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Razai MS, Mansour R, Goldsmith L, Freeman S, Mason-Apps C, Ravindran P, Kooner P, Berendes S, Morris J, Majeed A, Ussher M, Hargreaves S, Oakeshott P. Interventions to increase vaccination against COVID-19, influenza and pertussis during pregnancy: a systematic review and meta-analysis. J Travel Med 2023; 30:taad138. [PMID: 37934788 PMCID: PMC10755181 DOI: 10.1093/jtm/taad138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/19/2023] [Accepted: 10/22/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND Pregnant women and their babies face significant risks from three vaccine-preventable diseases: COVID-19, influenza and pertussis. However, despite these vaccines' proven safety and effectiveness, uptake during pregnancy remains low. METHODS We conducted a systematic review (PROSPERO CRD42023399488; January 2012-December 2022 following PRISMA guidelines) of interventions to increase COVID-19/influenza/pertussis vaccination in pregnancy. We searched nine databases, including grey literature. Two independent investigators extracted data; discrepancies were resolved by consensus. Meta-analyses were conducted using random-effects models to estimate pooled effect sizes. Heterogeneity was assessed using the I2 statistics. RESULTS From 2681 articles, we identified 39 relevant studies (n = 168 262 participants) across nine countries. Fifteen studies (39%) were randomized controlled trials (RCTs); the remainder were observational cohort, quality-improvement or cross-sectional studies. The quality of 18% (7/39) was strong. Pooled results of interventions to increase influenza vaccine uptake (18 effect estimates from 12 RCTs) showed the interventions were effective but had a small effect (risk ratio = 1.07, 95% CI 1.03, 1.13). However, pooled results of interventions to increase pertussis vaccine uptake (10 effect estimates from six RCTs) showed no clear benefit (risk ratio = 0.98, 95% CI 0.94, 1.03). There were no relevant RCTs for COVID-19. Interventions addressed the 'three Ps': patient-, provider- and policy-level strategies. At the patient level, clear recommendations from healthcare professionals backed by text reminders/written information were strongly associated with increased vaccine uptake, especially tailored face-to-face interventions, which addressed women's concerns, dispelled myths and highlighted benefits. Provider-level interventions included educating healthcare professionals about vaccines' safety and effectiveness and reminders to offer vaccinations routinely. Policy-level interventions included financial incentives, mandatory vaccination data fields in electronic health records and ensuring easy availability of vaccinations. CONCLUSIONS Interventions had a small effect on increasing influenza vaccination. Training healthcare providers to promote vaccinations during pregnancy is crucial and could be enhanced by utilizing mobile health technologies.
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Affiliation(s)
- Mohammad S Razai
- Population Health Research Institute, St George’s University of London, London, UK
| | - Rania Mansour
- Population Health Research Institute, St George’s University of London, London, UK
| | - Lucy Goldsmith
- Population Health Research Institute, St George’s University of London, London, UK
| | - Samuel Freeman
- Primary Care Unit, University Hospitals Sussex NHS Foundation Trust, Sussex, UK
| | - Charlotte Mason-Apps
- Population Health Research Institute, St George’s University of London, London, UK
| | - Pahalavi Ravindran
- Department of Respiratory Medicine, University Hospitals of Leicester NHS Foundation Trust, Leicester, UK
| | | | - Sima Berendes
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Joan Morris
- Population Health Research Institute, St George’s University of London, London, UK
| | - Azeem Majeed
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Michael Ussher
- Population Health Research Institute, St George’s University of London, London, UK
- Institute of Social Marketing and Health, University of Stirling, Stirling, UK
| | - Sally Hargreaves
- Population Health Research Institute, St George’s University of London, London, UK
- The Migrant Health Research Unit, Institute for Infection and Immunity, St George’s, University of London, London, UK
| | - Pippa Oakeshott
- Population Health Research Institute, St George’s University of London, London, UK
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Del Duca G, Tavelli A, Mastrorosa I, Aguglia C, Lanini S, Brita AC, Gagliardini R, Vita S, Vergori A, Paulicelli J, Natalini G, D’Urso A, Piselli P, Gallì P, Mondillo V, Mastroianni C, Tamburrini E, Sarmati L, Stingone C, Lichtner M, Nicastri E, Farinella M, Leserri F, Siddu A, Maggi F, d’Arminio Monforte A, Vairo F, Barca A, Vaia F, Girardi E, Mazzotta V, Antinori A. Risk Awareness as a Key Determinant of Early Vaccine Uptake in the Mpox Vaccination Campaign in an Italian Region: A Cross-Sectional Analysis. Vaccines (Basel) 2023; 11:1761. [PMID: 38140166 PMCID: PMC10748194 DOI: 10.3390/vaccines11121761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 11/16/2023] [Accepted: 11/23/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND we aim to investigate attitudes toward vaccination by analyzing empirical factors associated with vaccine acceptance in the Lazio region mpox vaccination (MpoxVax) campaign in Italy. METHODS all subjects who accessed MpoxVax and signed the informed consent were prospectively enrolled in the MPOX-VAC Study and were asked to fill out an anonymous survey. Two endpoints were selected: 'delayed acceptance' and 'early acceptance', defined as access for vaccination >60 and ≤30 days from the vaccination campaign starting (VCS), respectively. RESULTS over the study period, 1717 individuals underwent vaccination: 129 (7%) > 60 [1588 (92.5%) ≤ 60] and 676 (60%) ≤ 30 days from VCS. A bisexual orientation, a lower education level and a worse perceived physical and mental health were associated with delayed access to vaccination. Being pre-exposure prophylaxis (PrEP) users and, marginally, HIV positive; having a high perceived risk for mpox infection; and reporting high-risk behaviors like the use of recreational drugs/chems, sex under the influence of drugs and/or alcohol and having a higher number of principal sexual partners, were associated with early access to vaccination. CONCLUSIONS according to our data, risk awareness was a major determinant of early MpoxVax acceptance. Conversely, worse perceived health status and a low educational level were critical factors associated with delayed vaccination.
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Affiliation(s)
- Giulia Del Duca
- Clinical Infectious Diseases Department, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, 00149 Rome, Italy; (G.D.D.); (C.A.); (S.L.); (A.C.B.); (R.G.); (S.V.); (A.V.); (J.P.); (G.N.); (A.D.); (E.N.); (V.M.); (A.A.)
| | | | - Ilaria Mastrorosa
- Clinical Infectious Diseases Department, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, 00149 Rome, Italy; (G.D.D.); (C.A.); (S.L.); (A.C.B.); (R.G.); (S.V.); (A.V.); (J.P.); (G.N.); (A.D.); (E.N.); (V.M.); (A.A.)
| | - Camilla Aguglia
- Clinical Infectious Diseases Department, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, 00149 Rome, Italy; (G.D.D.); (C.A.); (S.L.); (A.C.B.); (R.G.); (S.V.); (A.V.); (J.P.); (G.N.); (A.D.); (E.N.); (V.M.); (A.A.)
- Department of System Medicine, University of Rome Tor Vergata, 00133 Rome, Italy;
| | - Simone Lanini
- Clinical Infectious Diseases Department, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, 00149 Rome, Italy; (G.D.D.); (C.A.); (S.L.); (A.C.B.); (R.G.); (S.V.); (A.V.); (J.P.); (G.N.); (A.D.); (E.N.); (V.M.); (A.A.)
| | - Anna Clelia Brita
- Clinical Infectious Diseases Department, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, 00149 Rome, Italy; (G.D.D.); (C.A.); (S.L.); (A.C.B.); (R.G.); (S.V.); (A.V.); (J.P.); (G.N.); (A.D.); (E.N.); (V.M.); (A.A.)
| | - Roberta Gagliardini
- Clinical Infectious Diseases Department, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, 00149 Rome, Italy; (G.D.D.); (C.A.); (S.L.); (A.C.B.); (R.G.); (S.V.); (A.V.); (J.P.); (G.N.); (A.D.); (E.N.); (V.M.); (A.A.)
| | - Serena Vita
- Clinical Infectious Diseases Department, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, 00149 Rome, Italy; (G.D.D.); (C.A.); (S.L.); (A.C.B.); (R.G.); (S.V.); (A.V.); (J.P.); (G.N.); (A.D.); (E.N.); (V.M.); (A.A.)
| | - Alessandra Vergori
- Clinical Infectious Diseases Department, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, 00149 Rome, Italy; (G.D.D.); (C.A.); (S.L.); (A.C.B.); (R.G.); (S.V.); (A.V.); (J.P.); (G.N.); (A.D.); (E.N.); (V.M.); (A.A.)
| | - Jessica Paulicelli
- Clinical Infectious Diseases Department, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, 00149 Rome, Italy; (G.D.D.); (C.A.); (S.L.); (A.C.B.); (R.G.); (S.V.); (A.V.); (J.P.); (G.N.); (A.D.); (E.N.); (V.M.); (A.A.)
| | - Giorgia Natalini
- Clinical Infectious Diseases Department, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, 00149 Rome, Italy; (G.D.D.); (C.A.); (S.L.); (A.C.B.); (R.G.); (S.V.); (A.V.); (J.P.); (G.N.); (A.D.); (E.N.); (V.M.); (A.A.)
| | - Angela D’Urso
- Clinical Infectious Diseases Department, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, 00149 Rome, Italy; (G.D.D.); (C.A.); (S.L.); (A.C.B.); (R.G.); (S.V.); (A.V.); (J.P.); (G.N.); (A.D.); (E.N.); (V.M.); (A.A.)
| | - Pierluca Piselli
- Department of Epidemiology, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, 00149 Rome, Italy; (P.P.); (F.V.)
| | - Paola Gallì
- Health Direction, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, 00149 Rome, Italy; (P.G.); (V.M.)
| | - Vanessa Mondillo
- Health Direction, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, 00149 Rome, Italy; (P.G.); (V.M.)
| | - Claudio Mastroianni
- Department of Public Health and Infectious Diseases, Sapienza University, AOU Policlinico Umberto 1, 00161 Rome, Italy;
| | - Enrica Tamburrini
- Fondazione Policlinico A. Gemelli, Catholic University of the Sacred Heart, 00168 Rome, Italy;
| | - Loredana Sarmati
- Department of System Medicine, University of Rome Tor Vergata, 00133 Rome, Italy;
| | - Christof Stingone
- STI/HIV Unit, San Gallicano IRCCS Dermatological Institute, 00144 Rome, Italy;
| | - Miriam Lichtner
- Neuroscience Mental Health and Sense Organs Department, Sapienza University of Rome, Polo Pontino, 04100 Latina, Italy;
| | - Emanuele Nicastri
- Clinical Infectious Diseases Department, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, 00149 Rome, Italy; (G.D.D.); (C.A.); (S.L.); (A.C.B.); (R.G.); (S.V.); (A.V.); (J.P.); (G.N.); (A.D.); (E.N.); (V.M.); (A.A.)
| | | | | | - Andrea Siddu
- General Directorate of Prevention, Ministry of Health, 00197 Rome, Italy; (A.S.); (F.V.)
| | - Fabrizio Maggi
- Laboratory of Virology, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, 00149 Rome, Italy;
| | | | - Francesco Vairo
- Department of Epidemiology, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, 00149 Rome, Italy; (P.P.); (F.V.)
| | - Alessandra Barca
- Unit of Health Promotion and Prevention, Directorate of Health and Integration, Lazio Region, 00145 Rome, Italy;
| | - Francesco Vaia
- General Directorate of Prevention, Ministry of Health, 00197 Rome, Italy; (A.S.); (F.V.)
| | - Enrico Girardi
- Scientific Direction, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, 00149 Rome, Italy;
| | - Valentina Mazzotta
- Clinical Infectious Diseases Department, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, 00149 Rome, Italy; (G.D.D.); (C.A.); (S.L.); (A.C.B.); (R.G.); (S.V.); (A.V.); (J.P.); (G.N.); (A.D.); (E.N.); (V.M.); (A.A.)
| | - Andrea Antinori
- Clinical Infectious Diseases Department, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, 00149 Rome, Italy; (G.D.D.); (C.A.); (S.L.); (A.C.B.); (R.G.); (S.V.); (A.V.); (J.P.); (G.N.); (A.D.); (E.N.); (V.M.); (A.A.)
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