Women’s experiences of accessing vaccines during pregnancy and for their babies during COVID-19

Background

COVID-19 changed access to healthcare, including vaccinations, in the United Kingdom (UK). This study explored UK women’s experiences of accessing pertussis vaccination during pregnancy and infant vaccinations during COVID-19.

Methods

An online cross-sectional survey was completed, between 3rd August-11th October 2020, by 1404 women aged 16+ years who were pregnant at some point after the first UK lockdown from March 23rd 2020. Ten follow-up semi-structured interviews were conducted.

Results

Most women surveyed were pregnant (65.7%) and a third postnatal (34.3%). Almost all women (95.6%) were aware that pertussis vaccination is recommended in pregnancy. Most pregnant (72.1%) and postnatal women (84.0%) had received pertussis vaccination however, access issues were reported. Over a third (39.6%) of women had a pregnancy vaccination appointment changed. COVID-19 made it physically difficult to access pregnancy vaccinations for one fifth (21.5%) of women and physically difficult to access infant vaccinations for almost half of women (45.8%). Nearly half of women (45.2%) reported feeling less safe attending pregnancy vaccinations and over three quarters (76.3%) less safe attending infant vaccinations due to COVID-19. The majority (94.2%) felt it was important to get their baby vaccinated during COVID-19. Pregnant women from ethnic-minorities and lower-income households were less likely to have been vaccinated. Minority-ethnicity women were more likely to report access problems and feeling less safe attending vaccinations for both themselves and their babies. Qualitative analysis found women experienced difficulties accessing antenatal care and relied on knowledge from previous pregnancies to access vaccine appointments.

Conclusions

COVID-19 disrupted access to vaccinations in the UK. Vaccine services must ensure equitable access to vaccine appointments during ongoing and future pandemics including tailoring services for lower income and ethnic minority families.

Key messages

• Pregnancy and infant vaccines was disrupted by COVID-19 with women feeling less safe and having difficulties accessing vaccinations with ethnic minority women more likely to report access issues.

• Equitable access to routine pregnancy and infant vaccine appointments must be prioritised during future pandemics, including considering tailoring services for different population groups.

Antibody responses to Bordetella pertussis and other childhood vaccines in infants born to mothers who received pertussis vaccine in pregnancy - a prospective, observational cohort study from the United Kingdom

The maternal Tdap (tetanus, diphtheria and acellular pertussis) vaccination programme in the United Kingdom has successfully reduced cases of pertussis in young infants. In addition to prevention of pertussis cases, it is also important to investigate the persistence of maternal antibodies during infancy and the possible interference of maternal antibodies with infant responses to vaccines. We recruited mother–infant pairs from vaccinated and unvaccinated pregnancies and measured concentrations of immunoglobulin (Ig)G against pertussis toxin (PTx), filamentous haemagglutinin (FHA), pertactin (Prn), diphtheria toxin (DTx), tetanus toxoid (TTx) Haemophilus influenzae type b (Hib) and Streptococcus pneumoniae in mothers and infants at birth, and in infants at 7 weeks and at 5 months. Thirty‐one mother–infant pairs were tested. Tdap‐vaccinated women had significantly higher antibody against Tdap antigens, compared to unvaccinated women (DTx, P = 0·01; PTx, FHA, Prn and TTx, P < 0·001). All antibodies were actively transferred to the infants (transfer ratio  > 1) with higher transfer of DTx (P = 0·04) and TTx (P = 0·02) antibody in Tdap‐vaccinated pregnancies compared to unvaccinated pregnancies. Infants from Tdap‐vaccinated pregnancies had significantly elevated antibodies to all antigens at birth (P < 0.001) and at 7 weeks (FHA, Prn, TTx, P < 0·001; DTx, P = 0.01; PTx, P = 0·004) compared to infants from unvaccinated pregnancies. Infants from Tdap‐vaccinated and ‐unvaccinated pregnancies had comparable antibody concentrations following primary pertussis immunization (PTx, P = 0·77; FHA, P = 0·58; Prn, P = 0·60; DTx, P = 0·09; TTx, P = 0·88). These results support maternal immunization as a method of protecting vulnerable infants during their first weeks of life.

The impact of timing of maternal influenza immunization on infant antibody levels at birth

Pregnant women and infants are at an increased risk of severe disease after influenza infection. Maternal immunization is a potent tool to protect both these at-risk groups. While the primary aim of maternal influenza vaccination is to protect the mother, a secondary benefit is the transfer of protective antibodies to the infant. A recent study using the tetanus, diphtheria and acellular pertussis (Tdap) vaccine indicated that children born to mothers immunized in the second trimester of pregnancy had the highest antibody titres compared to children immunized in the third trimester. The aim of the current study was to investigate how the timing of maternal influenza immunization impacts infant antibody levels at birth. Antibody titres were assessed in maternal and cord blood samples by both immunoglobulin (Ig)G-binding enzyme-linked immunosorbent assay (ELISA) and haemagglutination inhibition assay (HAI). Antibody titres to the H1N1 component were significantly higher in infants born to mothers vaccinated in either the second or third trimesters than infants born to unvaccinated mothers. HAI levels in the infant were significantly lower when maternal immunization was performed less than 4 weeks before birth. These studies confirm that immunization during pregnancy increases the antibody titre in infants. Importantly, antibody levels in cord blood were significantly higher when the mother was vaccinated in either trimesters 2 or 3, although titres were significantly lower if the mother was immunized less than 4 weeks before birth. Based on these data, seasonal influenza vaccination should continue to be given in pregnancy as soon as it becomes available.

Structure and phase diagram of self-assembled rigid rods: equilibrium polydispersity and nematic ordering in two dimensions

We investigate the influence of directional or bonding interactions on the structure and phase diagram of complex fluids. Using a generalization of the theory of associating fluids we study the interplay between the self-assembly process, driven by the bonding interactions, and the isotropic-nematic transition, driven by the anisotropic shape of the equilibrium clusters, for a model consisting of particles with two bonding sites and discrete orientational degrees of freedom. The theory is applied over a wide range of temperature and density in two dimensions and the results are compared with Monte Carlo simulations on the square lattice. The specific heat is shown to exhibit pronounced structure at the onset of self-assembly and at the nematic-isotropic transition that occur over a narrow range of temperature, at fixed density. The results reveal that bonding is enhanced by the nematic ordering, although a bonding temperature still occurs in the isotropic phase at low densities. The average rod length is described quantitatively in both phases, while the location of the ordering transition, which was found to be continuous, is predicted semiquantitatively by the theory.

Forintek’s value added pathfinder: a case study

The paper describes the development of a specialised bilingual online database providing hyperlinks to Internet and other resources for researchers. The project grew from the need to provide current information for a new business area coinciding with the wish of the library staff to demonstrate leadership in knowledge management, making information accessible, no matter what its format or geographic location. Steps in planning the project are laid out. International standards for cataloguing electronic resources were not finalised, so the team adopted the best available for their purpose, building in enough flexibility to allow future adaptation. Our experience demonstrates the urgent need for finalised standards and led us to conclude that although consensus building is often desirable, sometimes there is a need to move forward more quickly with defined standards to prevent development stalling or extensive rework being required. Database elements, based on the Dublin Core metadata structure, are detailed.

The status of injury in upstate South Carolina

In conclusion, injuries are a leading cause of emergency room visits and hospital admissions in the upstate of South Carolina. Age was a major factor in the type of injury risk, hospitalization and, once hospitalized, length of stay and cost of hospital care. Future research efforts should include both quantitative and qualitative approaches to develop a more precise profile of persons who are most at risk for injury due to falls, motor vehicle crashes and intentional injuries. Information is also needed on follow-up care, including the cost of care post-hospital discharge and after discharge from the emergency room. The recommendations offered in this report may provide health care providers and health care agencies in the four-county upstate region with a guide to begin examining the major types of injuries that occur within their respective communities. Moreover, populations that are disproportionately affected may be delineated, and interventions may be specifically designed for and implemented in partnership with these populations.

Spirituality and HIV disease: an integrated perspective

Spirituality is an important resource that individuals use to cope with a chronic illness such as HIV disease. Spirituality has both a religious and an existential component that share the concepts of meaning in life, hope, self-transcendence, and rituals. An integrated perspective utilizing these shared concepts is proposed to assist HIV-positive individuals in coping with the challenges of their disease. Nursing interventions include promoting hope, teaching, sharing information, and creating a sense of empowerment in people with HIV to address spiritual issues. The article concludes with a case study that emphasizes application of the integrated perspective of spirituality with an HIV-positive person.

Family structure and patient survival in an African-American end-stage renal disease population: a preliminary investigation

Few studies have examined the influence of the family on the course of chronic illness in African-Americans. We explore the relationship between family structure, defined as marital status and household composition, and patient survival. Patient gender was examined as a possible moderator in this relationship. Using data from a survey of 476 African-American end-stage renal disease (ESRD) patients, a significant association between household composition and patient survival was found. Results from Cox proportional hazards model, controlling for patient age, indicated that patients who live in 'complex' households (i.e. those with a partner and/or others) are at greater risk for shortened survival as compared to those who live alone or with a spouse/partner (p < 0.05). When we examined whether patient gender moderates this relationship, female patients who live in these households were found to be at 2 times greater risk for shortened survival (p < 0.01) than female patients who live alone or with their spouse/ partner only. Family structure was not significantly associated with survival in male patients. Discussion and implications of findings are addressed.

A spheroplast rate assay for determination of cell wall integrity in yeast

The rate of formation of spheroplasts of yeast can be used as an assay to study the structural integrity of cell walls. Lysis can be measured spectrophotometrically in hypotonic solution in the presence of Zymolyase, a mixture of cell wall-digesting enzymes. The optical density of the cell suspension decreases as the cells lyse. We optimized this assay with respect to enzyme concentration, temperature, pH, and growth conditions for several strains of Saccharomyces cerevisiae. The level of variability (standard deviation) was 1-5% between trials where the replications were performed on the same culture using enzyme prepared from the same lot, and 5-15% for different cultures of the same strain. This assay can quantitate differences in cell wall structure (1) between exponentially growing and stationary phase cells, (2) among different S. cerevisiae strains, (3) between S. cerevisiae and Candida albicans, (4) between parental and mutated lines, and (5) between drug- or chemically-treated cells and controls.

Engagement of African American families in research on chronic illness: a multisystem recruitment approach

Our multisystem approach addressed the recruitment of African American families with a chronically, physically ill member. The approach focused on the social transactions between the family, the healthcare team, and the research staff, and the influence of these transactions on family recruitment. This multisystem approach included three core strategies: defining the membership of families in a culturally appropriate fashion and engaging those members; engaging the healthcare team; and building and maintaining the skills and morale of the research staff. A description of a longitudinal family health study and potential sources of recruitment biases is provided. Descriptive and bivariate analyses examined the effectiveness of the recruitment approach. A focus groups explored the reciprocal process of family protectiveness that both facilitated and hindered family recruitment and the research staff's alliance with families and the dialysis staff. Discussion focuses on the family health study's recruitment rate, sampling biases, and methods for improving the effectiveness of the multisystem recruitment approach.

Family support and survival among African-American end-stage renal disease patients

Family support is a critical factor in the survival of African-American end-stage renal disease (ESRD) patients. Research suggests that survival among ESRD patients is related to the quality of family support. There is empirical evidence for low family support as a risk factor for early mortality among African-American ESRD patients. This review describes findings from studies linking family support and patient survival in African-American ESRD patients. It also discusses findings that suggest treatment adherence as a mediator between family support and patient survival. Finally, the implications for clinical practice and future research with African-American ESRD patients are discussed.

Staff security and work pressure: contrasting patterns of stability and change across five dialysis units

Differences among clinical care units in social dynamics and social organization are associated with differences in the clinical course of patients with a range of chronic illness. These differences are also associated with well-being of staff members. Recent attention has focused on understanding these differences among units with an eye towards correcting deficiencies and enhancing strengths of clinical care units. The current study sought to delineate the effect of social and organizational dynamics unique to each unit on staff perceptions of the security of their relationships with other staff and their perceived work pressure. The unit as a major source of differences among staff subjects was compared with the impact of ethnic identity, of work in the morning shift vs other shifts, and of professional role. Results confirmed that unit membership was, by far, the most important correlate of staff perceptions of the unit, particularly those concerning security of relationships with others and perceived work pressure. Moreover, the results suggested that unit differences in perceived security were due to differences among units in long standing turmoil within the unit or long standing problematic ties between the unit and the larger institution which controls it. However, perceived work pressure seems more transient and may reflect the challenge of shorter-term fluctuations in the demands of patient care.

One session of flooding as treatment for conditioned avoidance responding in humans: effect of individualization of treatment duration

An avoidance response was conditioned to three stimuli (tone, vibrator, and light) presented in serial order. Following conditioning, each group of subjects underwent a different treatment procedure. Group 1 received a completely individualized flooding procedure distributed over multiple trials. Duration of the conditioned stimulus presentations was individualized by making them contingent upon termination of conditioned suppression, and duration of the treatment session by termination of conditioned avoidance. The Group 2 flooding procedure was completely non-individualized, massed into one trial and yoked to Group 1 to control for the amount of exposure to each of the conditioned stimuli and the duration of treatment sessions. Group 3 experienced non-individualized duration of treatment, individualized conditioned stimulus presentations distributed over trials and controlled for the duration of the treatment session and the distribution of trials. Analysis indicated that individualized duration of the flooding session utilizing a measure of anxiety dissipation significantly hastened the extinction of avoidance responses. Implications for the effective practice of implosive therapy were discussed.