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Lin C, Mullen J, Smith D, Kotarba M, Kaplan SJ, Tu P. Healthcare Providers' Vaccine Perceptions, Hesitancy, and Recommendation to Patients: A Systematic Review. Vaccines (Basel) 2021; 9:vaccines9070713. [PMID: 34358132 PMCID: PMC8310254 DOI: 10.3390/vaccines9070713] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 06/09/2021] [Accepted: 06/16/2021] [Indexed: 12/13/2022] Open
Abstract
Despite vaccines' effectiveness in reducing the rate of preventable diseases, vaccine hesitancy has threatened public health and economies worldwide. Healthcare providers' (HCP) communications and behavior strongly influence patient receptivity and uptake. The goal of this review was to examine HCP vaccine perceptions, knowledge, and reservations and how these attitudes affect their recommendations and vaccination practices. Primary research studies published by 16 September 2020 were searched in PubMed, Web of Science, Embase, CINAHL, and PsycINFO. A 14-item scale was developed for survey study and risk of bias appraisal (SSRBA). In total, 96 papers from 34 countries were included, covering 17 vaccines (HPV and influenza vaccines the most studied). Recommendation was positively associated with provider knowledge and experience, beliefs about disease risk, and perceptions of vaccine safety, necessity, and efficacy. HCP vaccination attitudes and practices varied across specialties, vaccines, and countries; demographic impact was inconclusive. Barriers included anticipation of patient/parental concerns or refusal, lacking clear guidelines, time constraints, and cost. For HPV, vaccines were more often recommended to older, female adolescents and by physicians who discussed sexual health. HCPs are vital advocates for patients and the public, but studies indicated a prevalence of provider hesitancy pertaining to inadequate knowledge, low vaccine confidence, and suboptimal uptake themselves. Improving HCP knowledge and assuring their access to information they deem trustworthy are essential to supporting HCPs' role as "trusted messengers" to promote vaccine acceptance.
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Affiliation(s)
- Cheryl Lin
- Policy and Organizational Management Program, Duke University, Durham, NC 27705, USA; (C.L.); (D.S.); (M.K.)
| | - Jewel Mullen
- Dell Medical School, The University of Texas at Austin, Austin, TX 78712, USA;
| | - Danielle Smith
- Policy and Organizational Management Program, Duke University, Durham, NC 27705, USA; (C.L.); (D.S.); (M.K.)
| | - Michaela Kotarba
- Policy and Organizational Management Program, Duke University, Durham, NC 27705, USA; (C.L.); (D.S.); (M.K.)
| | - Samantha J. Kaplan
- Medical Center Library and Archives, Duke University, Durham, NC 27710, USA;
| | - Pikuei Tu
- Policy and Organizational Management Program, Duke University, Durham, NC 27705, USA; (C.L.); (D.S.); (M.K.)
- Correspondence:
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Li WF, Huang SY, Peng HH, Chang YL, Chang SD, Cheng PJ. Factors affecting pregnant women's decisions regarding prenatal pertussis vaccination: A decision-making study in the nationwide Prenatal Pertussis Immunization Program in Taiwan. Taiwan J Obstet Gynecol 2020; 59:200-206. [PMID: 32127138 DOI: 10.1016/j.tjog.2020.01.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2019] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To examine the factors affecting pregnant women's decisions to accept or decline the prenatal pertussis (Tdap) vaccination in Taiwan. MATERIALS AND METHODS We conducted a cross-sectional survey, recruiting pregnant women who had received prenatal care from eight maternity hospitals between January and December 2018. We examined the participants' demographic characteristics, perceptions of pertussis disease risk and vaccination effectiveness, beliefs regarding vaccine information, physician recommendation, and other potential factors affecting decision-making regarding prenatal vaccination. RESULTS The complete survey response rate among eligible women was 78%. Among the participants, 74% accepted and 26% declined prenatal Tdap vaccination. Most women accepted Tdap during pregnancy because of perceived severity of pertussis in their infants, perceived effectiveness of the prenatal Tdap in preventing neonatal pertussis, and perceived safety of the prenatal Tdap vaccine for the fetus, as well as a provider's recommendation, which was the factor strongly associated with actual Tdap reception. Most of the participants who accepted Tdap vaccination during pregnancy and who believed that the Tdap vaccine could protect their infants from pertussis reported the receiving sufficient information to make an informed decision and trust in the information. By contrast, a large proportion of the participants who declined Tdap and who did not want to experience possible fetal side effects of Tdap reported not getting sufficient information to make an informed decision and a lack of trust in the information. CONCLUSION Developing a comprehensive strategy involving government policy, the health care system, public media, health professionals, and pregnant women to launch a successful campaign may improve the nationwide acceptance of the prenatal pertussis vaccination.
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Affiliation(s)
- Wen-Fang Li
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital-Linkou Medical Center, Taoyuan, Taiwan; Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Shang-Yu Huang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital-Linkou Medical Center, Taoyuan, Taiwan; Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Hsiu-Huei Peng
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital-Linkou Medical Center, Taoyuan, Taiwan; Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Yao-Lung Chang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital-Linkou Medical Center, Taoyuan, Taiwan; Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Shuenn-Dyh Chang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital-Linkou Medical Center, Taoyuan, Taiwan; Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Po-Jen Cheng
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital-Linkou Medical Center, Taoyuan, Taiwan; Chang Gung University College of Medicine, Taoyuan, Taiwan.
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Fernández-Cano MI, Espada-Trespalacios X, Reyes-Lacalle A, Manresa Domínguez JM, Armadans-Gil L, Campins-Martí M, Falguera-Puig G, Toran Monserrat P. Vaccination coverage against pertussis in pregnant women of Catalonia in the first year of implementation of the immunisation program. Enferm Infecc Microbiol Clin 2016; 35:550-555. [PMID: 27769682 DOI: 10.1016/j.eimc.2016.09.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Revised: 09/08/2016] [Accepted: 09/13/2016] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The re-emergence of pertussis and the severity of its complications in infants younger than 3 months, were determining factors for starting a vaccination program for pregnant women in the third trimester of gestation in Catalonia in February 2014. This was the first autonomous community to introduce it in Spain. The aim of the study was to estimate the coverage of the program in its first year of implementation. METHODS A retrospective analysis was performed on the data from the Primary Care Centre computerised medical records of pregnant women attending Sexual and Reproductive Health Care centres of the Metropolitan Nord area of the province of Barcelona, part of the Catalan Institute of Health. The overall coverage was estimated, as well as the sociodemographic variables of Tdap vaccination of women who had registered a delivery of a live birth between August 2014 and August 2015. RESULTS A total of 6,697 deliveries of live births were recorded, and 1,713 pregnant women were vaccinated, which represented an overall coverage of 25.6% (95% CI; 24.1-26.1). Vaccination coverage was higher in pregnant women under 18 years and Spanish women (P=.018 and P=.036, respectively). CONCLUSION The estimation of vaccine coverage against pertussis in pregnant women in the third trimester of pregnancy, after the first year of implementation of the program in a health area of Catalonia was lower than the objective set. Strategies need to be designed in order to improve program coverage.
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Affiliation(s)
- María Isabel Fernández-Cano
- Departamento de Enfermería, Universitat Autònoma de Barcelona (UAB), Cerdanyola del Vallès, Barcelona, España.
| | - Xavier Espada-Trespalacios
- Atención a la Salud Sexual y reproductiva. Gerencia Territorial metropolitana norte, Institut Català de la Salut, Unidad de apoyo a la investigación Metropolitana Norte, Instituto Universitario de Investigación en Atención Primaria Jordi Gol (IDIAP Jordi Gol), Grupo de Investigación en Atención a la Salud Sexual y Reproductiva (GRASSIR), Barcelona, España
| | - Azahara Reyes-Lacalle
- Atención a la Salud Sexual y reproductiva. Gerencia Territorial metropolitana norte, Institut Català de la Salut, Unidad de apoyo a la investigación Metropolitana Norte, Instituto Universitario de Investigación en Atención Primaria Jordi Gol (IDIAP Jordi Gol), Grupo de Investigación en Atención a la Salud Sexual y Reproductiva (GRASSIR), Barcelona, España
| | - Josep Maria Manresa Domínguez
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari de Investigació en Atenció Primaria (IDIAP) Jordi Gol, Barcelona, España
| | - Lluís Armadans-Gil
- Servicio de Medicina Preventiva y Epidemiología, Hospital Universitario Vall d'Hebron, Barcelona, España
| | - Magda Campins-Martí
- Servicio de Medicina Preventiva y Epidemiología, Hospital Universitario Vall d'Hebron, Barcelona, España
| | - Gemma Falguera-Puig
- Atención a la Salud Sexual y reproductiva. Gerencia Territorial metropolitana norte, Institut Català de la Salut, Unidad de apoyo a la investigación Metropolitana Norte, Instituto Universitario de Investigación en Atención Primaria Jordi Gol (IDIAP Jordi Gol), Grupo de Investigación en Atención a la Salud Sexual y Reproductiva (GRASSIR), Barcelona, España
| | - Pere Toran Monserrat
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari de Investigación en Atenció Primaria (IDIAP) Jordi Gol, Barcelona, España
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Cheng PJ, Huang SY, Su SY, Peng HH, Chang CL. Increasing postpartum rate of vaccination with tetanus, diphtheria, and acellular pertussis vaccine by incorporating pertussis cocooning information into prenatal education for group B streptococcus prevention. Vaccine 2015; 33:7225-7231. [DOI: 10.1016/j.vaccine.2015.10.121] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 10/12/2015] [Accepted: 10/28/2015] [Indexed: 11/26/2022]
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Fernández-Cano MI, Armadans Gil L, Campins Martí M. Cost–benefit of the introduction of new strategies for vaccination against pertussis in Spain: Cocooning and pregnant vaccination strategies. Vaccine 2015; 33:2213-2220. [DOI: 10.1016/j.vaccine.2015.03.045] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 03/10/2015] [Accepted: 03/16/2015] [Indexed: 10/23/2022]
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Suryadevara M, Domachowske JB. Prevention of pertussis through adult vaccination. Hum Vaccin Immunother 2015; 11:1744-7. [PMID: 25912733 PMCID: PMC4517454 DOI: 10.1080/21645515.2015.1038442] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 03/19/2015] [Accepted: 04/01/2015] [Indexed: 12/23/2022] Open
Abstract
Pertussis is a vaccine preventable respiratory infection. Young infants are at high risk of developing severe complications from infection. Despite high rates of pediatric vaccine uptake, there continues to be increases in pertussis cases, likely due to waning immunity from childhood vaccine and increased transmission through adults. Currently, pertussis booster vaccine (Tdap) is recommended for unimmunized adults and for women in the third trimester of each pregnancy; yet adult Tdap coverage remains low. Administering Tdap vaccine at non-traditional vaccination clinics and at sites where adults are accessing care for their children are effective in improving adult Tdap uptake. While most are willing to receive vaccine when recommended by their provider, lack of provider recommendation is a major obstacle to immunization. Future studies to understand barriers to provider vaccine recommendations need to be undertaken to develop interventions to improve adult Tdap vaccine uptake and reduce pertussis infection in the susceptible population.
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Affiliation(s)
- Manika Suryadevara
- Department of Pediatrics; SUNY Upstate Medical University; Syracuse, NY, USA
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Seroprevalence of influenza A H1N1 and seroconversion of mothers and infants induced by a single dose of monovalent vaccine. Taiwan J Obstet Gynecol 2014; 52:356-9. [PMID: 24075373 DOI: 10.1016/j.tjog.2013.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2013] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To determine the prevalence of preexisting antibodies against the pandemic 2009 Influenza A (H1N1) virus in pregnant women and to evaluate the seroprotection of the mothers and infants by a single injection of monovalent vaccine during the pandemic. MATERIALS AND METHODS Seropositivity rate of H1N1 among the nonvaccinated were compared with the vaccinated women. A single dose of vaccine, either nonadjuvanted AdimFlu-S or MF59-adjuvanted vaccine, was injected to the voluntarily vaccinated group. Maternal and cord blood sera were collected to evaluate the antibody response of the H1N1 virus. Seropositivity was defined as a hemagglutination inhibition titer to H1N1 (A/Taiwan/126/09) ≥ 1:40. RESULTS A total of 210 healthy, singleton, pregnant women were enrolled between January 2010 and May 2010. Seropositivity (≥ 1:40) of maternal hemagglutination inhibition was significantly higher in the vaccinated group (78%) than the nonvaccinated group (9.5%); 41.6% (20/48) of seropositive titers were >1:80. In nine vaccinated cases resulting in negative serum titers (<1:40), the prevalence of negative titer in the women received AdimFlu-S (14.8%, 4/31) was lower (p = 0.025) than those received MF59-adjuvanted vaccine (50%, 5/10). CONCLUSIONS Subclinical infection against H1N1 was low in Taiwanese pregnant women in the pandemic 2009. Seropositivity >75% could be achieved in the paired maternal and cord serum samples by a single injection of monovalent H1N1 vaccine.
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