 7.3% of nonpregnant women. Most commonly ritonavir-boosted nirmatrelvir was administered. The prevalence of antiviral medication use was 67% lower among pregnant patients compared with nonpregnant patients (PR, 0.33 [95% confidence interval, .30-.36]), even among patients with ≥1 high-risk medical condition (0.29 [.25-.33]). Antiviral medication use was slightly lower among recently pregnant women with ≥1 high-risk medical condition than among nonpregnant women with similar conditions (PR, 0.57; [95% confidence interval, .44-.72]).

CONCLUSIONS

Despite US clinical guidelines, we observed low rates of outpatient treatment for COVID-19 among pregnant patients, indicating possible missed opportunities to treat COVID-19 illness during pregnancy and lactation.

Pertussis in Early Infancy: Diagnostic Challenges, Disease Burden, and Public Health Implications Amidst the 2024 Resurgence, with Emphasis on Maternal Vaccination Strategies

Bordetella pertussis is the causative agent of pertussis or whooping cough, an acute and highly contagious respiratory infection that can have serious and fatal complications such as pneumonia, encephalopathy, and seizures, especially for newborns. The disease is endemic not only in the European Union (EU)/European Economic Area (EEA) but also globally. Larger outbreaks are anticipated every three to five years, even in countries where vaccination rates are high. Despite the high pertussis vaccination coverage in developed countries and a low rate of pertussis incidence for many years, especially during the COVID-19 pandemic, the incidence of pertussis has been on the rise again, with outbreaks in some places, which is referred to as "re-emergence of pertussis". The aim of this review is to underscore the critical importance of achieving high vaccination coverage, particularly among pregnant women, to safeguard vulnerable neonates from pertussis during their early months, before they are eligible for vaccination. This aligns with the need to address diagnostic challenges, mitigate disease severity, and strengthen public health strategies in light of the ongoing 2024 Bordetella pertussis resurgence.

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.

Do Pregnant Persons Want Influenza Vaccines? Knowledge, Attitudes, Perceptions, and Practices Toward Influenza Vaccines in 8 Low- and Middle-Income Countries

BACKGROUND

Vaccination is the most effective way to prevent influenza infection and adverse outcomes; despite global recommendations to vaccinate pregnant persons, access to influenza vaccines remains low. We explored knowledge, attitudes, and practices of pregnant persons to inform actions to improve vaccine uptake.

METHODS

We pooled data from cross-sectional surveys assessing pregnant persons' attitudes toward influenza vaccines in 8 low- and middle-income countries. Countries used standard methods to measure attitudes and intents toward influenza vaccination. We stratified by presence/absence of a national influenza vaccination program, income group, geographic region, and individual-level factors.

RESULTS

Our analysis included 8556 pregnant persons from 8 countries. Most pregnant persons (6323, 74%) were willing to receive influenza vaccine if it was offered for free. Willingness differed by presence of an existing influenza vaccination program; acceptance was higher in countries without programs (2383, 89%) than in those with programs (3940, 67%, P < .001).

CONCLUSIONS

Most pregnant persons in middle-income countries, regardless of influenza vaccination program status, were willing to be vaccinated against influenza if the vaccine was provided free of charge. National investments in influenza vaccination programs present an opportunity to avert illness both in pregnant persons themselves and in their newborn babies.

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.

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.

Predictors of maternal pertussis vaccination acceptance among pregnant women in Norway

Maternal vaccination against pertussis is safe and provides effective protection against pertussis for the newborn, but the vaccine coverage rate remains generally low. Norway is currently planning for introduction of routine maternal pertussis vaccination. To assess maternal pertussis vaccination acceptance among pregnant Norwegian women, we surveyed women at 20-40 weeks gestation in 2019. Among the 1,148 pregnant women participating in this cross-sectional study, 73.8% reported they would accept pertussis vaccination during pregnancy if it was recommended, 6.9% would not accept and 19.2% were undecided. Predictors for low likelihood of accepting pertussis vaccination during pregnancy included low confidence in health authorities and in maternal pertussis vaccination safety and effectiveness, low awareness and adherence to influenza vaccination during pregnancy, and low awareness of pertussis vaccination. The major reasons reported for not accepting or being undecided about maternal pertussis vaccination were lack of information on vaccine safety for both mother and child. Most women reported that they would consult their general practitioner or a midwife for information if they were offered maternal pertussis vaccination. General practitioners and midwives were also regarded as the most trustworthy sources of information if the women were in doubt about accepting vaccination. We conclude that information addressing safety concerns and raising awareness about maternal pertussis vaccination could increase acceptance of maternal pertussis vaccination. Our findings highlight the pivotal role of the antenatal and primary health care services in providing such information to pregnant women.

Vaccination of pregnant women: an overview of European policies and strategies to promote it

Maternal immunization is a valuable tool for protecting mother and unborn child from vaccine-preventable diseases. However, the implementation of strategies for vaccinating pregnant women has only recently gained traction. This work is aimed at providing an overview of European vaccination strategies and gathering evidence on interventions enhancing vaccination knowledge, attitudes, and behaviors (KAB) in pregnant women. To summarize current pregnancy vaccination strategies in Europe, we consulted literature, institutional national health system websites, and the ECDC Vaccine Scheduler. The review of evidence on interventions targeting pregnant women's vaccination KAB was performed by searching primary studies on PubMed and Web of Science. The 27 EU member states offer various vaccinations in pregnancy, but only 10 recommend all of these: tetanus, pertussis, diphtheria, influenza, and COVID-19, albeit with different administration schedules. The literature review included 7 studies, 3 from Italy and 4 from other European countries (UK, Netherlands, Greece, Poland, and Ukraine). They were conducted in various settings such as childbirth preparation courses, prenatal visits, and online platforms, and all included educational interventions providing information on vaccine safety and efficacy during pregnancy. Knowledge about vaccines and vaccine-preventable diseases, generally low in the pre-intervention period, increased post-intervention, with a rise in awareness of the risks associated with infectious diseases and the recommended vaccines, a reduction in vaccine-related misinformation, and a greater propensity to vaccinate both newborns and themselves. Furthermore, there was a significant increase in adherence to recommended vaccinations, particularly among those with higher educational levels. However, vaccine hesitancy persisted, influenced by factors such as fear of adverse events and the lack of recommendations from healthcare providers. Variations in pregnancy vaccination strategies across Europe emphasize the importance of establishing a unified framework to optimize maternal and fetal health outcomes through evidence-based policies. Educational interventions may positively impact pregnant women's KAB, therefore promoting vaccination uptake.

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.

Coverage of influenza, pneumococcal and zoster vaccination and determinants of influenza and pneumococcal vaccination among adults with cardiovascular diseases in community

BACKGROUND

Cardiovascular disease (CVD) is the leading cause of death and illness globally. Influenza, pneumococcal disease and herpes zoster infection may trigger acute cardiovascular events or cause complications among cardiac patients. Vaccination is recommended for adults with CVD. There is a gap in research evidence around determinants and uptake of influenza, pneumococcal and zoster vaccines in adults with CVD.

OBJECTIVE

The aim of this study is to examine the rate of the uptake of influenza, zoster and pneumococcal vaccines, factors associated with the uptake of influenza vaccine, and the perceptions of influenza and pneumococcal vaccination among people with CVD in the community.

METHOD

Cross-sectional survey data was analysed from three separate surveys carried out in Australia between October 2019 and September 2020 of 972 adults with CVD. We used descriptive statistics to describe data. Thematic analysis examined the reasons for taking influenza vaccine. Multivariable analysis was used to identify independent predictors of the influenza vaccine uptake and perceptions associated with the uptake of influenza and pneumococcal vaccines.

RESULTS

Out of 972 participants, a total of 661 (68 %) people said they had received influenza vaccine in the last 12 months; 361 (37 %) had ever received pneumococcal vaccine; 196 (20 %) had ever received zoster vaccine. Among 661 participants who said they received influenza vaccine within the 12 months prior to the study, 543 (82 %) participants received it from doctors or general practitioners (GPs) offices. Age 65 and older, being born in Australia, being employed or retired and having comorbidity were positive predictors of influenza vaccination. Doctors' recommendations to take the vaccine and awareness of free vaccines positively predicted influenza and pneumococcal vaccine uptake.

CONCLUSION

The uptake of recommended pneumococcal and zoster vaccines is low in people with CVD. Doctors' recommendations, targeted health promotion programs in general practice, and easy access to vaccination may optimise vaccination uptake in patients with CVD.

Re-framing the importance of Group B Streptococcus as a gut-resident pathobiont

Streptococcus agalactiae (Group B Streptococcus, GBS) is a Gram-positive bacterial species that causes disease in humans across the lifespan. While antibiotics are used to mitigate GBS infections, it is evident that antibiotics disrupt human microbiomes (which can predispose people to other diseases later in life), and antibiotic resistance in GBS is on the rise. Taken together, these unintended negative impacts of antibiotics highlight the need for precision approaches for minimizing GBS disease. One possible approach involves selectively depleting GBS in its commensal niches before it can cause disease at other body sites or be transmitted to at-risk individuals. One understudied commensal niche of GBS is the adult gastrointestinal (GI) tract, which may predispose colonization at other body sites in individuals at risk for GBS disease. However, a better understanding of the host-, microbiome-, and GBS-determined variables that dictate GBS GI carriage is needed before precise GI decolonization approaches can be developed. In this review, we synthesize current knowledge of the diverse body sites occupied by GBS as a pathogen and as a commensal. We summarize key molecular factors GBS utilizes to colonize different host-associated niches to inform future efforts to study GBS in the GI tract. We also discuss other GI commensals that are pathogenic in other body sites to emphasize the broader utility of precise de-colonization approaches for mitigating infections by GBS and other bacterial pathogens. Finally, we highlight how GBS treatments could be improved with a more holistic understanding of GBS enabled by continued GI-focused study.

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.

Individual and familial factors associated with mRNA COVID-19 vaccine uptake in pregnancy: A large-scale registry-based linkage study

The association between maternal COVID-19 vaccination in pregnancy and factors such as high risk for severe COVID-19, pre-existing asthma, prior adverse reproductive history, or paternal COVID-19 vaccination during pregnancy, remains unclear. The aim of this study is two-fold: (i) to describe uptake of COVID-19 vaccine during pregnancy by maternal risk for severe COVID-19 and asthma, and (ii) to comprehensively examine individual and familial factors associated with vaccine uptake during pregnancy in Norway. Based on nation-wide registry-linkage data in Norway, we included 101,659 deliveries with gestational length ≥12 weeks, in 2021-2022. Our outcome measure was uptake of at least one dose of mRNA COVID-19 vaccine during pregnancy, using a narrow (first ever dose) and broad (any dose) definition. We fit univariate and multivariate modified Poisson regression models, clustered by county of residency and adjusted for calendar time, to estimate risk ratios (RR) with 95 % Confidence Intervals (CIs). Gestational uptake of any COVID-19 vaccine dose increased from <1 % before mid Aug-2021, to 38.8 % in the rest of 2021, and 48.9 % in 2022. Only 28.8 % and 33.9 % pregnant individuals with high risk for severe COVID-19 or asthma, respectively, received at least one COVID-19 vaccine dose. Paternal COVID-19 vaccination was strongly associated with greater vaccine uptake by pregnant individuals (adjusted RR: 7.2, 95 % CI: 6.8-7.5). Maternal SARS-CoV-2 infection pre-pregnancy (adjusted RR: 0.31, 95 % CI: 0.26, 0.37), familial and individual migrant status were associated with a considerable decreased likelihood of vaccine uptake in pregnancy. History of miscarriage or pregnancy with congenital anomaly were not associated with vaccine uptake. Despite rising COVID-19 vaccine rates in pregnancy, uptake remained low for high-risk individuals. Paternal vaccination, pre-pregnancy infection, migration status, and maternal citizenship were strongly associated with prenatal vaccine uptake. This knowledge can inform tailoring of future vaccination campaigns.

Precision Nanovaccines for Potent Vaccination

Compared with traditional vaccines, nanoparticulate vaccines are especially suitable for delivering antigens of proteins, peptides, and nucleic acids and facilitating lymph node targeting. Moreover, apart from improving pharmacokinetics and safety, nanoparticulate vaccines assist antigens and molecular adjuvants in crossing biological barriers, targeting immune organs and antigen-presenting cells (APC), controlled release, and cross-presentation. However, the process that stimulates and orchestrates the immune response is complicated, involving spatiotemporal interactions of multiple cell types, including APCs, B cells, T cells, and macrophages. The performance of nanoparticulate vaccines also depends on the microenvironments of the target organs or tissues in different populations. Therefore, it is necessary to develop precise nanoparticulate vaccines that accurately regulate vaccine immune response beyond simply improving pharmacokinetics. This Perspective summarizes and highlights the role of nanoparticulate vaccines with precise size, shape, surface charge, and spatial management of antigen or adjuvant for a precision vaccination in regulating the distribution, targeting, and immune response. It also discusses the importance of the rational design of nanoparticulate vaccines based on the anatomical and immunological microstructure of the target tissues. Moreover, the target delivery and controlled release of nanovaccines should be taken into consideration in designing vaccines for achieving precise immune responses. Additionally, it shows that the nanovaccines remodel the suppressed tumor environment and modulate various immune cell responses which are also essential.

COVID-19 vaccine safety during pregnancy and breastfeeding in women with autoimmune diseases: results from the COVAD study

OBJECTIVES

We investigated coronavirus disease 2019 (COVID-19) vaccine safety in pregnant and breastfeeding women with autoimmune diseases (AID) in the COVID-19 Vaccination in Autoimmune Diseases (COVAD) study.

METHODS

Delayed-onset (>7 days) vaccine-related adverse events (AE), disease flares and AID-related treatment modifications were analysed upon diagnosis of AID vs healthy controls (HC) and the pregnancy/breastfeeding status at the time of at least one dose of vaccine.

RESULTS

Among the 9201 participants to the self-administered online survey, 6787 (73.8%) were women. Forty pregnant and 52 breastfeeding patients with AID were identified, of whom the majority had received at least one dose of COVID-19 vaccine (100% and 96.2%, respectively). AE were reported significantly more frequently in pregnant than in non-pregnant patients (overall AE 45% vs 26%, P = 0.01; minor AE 40% vs 25.9%, P = 0.03; major AE 17.5% vs 4.6%, P < 0.01), but no difference was found in comparison with pregnant HC. No difference was observed between breastfeeding patients and HC with respect to AE. Post-vaccination disease flares were reported by 17.5% of pregnant and 20% of breastfeeding patients, and by 18.3% of age- and disease-matched non-pregnant and non-breastfeeding patients (n = 262). All pregnant/breastfeeding patients who experienced a disease flare were managed with glucocorticoids; 28.6% and 20% of them required initiation or change in immunosuppressants, respectively.

CONCLUSION

This study provides reassuring insights into the safety of COVID-19 vaccines administered to women with AID during the gestational and post-partum periods, helping overcome hesitant attitudes, as the benefits for the mother and for the fetus by passive immunization appear to outweigh potential risks.

Routine Maternal Vaccine Uptake during the COVID-19 Pandemic

OBJECTIVE

This study examines the impact of the coronavirus disease 2019 (COVID-19) pandemic on influenza and tetanus toxoid, reduced diphtheria toxoid and acellular pertussis (Tdap) vaccine uptake in a pregnant, low-income population.

STUDY DESIGN

This retrospective cohort study included women initiating prenatal care before (May-November 2019) or during the COVID-19 pandemic (May-November 2020) at two large Medicaid clinics. All patients entered prenatal care before 20 weeks and delivered full-term. Medical records were reviewed for vaccine uptake and demographic data. Multivariate logistic regression analysis was used to compare vaccination rates prior to and during the COVID-19 pandemic. Additional analysis was performed to identify association of demographic factors with vaccine uptake. IRB approval was obtained for this study.

RESULTS

A total of 939 patients met inclusion criteria, with 462 initiating care prior to and 477 initiating care during the COVID-19 pandemic. Influenza vaccination uptake was 78% (362/462) in the prepandemic group, significantly decreasing to 61% (291/477) in the pandemic group (p <0.01, odds ratio [OR] = 0.38, confidence interval [CI]: 0.26-0.53). Tdap vaccination uptake was 85% (392/462) in the prepandemic group, significantly decreasing to 76% (361/477) in the pandemic group (p <0.01, OR = 0.56, CI: 0.40-0.79). The decrease in influenza vaccine uptake was most significant in non-Hispanic Black patients, decreasing from 64% (73/114) in the prepandemic group to 35% (35/101) in the pandemic group (p <0.01, OR = 0.30, CI: 0.17-0.52), while there was no significant difference in age or parity in relation to vaccination status.

CONCLUSION

Routine vaccination uptake significantly decreased during the COVID-19 pandemic in a low-income population of pregnant women, with decrease more pronounced on influenza vaccine than on Tdap vaccine uptake, especially in non-Hispanic Black patients.

KEY POINTS

· Influenza and Tdap vaccination uptake during pregnancy has decreased during the COVID-19 pandemic.. · Influenza vaccine uptake decreased more than Tdap in pregnancy during the COVID-19 pandemic.. · The greatest decrease was seen in influenza vaccine uptake in non-Hispanic Black patients..

COVID-19 Vaccine Acceptance in Pregnancy

OBJECTIVE

The purpose of the study is to evaluate the acceptance rate of the coronavirus disease 2019 (COVID-19) vaccine among pregnant women at our institution prior to recommendations by national organizations (American College of Obstetricians and Gynecologists/The Society for Maternal-Fetal Medicine) in July 2021 and to determine whether factors including health disparities are associated with acceptance.

STUDY DESIGN

This is an Institutional Review Board exempt descriptive study. Anonymous surveys were administered from February 2021 to May 2021 to pregnant patients at Mount Sinai South Nassau's affiliated Maternal Fetal Medicine office. The survey was completed by 701 pregnant women. Descriptive statistics were calculated for the overall sample, as well as separately by group (acceptance versus declining/undecided about getting the COVID-19 vaccine). The two groups were compared using the chi-square test or Fisher's exact test and the two-sample t-test. Analysis was compared between two groups (patients who accepted the COVID-19 vaccine and people who declined/undecided about the vaccine). A result was considered statistically significant at the p < 0.05 level of significance.

RESULTS

Of the 701 pregnant women who completed the survey, 96 patients accepted the vaccine. More pregnant women who were older accepted the COVID-19 vaccine compared with those who were younger (p = 0.0343). Pregnant women willing to get the flu vaccine and/or the Tdap vaccine in pregnancy were more likely to obtain the COVID-19 vaccine (p < 0.05). Pregnant patients who had household members willing to receive the COVID-19 vaccine sought to obtain the vaccine for themselves (p < 0.0001). Interestingly, pregnant women who had an underlying respiratory illness in the pregnancy were less likely to accept the COVID-19 vaccine than those who had either other or no medical problems (p < 0.05).

CONCLUSION

There is a low rate of COVID-19 vaccine acceptance among pregnant women (13.69%). Efforts should be made to encourage the vaccine in this vulnerable population to protect them from the health risks of the COVID-19 virus.

KEY POINTS

· COVID-19 vaccine acceptance rates in our population were 13.6%.. · Accepting Tdap and influenza vaccines increased the likelihood of accepting the COVID vaccine.. · Pregnant patients with respiratory illnesses were more likely to decline the COVID vaccine..

A narrative review of COVID-19 vaccination in pregnancy and breastfeeding

The Coronavirus pandemic has affected millions of people due to the spread of the Severe acute respiratory syndrome Coronavirus-2 (SARS-CoV-2) virus. Pregnant individuals and infants are most vulnerable given the increased risk of developing severe complications from SARS-CoV-2 infection. Recently, COVID-19 vaccination is recommended for pregnant women and infants starting at 6 months of age to prevent disease contraction and minimize disease severity. We conducted a review of the literature on COVID-19 vaccination to discuss vaccine safety and efficacy, immunity after maternal vaccination, transplacental transfer and persistence of antibodies, and public health implications. Current evidence supports the safety and efficacy of vaccination during pregnancy. Maternal vaccination provides greater antibody persistence in infants compared to immunity from natural infection. Furthermore, vaccination has demonstrated an increased rate of passive antibody transfer through the placenta and breast milk. Public health interventions are important in achieving herd immunity and ultimately ending the pandemic. IMPACT: This article highlights the benefits of COVID-19 vaccination during pregnancy with a review of the data describing safety and efficacy, passive and active immunity after maternal immunization, trans-placental transfer and persistence of protective antibodies, and public health implications. With this information, healthcare providers can provide up-to-date knowledge to their pregnant patients to help them form an informed decision on vaccination and combat vaccine hesitancy.

COVID-19 vaccination in pregnancy: ambiguity in decision-making

Throughout the COVID-19 pandemic, pregnant women/people were identified as an at-risk group of severe COVID-19 disease. Consequently, vaccine uptake among this group became a public health priority. However, the relationship between pregnancy and vaccination decision-making is complex, and the heightened uncertainty and anxiety produced through the pandemic further exacerbated this immunization decision. This study explores COVID-19 vaccination decision-making during pregnancy in Aotearoa New Zealand by using an online story completion survey tool. Ninety-five responses were received and analysed using thematic analysis where ambiguity was a core facet within and across stories. Three ambiguities were identified, including who makes the decision (agential), what the risks are (risk) and how immunity to this threat can be best achieved (immunity). We discuss the implications of this ambiguity and how the strong desire to protect the baby persisted across accounts. The recognition of the rather persistent ambiguity in vaccination decision-making helps conceptualize influencing factors taken into account in a more nuanced manner for further research, public health campaigns and health professionals. Future public health campaigns can consider redistributing responsibility for vaccination decision-making in pregnancy, traverse an either/or perspective of 'natural' and 'artificial' immunity-boosting and consider how risk is perceived through anecdotes and viral immediacy.

Effects of an online tailored decision aid to promote informed decision making about maternal pertussis vaccination in the Netherlands: A randomized controlled trial

INTRODUCTION

In 2019, maternal pertussis vaccination (MPV) during pregnancy was introduced in the Netherlands. New interventions to promote informed decision making (IDM) about vaccinations are highly needed, especially for new vaccinations. Decision aids (DAs) have the potential to support IDM. This study evaluates the effects of an online DA on IDM and MPV uptake.

METHODS

Pregnant individuals, recruited for the randomized controlled trial (RCT), who gave informed consent (N = 1,236) were randomly assigned to the control (N = 650; no information) or intervention condition (N = 586; DA at 18 weeks pregnancy). MPV uptake and IDM were primary outcomes, decisional certainty and psychological determinants of MPV uptake were secondary outcomes. Measures were taken at 18 weeks of pregnancy (baseline) and at 20 weeks of pregnancy (post-test); intervention use was logged. Data were analysed using intention-to-treat analyses, logistic regression, and linear mixed regression models.

RESULTS

Uptake of MPV was high in our sample (92.3 %). No significant effect of the DA condition on MPV uptake was found compared to the control condition. We found that the DA increased IDM (β = 0.24, p < .004) and one of its components level of knowledge about MPV (β = 0.31, p < .004). We also found an increase in decisional certainty (β = 0.24, p < .004), perceived susceptibility (β = 0.24, p < .004), severity of pertussis (β = 0.41, p < .004), and positive affect about MPV (β = 0.15, p < .004). There was a positive association between dose of the intervention and MPV uptake (β = 0.05, p < .004).

DISCUSSION

The DA seemed effective in promoting IDM about and determinants of MPV uptake. No main effect was found on MPV uptake, but MPV uptake was related to the level of exposure to the DA. People with high intentions towards MPV were overrepresented in the sample. However, effects on IDM were consistent among participants with different levels of MPV intention at baseline.

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.

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.

"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.

A Mother's Dilemma: The 5-P Model for Vaccine Decision-Making in Pregnancy

Pregnant women are a highly vaccine-resistant population and face unique circumstances that complicate vaccine decision-making. Pregnant women are also at increased risk of adverse maternal and neonatal outcomes to many vaccine-preventable diseases. Several models have been proposed to describe factors informing vaccine hesitancy and acceptance. However, none of these existing models are applicable to the complex decision-making involved with vaccine acceptance during pregnancy. We propose a model for vaccine decision-making in pregnancy that incorporates the following key factors: (1) perceived information sufficiency regarding vaccination risks during pregnancy, (2) harm avoidance to protect the fetus, (3) relationship with a healthcare provider, (4) perceived benefits of vaccination, and (5) perceived disease susceptibility and severity during pregnancy. In addition to these factors, the availability of research on vaccine safety during pregnancy, social determinants of health, structural barriers to vaccine access, prior vaccine acceptance, and trust in the healthcare system play roles in decision-making. As a final step, the pregnant individual must balance the risks and benefits of vaccination for themselves and their fetus, which adds greater complexity to the decision. Our model represents a first step in synthesizing factors informing vaccine decision-making by pregnant women, who represent a highly vaccine-resistant population and who are also at high risk for adverse outcomes for many infectious diseases.

The association between vaccine hesitancy and pertussis: a systematic review and meta-analysis

BACKGROUND

Robust routine immunization schedules for pertussis-containing vaccines have been applied for years, but pertussis outbreaks remain a worldwide problem. This study aimed to investigate the association between vaccine hesitancy and pertussis in infants and children.

METHODS

We searched PubMed, Cochrane, Web of Science, Embase, and China National Knowledge Internet for studies published between January 2012 and June 2022. This study included case-control and cohort studies that assessed the association between childhood/maternal vaccine hesitancy and odds ratios (ORs), risk ratios (RRs), and vaccine effectiveness (VE) related to pertussis in infants and children [Formula: see text] 9 years old. ORs/VEs with a 95% confidence interval (CI) were calculated. Random-effects meta-analysis models were used for appropriate pooled estimates, and heterogeneity was assessed using [Formula: see text]. Cumulative meta-analysis and subgroup analyses stratified by study characteristics were performed.

RESULTS

Twenty-two studies were included, with a mean quality score of 7.0 (range 6.0-9.0). Infants and children with pertussis were associated with higher vaccine hesitancy to all doses (OR = 4.12 [95% CI: 3.09-5.50]). The highest OR was between children who were unvaccinated over four doses and children who were fully vaccinated (OR = 14.26 [95%CI: 7.62-26.70]); childhood vaccine delay was not statistically significantly associated with pertussis risk (OR = 1.18 [95% CI: 0.74-1.89]). Maternal vaccine hesitancy was associated with significantly higher pertussis risk in infants aged 2 and 3 months old, with higher pertussis ORs in infants [Formula: see text] 2 months old (OR = 6.02 [95%CI: 4.31-8.50], OR = 5.14 [95%CI: 1.95-13.52] for infants [Formula: see text] 2 and [Formula: see text] 3 months old, respectively). Maternal and childhood VEs were high in reducing pertussis infection in infants and children. The administration time of maternal vaccination had little effect on VE.

CONCLUSION

Vaccine hesitancy increased pertussis risks in infants and children. Ensuring that children receive up-to-date pertussis vaccines is essential; short delays in receiving childhood vaccinations may be unimportant. Maternal vaccinations for pertussis should be encouraged.

Barriers to and facilitators of populational adherence to prevention and control measures of COVID-19 and other respiratory infectious diseases: a qualitative evidence synthesis

AIMS

To summarise the evidence on barriers to and facilitators of population adherence to prevention and control measures for coronavirus disease 2019 (COVID-19) and other respiratory infectious diseases.

METHODS

A qualitative synthesis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis and the Cochrane Effective Practice and Organization of Care: Qualitative Evidence Synthesis. We performed an electronic search on MEDLINE, Embase and PsycINFO from their inception to March 2023.

RESULTS

We included 71 studies regarding COVID-19, pneumonia, tuberculosis, influenza, pertussis and H1N1, representing 5966 participants. The measures reported were vaccinations, physical distancing, stay-at-home policy, quarantine, self-isolation, facemasks, hand hygiene, contact investigation, lockdown, infection prevention and control guidelines, and treatment. Tuberculosis-related measures were access to care, diagnosis and treatment completion. Analysis of the included studies yielded 37 barriers and 23 facilitators.

CONCLUSIONS

This review suggests that financial and social support, assertive communication, trust in political authorities and greater regulation of social media enhance adherence to prevention and control measures for COVID-19 and infectious respiratory diseases. Designing and implementing effective educational public health interventions targeting the findings of barriers and facilitators highlighted in this review are key to reducing the impact of infectious respiratory diseases at the population level.

A Descriptive Study of Maternal Vaccination Uptake, Attitudes, and Beliefs in Pregnancy Among Persons Delivering at an Urban Safety Net Hospital

Objective

To estimate uptake of influenza, tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap), and COVID-19 vaccines during pregnancy and describe vaccine attitudes and beliefs among predominantly racial and ethnic minority individuals delivering at a publicly funded hospital.

Methods

We collected survey and electronic medical record data for English-speaking postpartum individuals who delivered a live-born infant from July 7, 2022, through August 21, 2022, and agreed to participate in our study. The 58-item survey included questions about general vaccine attitudes and beliefs as well as vaccine-specific questions. We calculated rates of influenza, Tdap, and COVID-19 vaccinations and compared distributions of survey responses by number (no vaccines, one vaccine, or two or three of the recommended vaccines) and type of vaccines received during pregnancy.

Results

Of the 231 eligible individuals, 125 (54.1%) agreed to participate. Rates of influenza, Tdap, and COVID-19 vaccination were 18.4%, 48.0%, and 5.6% respectively. A total of 61 (48.8%) did not receive any recommended vaccines during pregnancy, 40 (32.0%) received one vaccine, and 24 (19.0%) received two or three vaccines. Approximately 66.1% of the no vaccine group, 81.6% of the one vaccine group, and 87.5% of the two or three vaccine group strongly agreed or agreed that they trusted the vaccine information provided by their obstetrician or midwife. While most (>69.2%) agreed that the vaccine-preventable diseases were dangerous for pregnant women, only 24.0%, 29.3%, and 40.3% agreed that they were worried about getting influenza, whooping cough, or COVID-19, respectively, while pregnant.

Discussion

Vaccine uptake in our population was low and may be due, in part, to low perceived susceptibility to vaccine-preventable diseases. Obstetricians and midwives were trusted sources of vaccine information, suggesting that enhanced communication strategies could be critical for addressing maternal vaccine hesitancy, particularly in communities of color justifiably affected by medical mistrust.

Maternal third dose of BNT162b2 mRNA vaccine and risk of infant COVID-19 hospitalization

Infants are at a higher risk of Coronavirus Disease 2019 (COVID-19)-related hospitalizations compared to older children. In this study, we investigated the effect of the recommended third maternal dose of BNT162b2 COVID-19 vaccine during pregnancy on rates of infant COVID-19-related hospitalizations. We conducted a nationwide cohort study of all live-born infants delivered in Israel between 24 August 2021 and 15 March 2022 to estimate the effectiveness of the third booster dose versus the second dose against infant COVID-19-related hospitalizations. Data were analyzed for the overall study period, and the Delta and Omicron periods were analyzed separately. Cox proportional hazard regression models estimated hazard ratios and 95% confidence intervals (CIs) for infant hospitalizations according to maternal vaccination status at delivery. Among 48,868 live-born infants included in the analysis, rates of COVID-19 hospitalization were 0.4%, 0.6% and 0.7% in the third-dose, second-dose and unvaccinated groups, respectively. Compared to the second dose, the third dose was associated with reduced infant hospitalization with estimated effectiveness of 53% (95% CI: 36-65%). Greater protection was associated with a shorter interval between vaccination and delivery. A third maternal dose during pregnancy reduced the risk of infant hospitalization for COVID-19 during the first 4 months of life, supporting clinical and public health guidance for maternal booster vaccination to prevent infant COVID-19 hospitalization.

Past and Future Influenza Vaccine Uptake Motivation: A Cross-Sectional Analysis among Italian Health Sciences Students

Despite its effectiveness in the prevention of seasonal flu, influenza vaccination uptake remains low, even among healthcare workers (HCWs), despite their occupational risk. The aim of this study was to explore the association between main reasons for accepting or refusing influenza vaccination and the decision to receive the vaccination during both previous and following year among health sciences students. A multi-center, cross-sectional study was performed using a validated online questionnaire. Data were analyzed by performing univariable and multivariable logistic analysis. Data from over 3000 participants showed that avoiding the spread of infection to family members and the general population (aOR: 43.55), as well as to patients (aOR: 16.56) were the main reasons associated with the highest probability of taking the influenza vaccination the following year. On the contrary, not considering influenza as a severe disease was the reason associated with the lowest probability for past (aOR: 0.17) and future vaccination (aOR: 0.01). Therefore, the importance of vaccination to protect others should always be the core of vaccination campaigns for health sciences students, together with tools to increase their awareness of the severity of this disease.

Boosting maternal and neonatal anti-SARS-CoV-2 humoral immunity using a third mRNA vaccine dose

BACKGROUND

To minimize COVID-19 pandemic burden and spread, 3-dose vaccination campaigns commenced worldwide. Since patients who are pregnant are at increased risk for severe disease, they were recently included in that policy, despite the lack of available evidence regarding the impact of a third boosting dose during pregnancy, underscoring the urgent need for relevant data. We aimed to characterize the effect of the third boosting dose of mRNA Pfizer BNT162b2 vaccine in pregnancy.

METHODS

We performed a prospective cohort study of anti-SARS-CoV-2 antibody titers (n = 213) upon delivery in maternal and cord blood of naive fully vaccinated parturients who received a third dose (n = 86) as compared with 2-dose recipients (n = 127).

RESULTS

We found a robust surge in maternal and cord blood levels of anti-SARS-CoV-2 titers at the time of delivery, when comparing pregnancies in which the mother received a third boosting dose with 2-dose recipients. The effect of the third boosting dose remained significant when controlling for the trimester of last exposure, suggesting additive immunity extends beyond that obtained after the second dose. Milder side effects were reported following the third dose, as compared with the second vaccine dose, among the fully vaccinated group.

CONCLUSION

The third boosting dose of mRNA Pfizer BNT162b2 vaccine augmented maternal and neonatal immunity with mild side effects. These data provide evidence to bolster clinical and public health guidance, reassure patients, and increase vaccine uptake among patients who are pregnant.

FUNDING

Israel Science Foundation KillCorona grant 3777/19; Research grant from the "Ofek" Program of the Hadassah Medical Center.

Monkeypox in pregnancy: virology, clinical presentation, and obstetric management

The 2022 monkeypox outbreak, caused by the zoonotic monkeypox virus, has spread across 6 World Health Organization regions (the Americas, Africa, Europe, Eastern Mediterranean, Western Pacific, and South-East Asia) and was declared a public health emergency of international concern on July 23, 2022. The global situation is especially concerning given the atypically high rate of person-to-person transmission, which suggests viral evolution to an established human pathogen. Pregnant women are at heightened risk of vertical transmission of the monkeypox virus because of immune vulnerability and natural depletion of population immunity to smallpox among reproductive-age women, and because orthopoxviral cell entry mechanisms can overcome the typically viral-resistant syncytiotrophoblast barrier within the placenta. Data on pregnancy outcomes following monkeypox infection are scarce but include reports of miscarriage, intrauterine demise, preterm birth, and congenital infection. This article forecasts the issues that maternity units might face and proposes guidelines to protect the health of pregnant women and fetuses exposed to the monkeypox virus. We review the pathophysiology and clinical features of monkeypox infection and discuss the obstetrical implications of the unusually high prevalence of anogenital lesions. We describe the use of real-time polymerase chain reaction tests from mucocutaneous and oropharyngeal sites to confirm infection, and share an algorithm for the antenatal management of pregnant women with monkeypox virus exposure. On the basis of the best available knowledge from prenatal orthopoxvirus infections, we discuss the sonographic features of congenital monkeypox and the role of invasive testing in establishing fetal infection. We suggest a protocol for cesarean delivery to avoid the horizontal transmission of the monkeypox virus at birth and address the controversy of mother-infant separation in the postpartum period. Obstetrical concerns related to antiviral therapy with tecovirimat and vaccinia immune globulin are highlighted, including the risks of heart rate-corrected QT-interval prolongation, inaccuracies in blood glucose monitoring, and the predisposition to iatrogenic venous thromboembolism. The possibility of monkeypox vaccine hesitancy during pregnancy is discussed, and strategies are offered to mitigate these risks. Finally, we conclude with a research proposal to address knowledge gaps related to the impact of monkeypox infection on maternal, fetal, and neonatal health.

Vaccination in pregnancy: The role of the midwife

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.

Association between social vulnerability and COVID-19 vaccination hesitancy and vaccination in pregnant and postpartum individuals

OBJECTIVE

To evaluate the association of community-level social vulnerability with COVID-19 vaccine hesitancy and vaccination among pregnant and postpartum individuals.

METHODS

Prospective cohort study assessing COVID-19 vaccine hesitancy among pregnant and postpartum individuals. We performed a baseline survey on COVID-19 vaccine hesitancy from 03/22/21 to 04/02/21, and a follow-up survey on COVD-19 vaccination status 3- to 6-months later. The primary exposure was the Centers for Disease Control and Prevention SVI (Social Vulnerability Index), measured in quartiles. Higher SVI quartiles indicated greater community-level social vulnerability with the lowest quartile (quartile 1) as the referent group. The primary outcome was COVID-19 vaccine hesitancy on the baseline survey (uncertainty or refusal of the vaccine), and the secondary outcome was self-report of not being vaccinated (unvaccinated) for COVID-19 on the follow-up survey.

RESULTS

Of 456 assessed individuals, 46% reported COVID-19 vaccine hesitancy on the baseline survey; and of 290 individuals (290/456, 64%) who completed the follow-up survey, 48% (140/290) were unvaccinated. The frequency of baseline vaccine hesitancy ranged from 25% in quartile 1 (low SVI) to 68% in quartile 4 (high SVI), and being unvaccinated at follow-up ranged from 29% in quartile 1 to 77% in quartile 4. As social vulnerability increased, the risk of COVID-19 vaccine hesitancy at baseline increased (quartile 2 aRR (adjusted relative risk): 1.46; 95% CI:0.98 to 2.19; quartile 3 aRR: 1.86; 95% CI:1.28 to 2.71; and quartile 4 aRR: 2.24; 95% CI:1.56 to 3.21), as did the risk of being unvaccinated at follow-up (quartile 2 aRR: 1.00; 95% CI:0.66 to 1.51; quartile 3 aRR: 1.68; 95% CI:1.17 to 2.41; and quartile 4 aRR: 1.82; 95% CI:1.30 to 2.56).

CONCLUSIONS

Pregnant and postpartum individuals living in an area with higher community-level social vulnerability were more likely to report COVID-19 vaccine hesitancy and subsequently to be unvaccinated at follow-up.

SARS-CoV-2 vaccine uptake and reasons for hesitancy among Canadian pregnant people: a prospective cohort study

BACKGROUND

Several vaccines against SARS-CoV-2 have been developed and approved at an unparalleled speed. Given that SARS-CoV-2 vaccines are recommended to pregnant people, our aim was to quantify vaccination uptake, and describe vaccination hesitancy and behavioural attitudes surrounding SARS-CoV-2 vaccination in pregnancy in Canada.

METHODS

The CONCEPTION study is an ongoing international study started in June 2020, evaluating the impact of the COVID-19 pandemic on the health of pregnant people and their children. For this study, pregnant people recruited from Apr. 20, 2021, to Feb. 8, 2022, and residing in Canada were invited to complete a Web-based survey. In addition to all CONCEPTION variables, data on vaccine uptake as well as personal knowledge of COVID-19 severity in pregnancy and of SARS-CoV-2 vaccine safety and efficacy were collected. Marginal risk differences and adjusted odds ratios (ORs) were calculated to assess determinants of SARS-CoV-2 vaccination during pregnancy.

RESULTS

From Apr. 20, 2021, to Feb. 8, 2022, 603 pregnant people were recruited and gave consent, of which 83.7% (n = 505) were vaccinated and 16.3% (n = 98) were not vaccinated against SARS-CoV-2. Uptake of the influenza vaccine in 2020/21 was a significant predictor of being vaccinated against SARS-CoV-2 or intention to be vaccinated (marginal risk difference 3.2%, 95% confidence interval [CI] 3.0% to 3.3%, adjusted OR 4.43, 95% CI 2.32 to 9.25), and being employed (marginal risk difference 11.2%, 95% CI 10.6% to 11.9%, adjusted OR 2.17, 95% CI 1.03 to 4.35) increased the likelihood of being vaccinated against SARS-CoV-2. Self-assessed knowledge of COVID-19 severity and vaccine efficacy was not associated with vaccine uptake.

INTERPRETATION

Among the Canadian pregnant people who responded to this study, vaccine uptake against SARS-CoV-2 was high. However, our results underscore the importance of improving knowledge transfer about the efficacy of SARS-CoV-2 vaccines in pregnancy to guide vaccination efforts.

Planning and Organization of the COVID-19 Vaccination Campaign: An Overview of Eight European Countries

The initial progress of the COVID-19 vaccination campaign worldwide depended on several aspects, including programmatic/practical issues. This paper focused on the planning and organization of COVID-19 vaccination campaigns in eight European countries (Sweden, Denmark, Romania, Hungary, Italy, Spain, Germany, and France), from the launch to August 2021. Information on the planning of the vaccination campaign (release and update of a national immunization plan, types of vaccines being used and their limitations/suspensions) and its organization (vaccination target groups, possibility of citizens' choice, vaccination workforce and settings, vaccines procurement) were obtained through desk research of international and national reports, plans, and websites. Eventually, data on vaccination coverage were drawn from Our world in data and analyzed through join point regression. The eight countries showed differences in groups prioritization, limitations/suspensions of use of specific vaccines, citizens' possibility to choose vaccines, and vaccination workforce involved. These issues could have contributed to the different progress towards high levels of vaccination coverage. In respect to vaccination coverage, Romania reached much lower levels than other countries. Further comparative research is needed in order to identify best practices in vaccination campaign that could be useful for the next phases of the COVID-19 pandemic, and be better prepared for future potential pandemic.

Boosting maternal and neonatal humoral immunity following SARS-CoV-2 infection using a single messenger RNA vaccine dose

BACKGROUND

Post-COVID-19 vaccine boosting is a potent tool in the ongoing pandemic. Relevant data regarding this approach during pregnancy are lacking, which affects vaccination policy guidance, public acceptance, and vaccine uptake during pregnancy. We aimed to investigate the dynamics of anti-SARS-CoV-2 antibody levels following SARS-CoV-2 infection during pregnancy and to characterize the effect of a single postinfection vaccine booster dose on the anti-SARS-CoV-2 antibody levels in parturients in comparison with the levels in naïve vaccinated and convalescent, nonboosted parturients.

STUDY DESIGN

Serum samples prospectively collected from parturients and umbilical cords at delivery at our university-affiliated urban medical center in Jerusalem, Israel, from May to October 2021, were selected and analyzed in a case-control manner. Study groups comprised the following participants: a consecutive sample of parturients with a polymerase chain reaction-confirmed history of COVID-19 during any stage of pregnancy; and comparison groups selected according to time of exposure comprising (1) convalescent, nonboosted parturients with polymerase chain reaction-confirmed COVID-19; (2) convalescent parturients with polymerase chain reaction-confirmed COVID-19 who received a single booster dose of the BNT162b2 messenger RNA vaccine; and (3) infection-naïve, fully vaccinated parturients who received 2 doses of the BNT162b2 messenger RNA vaccine. Outcomes that were determined included maternal and umbilical cord blood anti-SARS-CoV-2 antibody levels detected at delivery, the reported side effects, and pregnancy outcomes.

RESULTS

A total of 228 parturients aged 18 to 45 years were included. Of those, samples from 64 were studied to characterize the titer dynamics following COVID-19 at all stages of pregnancy. The boosting effect was determined by comparing (1) convalescent (n=54), (2) boosted convalescent (n=60), and (3) naïve, fully vaccinated (n=114) parturients. Anti-SARS-CoV-2 antibody levels detected on delivery showed a gradual and significant decline over time from infection to delivery (r=0.4371; P=.0003). Of the gravidae infected during the first trimester, 34.6% (9/26) tested negative at delivery, compared with 9.1% (3/33) of those infected during the second trimester (P=.023). Significantly higher anti-SARS-CoV-2 antibody levels were observed among boosted convalescent than among nonboosted convalescent (17.6-fold; P<.001) and naïve vaccinated parturients (3.2-fold; P<.001). Similar patterns were observed in umbilical cord blood. Side effects in convalescent gravidae resembled those in previous reports of mild symptoms following COVID-19 vaccination during pregnancy.

CONCLUSION

Postinfection maternal humoral immunity wanes during pregnancy, leading to low or undetectable protective titers for a marked proportion of patients. A single boosting dose of the BNT162b2 messenger RNA vaccine induced a robust increase in protective titers for both the mother and newborn with moderate reported side effects.

Understanding drivers of influenza vaccine hesitancy among pregnant women in China: evidence from an extended theory of planned behavior

BACKGROUND

Pregnant women have a low uptake of influenza vaccination, although being recommended as a priority.

RESEARCH DESIGN AND METHODS

We conducted a cross-sectional questionnaire survey in China from June to July 2021. Hierarchical regression analysis and structural equation modeling were performed based on the extended theory of planned behavior, in which attitudes, subjective norms, perceived behavioral control, and intention each affect the vaccine hesitancy; four variables of response efficacy, knowledge, vulnerability, and severity were added as extended dimensions; vaccination history played a moderator role in this model-to test the validity of the framework.

RESULTS

Totally, 1283 pregnant women participated in this study. The intention existed as a mediator between attitude [β_indirect=0.142 (95% confidence interval (CI): 0.084, 0.206), P<0.001], subjective norms [β_indirect=0.568 (95%CI: 0.424, 0.754), P<0.001], perceived behavioral control [β_indirect=0.070 (95%CI: 0.025, 0.118), P=0.004] and vaccine hesitancy. Further, the differences in indirect effect between the two dimensions of attitude (P<0.001), perceived behavioral control (P<0.001), and subjective norms were each statistically significant. Vaccination history did not moderate the association between attitude (P=0.679), subjective norms (P=0.645), and hesitancy.

CONCLUSIONS

The subjective norms dimension has a strong association with influenza vaccine hesitancy. Vaccination history had limited ability to reduce hesitancy during pregnancy.

COVID-19 vaccine hesitancy among pregnant women: a systematic review and meta-analysis

OBJECTIVE

The aim of this study was to perform a systematic review and meta-analysis to estimate the vaccines' acceptance level and to find the factors influencing pregnant women's vaccination decisions, with the goal of assisting in the development of interventions and promoting more research in this area.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

MEDLINE, Embase, CINAHL and PubMed.

ELIGIBILITY CRITERIA

Studies providing any kind of quantitative assessment of overall COVID-19 vaccination acceptance among pregnant women in any country or region across the globe.

DATA EXTRACTION AND SYNTHESIS

The pooled prevalence of COVID-19 vaccine acceptance among pregnant women was calculated using the random-effects model. Subgroup (sensitivity) analysis was performed to determine the overall COVID-19 vaccine acceptance level to understand the sources of substantial heterogeneity.

RESULTS

Out of the 375 studies identified, 17 studies from four continents assessing 25 147 participants (pregnant women) were included in this study. Among the participants, only 49% (95% CI 42% to 56%, p<0.001) had COVID-19 vaccine acceptance. High-income countries (47%; 95% CI 38% to 55%, p<0.001), participants with fewer than 12 years of education (38%; 95% CI 19% to 58%, p<0.001) and multiparous women (48%; 95% CI 31% to 66%, p<0.001) had lower COVID-19 vaccine acceptance. Overall heterogeneity was high (I2 ≥98%), and publication bias was present (p<0.001). A very weak positive correlation between COVID-19 knowledge and COVID-19 vaccine acceptance was observed (r=0.164; 95% CI -0.946 to 0.972; p=0.8359).

CONCLUSION

Overall, COVID-19 vaccine acceptance among pregnant women was low across the studies and considerably low among some specific subgroups of participants. These research findings have implications for the development of effective interventions that could increase the COVID-19 vaccine acceptance level among pregnant women to attain herd immunity.

PROSPERO REGISTRATION NUMBER

CRD42021277754.

Vaccination Intention and Behavior of the General Public in China: Cross-sectional Survey and Moderated Mediation Model Analysis

BACKGROUND

Promoting vaccination and eliminating vaccine hesitancy are key measures for controlling vaccine-preventable diseases.

OBJECTIVE

We aimed to understand the beliefs surrounding and drivers of vaccination behavior, and their relationships with and influence on vaccination intention and practices.

METHODS

We conducted a web-based survey in 31 provinces in mainland China from May 24, 2021 to June 15, 2021, with questions pertaining to vaccination in 5 dimensions: attitude, subjective norms, perceived behavioral control, intention, and behavior. We performed hierarchical regression analysis and structural equation modeling based on the theory of planned behavior-in which, the variables attitude, subjective norms, and intention each affect the variable intention; the variable intention mediates the relationships of attitude and subjective norms with behavior, and the variable perceived behavioral control moderates the strength of this mediation-to test the validity of the theoretical framework.

RESULTS

A total of 9924 participants, aged 18 to 59 years, were included in this study. Vaccination intention mediated the relationships of attitude and subjective norms with vaccination behavior. The indirect effect of attitude on vaccination behavior was 0.164 and that of subjective norms was 0.255, and the difference was statistically significant (P<.001). The moderated mediation analysis further indicated that perceived behavioral control would affect the mediation when used as moderator, and the interaction terms for attitude (β=-0.052, P<.001) and subjective norms (β=-0.028, P=.006) with perceived behavioral control were significant.

CONCLUSIONS

Subjective norms have stronger positive influences on vaccination practices than attitudes. Perceived behavioral control, as a moderator, has a substitution relationship with attitudes and subjective norms and weakens their positive effects on vaccination behavior.

Attitude and Level of COVID-19 Vaccination among Women in Reproductive Age during the Fourth Pandemic Wave: A Cross-Sectional Study in Poland

COVID-19 vaccination, apart from the sanitary regime, is the most efficient strategy to limit the spread of the SARS-CoV-2 virus and significantly reduce the severity of the disease following infection. A cross-sectional survey was conducted during the fourth wave of the COVID-19 pandemic among pregnant Polish women and women who have already given birth to evaluate the level and attitude to vaccination. Briefly, 1196 women (256 pregnant and 940 mothers) participated in the study; 68.0% of pregnant women and 66.2% of mothers declared that they had received COVID-19 vaccination. The most frequently stated reasons not to get vaccinated were possible adverse effects on the mother, fetus or breastfed child, post-vaccination complications and limited scientific evidence on the safety of the COVID-19 vaccine. The identified predictors of avoiding COVID-19 vaccination are young age, residing in small cities or rural areas, cohabitation, low anxiety level regarding SARS-CoV-2 infection, and little knowledge concerning maternal vaccine-induced immune protection delivered to offspring. Despite the unlimited access to COVID-19 vaccination, the declared level of vaccination is worryingly low. The knowledge concerning the benefits of vaccination to mothers and their offspring is not satisfactory and requires urgent educational action, particularly among young women living outside big cities and single motherhood.

Association between social vulnerability and influenza and tetanus-diphtheria-acellular pertussis vaccination in pregnant and postpartum individuals

BACKGROUND

Despite current guidelines recommending universal vaccination, the frequency of vaccination in pregnancy for influenza and tetanus-diphtheria-acellular pertussis remains low.

OBJECTIVE

This study aimed to evaluate the association between community-level social vulnerability and influenza and anticipated tetanus-diphtheria-acellular pertussis vaccinations among pregnant and postpartum individuals.

STUDY DESIGN

We conducted a cross-sectional survey of vaccine hesitancy in the peripartum period among pregnant and postpartum participants enrolled in prenatal care at a single tertiary care center from March 22, 2021, to April 02, 2021. Participant addresses were geocoded using ArcGIS and linked at the census tract level. The primary exposure was community-level social vulnerability as measured by the US Centers for Disease Control and Prevention's Social Vulnerability Index. This index incorporates 15 census variables to produce a composite score and subscores across 4 major thematic domains (socioeconomic status, household composition and disability, minority status and language, and housing type and transportation). The scores range from 0 to 1, with higher values indicating greater social vulnerability. The primary outcomes were self-reported influenza vaccination during the current influenza season and having received or planning to receive the tetanus-diphtheria-acellular pertussis vaccination in pregnancy. We used multivariable logistic regression and adjusted for age, self-reported race and ethnicity, parity, trimester of pregnancy, and chronic comorbid conditions.

RESULTS

Of 456 assessed individuals (95% pregnant individuals and 5% postpartum individuals), the frequency of influenza vaccination was 58% (95% confidence interval, 53-62), and the anticipated tetanus-diphtheria-acellular pertussis vaccination was 72% (95% confidence interval, 68-76). Individuals from communities with a higher Social Vulnerability Index were less likely to report vaccination in pregnancy than those from communities with a lower Social Vulnerability Index. Specifically, for each 0.1-unit increase in the Social Vulnerability Index, the odds of influenza vaccination (adjusted odds ratio, 0.23; 95% confidence interval, 0.11-0.46) and anticipated tetanus-diphtheria-acellular pertussis vaccination (adjusted odds ratio, 0.24; 95% confidence interval, 0.11-0.53) decreased by >70%. By domain, the Social Vulnerability Index subscores of socioeconomic status (influenza adjusted odds ratio, 0.20 [95% confidence interval, 0.10-0.40]; tetanus-diphtheria-acellular pertussis adjusted odds ratio, 0.25 [95% confidence interval, 0.12-0.53]) and housing type and transportation (influenza adjusted odds ratio, 0.41 [95% confidence interval, 0.19-0.84; tetanus-diphtheria-acellular pertussis adjusted odds ratio, 0.39 [95% confidence interval, 0.18-0.87) were inversely associated with a lower odds of influenza and tetanus-diphtheria-acellular pertussis vaccinations.

CONCLUSION

Pregnant and postpartum individuals living in areas with higher social vulnerability were less likely to report influenza and anticipated tetanus-diphtheria-acellular pertussis vaccinations in pregnancy. The Social Vulnerability Index could be used as a tool to improve vaccine equity and address disparities in vaccination in pregnancy.

RSV Prevention in All Infants: Which Is the Most Preferable Strategy?

Respiratory syncytial virus (RSV) causes a spectrum of respiratory illnesses in infants and young children that may lead to hospitalizations and a substantial number of outpatient visits, which result in a huge economic and healthcare burden. Most hospitalizations happen in otherwise healthy infants, highlighting the need to protect all infants against RSV. Moreover, there is evidence on the association between early-life RSV respiratory illness and recurrent wheezing/asthma-like symptoms As such, RSV is considered a global health priority. However, despite this, the only prevention strategy currently available is palivizumab, a monoclonal antibody (mAb) indicated in a subset of preterm infants or those with comorbidities, hence leaving the majority of the infant population unprotected against this virus. Therefore, development of prevention strategies against RSV for all infants entering their first RSV season constitutes a large unmet medical need. The aim of this review is to explore different immunization approaches to protect all infants against RSV. Prevention strategies include maternal immunization, immunization of infants with vaccines, immunization of infants with licensed mAbs (palivizumab), and immunization of infants with long-acting mAbs (e.g., nirsevimab, MK-1654). Of these, palivizumab use is restricted to a small population of infants and does not offer a solution for all-infant protection, whereas vaccine development in infants has encountered various challenges, including the immaturity of the infant immune system, highlighting that future pediatric vaccines will most likely be used in older infants (>6 months of age) and children. Consequently, maternal immunization and immunization of infants with long-acting mAbs represent the two feasible strategies for protection of all infants against RSV. Here, we present considerations regarding these two strategies covering key areas which include mechanism of action, "consistency" of protection, RSV variability, duration of protection, flexibility and optimal timing of immunization, benefit for the mother, programmatic implementation, and acceptance of each strategy by key stakeholders. We conclude that, based on current data, immunization of infants with long-acting mAbs might represent the most effective approach for protecting all infants entering their first RSV season.

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.

Oxford COVID-19 Vaccine Hesitancy in School Principals: Impacts of Gender, Well-Being, and Coronavirus-Related Health Literacy

Purposes: To explore the associated factors of COVID-19 vaccine hesitancy and examine psychometric properties of the coronavirus-related health literacy questionnaire (HLS-COVID-Q22) and Oxford COVID-19 Vaccine Hesitancy questionnaire. Methods: An online survey was conducted from 23 June to 16 July 2021 on 387 school principals across Taiwan. Data collection included socio-demographic characteristics, information related to work, physical and mental health, COVID-19 related perceptions, sense of coherence, coronavirus-related health literacy, and vaccine hesitancy. Principal component analysis, correlation analysis, linear regression models were used for validating HLS-COVID-Q22, Oxford COVID-19 Vaccine Hesitancy, and examining the associations. Results: HLS-COVID-Q22 and Oxford COVID-19 Vaccine Hesitancy were found with satisfactory construct validity (items loaded on one component with factor loading values range 0.57 to 0.81, and 0.51 to 0.78), satisfactory convergent validity (item-scale correlations range 0.60 to 0.79, and 0.65 to 0.74), high internal consistency (Cronbach’s alpha = 0.96 and 0.90), and without floor or ceiling effects (percentages of possibly lowest score and highest score <15%), respectively. Low scores of vaccine hesitancy were found in male principals (regression coefficient, B, −0.69; 95% confidence interval, 95%CI, −1.29, −0.10; p = 0.023), principals with better well-being (B, −0.25; 95%CI, −0.47, −0.03; p = 0.029), and higher HLS-COVID-Q22 (B, −1.22; 95%CI, −1.89, −0.54; p < 0.001). Conclusions: HLS-COVID-Q22 and Oxford COVID-19 Vaccine Hesitancy were valid and reliable tools. Male principals and those with better well-being, and higher health literacy had a lower level of vaccine hesitancy. Improving principals’ health literacy and well-being is suggested to be a strategic approach to increase vaccine acceptance for themselves, their staff, and students.