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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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Factors Influencing Maternal Antepartum Tdap Vaccination. Matern Child Health J 2022; 26:2385-2395. [PMID: 36173502 PMCID: PMC9519405 DOI: 10.1007/s10995-022-03557-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2022] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Antepartum Tdap remains low despite national recommendations. This prospective observational study aims to identify factors associated with lower antepartum Tdap rates. METHODS Maternal demographics, personal health beliefs, Tdap vaccination status, and recall of in-office obstetric provider actions were collected from a convenience sample of postpartum women in a New York metropolitan hospital. Bivariate and multivariable logistic regression were used to identify significant factors and adjusted odds ratios (OR) for recorded Tdap; OR > 1 reflects elements with increased odds of not receiving antepartum Tdap, while OR < 1 demonstrates increased odds of receipt. RESULTS Surveys were collected (n = 1682) from a study population demographically similar to New York City and more diverse in race/ethnicity than the national population. Demographic analysis showed Hispanic women less likely than white, non-Hispanic women to vaccinate (OR 2.44, CI 1.54-3.88). Health beliefs associated with non-receipt of antepartum Tdap included "It is dangerous for pregnant women to get vaccines" (OR 1.68, CI 1.01-2.77), and "I worry about the safety of the Tdap vaccine" (OR 1.59, CI 1.12-2.24). Obstetric provider actions associated with vaccination included receiving an OB recommendation (OR 0.39, CI 0.23-0.65), getting written information about Tdap (OR 0.44, CI 0.30-0.64), and having Tdap offered in office (OR 0.24, CI 0.15-0.37). Health beliefs associated with antepartum Tdap included "I generally do what my OB/GYN provider recommends" (OR 0.49, CI 0.30-0.80), and "Pregnant women should get the Tdap (pertussis) vaccine" (OR 0.17, CI 0.09-0.33). DISCUSSION Maternal race/ethnicity, personal health beliefs, and obstetric provider actions predict antepartum Tdap.
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Patel KM, Vazquez Guillamet L, Pischel L, Ellingson MK, Bardají A, Omer SB. Strategies to increase uptake of maternal pertussis vaccination. Expert Rev Vaccines 2021; 20:779-796. [PMID: 34129416 DOI: 10.1080/14760584.2021.1940146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Pertussis is a highly contagious respiratory disease that results in disproportionate morbidity and mortality in infants who have yet to receive the primary diphtheria-tetanus-pertussis vaccine series. In the preceding decades numerous countries began to pursue either prenatal vaccination of pregnant women or postpartum vaccination of caregivers to protect infants. Despite proven benefit, maternal uptake of pertussis vaccine continues to remain suboptimal. AREAS COVERED Many studies have been conducted to address the suboptimal uptake of maternal pertussis vaccination. This systematic review was undertaken to systematically identify those studies, highlight the most successful strategies and find the knowledge gaps that need to be filled over the coming years to improve vaccine uptake. Twenty-five studies were identified from six different databases. EXPERT OPINION Five different interventions were shown to be successful in promoting uptake of pertussis vaccination: (1) standing orders, (2) opt-in orders, (3) provider education, (4) on-site vaccination and (5) interactive patient education. Three major knowledge gaps were also identified that need to be filled over the coming years: (1) lack of studies in low- and middle-income countries, (2) lack of studies targeting midwives and/or home birth and (3) lack of studies on the process of vaccine communication.
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Affiliation(s)
- Kavin M Patel
- Department of Internal Medicine, Infectious Disease, Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Lauren Pischel
- Department of Internal Medicine, Infectious Disease, Yale School of Medicine, New Haven, Connecticut, USA
| | - Mallory K Ellingson
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, USA
| | - Azucena Bardají
- ISGlobal, Hospital Clínic-Universitat De Barcelona, Barcelona, Spain.,Manhiça Health Research Centre - Centro De Investigação Em Saúde De Manhiça (CISM), Maputo, Mozambique.,Consorcio De Investigación Biomédica En Red De Epidemiología Y Salud Pública (CIBERESP), Madrid, Spain
| | - Saad B Omer
- Department of Internal Medicine, Infectious Disease, Yale School of Medicine, New Haven, Connecticut, USA.,Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, USA.,Yale School of Nursing, Orange, Connecticut, USA.,Yale Institute for Global Health, New Haven, Connecticut, USA
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Spina CI, Brewer SE, Ellingson MK, Chamberlain AT, Limaye RJ, Orenstein WA, Salmon DA, Omer SB, O'Leary ST. Adapting Center for Disease Control and Prevention's immunization quality improvement program to improve maternal vaccination uptake in obstetrics. Vaccine 2020; 38:7963-7969. [PMID: 33121843 DOI: 10.1016/j.vaccine.2020.10.051] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/13/2020] [Accepted: 10/15/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Maternal vaccination is critical for improving maternal and child health. Quality Improvement (QI) models1, such as the Centers for Disease Control and Prevention's (CDC) Assessment, Feedback, Incentives, eXchange (AFIX)2 model, have not yet been adapted to maternal vaccinations. This study assesses the impact of AFIX-OB, an adapted version of AFIX for obstetric settings, on maternal vaccination rates. METHODS Between December 2016 and May 2018, state health departments and obstetric practices in Colorado and Georgia implemented the adapted AFIX-OB model. The model addressed unique patterns in patient encounters, practice flow, health records systems and competing clinical priorities in the obstetric setting through a menu of clearly-defined QI strategies, bi-weekly technical assistance meetings with designated immunization champions, incentives for champions/staff, and adapted tools to aid each practice during implementation. Vaccination rates were assessed by random chart reviews pre- and post-intervention. RESULTS The AFIX-OB model was evaluated in eleven obstetric practices in two states as part of a multi-level intervention to increase maternal vaccination. Post AFIX-OB implementation, documented influenza vaccination rates increased from 56% at baseline to 65% (p < 0.01); and tetanus, diphtheria, and acellular pertussis (Tdap) vaccination rates increased from 77% at baseline to 84% (p < 0.02) across all practices. CONCLUSIONS The AFIX-OB model showed improvement in maternal vaccination rates for both influenza and Tdap vaccines. AFIX-OB may provide a useful framework for obstetric practices, as well as for other health care specialties. The focused goal should be on broader dissemination among those interested in adopting an evidence-based model for increasing vaccine uptake.
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Affiliation(s)
- Christine I Spina
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO, United States.
| | - Sarah E Brewer
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO, United States; Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Mallory K Ellingson
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, United States
| | - Allison T Chamberlain
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Rupali J Limaye
- Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Walter A Orenstein
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States; Emory Vaccine Center, Emory University, Atlanta, GA, United States; Department of Medicine, School of Medicine, Emory University, Atlanta, GA, United States
| | - Daniel A Salmon
- Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Saad B Omer
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, United States; Yale Institute for Global Health, Yale University, New Haven, CT, United States; Department of Internal Medicine (Infectious Disease), Yale School of Medicine, New Haven, CT, United States; Yale School of Nursing, Yale University, New Haven, CT, United States
| | - Sean T O'Leary
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO, United States; Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
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