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Hansen BT, Winje BA, Stålcrantz J, Greve-Isdahl M. Predictors of maternal pertussis vaccination acceptance among pregnant women in Norway. Hum Vaccin Immunother 2024; 20:2361499. [PMID: 38847213 PMCID: PMC11164220 DOI: 10.1080/21645515.2024.2361499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 05/25/2024] [Indexed: 06/12/2024] Open
Abstract
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.
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Affiliation(s)
- Bo T. Hansen
- Department of Infection Control and Vaccine, Norwegian Institute of Public Health, Oslo, Norway
| | - Brita A. Winje
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Jeanette Stålcrantz
- Department of Infection Control and Vaccine, Norwegian Institute of Public Health, Oslo, Norway
| | - Margrethe Greve-Isdahl
- Department of Infection Control and Vaccine, Norwegian Institute of Public Health, Oslo, Norway
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Pley C, Kampmann B. Opportunities and challenges to the development and deployment of vaccines for pregnant women in Germany. Vaccine 2024:S0264-410X(24)00735-7. [PMID: 38944576 DOI: 10.1016/j.vaccine.2024.06.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 05/11/2024] [Accepted: 06/26/2024] [Indexed: 07/01/2024]
Abstract
Maternal immunisation is a powerful tool to protect both pregnant women and their children. A new maternal RSV vaccine holds promise to protect newborns from RSV-associated illness in the first few months of life, but no official recommendation has been made in Germany. Since RSV causes a significant burden of paediatric hospital admissions, we consider it a pertinent opportunity to review barriers to maternal vaccination in Germany, which might also apply to other settings. Access to vaccination for pregnant women in Germany is shaped by an interplay of legal, regulatory, institutional, and sociocultural factors, with a less permissive clinical research environment, delays in recommendation and roll-out, and lower acceptance by healthcare professionals and the population. Actionable recommendations to improve availability and uptake include coordination with other national regulatory bodies to reduce delays, awareness and literacy campaigns for health professionals and the general public, and capacity building for vaccine clinical research.
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Affiliation(s)
- Caitlin Pley
- Charité Center for Global Health, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Beate Kampmann
- Charité Center for Global Health, Charité Universitätsmedizin Berlin, Berlin, Germany; Vaccine Centre, London School of Hygiene and Tropical Medicine, London, UK.
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Knowledge, Perceptions, Attitudes and Practices of Midwives Regarding Maternal Influenza and Pertussis Vaccination: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148391. [PMID: 35886242 PMCID: PMC9322479 DOI: 10.3390/ijerph19148391] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/28/2022] [Accepted: 07/07/2022] [Indexed: 02/04/2023]
Abstract
The coverage of maternal vaccination against pertussis and, particularly, influenza is lower than expected. The lack of recommendation from healthcare providers conditions non-vaccination in pregnant women. The purpose was to determine the knowledge, perceptions, attitudes and practices of midwives regarding maternal influenza and pertussis vaccination. A qualitative descriptive study based on semi-structured, face-to-face interviews with seventeen midwives was conducted, including purposive sampling and thematic analyses. Midwives had disparate knowledge and perceptions about the severity of influenza and pertussis in pregnant women, and influenza was not considered very serious. The vaccines were generally considered safe. However, because midwives did not have enough information about the safety of the influenza vaccine, there was a tendency not to recommend it. While most midwives had a positive attitude toward vaccination, their advocation for vaccination against influenza was not as clear as it was for pertussis. Not wanting to influence the decision and assuming an informative–facilitating role also led providers to recommend the influenza vaccine less frequently. Midwives are among the main sources of professional advice for pregnant women. Addressing their understanding and professional practices regarding maternal vaccination is key to change the attitude of pregnant women and thus increase vaccine uptake among them, particularly for influenza.
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Cappozzo F, Dal Zotto A, Scollo M, Bernardini D, Maria Dal Zotto A, Bonvecchio L, Tognetto G, Marinangeli S, Negrello C, Lanza P, Cocco A, Falivene P, Vianello L, Di Caprio A, Gabutti G, Saugo M. dTap vaccination uptake during pregnancy: Pregnant women-focused and health professionals-focused predictors in the Veneto Region (Italy). Vaccine 2021; 39:6913-6919. [PMID: 34711438 DOI: 10.1016/j.vaccine.2021.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 09/08/2021] [Accepted: 10/07/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Despite recommendations, the uptake of dTap maternal vaccination is still low in many countries. The reasons for this must be investigated both on the patient's and the healthcare professionals' sides. METHODS A record linkage study was performed linking Birth Assitance Certificates and dTap mothers' vaccination records (5183 deliveries) to describe the influence of socioeconomical and obstetrical-gynecological factors after the recommendations concerning dTap vaccination in pregnancy issued by the Italian Ministry of Health (August 2018). An interview was also administered to a subgroup of 656 new mothers on the occasion of the first vaccination of their newborns, in order to assess the dTap vaccination advice received from maternal care providers during pregnancy. A generalized linear model (binomial family, log link) was implemented to give a correct estimate of the mother's relative risk of being vaccinated. RESULTS Several pregnant women-focused factors are evident, but the most important ones are related to maternal care providers' practices: after mutual adjustment, the explicit advice towards dTap maternal vaccination given by the Obstetrician-Gynecologist or the Midwife is associated with a 12-fold increase in the dTap coverage. CONCLUSIONS Multiprofessional training is essential to make Obstetricians-Gynecologists and Midwives more confident in recommending dTaP maternal immunization.
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Affiliation(s)
- Francesco Cappozzo
- Obstetric and Gynecology Department, Local Health Unit 7, Bassano del Grappa, Italy
| | | | - Marcello Scollo
- Obstetric and Gynecology Department, Local Health Unit 7, Bassano del Grappa, Italy
| | - Daniele Bernardini
- Department of Prevention, Local Health Unit 7, Bassano del Grappa, Italy
| | | | - Lucia Bonvecchio
- Department of Prevention, Local Health Unit 7, Bassano del Grappa, Italy
| | - Gabriella Tognetto
- Department of Prevention, Local Health Unit 7, Bassano del Grappa, Italy
| | | | - Chiara Negrello
- Family Counseling Center, Local Health Unit 7, Bassano del Grappa, Italy
| | - Paola Lanza
- Obstetric and Gynecology Department, Local Health Unit 7, Bassano del Grappa, Italy
| | - Andrea Cocco
- Obstetric and Gynecology Department, Local Health Unit 7, Bassano del Grappa, Italy
| | - Patrizia Falivene
- Department of Prevention, Local Health Unit 7, Bassano del Grappa, Italy
| | - Liviano Vianello
- Department of Prevention, Local Health Unit 7, Bassano del Grappa, Italy
| | - Antonio Di Caprio
- Health Services Director, Local Health Unit 7, Bassano del Grappa, Italy
| | - Giovanni Gabutti
- Department of Medical Sciences,University of Ferrara, Ferrara, Italy
| | - Mario Saugo
- Department of Prevention, Local Health Unit 7, Bassano del Grappa, Italy.
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Larson A, Skolnik A, Bhatti A, Mitrovich R. Addressing an urgent global public health need: Strategies to recover routine vaccination during the COVID-19 pandemic. Hum Vaccin Immunother 2021; 18:1975453. [PMID: 34674605 PMCID: PMC8920227 DOI: 10.1080/21645515.2021.1975453] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Routine vaccination has been severely impacted by the COVID-19 pandemic, with 37% of countries reporting continuing disruptions to vaccination services into 2021. These programs have been faced with the challenges of achieving high vaccination coverage rates (VCRs), as well as identifying and vaccinating those who missed recommended doses since the pandemic began. Declines in VCRs, even for short periods, can lead to an increase in disease outbreaks, place additional pressure on health systems, and leave communities across the world at risk of death and disease from vaccine-preventable diseases.In the face of these disruptions, select governments are implementing promising approaches to address low VCRs, some of which represent innovative solutions to advance short-term, as well as longer-term program improvement. However, expanded action is urgently required to fully recover vaccination programs and strengthen vaccine system infrastructure. The COVID-19 pandemic provides a unique opportunity to modernize routine programs and corresponding infrastructure to meet today's and tomorrow's health challenges more effectively and efficiently. This can be achieved by prioritizing routine vaccination as an essential health service, improving access to vaccination across the life-course, strengthening data systems, ensuring sustainable immunization financing, and building confidence in vaccination.
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Röbl-Mathieu M, Kunstein A, Liese J, Mertens T, Wojcinski M. Vaccination in Pregnancy. DEUTSCHES ARZTEBLATT INTERNATIONAL 2021; 118:262-268. [PMID: 34114547 PMCID: PMC8287076 DOI: 10.3238/arztebl.m2021.0020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 06/24/2020] [Accepted: 11/02/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Vaccination during pregnancy can protect both the expecting mother and the unborn and newborn child from infectious diseases. METHODS This review is based on publications retrieved by a selective literature search on the immunological particularities of infectious diseases affecting pregnant women, unborn children, and neonates, with particular attention to the guidelines of the German Standing Committee on Vaccinations (Ständige Impfkommission, STIKO) and the pertinent guidelines. RESULTS Vaccination during pregnancy protects the expecting mother from a severe course of a number of different infectious diseases. Vaccination with inactivated vaccines against influenza, tetanus, and pertussis is effective, safe, and well tolerated. Women who are pregnant or of child-bearing age should be immunized against tetanus according to the STIKO recommendations. All pregnant women from the second trimester onward should receive an inactivated quadrivalent influenza vaccine. The immunity acquired after vaccination with an acellular pertussis vaccine is present only for a limited time. In a cohort study involving 72,781 pregnant women, pertussis vaccination during pregnancy was found to yield 91% protection against pertussis for their subsequently born children in the first three months of life. Further types of vaccine can also be given during pregnancy if indicated. Additional reasonable measures to protect the health of mother and child include the vaccination of other persons in close contact as well as the closure of relevant vaccination gaps among young adults, particularly women of child-bearing age. Treating physicians play a crucial role in encouraging vaccine acceptance by their patients. CONCLUSION Maternal immunization is a safe and effective strategy for giving neo - nates passive immune protection against life-threatening infections by the vertical transmission of maternal antibodies until they are able to build up their own adaptive immunity.
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Affiliation(s)
- Marianne Röbl-Mathieu
- Gynecologist's office, Munich; Member of STIKOGynecologist's office, MunichDepartment of Pediatrics, University Hospital WürzburgInstitute of Virology, Ulm University Hospital, Ulm; Member of STIKOWorking Group Vaccination in Pregnancy, German Professional Association of Gynecologists, Munich
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Smith SE, Gum L, Thornton C. An exploration of midwives' role in the promotion and provision of antenatal influenza immunisation: A mixed methods inquiry. Women Birth 2021; 34:e7-e13. [PMID: 32418653 PMCID: PMC7211614 DOI: 10.1016/j.wombi.2020.04.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 04/27/2020] [Accepted: 04/29/2020] [Indexed: 11/05/2022]
Abstract
PROBLEM No South Australian study has previously investigated the role of midwives in the promotion and provision of antenatal influenza immunisation. BACKGROUND Influenza acquired in pregnancy can have serious sequalae for both mother and foetus. Recent studies have demonstrated that influenza vaccine in pregnancy is both safe and effective. Despite this, evidence suggests that vaccine uptake in pregnancy is suboptimal in both Australia and worldwide. AIM The aim of this study was to investigate the role of midwives in the promotion and provision of antenatal influenza vaccine and, to provide a statistical and thematic description of the barriers and enablers midwives encounter. METHODS This mixed method study incorporated a cross sectional on-line survey and in-depth interviews conducted with midwives, employed in urban and regional South Australia. FINDINGS Quantitative data were available for 137 midwives and 10 midwives participated in the interviews. Recruitment for the interview phase was through the last question on the survey. Whilst all midwives indicated that education and vaccine promotion were part of their role, immunisation knowledge varied between Registered Nurse/Midwives (RM/RN) 80% and Registered Midwives (RM) 48.90% (p = 0.001). Quantitative data showed that only 43% of midwives felt sufficiently educated to provide the vaccine. Midwives who had received formal immunisation training were more likely to recommend the vaccine 93.7% (p = 0.001). Qualitative data confirmed these results and identified the lack of immunisation education as a barrier to practise. CONCLUSION Midwives identified an immunisation knowledge deficit. Midwives who had received immunisation education were more likely to actively promote and provide the vaccine to pregnant women. These findings indicate the need for more immunisation education of midwives in both tertiary and practice settings.
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Affiliation(s)
- Susan Elizabeth Smith
- Flinders University, College of Nursing and Health Science, Sturt Street, Bedford Park, Adelaide, SA 5154, Australia.
| | - Lyn Gum
- Flinders University, College of Nursing and Health Science, Sturt Street, Bedford Park, Adelaide, SA 5154, Australia
| | - Charlene Thornton
- Flinders University, College of Nursing and Health Science, Sturt Street, Bedford Park, Adelaide, SA 5154, Australia
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Carcelen AC, Vilajeliu A, Malik F, Gilman RH, Omer S. Perceptions and attitudes towards vaccination during pregnancy in a peri urban area of Lima, Peru. Vaccine 2020; 39 Suppl 2:B27-B33. [PMID: 33349458 DOI: 10.1016/j.vaccine.2020.10.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 08/28/2020] [Accepted: 10/09/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Maternal immunization has the potential to reduce both maternal and infant morbidity and mortality by protecting women from complications during pregnancy as well as conferring protection for babies who are too young to be vaccinated. Limited evidence is available about the drivers of maternal immunization in middle-income countries such as Peru. Vaccines against tetanus, diphtheria and influenza are recommended beginning in the second trimester in Peru; however, vaccination coverage has remained low in Peru compared to other countries in the region. As additional vaccines are recommended for administration in pregnancy, a better understanding of the perceptions and attitudes of pregnant women that influence vaccination are needed to design communication materials. METHODS We conducted an exploratory qualitative study to understand the individual level factors influencing pregnant women's vaccine uptake. We interviewed pregnant women about their knowledge, perceptions and experiences with vaccination during pregnancy. Community health workers recruited women in a peri urban area of Peru in April 2018. RESULTS Twelve women were interviewed, the majority of which had received vaccination during the current pregnancy. The most common reasons for vaccination were to protect the baby and because vaccines are effective. Concerns included vaccine safety during pregnancy and adverse effects on the unborn baby. Some women mentioned that because vaccines are given later in pregnancy, the unborn baby is stronger, so vaccines will not harm them. Women highlighted that the main reason for not being vaccinated was lack of information. They also noted that they were the decision-maker in whether or not they were vaccinated. Most women said that they trusted healthcare providers and that trust was linked to providing information through open communication. CONCLUSIONS Overall, participants were supportive of maternal vaccination. They believed that vaccines were effective in protecting both their unborn baby and themselves. The main reason given for non-vaccination was lack of knowledge about vaccination in pregnancy. The strong desire expressed by study participants to get more information presents an opportunity for immunization programs to develop interventions that facilitate better information dissemination to pregnant women to increase vaccination uptake.
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Affiliation(s)
- Andrea C Carcelen
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Alba Vilajeliu
- Department of Family, Health Promotion and Life Course, Pan American Health Organization/World Health Organization Regional Office for the Americas, Washington, DC, USA.
| | - Fauzia Malik
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA.
| | - Robert H Gilman
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Saad Omer
- Yale Institute for Global Health, New Haven, CT, USA; Department of Internal Medicine (Infectious Diseases), Yale School of Medicine, New Haven, CT, USA; Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA; Yale School of Nursing, Orange, CT, USA.
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Otieno NA, Nyawanda B, Otiato F, Adero M, Wairimu WN, Atito R, Wilson AD, Gonzalez-Casanova I, Malik FA, Verani JR, Widdowson MA, Omer SB, Chaves SS. Knowledge and attitudes towards influenza and influenza vaccination among pregnant women in Kenya. Vaccine 2020; 38:6832-6838. [PMID: 32893035 PMCID: PMC7526973 DOI: 10.1016/j.vaccine.2020.08.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 08/04/2020] [Accepted: 08/06/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Influenza vaccination during pregnancy benefits mothers and children. Kenya and other low- and middle-income countries have no official influenza vaccination policies to date but are moving towards issuing such policies. Understanding determinants of influenza vaccine uptake during pregnancy in these settings is important to inform policy decisions and vaccination rollout. METHODS We interviewed a convenience sample of women at antenatal care facilities in four counties (Nairobi, Mombasa, Marsabit, Siaya) in Kenya. We described knowledge and attitudes regarding influenza vaccination and assessed factors associated with willingness to receive influenza vaccine. RESULTS We enrolled 507 pregnant women, median age was 26 years (range 15-43). Almost half (n = 240) had primary or no education. Overall, 369 (72.8%) women had heard of influenza. Among those, 288 (78.1%) believed that a pregnant woman would be protected if vaccinated, 252 (68.3%) thought it was safe to receive a vaccine while pregnant, and 223 (60.4%) believed a baby would be protected if mother was vaccinated. If given opportunity, 309 (83.7%) pregnant women were willing to receive the vaccine. Factors associated with willingness to receive influenza vaccine were mothers' belief in protective effect (OR 3.87; 95% CI 1.56, 9.59) and safety (OR 5.32; 95% CI 2.35, 12.01) of influenza vaccines during pregnancy. CONCLUSION Approximately one third of pregnant women interviewed had never heard of influenza. Willingness to receive influenza vaccine was high among women who had heard about influenza. If the Kenyan government recommends influenza vaccine for pregnant women, mitigation of safety concerns and education on the benefits of vaccination could be the most effective strategies to improve vaccine acceptance.
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Affiliation(s)
- Nancy A Otieno
- Kenya Medical Research Institute, Center for Global Health Research, Kisumu, Kenya.
| | - Bryan Nyawanda
- Kenya Medical Research Institute, Center for Global Health Research, Kisumu, Kenya
| | - Fredrick Otiato
- Kenya Medical Research Institute, Center for Global Health Research, Kisumu, Kenya
| | - Maxwel Adero
- Kenya Medical Research Institute, Center for Global Health Research, Kisumu, Kenya
| | - Winnie N Wairimu
- Kenya Medical Research Institute, Center for Global Health Research, Kisumu, Kenya
| | - Raphael Atito
- Kenya Medical Research Institute, Center for Global Health Research, Kisumu, Kenya
| | - Andrew D Wilson
- Emory University Rollins School of Public Health, Hubert Department of Global Health, Atlanta, GA, USA
| | - Ines Gonzalez-Casanova
- Emory University Rollins School of Public Health, Hubert Department of Global Health, Atlanta, GA, USA
| | - Fauzia A Malik
- Emory University Rollins School of Public Health, Hubert Department of Global Health, Atlanta, GA, USA
| | - Jennifer R Verani
- Centers for Disease Control and Prevention, Division of Global Health Protection, Kenya
| | - Marc-Alain Widdowson
- Centers for Disease Control and Prevention, Division of Global Health Protection, Kenya
| | - Saad B Omer
- Emory University Rollins School of Public Health, Hubert Department of Global Health, Atlanta, GA, USA
| | - Sandra S Chaves
- Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Kenya
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Abu-Raya B, Maertens K, Edwards KM, Omer SB, Englund JA, Flanagan KL, Snape MD, Amirthalingam G, Leuridan E, Damme PV, Papaevangelou V, Launay O, Dagan R, Campins M, Cavaliere AF, Frusca T, Guidi S, O'Ryan M, Heininger U, Tan T, Alsuwaidi AR, Safadi MA, Vilca LM, Wanlapakorn N, Madhi SA, Giles ML, Prymula R, Ladhani S, Martinón-Torres F, Tan L, Michelin L, Scambia G, Principi N, Esposito S. Global Perspectives on Immunization During Pregnancy and Priorities for Future Research and Development: An International Consensus Statement. Front Immunol 2020; 11:1282. [PMID: 32670282 PMCID: PMC7326941 DOI: 10.3389/fimmu.2020.01282] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 05/20/2020] [Indexed: 12/17/2022] Open
Abstract
Immunization during pregnancy has been recommended in an increasing number of countries. The aim of this strategy is to protect pregnant women and infants from severe infectious disease, morbidity and mortality and is currently limited to tetanus, inactivated influenza, and pertussis-containing vaccines. There have been recent advancements in the development of vaccines designed primarily for use in pregnant women (respiratory syncytial virus and group B Streptococcus vaccines). Although there is increasing evidence to support vaccination in pregnancy, important gaps in knowledge still exist and need to be addressed by future studies. This collaborative consensus paper provides a review of the current literature on immunization during pregnancy and highlights the gaps in knowledge and a consensus of priorities for future research initiatives, in order to optimize protection for both the mother and the infant.
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Affiliation(s)
- Bahaa Abu-Raya
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Kirsten Maertens
- Faculty of Medicine and Health Sciences, Centre for the Evaluation of Vaccination, Vaccine and Infectious Diseases Institute, University of Antwerp, Antwerp, Belgium
| | - Kathryn M. Edwards
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, United States
| | - Saad B. Omer
- Department of Internal Medicine (Infectious Diseases), Department of Epidemiology of Microbial Diseases, Yale School of Medicine, Yale School of Public Health, New Haven, CT, United States
| | - Janet A. Englund
- Department of Pediatrics, Seattle Children's Research Institute, University of Washington, Seattle, WA, United States
| | - Katie L. Flanagan
- Faculty of Health Sciences, School of Medicine, University of Tasmania, Launceston, TAS, Australia
- School of Health and Biomedical Science, RMIT University, Melbourne, VIC, Australia
- Department of Immunology and Pathology, Monash University, Melbourne, VIC, Australia
| | - Matthew D. Snape
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Gayatri Amirthalingam
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, London, United Kingdom
| | - Elke Leuridan
- Faculty of Medicine and Health Sciences, Centre for the Evaluation of Vaccination, Vaccine and Infectious Diseases Institute, University of Antwerp, Antwerp, Belgium
| | - Pierre Van Damme
- Faculty of Medicine and Health Sciences, Centre for the Evaluation of Vaccination, Vaccine and Infectious Diseases Institute, University of Antwerp, Antwerp, Belgium
| | - Vana Papaevangelou
- Third Department of Pediatrics, University Hospital ATTIKON, National and Kapodistrian University of Athens, Athens, Greece
| | - Odile Launay
- Université de Paris, Inserm, CIC 1417, F-CRIN I REIVAC, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Ron Dagan
- The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Magda Campins
- Preventive Medicine and Epidemiology Department, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Anna Franca Cavaliere
- Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario “A. Gemelli” IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | - Tiziana Frusca
- Department of Medicine and Surgery, Obstetrics and Gynaecology Unit, University of Parma, Parma, Italy
| | - Sofia Guidi
- Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario “A. Gemelli” IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | - Miguel O'Ryan
- Microbiology and Mycology Program, Faculty of Medicine, Institute of Biomedical Sciences and Associate Researcher, Millennium Institute of Immunology and Immunotherapy, University of Chile, Santiago, Chile
| | - Ulrich Heininger
- Pediatric Infectious Diseases, University of Basel Children's Hospital, Basel, Switzerland
| | - Tina Tan
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Ahmed R. Alsuwaidi
- Department of Pediatrics, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Marco. A. Safadi
- Department of Pediatrics, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
| | - Luz M. Vilca
- Unit of Obstetrics and Gynecology, Buzzi Hospital - ASST Fatebenefratelli Sacco, University of Milan, Milan, Italy
| | - Nasamon Wanlapakorn
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Shabir A. Madhi
- Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Michelle L. Giles
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia
| | - Roman Prymula
- School of Medicine Hradec Kralove, Institute of Social Medicine, Charles University Prague, Prague, Czechia
| | - Shamez Ladhani
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, London, United Kingdom
| | - Federico Martinón-Torres
- Translational Pediatrics and Infectious Diseases, Pediatrics Department, Hospital Clínico Universitario de Santiago de Compostela, University of Santiago, Santiago de Compostela, Spain
| | - Litjen Tan
- Immunization Action Coalition, St. Paul, MN, United States
| | - Lessandra Michelin
- Infectious Diseases and Vaccinology Division, Health Sciences Post Graduation Program, University of Caxias Do Sul, Caxias Do Sul, Brazil
| | - Giovanni Scambia
- Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario “A. Gemelli” IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Susanna Esposito
- Department of Medicine and Surgery, Pediatric Clinic, Pietro Barilla Children's Hospital, University of Parma, Parma, Italy
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Vilca LM, Cesari E, Tura AM, Di Stefano A, Vidiri A, Cavaliere AF, Cetin I. Barriers and facilitators regarding influenza and pertussis maternal vaccination uptake: A multi-center survey of pregnant women in Italy. Eur J Obstet Gynecol Reprod Biol 2020; 247:10-15. [PMID: 32044622 DOI: 10.1016/j.ejogrb.2020.02.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 01/31/2020] [Accepted: 02/04/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE In 2017, the Italian Ministry of Health issued the new 2017-19 National Plan of Vaccine Prevention and pregnant women were targeted to be vaccinated against influenza and pertussis. Our study aim was to assess the barriers and facilitators regarding maternal immunization acceptance among pregnant women after the launch of this program. STUDY DESIGN We conducted a multi-center survey in three Italian cities between March and June 2018. Collected data were analyzed anonymously, and included information about current recommendations of maternal immunization, antenatal care characteristics and reasons for accepting or rejecting vaccination. RESULTS A total of 743 pregnant women completed the survey. Half of the study population were aged 25-35 years and 88 % were Italian. Only 18 % pregnant women received advice to be vaccinated. In this group, the vaccine was recommended in most cases by an obstetrician-gynecologist (68 %) and during a routine antenatal visit (74 %). Self-reported influenza and pertussis vaccination coverage was 6.5 % (95 % confidence interval, 4.9 %-8.5 %) and 4.8 % (95 % confidence interval, 3.5 %-6.6 %), respectively. The main vaccination barriers identified were lack of vaccine recommendation by any health-care provider (81 %) and safety concerns (18 %). Respondents mentioned the willingness to protect their offspring (82 %) and themselves (66 %) and having received immunization advice by a maternal care provider (62 %), as the main vaccination facilitators. CONCLUSIONS Lack of immunization advice by health-care providers and safety concerns were the main vaccination barriers against influenza and pertussis, among surveyed pregnant women. Vaccine delivery in the antenatal care setting could lead to increase of vaccine acceptance among pregnant women.
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Affiliation(s)
- Luz Maria Vilca
- Unit of Obstetrics and Gynecology, Buzzi Hospital - ASST Fatebenefratelli Sacco, University of Milan, Via L. Castelvetro 32, Milan, 20154, Italy.
| | - Elena Cesari
- Unit of Obstetrics and Gynecology, Buzzi Hospital - ASST Fatebenefratelli Sacco, University of Milan, Via L. Castelvetro 32, Milan, 20154, Italy
| | - Adele Matilde Tura
- Unit of Obstetrics and Gynecology, Buzzi Hospital - ASST Fatebenefratelli Sacco, University of Milan, Via L. Castelvetro 32, Milan, 20154, Italy
| | - Annalisa Di Stefano
- Woman's Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, Via F. Corridoni 11, Ancona, 60123, Italy
| | - Annalisa Vidiri
- Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario "A. Gemelli" IRCCS-Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, Rome, 00168, Italy
| | - Anna Franca Cavaliere
- Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario "A. Gemelli" IRCCS-Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, Rome, 00168, Italy
| | - Irene Cetin
- Unit of Obstetrics and Gynecology, Buzzi Hospital - ASST Fatebenefratelli Sacco, University of Milan, Via L. Castelvetro 32, Milan, 20154, Italy
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Marchetti F, Vilca LM, Cetin I. Insights and expectations for Tdap vaccination of pregnant women in Italy. J Matern Fetal Neonatal Med 2019; 34:2132-2139. [PMID: 31456459 DOI: 10.1080/14767058.2019.1659240] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Pertussis is a widespread vaccine-preventable disease, associated with an increasing trend to hospitalization among newborns. Pertussis in newborns can be fatal, and the most effective way to prevent it is maternal immunization (MI) with a reduced antigen content tetanus, diphtheria, and acellular pertussis vaccine (Tdap). In Italy, the National Immunization Plan (NIP) 2017-2019 introduced de novo Tdap vaccination during each pregnancy at no cost for the recipient. Despite this, vaccination coverage is suboptimal. This survey of pregnant women across Italy was conducted to investigate their knowledge and expectations of Tdap. METHODS A cross-sectional survey was conducted. Pregnant women up to 28th gestational weeks were interviewed by Telephone using a questionnaire with 16 questions. Statistics were descriptive. RESULTS The final sample recruited 600 respondents evenly distributed across Italy. The average duration of pregnancy at the time of the interview was 20.8 weeks (standard deviation [SD] 6.0). Most women (60.7%) were between 30 and 40 years of age. About half were aware of the risks of pertussis for newborns (54.5%) and the increased risk of hospitalization (59.8%); 47.2% were aware that Tdap MI was offered free of charge under the NIP. Safety information regarding the mother and newborn was considered the most important information in deciding whether to be vaccinated (47.4%), followed by safety information related only to the newborn (29.5%). About half (52.2%) stated that they would "certainly" accept MI, and 25.3% would like to receive more information. Gynecologists were the preferred healthcare providers (HCPs) for the provision of MI information (34.3%), followed by pediatricians (25.5%). Two-thirds of the respondents would prefer to be informed about MI before getting pregnant (66.0%). Vaccines investigated specifically for use in pregnancy were preferred by respondents. Overall, no relevant differences were observed between women pregnant for the first time and those with more than one pregnancy, nor between geographical regions. CONCLUSIONS The results show room for improving the awareness and understanding of the risks of pertussis for infants and the protective role of MI. The pregnant women preferred to receive advice on MI from an HCP, primarily their gynecologist. They were most interested in information on the safety profile of Tdap during pregnancy, on the mother, fetus, and newborn. The potential impact of this study to support clinical practice of Healthcare Providers is highlighted in the Focus on the Patient section. [Formula: see text].
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Affiliation(s)
| | - Luz Maria Vilca
- Department of Pediatrics, Obstetrics and Gynecology and Preventive Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Irene Cetin
- Department of Obstetrics and Gynecology, University of Milano, Milano, Italy
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Mesini A, Moscatelli A, Castagnola E. Pertussis vaccination in pregnancy: how many pediatric hospitalizations could be prevented? MINERVA GINECOLOGICA 2019; 71:245-248. [PMID: 31089073 DOI: 10.23736/s0026-4784.19.04378-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Pertussis is a severe disease in children, especially in neonates and it is preventable by vaccination during pregnancy. After the observation of a 2-month-old toddler who needed extracorporeal membrane oxygenation for severe RSV plus Bordetella pertussis infection, we performed a review of all cases of pertussis admitted at the Istituto Giannina Gaslini, Genoa, Italy, from 2012 to 2018. We retrieved 72 cases of admission for pertussis, 46% aging less than 3 months, 42% with at least one comorbidity. Two patients needed ICU admission. Pertussis vaccination during pregnancy could contribute to reduce this burden of hospitalizations in youngest subjects.
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Brousseau N, Gagnon D, Vivion M, Poliquin V, Boucoiran I, Tapiéro B, Dubé E. Expected challenges of implementing universal pertussis vaccination during pregnancy in Quebec: a cross-sectional survey. CMAJ Open 2018; 6:E391-E397. [PMID: 30237315 PMCID: PMC6182110 DOI: 10.9778/cmajo.20180040] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Vaccination of all pregnant women with an acellular pertussis-containing vaccine (tetanus, diphtheria, pertussis [Tdap]) was recently recommended in Canada, ideally between 27 and 32 weeks of gestation. This study aimed to describe the existing model of prenatal care in Quebec and determine to what extent maternal vaccination against pertussis could be integrated into this model. METHODS In Quebec, health care is organized around Local Community Service Centres (LCSCs) that serve specific geographic areas. For each of 158 LCSCs (98.1% of LCSCs in the province), we invited 1 nurse or manager involved in prenatal care to participate in a cross-sectional Web-based survey. The structure of prenatal care visits and potential integration of maternal Tdap vaccination into the existing model were documented and compared according to urbanization level, determined with the use of census data. RESULTS A completed survey was obtained for 127 LCSCs (response rate 80.4%). Only 13 (10.2%) and 14 (11.0%) LCSCs offered on-site visits with a nurse for the majority of pregnant women during the second and third trimesters, respectively. A significantly higher proportion of rural LCSCs than urban LCSCs offered on-site visits to pregnant women in the third trimester (13 [18%] v. 1 [2%]) (p = 0.003). In at least 50 LCSC service areas (39.4%), vaccines were not available in most medical clinics offering prenatal care. INTERPRETATION Given the current situation in Quebec, implementing universal maternal Tdap vaccination may be challenging, which may result in suboptimal vaccine coverage among pregnant women. As other Canadian provinces may face similar issues, a priority will be to evaluate province-based implementation models to develop efficient ways to provide maternal Tdap vaccination across Canada.
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Affiliation(s)
- Nicholas Brousseau
- Institut national de santé publique du Québec (Brousseau, Gagnon, Vivion, Dubé); Université Laval (Brousseau, Vivion, Dubé), Québec, Que.; Department of Obstetrics, Gynecology and Reproductive Sciences (Poliquin), University of Manitoba, Winnipeg, Man.; Centre hospitalier universitaire Sainte-Justine (Boucoiran, Tapiéro), Montréal, Que.
| | - Dominique Gagnon
- Institut national de santé publique du Québec (Brousseau, Gagnon, Vivion, Dubé); Université Laval (Brousseau, Vivion, Dubé), Québec, Que.; Department of Obstetrics, Gynecology and Reproductive Sciences (Poliquin), University of Manitoba, Winnipeg, Man.; Centre hospitalier universitaire Sainte-Justine (Boucoiran, Tapiéro), Montréal, Que
| | - Maryline Vivion
- Institut national de santé publique du Québec (Brousseau, Gagnon, Vivion, Dubé); Université Laval (Brousseau, Vivion, Dubé), Québec, Que.; Department of Obstetrics, Gynecology and Reproductive Sciences (Poliquin), University of Manitoba, Winnipeg, Man.; Centre hospitalier universitaire Sainte-Justine (Boucoiran, Tapiéro), Montréal, Que
| | - Vanessa Poliquin
- Institut national de santé publique du Québec (Brousseau, Gagnon, Vivion, Dubé); Université Laval (Brousseau, Vivion, Dubé), Québec, Que.; Department of Obstetrics, Gynecology and Reproductive Sciences (Poliquin), University of Manitoba, Winnipeg, Man.; Centre hospitalier universitaire Sainte-Justine (Boucoiran, Tapiéro), Montréal, Que
| | - Isabelle Boucoiran
- Institut national de santé publique du Québec (Brousseau, Gagnon, Vivion, Dubé); Université Laval (Brousseau, Vivion, Dubé), Québec, Que.; Department of Obstetrics, Gynecology and Reproductive Sciences (Poliquin), University of Manitoba, Winnipeg, Man.; Centre hospitalier universitaire Sainte-Justine (Boucoiran, Tapiéro), Montréal, Que
| | - Bruce Tapiéro
- Institut national de santé publique du Québec (Brousseau, Gagnon, Vivion, Dubé); Université Laval (Brousseau, Vivion, Dubé), Québec, Que.; Department of Obstetrics, Gynecology and Reproductive Sciences (Poliquin), University of Manitoba, Winnipeg, Man.; Centre hospitalier universitaire Sainte-Justine (Boucoiran, Tapiéro), Montréal, Que
| | - Eve Dubé
- Institut national de santé publique du Québec (Brousseau, Gagnon, Vivion, Dubé); Université Laval (Brousseau, Vivion, Dubé), Québec, Que.; Department of Obstetrics, Gynecology and Reproductive Sciences (Poliquin), University of Manitoba, Winnipeg, Man.; Centre hospitalier universitaire Sainte-Justine (Boucoiran, Tapiéro), Montréal, Que
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