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Litman E, Young B, Spiel M. Novel Insights on Group B Streptococcus in Pregnancy. Clin Obstet Gynecol 2024:00003081-990000000-00164. [PMID: 38902963 DOI: 10.1097/grf.0000000000000883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2024]
Abstract
Group B Streptococcus (GBS) is a frequent colonizer of the human genital and gastrointestinal tract. In pregnant or postpartum persons, colonization is often asymptomatic and can contribute to infectious morbidity in both the parturient and the newborn. The prevalence of invasive GBS disease has dramatically decreased over the past 3 decades. However, despite standardized clinical algorithms, GBS disease remains a public health concern. Our review summarizes the GBS bacteria pathophysiology, morbidity, management guidelines, and summarizes ongoing research. While novel testing and parturient vaccination are being explored, barriers exist, preventing guideline updates and widespread implementation.
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Affiliation(s)
- Ethan Litman
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center
- Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA
| | - Brett Young
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center
- Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA
| | - Melissa Spiel
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center
- Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA
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Rick AM, Beigi R. Maternal Immunizations: Past, Present, and Future. Clin Obstet Gynecol 2024:00003081-990000000-00163. [PMID: 38899806 DOI: 10.1097/grf.0000000000000882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
Maternal vaccines during pregnancy offer crucial protection against infections for both the pregnant person and their newborn. Vaccines against influenza, pertussis, coronavirus disease 2019, and respiratory syncytial virus are routinely recommended by the Centers for Disease Control and Prevention to safeguard pregnant women and their infants from potentially severe complications. Administering these vaccines during pregnancy helps transfer protective antibodies from the mother to the baby, enhancing immunity during the vulnerable early months of life. Extensive research supports the safety and efficacy of maternal vaccines, with numerous studies demonstrating their protective benefits for both pregnant people and newborns.
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Affiliation(s)
- Anne-Marie Rick
- Department of Pediatrics, Division of General Academic Pediatrics, University of Pittsburgh School of Medicine
| | - Richard Beigi
- Department of Obstetrics, Gynecology and Reproductive Sciences University of Pittsburgh School of Medicine
- UPMC Magee-Womens Hospital, Pittsburgh, Pennsylvania
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Seravalli V, Romualdi I, Ammar O, De Blasi C, Boccalini S, Bechini A, Di Tommaso M. Vaccination coverage during pregnancy and factors associated with refusal of recommended vaccinations: An Italian cross sectional study. Vaccine X 2024; 18:100483. [PMID: 38623567 PMCID: PMC11016930 DOI: 10.1016/j.jvacx.2024.100483] [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] [Received: 09/25/2023] [Revised: 03/31/2024] [Accepted: 04/07/2024] [Indexed: 04/17/2024] Open
Abstract
Background The vaccines recommended during pregnancy are the Tdap, the influenza vaccine, and, during the SARS-CoV-2 pandemic, the vaccine against COVID-19. This survey aimed at determining vaccination coverage among pregnant women and adverse events, reasons for vaccine refusal, and factors associated with vaccine uptake. Methods A single-center cross-sectional study was conducted on women who delivered between March and April 2022 at Careggi University Hospital in Florence, Italy. Information on the vaccinations (Tdap, influenza and COVID-19) received during pregnancy were collected through in-person interviews. Results Among 307 enrolled women (response rate 99 % on a study population of 310 eligible women), 74 % of patients were vaccinated with Tdap, 82 % against COVID-19, and only 33 % against influenza. Vaccination coverage for Tdap and COVID-19 was significantly higher among Italian than foreign patients (80 % vs 51 %, p < 0.001 and 86 % vs 69 %, p = 0.002, respectively), and for Tdap was higher among patients followed in the private vs public care setting. The main reasons behind refusal of vaccinations were low risk perception of influenza (41 %), insufficient information received from the prenatal care provider regarding the Tdap (35 %), and, for the COVID-19, fear of vaccine side effects (64 %), and concerns about effects on the fetus (70 %). Conclusions Adherence to the influenza vaccine was low because of reduced perception of the disease risks. The difference in vaccination coverage between Italians and foreigners is an example of healthcare disparity. Better information provided to patients about vaccines' efficacy and safety is advisable to increase acceptance of recommended vaccines.
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Affiliation(s)
- Viola Seravalli
- Department of Health Sciences, Section of Obstetrics and Gynecology, Careggi Hospital, University of Florence, Florence, Italy
| | - Irene Romualdi
- Department of Health Sciences, Section of Obstetrics and Gynecology, Careggi Hospital, University of Florence, Florence, Italy
| | - Oumaima Ammar
- Department of Health Sciences, Section of Obstetrics and Gynecology, Careggi Hospital, University of Florence, Florence, Italy
| | - Chiara De Blasi
- Department of Health Sciences, Section of Obstetrics and Gynecology, Careggi Hospital, University of Florence, Florence, Italy
| | - Sara Boccalini
- Department of Health Sciences, Section of Hygiene, Preventive Medicine, Nursing and Public Health, University of Florence, Florence, Italy
| | - Angela Bechini
- Department of Health Sciences, Section of Hygiene, Preventive Medicine, Nursing and Public Health, University of Florence, Florence, Italy
| | - Mariarosaria Di Tommaso
- Department of Health Sciences, Section of Obstetrics and Gynecology, Careggi Hospital, University of Florence, Florence, Italy
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Perelman AD, Trostle ME, Pecoriello J, Quinn GP, Roman AS, Penfield CA. Acceptance of Routine Vaccines in Pregnancy during the COVID-19 Pandemic. Am J Perinatol 2024; 41:e3059-e3064. [PMID: 37816391 DOI: 10.1055/a-2188-8511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/12/2023]
Abstract
OBJECTIVE This study aimed to evaluate the rates of vaccination against infectious diseases (Tetanus, Diphtheria, and Pertussis [Tdap] and influenza) in pregnancy during the coronavirus disease 2019 (COVID-19) pandemic compared to contemporary historical controls. STUDY DESIGN This was a retrospective cohort study comparing rates of Tdap and influenza vaccination in pregnant people who received care at NYU Langone Health and delivered from September 1, 2020, to January 31, 2021 ("COVID cohort") to the same period the prior year ("2019 cohort"). Demographic information, trimester of initiation of prenatal care, insurance status, and medical comorbidities were evaluated. Outcomes were analyzed using chi-square, Fisher's exact test, and multivariable logistic regression, with significance of p < 0.05. RESULTS In total, 1,713 pregnant people were included. Compared to historical controls, the COVID cohort differed in age, race, timing of initiation of prenatal care, insurance status, and medical comorbidities. After adjusting for these covariates, pregnant people were significantly more likely to accept influenza vaccine in the COVID cohort (adjusted odds ratio [aOR] 1.7, 95% confidence interval [CI] 1.27-2.29) and had similar Tdap acceptance (aOR 1.5, 95% CI 0.99-2.17). However, this trend was not observed for the entire obstetric population; public insurance status and medical comorbidities were associated with lower vaccine rates during the pandemic. For those who had public insurance, rates of influenza vaccination decreased from 83% in 2019 to 40% during COVID (aOR 0.16, 95% CI 0.10-0.24) and for Tdap rates decreased from 93 to 54% (aOR 0.13, 95% CI 0.08-0.21). CONCLUSION During the COVID-19 pandemic era, pregnant people at large were more likely to accept the influenza vaccine. However, this trend did not apply to Tdap, and high-risk groups with public insurance and medical comorbidities. This study highlights potential disparities in vaccination rates, which need to be accounted for when evaluating national vaccine trends. These data support increased efforts in vaccine counseling for high-risk populations. KEY POINTS · Antenatal flu vaccination increased during the pandemic.. · Antenatal Tdap vaccination was unchanged during the pandemic.. · High-risk pregnant patients had decreased vaccine uptake.. · High-risk subgroups were not included in overarching vaccination trends..
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Affiliation(s)
- Allison D Perelman
- Department of Obstetrics & Gynecology, NYU Langone Health, New York, New York
| | - Megan E Trostle
- Department of Obstetrics & Gynecology, Division of Maternal Fetal Medicine, NYU Langone Health, New York, New York
| | - Jillian Pecoriello
- Department of Obstetrics & Gynecology, NYU Langone Health, New York, New York
| | - Gwendolyn P Quinn
- Department of Obstetrics & Gynecology, NYU Langone Health, New York, New York
| | - Ashley S Roman
- Department of Obstetrics & Gynecology, Division of Maternal Fetal Medicine, NYU Langone Health, New York, New York
| | - Christina A Penfield
- Department of Obstetrics & Gynecology, Division of Maternal Fetal Medicine, NYU Langone Health, New York, New York
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Jarshaw CL, Omoregie O, Peck JD, Pierce S, Jones EJ, Hosseinzadeh P, Craig LB. Vaccination during pregnancy by race/ethnicity: a focus on American Indians/Alaska Natives. AJOG GLOBAL REPORTS 2024; 4:100318. [PMID: 38445103 PMCID: PMC10914583 DOI: 10.1016/j.xagr.2024.100318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Vaccination during pregnancy reduces the incidence of infections and their associated adverse outcomes in both mothers and infants. The American College of Obstetricians and Gynecologists has recommended influenza and Tdap vaccination during pregnancy since 2004 and 2013, respectively. Several studies have examined disparities in vaccination rates during pregnancy by race/ethnicity. However, none have included American Indians/Alaska Natives as a specific racial/ethnic group on a national level. Current literature suggests that American Indian/Alaska Native infants experience increased morbidity and mortality from both influenza and pertussis infections compared with most other groups in the United States. OBJECTIVE This study aimed to evaluate the uptake of influenza and Tdap vaccinations during pregnancy by race/ethnicity, with a specific focus on American Indian/Alaska Native people. STUDY DESIGN This cross-sectional study used data from the Pregnancy Risk Assessment Monitoring System. Comparisons of vaccine uptake across racial/ethnic groups (American Indian/Alaska Native, Asian, non-Hispanic Black, non-Hispanic White, Hispanic, and "None of the above") were evaluated using weighted logistic regression analyses to estimate prevalence odds ratios with 95% confidence intervals. Models were adjusted for maternal age, parity, maternal education, marital status, payment method at delivery, prenatal care in first trimester, maternal smoking status, Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participation, and receipt of influenza vaccine reported by a health care provider. RESULTS For both vaccines, Asian respondents had the highest uptake (influenza, 70.1%; Tdap, 68.2%), whereas Black respondents reported the lowest uptake (influenza, 44.4%; Tdap, 57.9%). For the influenza vaccine, American Indian/Alaska Native respondents demonstrated a higher uptake compared with White respondents, and the magnitude of difference increased markedly after adjusting for respondent characteristics (adjusted odds ratio, 1.74; 95% confidence interval, 1.58-1.90). In the unadjusted analyses, Black individuals reported influenza vaccination at approximately half the rate of their White counterparts during pregnancy. This effect was attenuated but remained lower after adjustment for respondent characteristics (adjusted odds ratio, 0.73; 95% confidence interval, 0.70-0.76). For the Tdap vaccine, American Indian/Alaska Native respondents reported lower uptake than White respondents; however, this difference disappeared when adjusted for respondent characteristics (adjusted odds ratio, 0.99; 95% confidence interval, 0.83-1.19). Asian and Hispanic respondents displayed a similar uptake compared with their White counterparts for both vaccines. CONCLUSION Our findings indicate that there are racial/ethnic disparities in influenza and Tdap vaccination rates among pregnant individuals in the United States. Demonstration of increased uptake among American Indian/Alaska Native people in the crude analysis may reflect the success of various public health interventions through Tribal and Indian Health Service hospitals. Nonetheless, vaccination status during pregnancy remains seriously below national guideline recommendations. Greater measures must be taken to support preventative care in marginalized populations, with particular emphasis on community-driven solutions rooted in justice.
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Affiliation(s)
- Christen L. Jarshaw
- Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, College of Medicine, University of Oklahoma Health Sciences Center (Dr Jarshaw), Oklahoma City, OK
- Department of Obstetrics and Gynecology, Mountain Area Health Education Center (Dr Jarshaw), Asheville, NC
| | - Osariemen Omoregie
- Hudson College of Public Health, University of Oklahoma Health Sciences Center (Ms. Omoregie and Dr Peck), Oklahoma City, OK
| | - Jennifer D. Peck
- Hudson College of Public Health, University of Oklahoma Health Sciences Center (Ms. Omoregie and Dr Peck), Oklahoma City, OK
| | - Stephanie Pierce
- Section of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, College of Medicine, University of Oklahoma Health Sciences Center (Dr Pierce), Oklahoma City, OK
| | - Emily J. Jones
- Fran and Earl Ziegler College of Nursing, University of Oklahoma Health Sciences Center (Dr Jones), Oklahoma City, OK
| | - Pardis Hosseinzadeh
- Section of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, College of Medicine, University of Oklahoma Health Sciences Center (Drs Jarshaw, Hosseinzadeh and Craig), Oklahoma City, OK
- John's Hopkins Fertility Center, Department of Gynecology and Obstetrics (Dr Hosseinzadeh), Baltimore, MD
| | - LaTasha B. Craig
- Section of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, College of Medicine, University of Oklahoma Health Sciences Center (Drs Jarshaw, Hosseinzadeh and Craig), Oklahoma City, OK
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Boulet SL, Stanhope KK, DeSantis C, Goebel A, Dolak J, Eze O, Gathoo A, Braun C, Sutton M, Jamieson DJ. A Descriptive Study of Maternal Vaccination Uptake, Attitudes, and Beliefs in Pregnancy Among Persons Delivering at an Urban Safety Net Hospital. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2023; 4:288-297. [PMID: 37363358 PMCID: PMC10285378 DOI: 10.1089/whr.2023.0032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/10/2023] [Indexed: 06/28/2023]
Abstract
Objective To estimate uptake of influenza, tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap), and COVID-19 vaccines during pregnancy and describe vaccine attitudes and beliefs among predominantly racial and ethnic minority individuals delivering at a publicly funded hospital. Methods We collected survey and electronic medical record data for English-speaking postpartum individuals who delivered a live-born infant from July 7, 2022, through August 21, 2022, and agreed to participate in our study. The 58-item survey included questions about general vaccine attitudes and beliefs as well as vaccine-specific questions. We calculated rates of influenza, Tdap, and COVID-19 vaccinations and compared distributions of survey responses by number (no vaccines, one vaccine, or two or three of the recommended vaccines) and type of vaccines received during pregnancy. Results Of the 231 eligible individuals, 125 (54.1%) agreed to participate. Rates of influenza, Tdap, and COVID-19 vaccination were 18.4%, 48.0%, and 5.6% respectively. A total of 61 (48.8%) did not receive any recommended vaccines during pregnancy, 40 (32.0%) received one vaccine, and 24 (19.0%) received two or three vaccines. Approximately 66.1% of the no vaccine group, 81.6% of the one vaccine group, and 87.5% of the two or three vaccine group strongly agreed or agreed that they trusted the vaccine information provided by their obstetrician or midwife. While most (>69.2%) agreed that the vaccine-preventable diseases were dangerous for pregnant women, only 24.0%, 29.3%, and 40.3% agreed that they were worried about getting influenza, whooping cough, or COVID-19, respectively, while pregnant. Discussion Vaccine uptake in our population was low and may be due, in part, to low perceived susceptibility to vaccine-preventable diseases. Obstetricians and midwives were trusted sources of vaccine information, suggesting that enhanced communication strategies could be critical for addressing maternal vaccine hesitancy, particularly in communities of color justifiably affected by medical mistrust.
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Affiliation(s)
- Sheree L. Boulet
- Department of Gynecology and Obstetrics, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Kaitlyn K. Stanhope
- Department of Gynecology and Obstetrics, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Carol DeSantis
- Department of Gynecology and Obstetrics, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Anna Goebel
- Department of Gynecology and Obstetrics, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Julia Dolak
- Department of Gynecology and Obstetrics, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Onyie Eze
- Department of Gynecology and Obstetrics, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Asmita Gathoo
- Department of Gynecology and Obstetrics, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Caroline Braun
- Department of Gynecology and Obstetrics, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Madeline Sutton
- Department of Obstetrics and Gynecology, Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Denise J. Jamieson
- Department of Gynecology and Obstetrics, School of Medicine, Emory University, Atlanta, Georgia, USA
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Kaur H, Sehgal A, Malik N, Kaushal S, Kaundal A. Knowledge and Practice of Gynecologists About Tdap and Influenza Vaccination: A Cross-Sectional Study. Cureus 2023; 15:e40037. [PMID: 37425540 PMCID: PMC10324430 DOI: 10.7759/cureus.40037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2023] [Indexed: 07/11/2023] Open
Abstract
BACKGROUND Infants are vulnerable to diphtheria and pertussis in their early months. In this initial period, maternally derived antibodies provide significant protection to newborns. Similarly, influenza poses a significant risk of morbidity and mortality for pregnant mothers and infants. It has been observed that, despite the evident recommendations, the uptake of these vaccines is still not optimal. METHODOLOGY The current study was undertaken as a cross-sectional survey among the practicing gynecologists of North India voluntarily. A structured questionnaire was made available online to 300 practicing gynecologists either on their WhatsApp or email addresses. The data were compared based on urban and rural practices. A record was also made of the participants' type of practice setup, e.g., working in a primary health setting, a district hospital, or a teaching institute. Results: Of the 148 participants who responded to the survey, 45.3% and 64.2%, respectively, administered influenza and Tdap vaccines to their patients. The main barriers cited by the respondent doctors were the non-affordability, non-availability, and non-inclusion of vaccines in the national immunization program and a lack of awareness among the practitioners (Spearman correlation 0.4; p<0.000). CONCLUSION The results of this survey suggest that increasing awareness among gynecologists and the public and improving the availability of vaccines and their inclusion in the national program could most likely increase the practice of the recommendation or administration of the Tdap vaccine in pregnant females.
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Affiliation(s)
- Harpreet Kaur
- Obstetrics and Gynecology, All India Institute of Medical Sciences, Bilaspur, Bilaspur, IND
| | - Alka Sehgal
- Gynaecology, Government Medical College and Hospital, Chandigarh, IND
| | - Nisha Malik
- Obstetrics and Gynecology, All India Institute of Medical Sciences, Bilaspur, Bilaspur, IND
| | - Sushruti Kaushal
- Obstetrics and Gynecology, All India Institute of Medical Sciences, Bilaspur, Bilaspur, IND
| | - Asmita Kaundal
- Obstetrics and Gynecology, All India Institute of Medical Sciences, Bilaspur, Bilaspur, IND
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Spires B, Brewton A, Maples JM, Ehrlich SF, Fortner KB. Vaccine Hesitancy in Women's Health. Obstet Gynecol Clin North Am 2023; 50:401-419. [PMID: 37149319 DOI: 10.1016/j.ogc.2023.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
The development of vaccines is considered one of the greatest breakthroughs of modern medicine, saving millions of lives around the world each year. Despite vaccines' proven success, vaccine hesitancy remains a major issue affecting vaccine uptake. Common themes exist in patients' apprehension to receive vaccines. Women's health providers possess an important role in addressing these concerns and dispelling common misconceptions that may increase vaccine hesitancy thereby reduce vaccine uptake. This review aims to explore many of these topics as they are related to women's health and provide strategies for providers to implement which may reduce vaccine hesitancy among our patients.
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Affiliation(s)
- Benjamin Spires
- Department of Ob/Gyn, Uniformed Services University of the Health Sciences, 307 Boatner Road, Eglin Air Force Base, FL 32542, USA
| | - Annabeth Brewton
- Department of Ob/Gyn, University of Tennessee Graduate School of Medicine, 1924 Alcoa Highway, Box U-27, Knoxville, TN 37920, USA
| | - Jill M Maples
- Department of Ob/Gyn, University of Tennessee Graduate School of Medicine, 1924 Alcoa Highway, Box U-27, Knoxville, TN 37920, USA
| | - Samantha F Ehrlich
- Department of Public Health, University of Tennessee, 369 HPER, 1914 Andy Holt Avenue, Knoxville, TN 37996, USA
| | - Kimberly B Fortner
- Department of Ob/Gyn, University of Tennessee Graduate School of Medicine, 1924 Alcoa Highway, Box U-27, Knoxville, TN 37920, USA.
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Downing J, Sjeklocha L. Trauma in Pregnancy. Emerg Med Clin North Am 2023; 41:223-245. [PMID: 37024160 DOI: 10.1016/j.emc.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
Trauma is the leading cause of nonobstetric maternal death. Pregnant patients have a similar spectrum of traumatic injuries with a noted increase in interpersonal violence. A structured approach to trauma evaluation and management is recommended with several guidelines expanding on ATLS principles; however, evidence is limited. Optimal management requires understanding of physiologic changes in pregnancy, a team-based approach, and preparation for interventions that may including neonatal resuscitation. The principles of trauma management are the same in pregnancy with a systematic approach and initial maternal focused resuscitation..
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Affiliation(s)
- Jessica Downing
- R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, 22 South Greene Street, Baltimore, MD 21201, USA
| | - Lucas Sjeklocha
- Department of Emergency Medicine, Program in Trauma, R Adams Cowley Shock Trauma Center, University of Maryland, School of Medicine, 22 South Greene Street, Baltimore, MD 21201, USA.
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Alsuhebany N, Alowais SA, Aldairem A, Almohareb SN, Bin Saleh K, Kahtani KM, Alnashwan LI, Alay SM, Alamri MG, Alhathlol GK, Asiri I. Identifying gaps in vaccination perception after mandating the COVID-19 vaccine in Saudi Arabia. Vaccine 2023:S0264-410X(23)00481-4. [PMID: 37164821 PMCID: PMC10130326 DOI: 10.1016/j.vaccine.2023.04.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 04/20/2023] [Accepted: 04/21/2023] [Indexed: 05/12/2023]
Abstract
OBJECTIVE The burden of COVID-19 pandemic affected the globe, and it is unclear how it has impacted the general perception of other vaccines. We aimed to investigate the public awareness, knowledge, and attitude towards other complementary vaccines after the mandate of the COVID-19 vaccine. METHODS A cross-sectional study was conducted in Saudi Arabia using a survey distributed via several social media platforms in June 2022. The questionnaire had three main sections; awareness; attitudes; and demographic information. Descriptive analysis was mainly used and supplemented with Chi-square test for correlation. All individuals over the age of 18 were eligible to participate in the study. RESULTS A total of 1,045 participants from Saudi Arabia completed the survey. Of the respondents, 55.9% were female, and 95% were Saudi citizens. Public awareness towards vaccines after the mandate of COVID-19 vaccine was the highest with the influenza vaccine (98.2%), followed by human papillomavirus (HPV) (40.7%), tetanus, diphtheria, and pertussis (Tdap) (37.2%), and lastly, pneumococcal vaccine (17%). More than 50% of the participants expressed their willingness to receive any of the four vaccines if they knew about the benefits related to these vaccines. CONCLUSION The study showed that participants were willing to receive the vaccination if they were aware of the general benefits of vaccinations. Therefore, health education and campaigns toward recommended vaccines for high-risk group are essential and needed.
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Affiliation(s)
- Nada Alsuhebany
- College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
| | - Shuroug A Alowais
- College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Atheer Aldairem
- College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Sumaya N Almohareb
- College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Khalid Bin Saleh
- College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Khawla M Kahtani
- College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Lama I Alnashwan
- College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Saeed M Alay
- College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Mohammed G Alamri
- College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Ghaida K Alhathlol
- College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Ibrahim Asiri
- Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Vargas-Zambrano JC, Clark LR, Johnson DR, Monfredo C, Pool V, Li L, Bouvet PE, Blangero Y, Macina D. Prenatal tetanus-diphtheria-acellular pertussis vaccine effectiveness at preventing infant pertussis. Vaccine 2023; 41:2968-2975. [PMID: 37032227 DOI: 10.1016/j.vaccine.2023.03.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 02/28/2023] [Accepted: 03/22/2023] [Indexed: 04/11/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of the tetanus, diphtheria, and acellular pertussis (Tdap) vaccine containing five pertussis components (Tdap5; Adacel®, Sanofi) when given during pregnancy at preventing pertussis in infants less than 2 months of age. METHODS The US Centers for Disease Control and Prevention (CDC), in collaboration with the Emerging Infections Program (EIP) Network, undertook a case-control study evaluating the effectiveness of Tdap vaccination in pregnancy against pertussis in infants less than 2 months of age based on data collected by the EIP Network from 2011 through 2014. The dataset from the CDC/EIP Network study was used to conduct this product-specific vaccine effectiveness analysis of Tdap5 vaccination in pregnancy to prevent disease in young infants. The main outcome of interest was vaccine effectiveness in infants whose pregnant parents were vaccinated with Tdap5 between 27 and 36 weeks' gestation, in accordance with the ideal timing for Tdap vaccination in pregnancy recommended by the US Advisory Committee on Immunization Practices. Odd ratios (ORs) and 95 % confidence intervals (CIs) were estimated using conditional logistic regression, and vaccine effectiveness was calculated as (1-OR) × 100 %. RESULTS There were 160 infant pertussis cases and 302 matched controls included in this Tdap5-specific study. Tdap5 effectiveness in preventing pertussis in infants whose pregnant parents were vaccinated between 27 and 36 weeks' gestation was 92.5 % (95 % CI, 38.5 %-99.1 %). Effectiveness of Tdap5 against pertussis-related hospitalization in infants whose pregnant parents were vaccinated between 27 and 36 weeks' gestation could not be calculated due to lack of discordance among matched cases and controls. Vaccination of the parents after pregnancy or less than 14 days before delivery did not protect infants from pertussis. CONCLUSIONS Tdap5 vaccination in pregnancy between 27 and 36 weeks' gestation is highly effective at protecting young infants from pertussis. STUDY REGISTRATION ClinicalTrials.gov, NCT05040802.
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Affiliation(s)
| | | | | | | | | | - Lin Li
- Epidemiology and Benefit Risk, Sanofi, Bridgewater, NJ, USA
| | | | | | - Denis Macina
- Global Medical Evidence Generation, Sanofi, Lyon, France
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12
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Egan RC, Chaiken SR, Derrah K, Doshi U, Hersh A, Packer CH, Caughey AB. Universal Tetanus-Diphtheria-Pertussis Vaccination During Pregnancy: A Cost-Effectiveness Analysis. Obstet Gynecol 2023; 141:837-844. [PMID: 36897561 DOI: 10.1097/aog.0000000000005103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 12/15/2022] [Indexed: 03/11/2023]
Abstract
OBJECTIVE To assess the cost effectiveness of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccination in pregnant patients in the United States. METHODS A decision-analytic model in TreeAge was developed to compare universal Tdap vaccination in pregnancy with no Tdap vaccination in pregnancy using a theoretical cohort of 3.66 million pregnant individuals, the approximate number of deliveries per year in the United States. Outcomes included infant pertussis infections, infant hospitalizations, infant encephalopathy cases, infant deaths, and maternal pertussis infections. All probabilities and costs were derived from the literature. Utilities were applied to discounted life expectancies at a rate of 3% to generate quality-adjusted life-years (QALYs). A strategy was considered cost effective if it had an incremental cost-effectiveness ratio of less than $100,000 per QALY. Univariable and multivariable sensitivity analyses were performed to assess the robustness of the model to changes in the baseline assumptions. RESULTS With a baseline assumption of vaccine cost at $47.75, Tdap vaccination was cost effective at $7,601 per QALY. The vaccination strategy was associated with a decrease of 22 infant deaths, 11 infant encephalopathy cases, 2,018 infant hospitalizations, 6,164 infant pertussis infections, and 8,585 maternal pertussis infections, with an increase of 19,489 QALYs. In sensitivity analyses, the strategy was cost effective until the incidence of maternal pertussis became lower than 1.6 cases per 10,000 individuals, the cost of the Tdap vaccine was greater than $540, or previous pertussis immunity was present in more than 92.1% of pregnant individuals. CONCLUSION In a theoretical U.S. cohort of 3.66 million pregnant individuals, Tdap vaccination during pregnancy is cost effective and reduces infant morbidity and mortality compared with no vaccination during pregnancy. These findings are especially relevant given that approximately half of individuals are not vaccinated during pregnancy and recent data have shown that postpartum maternal vaccination and cocooning strategies are ineffective. Public health strategies to encourage greater uptake of Tdap vaccination should be used to reduce the morbidity and mortality of pertussis infection.
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Affiliation(s)
- Rachel C Egan
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon
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13
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Kramer C, Thomas K, Patil A, Hayes CM, Sufrin CB. Shackling and pregnancy care policies in US prisons and jails. Matern Child Health J 2023; 27:186-196. [PMID: 36372806 PMCID: PMC9660187 DOI: 10.1007/s10995-022-03526-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The number of incarcerated women in the United States has risen exponentially. Many are of childbearing age with 3-4% being pregnant at intake. Despite the need for comprehensive pregnancy-related health care in prisons and jails, there is no oversight that requires adherence to the established standards. The objective of this study was to assess prison and jail pregnancy policies and practices with an emphasis on restraint use and compliance with anti-shackling legislation. METHODS We conducted a survey of 22 state prisons and six jails, including the five largest jails, from 2016-2017 regarding pregnancy policies and practices including restraint use, prenatal care, delivery and birth, and other pregnancy accommodations. We compared reported restraint policies to state legislation at the time of the survey. RESULTS Data indicate that pregnancy policies and services in prisons and jails vary and compliance inconsistencies with anti-shackling legislation exist. A third of the prisons and half of the jails did not have accredited health care services. All study facilities provided prenatal vitamins and most provided supplemental snacks. Most facilities stationed an officer inside the hospital room during labor and delivery, but nearly one-third of facilities did not require a female-identifying officer. CONCLUSIONS FOR PRACTICE Limited oversight and standardization of carceral health care and accommodations for pregnant people lead to variability in prisons and jails. Prisons and jails should adopt and implement standards of care guidelines to ensure the safety and well-being of pregnant people who have unique healthcare needs. Incarcerated pregnant people should be viewed as expectant parents in need of comprehensive health care, rather than as criminals who forfeited their right to a safe, respectful, and humane childbirth.
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Affiliation(s)
- Camille Kramer
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, 4940 Eastern Ave., A101, 21224 Baltimore, MD USA
| | - Karenna Thomas
- School of Public Health, Yale University, 60 College St, 06510 New Haven, CT USA
| | - Ankita Patil
- Department of Psychology, The College of New Jersey, 2000 Pennington Rd. Ewing Township, 08618 Ewing, NJ USA
| | - Crystal M. Hayes
- Center of Excellence, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Carolyn B. Sufrin
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, 4940 Eastern Ave., A101, 21224 Baltimore, MD USA
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, 21205 Baltimore, MD USA
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Alcendor DJ, Matthews-Juarez P, Smoot D, Hildreth JEK, Tabatabai M, Wilus D, Brown KY, Juarez PD. The COVID-19 Vaccine and Pregnant Minority Women in the US: Implications for Improving Vaccine Confidence and Uptake. Vaccines (Basel) 2022; 10:2122. [PMID: 36560532 PMCID: PMC9784552 DOI: 10.3390/vaccines10122122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/25/2022] [Accepted: 12/09/2022] [Indexed: 12/14/2022] Open
Abstract
The American College of Obstetricians and Gynecologists (AGOG) recommends the FDA-approved Pfizer and Moderna mRNA COVID-19 vaccines and boosters for all eligible pregnant women in the US. However, COVID-19 vaccine confidence and uptake among pregnant minority women have been poor. While the underlying reasons are unclear, they are likely to be associated with myths and misinformation about the vaccines. Direct and indirect factors that deter minority mothers in the US from receiving the mRNA COVID-19 vaccines require further investigation. Here, we examine the historical perspectives on vaccinations during pregnancy. We will examine the following aspects: (1) the influenza and tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccinations during pregnancy; (2) the exclusion of pregnant and lactating women from COVID-19 vaccine trials; (3) COVID-19 vaccine safety during pregnancy, obstetric complications associated with symptomatic COVID-19 during pregnancy, COVID-19 vaccine hesitancy among pregnant minority women, and racial disparities experienced by pregnant minority women due to the COVID-19 pandemic as well as their potential impact on pregnancy care; and (4) strategies to improve COVID-19 vaccine confidence and uptake among pregnant minority women in the US. COVID-19 vaccine hesitancy among minority mothers can be mitigated by community engagement efforts that focus on COVID-19 vaccine education, awareness campaigns by trusted entities, and COVID-19-appropriate perinatal counseling aimed to improve COVID-19 vaccine confidence and uptake.
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Affiliation(s)
- Donald J. Alcendor
- Department of Microbiology, Immunology and Physiology, Center for AIDS Health Disparities Research, School of Medicine, Meharry Medical College, 1005 Dr. D.B. Todd Jr. Blvd., Nashville, TN 37208, USA
| | - Patricia Matthews-Juarez
- Department of Family & Community Medicine, Meharry Medical College, 1005 D.B. Todd Jr. Blvd., Nashville, TN 37208, USA
| | - Duane Smoot
- Department of Internal Medicine, School of Medicine, Meharry Medical College, 1005 D.B. Todd Jr. Blvd., Nashville, TN 37208, USA
| | - James E. K. Hildreth
- Department of Microbiology, Immunology and Physiology, Center for AIDS Health Disparities Research, School of Medicine, Meharry Medical College, 1005 Dr. D.B. Todd Jr. Blvd., Nashville, TN 37208, USA
- Department of Family & Community Medicine, Meharry Medical College, 1005 D.B. Todd Jr. Blvd., Nashville, TN 37208, USA
- Department of Internal Medicine, School of Medicine, Meharry Medical College, 1005 D.B. Todd Jr. Blvd., Nashville, TN 37208, USA
| | - Mohammad Tabatabai
- School of Graduate Studies and Research, Meharry Medical College, 1005 D.B. Todd Jr. Blvd., Nashville, TN 37208, USA
| | - Derek Wilus
- School of Graduate Studies and Research, Meharry Medical College, 1005 D.B. Todd Jr. Blvd., Nashville, TN 37208, USA
| | - Katherine Y. Brown
- Department of Family & Community Medicine, Meharry Medical College, 1005 D.B. Todd Jr. Blvd., Nashville, TN 37208, USA
| | - Paul D. Juarez
- Department of Family & Community Medicine, Meharry Medical College, 1005 D.B. Todd Jr. Blvd., Nashville, TN 37208, USA
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Gupta A, Kamity R, Sharma R, Caprio M, Mally P, Verma S. Mother to Newborn Transmission of SARS-CoV-2 Infection: Evolution of Evidence in 1.5 Years of COVID-19 Pandemic. Am J Perinatol 2022; 39:1764-1778. [PMID: 35738288 DOI: 10.1055/s-0042-1749635] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Coronavirus disease 2019 (COVID-19) pandemic caused significant mortality and morbidity in people of all age groups worldwide. Given the uncertainty regarding the mode of transmission and potential effects of COVID-19 on pregnant mothers and their newborns, guidelines for taking care of maternal-newborn dyads have evolved tremendously since the pandemic began. There has been an enormous influx of published materials regarding the outcomes of mothers and newborns. Still, multiple knowledge gaps regarding comprehensive information about risk to the mothers and newborns exist, which need to be addressed. Current evidence suggests that mothers with symptomatic COVID-19 infection are at increased risk of severe illness during pregnancy, with a higher need for respiratory support and premature deliveries. Neonates born to mothers with COVID-19 are at increased risk of needing intensive care; however, most newborns do well after birth. As new mutant variants arise, we need to be cautious while proactively understanding any new evolving patterns. All leading health authorities strongly recommend COVID-19 vaccination before or during pregnancy to reduce the risk of maternal morbidities and benefit from passing antibodies to newborns prenatally and via breastmilk. Additionally, there are racial, ethnic, and socioeconomic disparities in outcomes and vaccination coverage for pregnant women. This article summarizes the rapidly evolving evidence for the last 1.5 years and aims to help health care professionals care for mothers with COVID-19 and their newborns. KEY POINTS: · COVID-19 in pregnancy can cause perinatal morbidities.. · Breastfeeding and breast milk are safe for newborns.. · COVID-19 vaccination reduces the risk for morbidities..
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Affiliation(s)
- Arpit Gupta
- Division of Neonatology, Department of Pediatrics, NYC Health, Hospitals/Metropolitan, New York City, New York
| | - Ranjith Kamity
- Division of Neonatology, Department of Pediatrics, NYU Long Island School of Medicine, New York City, New York
| | - Rishika Sharma
- Department of Pediatrics, Family Healthcare Network, Visalia, California
| | - Martha Caprio
- Division of Neonatology, Department of Pediatrics, NYU Grossman School of Medicine, New York City, New York
| | - Pradeep Mally
- Division of Neonatology, Department of Pediatrics, NYU Grossman School of Medicine, New York City, New York
| | - Sourabh Verma
- Division of Neonatology, Department of Pediatrics, NYU Grossman School of Medicine, New York City, New York
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Homer CSE, Javid N, Wilton K, Bradfield Z. Vaccination in pregnancy: The role of the midwife. Front Glob Womens Health 2022; 3:929173. [PMID: 36353468 PMCID: PMC9637860 DOI: 10.3389/fgwh.2022.929173] [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] [Received: 04/26/2022] [Accepted: 10/07/2022] [Indexed: 11/14/2022] Open
Abstract
Midwives are the front-line workers providing maternity care for women in many countries. The role of the midwife includes providing information about, and recommendations for, maternal vaccination in pregnancy and for the baby in the postnatal period. Vaccinations recommended in pregnancy include those to prevent influenza, pertussis, tetanus and now COVID-19. Vaccinations for the newborn baby include hepatitis B. Healthcare professionals play an important role in influencing decision-making around vaccination and midwives are key in supporting vaccination uptake. Midwives are strong influencer in women's decisions around vaccination for themselves and their babies. The COVID-19 vaccination programs have shone a light on vaccination in pregnancy especially as SARS-COV-2 infection has significant adverse effects in pregnancy. COVID-19 vaccination has been shown to be safe and effective in pregnancy. Despite this, there is vaccine hesitancy from pregnant women in many countries. Midwives play a unique role in the provision of care to women and families but they need specific support and information regarding vaccination in pregnancy. Targeted education, supportive mentoring and supervision and opportunities to lead innovative ways of ensuring vaccine access is logistically easy and possible are all needed. This Commentary outlines the key vaccinations recommended in pregnancy including COVID-19 vaccination and highlights some strategies to scale-up vaccination programs in pregnancy with a particular focus on the role of midwives.
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Affiliation(s)
- Caroline S. E. Homer
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC, Australia,Faculty of Health, Universityof Technology Sydney, Sydney, NSW, Australia,Correspondence: Caroline S. E. Homer
| | - Nasrin Javid
- Faculty of Health, Universityof Technology Sydney, Sydney, NSW, Australia,Nursing and Midwifery Research Alliance, South West Sydney Local Health District, Liverpool, NSW, Australia
| | - Kellie Wilton
- Australian College of Midwives, Canberra, ACT, Australia
| | - Zoe Bradfield
- Faculty of Health Sciences, King Edward Memorial Hospital and Curtin University, Perth, WA, Australia
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17
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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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18
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Gabutti G, Cetin I, Conversano M, Costantino C, Durando P, Giuffrida S. Experts' Opinion for Improving Pertussis Vaccination Rates in Adolescents and Adults: A Call to Action. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074412. [PMID: 35410091 PMCID: PMC8998413 DOI: 10.3390/ijerph19074412] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/30/2022] [Accepted: 04/04/2022] [Indexed: 12/25/2022]
Abstract
This article highlights the importance of diphtheria-tetanus-acellular pertussis (with reduced antigen content, dTap) vaccination in preventing pertussis, a respiratory infection that is still widespread and easily transmitted. In particular, it highlights the need to receive a booster vaccination throughout life to maintain high antibody levels, which decrease through time. This document collects the opinions that emerged from the comparison between major Italian experts in the field of vaccination. This working group was created to promote a "call to action", aimed at raising awareness among all institutions, public health authorities, and health workers involved in the vaccination process, about the importance of dTap vaccine administration and with the mindset of implementing the strategic vaccination plan provided by the National Vaccine Plan (NVP). In fact, despite this vaccine being included in the NVP, there are some issues attributable to the practice of vaccination (local health authorities, vaccination centers, occupational health services, gynecology centers, societies of work). Therefore, it is necessary that the Ministry defines the vaccination coverage objectives, identifies the groups of subjects who should receive the booster vaccine (subjects exposed to greater risk of infection, subjects over 60, pregnant women), and applies all the necessary measures to encourage the implementation of this practice.
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Affiliation(s)
- Giovanni Gabutti
- Department of Medical Sciences, Section of Public Health Medicine, University of Ferrara, 44121 Ferrara, Italy
- Correspondence: ; Tel.: +39-34-7888-9342
| | - Irene Cetin
- Obstetrics and Gynecology, Department “Woman, Mother and Child”—ASST Fatebenefratelli Sacco, Buzzi Children’ Hospital, University of Milan, 20157 Milan, Italy;
| | | | - Claudio Costantino
- Department of Health Promotion, Maternal and Child Care, Internal Medicine and Excellence Specialties, University of Palermo, 90133 Palermo, Italy;
| | - Paolo Durando
- Occupational Medicine, Department of Health Sciences, University of Genoa, 16132 Genoa, Italy;
- Occupational Medicine Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Sandro Giuffrida
- Department of Prevention, Azienda Sanitaria Provinciale of Reggio Calabria, 89124 Reggio Calabria, Italy;
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Nir O, Schwartz A, Toussia-Cohen S, Leibovitch L, Strauss T, Asraf K, Doolman R, Sharabi S, Cohen C, Lustig Y, Regev-Yochay G, Yinon Y. Maternal-neonatal transfer of SARS-CoV-2 immunoglobulin G antibodies among parturient women treated with BNT162b2 messenger RNA vaccine during pregnancy. Am J Obstet Gynecol MFM 2022; 4:100492. [PMID: 34547533 PMCID: PMC8451978 DOI: 10.1016/j.ajogmf.2021.100492] [Citation(s) in RCA: 72] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 09/11/2021] [Accepted: 09/14/2021] [Indexed: 10/29/2022]
Abstract
BACKGROUND The exclusion of pregnant women from initial COVID-19 messenger RNA vaccine trials raised hesitancy regarding the benefits of vaccination for pregnant women, hence little is known about vaccines' efficacy in this population. OBJECTIVE To determine the maternal-neonatal transplacental transfer of SARS-CoV-2 antibodies among vaccinated parturient women. A control group of COVID-19-recovered patients was included to compare the immunoglobulin G levels between vaccinated and recovered patients. STUDY DESIGN This is a prospective cohort study conducted in a single tertiary medical center in Israel between February and March 2021; parturient women vaccinated with the BNT162b2 messenger RNA vaccine during pregnancy were included and compared with COVID-19-recovered parturient women. SARS-CoV-2 immunoglobulin G antibodies were measured in maternal and cord sera, dried blood spot samples taken from newborns, and breast milk samples. The primary aim was to determine whether neonatal cord and dried blood spot samples were positive for SARS-CoV-2 antibodies and to evaluate the transfer ratio, defined as cord blood immunoglobulin G divided by maternal immunoglobulin G levels. RESULTS The study included 64 vaccinated parturient women and 11 parturient women who had COVID-19 during pregnancy. All maternal blood sera samples and 98.3% of the cord blood sera samples were positive for SARS-Cov-2 immunoglobulin G with median concentrations of 26.1 (interquartile range, 22.0-39.7) and 20.2 (interquartile range, 12.7-29.0), respectively. Similarly, 96.4% of neonatal blood spot samples and all breast milk samples were positive for SARS-CoV-2 immunoglobulin G with median concentrations of 11.0 (interquartile range, 7.2-12.8) and 4.9 (interquartile range, 3.8-6.0), respectively. There was a significant positive correlation between maternal serum levels of SARS-CoV-2 immunoglobulin G and cord blood (r=0.483; P=.0001), neonatal blood spot (r=0.515; P=.004), and breast milk levels (r=0.396; P=.005) of SARS-CoV-2 immunoglobulin G. The median placental transfer ratio of SARS-COV-2 immunoglobulin G was 0.77. Comparison of vaccinated and recovered COVID-19 patients revealed significantly higher SARS-CoV-2 immunoglobulin G levels in maternal serum and cord blood among vaccinated women (P<.0001). CONCLUSION Our study demonstrated the efficient transfer of SARS-CoV-2 immunoglobulin G across the placenta in women, vaccinated with the BNT162b2 messenger RNA vaccine during pregnancy, to their neonates, with a positive correlation between maternal serum and cord blood antibody concentrations. In addition to maternal protection against COVID-19, the vaccine may also provide neonatal humoral immunity.
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Affiliation(s)
- Omer Nir
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel HaShomer, Israel (Drs Nir, Schwartz, Toussia-Cohen, and Yinon); Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (Drs Nir, Schwartz, Toussia-Cohen, Leibovitch, Strauss, Cohen, Lustig, Regev-Yochay, and Yinon)
| | - Anat Schwartz
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel HaShomer, Israel (Drs Nir, Schwartz, Toussia-Cohen, and Yinon); Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (Drs Nir, Schwartz, Toussia-Cohen, Leibovitch, Strauss, Cohen, Lustig, Regev-Yochay, and Yinon)
| | - Shlomi Toussia-Cohen
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel HaShomer, Israel (Drs Nir, Schwartz, Toussia-Cohen, and Yinon); Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (Drs Nir, Schwartz, Toussia-Cohen, Leibovitch, Strauss, Cohen, Lustig, Regev-Yochay, and Yinon)
| | - Leah Leibovitch
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (Drs Nir, Schwartz, Toussia-Cohen, Leibovitch, Strauss, Cohen, Lustig, Regev-Yochay, and Yinon); Department of Neonataology, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel HaShomer, Israel (Drs Leibovitch and Strauss)
| | - Tzipi Strauss
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (Drs Nir, Schwartz, Toussia-Cohen, Leibovitch, Strauss, Cohen, Lustig, Regev-Yochay, and Yinon); Department of Neonataology, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel HaShomer, Israel (Drs Leibovitch and Strauss)
| | - Keren Asraf
- The Dworman Automated Mega Laboratory, Sheba Medical Center, Tel HaShomer, Israel (Drs Asraf and Doolman and Ms Sharabi)
| | - Ram Doolman
- The Dworman Automated Mega Laboratory, Sheba Medical Center, Tel HaShomer, Israel (Drs Asraf and Doolman and Ms Sharabi)
| | - Sivan Sharabi
- The Dworman Automated Mega Laboratory, Sheba Medical Center, Tel HaShomer, Israel (Drs Asraf and Doolman and Ms Sharabi)
| | - Carmit Cohen
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (Drs Nir, Schwartz, Toussia-Cohen, Leibovitch, Strauss, Cohen, Lustig, Regev-Yochay, and Yinon); Infection Prevention & Control Unit, Sheba Medical Center, Tel HaShomer, Israel (Drs Cohen and Regev-Yochay)
| | - Yaniv Lustig
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (Drs Nir, Schwartz, Toussia-Cohen, Leibovitch, Strauss, Cohen, Lustig, Regev-Yochay, and Yinon); Central Virology Laboratory, Ministry of Health, Sheba Medical Center, Tel HaShomer, Israel (Dr Lustig)
| | - Gili Regev-Yochay
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (Drs Nir, Schwartz, Toussia-Cohen, Leibovitch, Strauss, Cohen, Lustig, Regev-Yochay, and Yinon); Infection Prevention & Control Unit, Sheba Medical Center, Tel HaShomer, Israel (Drs Cohen and Regev-Yochay)
| | - Yoav Yinon
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel HaShomer, Israel (Drs Nir, Schwartz, Toussia-Cohen, and Yinon); Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (Drs Nir, Schwartz, Toussia-Cohen, Leibovitch, Strauss, Cohen, Lustig, Regev-Yochay, and Yinon).
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Li Y, Brousseau N, Guay M, Dubé È, Laghdir Z, Boucoiran I, Tapiéro B, Quach C. Coverage for pertussis vaccination during pregnancy with 4 models of vaccine delivery: a quasiexperimental, multicentre observational study. CMAJ Open 2022; 10:E56-E63. [PMID: 35105682 PMCID: PMC8812719 DOI: 10.9778/cmajo.20210011] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Vaccination of pregnant people with a vaccine containing acellular pertussis (tetanus-diphtheria-acellular pertussis [Tdap]) has been recommended in Canada since 2018, and the evaluation of delivery models for efficient maternal Tdap administration is a priority for the Quebec Ministry of Health. We implemented 3 vaccine delivery models, in addition to the existing standard of practice model, and compared the vaccine coverage achieved by the 4 models in Quebec. METHODS In this quasiexperimental, multicentre observational study, we recruited pregnant people at less than 21 weeks' gestation in 4 Quebec regions from April to October 2019. We compared 4 vaccine delivery models: local community service centres (centre local de services communautaires [CLSCs], baseline), family medicine groups (FMGs), obstetrics clinic and the oral glucose challenge test (OGCT). In addition to the CLSCs, 3 FMGs, 1 obstetric clinic and a hospital-based OGCT screening program participated. We determined vaccination status from a self-reported questionnaire, the Quebec Immunization Registry or medical charts. We compared model-specific (for participants recruited to a model and subsequently vaccinated within that model) and overall vaccine coverage (considering all vaccine delivery pathways) and used logistic regression to adjust for sociodemographic variables. RESULTS Overall, 946 of 1000 recruited pregnant people were eligible for analyses. Vaccination via the FMGs achieved the highest model-specific vaccine coverage (67.8%, 95% confidence interval [CI] 60.5%-74.4%), but coverage was not significantly different from the CLSCs (63.8%, 95% CI 57.6%-69.6%). For overall vaccine coverage, the FMG (86.5%, 95% CI 80.6%-90.9%) and obstetrics models (85.9%, 95% CI 80.9%-89.7%) achieved significantly higher vaccine coverage than the CLSCs (66.3%, 95% CI 60.1%-71.9%). The OGCT model did not improve overall vaccine coverage (61.8%, 95% CI 56.1%-67.2%). INTERPRETATION Compared with CLSCs, overall vaccine coverage was higher when Tdap was offered in FMGs or an obstetrics clinic providing prenatal care. Health professionals involved in pregnancy follow-up recommending and offering the vaccine may be a key factor in optimizing vaccine coverage.
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Affiliation(s)
- Yinan Li
- Department of Epidemiology, Biostatistics & Occupational Health (Li), McGill University; CHU Sainte-Justine Research Center (Li, Laghdir, Boucoiran, Tapiéro), Montréal, Que.; Direction des risques biologiques et de la santé au travail (Brousseau, Dubé), Institut national de la santé publique du Québec; CHU de Quebec Research Center (Brousseau, Dubé), Université Laval, Québec City, Que.; Research Center (Guay), Hôpital Charles-Lemoyne, Longueuil, Que.; Département des sciences de la santé communautaire (Guay), Université de Sherbrooke, Sherbrooke, Que.; Department of Obstetrics & Gynecology (Boucoiran), School of Public Health, Université de Montréal; Infectious Diseases Division (Tapiéro), Department of Pediatrics, CHU Sainte-Justine; Department of Microbiology, Infectious Diseases and Immunology (Quach), Université de Montréal; Infection Prevention and Control (Quach), Clinical Department of Laboratory Medicine, CHU Sainte-Justine, Montréal, Que
| | - Nicholas Brousseau
- Department of Epidemiology, Biostatistics & Occupational Health (Li), McGill University; CHU Sainte-Justine Research Center (Li, Laghdir, Boucoiran, Tapiéro), Montréal, Que.; Direction des risques biologiques et de la santé au travail (Brousseau, Dubé), Institut national de la santé publique du Québec; CHU de Quebec Research Center (Brousseau, Dubé), Université Laval, Québec City, Que.; Research Center (Guay), Hôpital Charles-Lemoyne, Longueuil, Que.; Département des sciences de la santé communautaire (Guay), Université de Sherbrooke, Sherbrooke, Que.; Department of Obstetrics & Gynecology (Boucoiran), School of Public Health, Université de Montréal; Infectious Diseases Division (Tapiéro), Department of Pediatrics, CHU Sainte-Justine; Department of Microbiology, Infectious Diseases and Immunology (Quach), Université de Montréal; Infection Prevention and Control (Quach), Clinical Department of Laboratory Medicine, CHU Sainte-Justine, Montréal, Que
| | - Maryse Guay
- Department of Epidemiology, Biostatistics & Occupational Health (Li), McGill University; CHU Sainte-Justine Research Center (Li, Laghdir, Boucoiran, Tapiéro), Montréal, Que.; Direction des risques biologiques et de la santé au travail (Brousseau, Dubé), Institut national de la santé publique du Québec; CHU de Quebec Research Center (Brousseau, Dubé), Université Laval, Québec City, Que.; Research Center (Guay), Hôpital Charles-Lemoyne, Longueuil, Que.; Département des sciences de la santé communautaire (Guay), Université de Sherbrooke, Sherbrooke, Que.; Department of Obstetrics & Gynecology (Boucoiran), School of Public Health, Université de Montréal; Infectious Diseases Division (Tapiéro), Department of Pediatrics, CHU Sainte-Justine; Department of Microbiology, Infectious Diseases and Immunology (Quach), Université de Montréal; Infection Prevention and Control (Quach), Clinical Department of Laboratory Medicine, CHU Sainte-Justine, Montréal, Que
| | - Ève Dubé
- Department of Epidemiology, Biostatistics & Occupational Health (Li), McGill University; CHU Sainte-Justine Research Center (Li, Laghdir, Boucoiran, Tapiéro), Montréal, Que.; Direction des risques biologiques et de la santé au travail (Brousseau, Dubé), Institut national de la santé publique du Québec; CHU de Quebec Research Center (Brousseau, Dubé), Université Laval, Québec City, Que.; Research Center (Guay), Hôpital Charles-Lemoyne, Longueuil, Que.; Département des sciences de la santé communautaire (Guay), Université de Sherbrooke, Sherbrooke, Que.; Department of Obstetrics & Gynecology (Boucoiran), School of Public Health, Université de Montréal; Infectious Diseases Division (Tapiéro), Department of Pediatrics, CHU Sainte-Justine; Department of Microbiology, Infectious Diseases and Immunology (Quach), Université de Montréal; Infection Prevention and Control (Quach), Clinical Department of Laboratory Medicine, CHU Sainte-Justine, Montréal, Que
| | - Zineb Laghdir
- Department of Epidemiology, Biostatistics & Occupational Health (Li), McGill University; CHU Sainte-Justine Research Center (Li, Laghdir, Boucoiran, Tapiéro), Montréal, Que.; Direction des risques biologiques et de la santé au travail (Brousseau, Dubé), Institut national de la santé publique du Québec; CHU de Quebec Research Center (Brousseau, Dubé), Université Laval, Québec City, Que.; Research Center (Guay), Hôpital Charles-Lemoyne, Longueuil, Que.; Département des sciences de la santé communautaire (Guay), Université de Sherbrooke, Sherbrooke, Que.; Department of Obstetrics & Gynecology (Boucoiran), School of Public Health, Université de Montréal; Infectious Diseases Division (Tapiéro), Department of Pediatrics, CHU Sainte-Justine; Department of Microbiology, Infectious Diseases and Immunology (Quach), Université de Montréal; Infection Prevention and Control (Quach), Clinical Department of Laboratory Medicine, CHU Sainte-Justine, Montréal, Que
| | - Isabelle Boucoiran
- Department of Epidemiology, Biostatistics & Occupational Health (Li), McGill University; CHU Sainte-Justine Research Center (Li, Laghdir, Boucoiran, Tapiéro), Montréal, Que.; Direction des risques biologiques et de la santé au travail (Brousseau, Dubé), Institut national de la santé publique du Québec; CHU de Quebec Research Center (Brousseau, Dubé), Université Laval, Québec City, Que.; Research Center (Guay), Hôpital Charles-Lemoyne, Longueuil, Que.; Département des sciences de la santé communautaire (Guay), Université de Sherbrooke, Sherbrooke, Que.; Department of Obstetrics & Gynecology (Boucoiran), School of Public Health, Université de Montréal; Infectious Diseases Division (Tapiéro), Department of Pediatrics, CHU Sainte-Justine; Department of Microbiology, Infectious Diseases and Immunology (Quach), Université de Montréal; Infection Prevention and Control (Quach), Clinical Department of Laboratory Medicine, CHU Sainte-Justine, Montréal, Que
| | - Bruce Tapiéro
- Department of Epidemiology, Biostatistics & Occupational Health (Li), McGill University; CHU Sainte-Justine Research Center (Li, Laghdir, Boucoiran, Tapiéro), Montréal, Que.; Direction des risques biologiques et de la santé au travail (Brousseau, Dubé), Institut national de la santé publique du Québec; CHU de Quebec Research Center (Brousseau, Dubé), Université Laval, Québec City, Que.; Research Center (Guay), Hôpital Charles-Lemoyne, Longueuil, Que.; Département des sciences de la santé communautaire (Guay), Université de Sherbrooke, Sherbrooke, Que.; Department of Obstetrics & Gynecology (Boucoiran), School of Public Health, Université de Montréal; Infectious Diseases Division (Tapiéro), Department of Pediatrics, CHU Sainte-Justine; Department of Microbiology, Infectious Diseases and Immunology (Quach), Université de Montréal; Infection Prevention and Control (Quach), Clinical Department of Laboratory Medicine, CHU Sainte-Justine, Montréal, Que
| | - Caroline Quach
- Department of Epidemiology, Biostatistics & Occupational Health (Li), McGill University; CHU Sainte-Justine Research Center (Li, Laghdir, Boucoiran, Tapiéro), Montréal, Que.; Direction des risques biologiques et de la santé au travail (Brousseau, Dubé), Institut national de la santé publique du Québec; CHU de Quebec Research Center (Brousseau, Dubé), Université Laval, Québec City, Que.; Research Center (Guay), Hôpital Charles-Lemoyne, Longueuil, Que.; Département des sciences de la santé communautaire (Guay), Université de Sherbrooke, Sherbrooke, Que.; Department of Obstetrics & Gynecology (Boucoiran), School of Public Health, Université de Montréal; Infectious Diseases Division (Tapiéro), Department of Pediatrics, CHU Sainte-Justine; Department of Microbiology, Infectious Diseases and Immunology (Quach), Université de Montréal; Infection Prevention and Control (Quach), Clinical Department of Laboratory Medicine, CHU Sainte-Justine, Montréal, Que.
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21
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Flu and Tdap Maternal Immunization Hesitancy in Times of COVID-19: An Italian Survey on Multiethnic Sample. Vaccines (Basel) 2021; 9:vaccines9101107. [PMID: 34696217 PMCID: PMC8537858 DOI: 10.3390/vaccines9101107] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 09/12/2021] [Accepted: 09/13/2021] [Indexed: 11/29/2022] Open
Abstract
Background: Tdap and flu immunization in pregnancy has been proven to be both effective and safe. Despite this, the vaccination rate in pregnant women is low in Italy. The COVID-19 pandemic has focused the attention of public opinion on communicable diseases, underlining the importance of primary prevention measures such as vaccination. We conducted a survey to investigate the behavior of pregnant women during the COVID-19 pandemic regarding maternal immunization to identify the reasons for vaccine hesitancy in order to overcome them. The new challenge is COVID-19 vaccination in pregnancy, and preliminary data show hesitancy towards it. Our analysis may be useful to improve immunization in the pregnant population, including through the COVID-19 vaccine. Methods: A targeted survey was performed in Italy including 520 women who experienced in the first trimester of pregnancy, prior to the novel coronavirus spread, the 2019–2020 influenza vaccination campaign and the Tdap vaccine recommendation in the third trimester during the COVID pandemic. They represent a unique model to investigate if the new coronavirus outbreak might have changed attitudes towards vaccination in pregnancy in the same patients. Data were collected from a self-completed paper questionnaire. Descriptive statistics were calculated and percentages were compared using the chi-2 test or Fisher’s exact test. Results: We obtained data from 195 of the 520 women who gave birth during the inclusion period; 325 cases declined to participate in the survey. A total of 8.7% (17 cases) performed flu vaccination in the first trimester of pregnancy (pre-COVID era), 50.8% (99 cases) accepted Tdap immunization during their third trimester of gestation (COVID-19 pandemic) and 6.7% (13 cases) received both vaccines during pregnancy. For both the flu and Tdap shots, pregnant patients were more likely to accept the vaccines if they were recommended by a healthcare provider, whereas the main reason not to be vaccinated was the lack of such a recommendation. Conclusions: Our survey shows that the COVID-19 experience, which has raised awareness as to the role of vaccines in preventable diseases, may positively change attitudes toward immunization in pregnancy. Vaccination must be recommended to all pregnant women and organized during routine prenatal care as an important element for the prevention of communicable diseases. Vaccination hesitancy can be minimized through consistent recommendation to all pregnant women offered by obstetric staff during routine prenatal care. This approach is likely to be effective in terms of building trust in flu and Tdpa immunization among pregnant women, as well as to avoid unjustified hesitancy towards the more recent COVID-19 vaccines.
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22
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Arreciado Marañón A, Fernández-Cano MI, Montero-Pons L, Feijoo-Cid M, Reyes-Lacalle A, Cabedo-Ferreiro RM, Manresa-Domínguez JM, Falguera-Puig G. Understanding factors that influence the decision to be vaccinated against influenza and pertussis in pregnancy: A qualitative study. J Clin Nurs 2021; 31:1531-1546. [PMID: 34423873 DOI: 10.1111/jocn.16006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 07/29/2021] [Accepted: 08/04/2021] [Indexed: 01/08/2023]
Abstract
AIMS AND OBJECTIVES To identify how pregnant women perceive pertussis and influenza and the factors that influence their decision to be vaccinated. BACKGROUND Suffering from influenza during pregnancy increases complications in the pregnant woman, foetus and newborn. Pertussis in children under six months of age causes severe complications. Maternal vaccination against influenza and pertussis is effective and safe. However, vaccination rates are insufficient. DESIGN We conducted a qualitative descriptive study, using semi-structured interviews. This research adheres to the COREQ guidelines and checklist. METHODS We carried out 18 semi-structured face-to-face interviews with pregnant women, using intentional sampling and thematic analysis. RESULTS We identified an overarching theme, 'factors that influenced participants' decision to be vaccinated or not', which was composed of four subthemes that were in turn made up of 12 categories. The factors that influenced participants' decision to be vaccinated against influenza and pertussis were related to their knowledge of and their perception of risk for these diseases. Participants perceived the risk of pertussis to be greater, and they focused their concern on the newborn. The recommendations and convictions of nurse-midwives were the most important factors encouraging vaccination. Participants trusted their nurse-midwives and most reported that they would have been vaccinated if their midwife had recommended it. Other factors were linked to lack of information, fear and concerns about economic interests. CONCLUSIONS The convictions and actions of the nurse-midwife in recommending vaccination to pregnant women are decisive. Strategies to improve vaccination rates should be directed to helping health professionals understand how their practice affects the final decision of pregnant women. RELEVANCE TO CLINICAL PRACTICE Understanding the factors that limit vaccination rates among pregnant women provides valuable information to nurse-midwives that can help to improve vaccination strategies and practices. Increased maternal vaccination rates would reduce morbidity and mortality among pregnant women and newborns.
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Affiliation(s)
- Antonia Arreciado Marañón
- Department of Nursing, Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.,Multidisciplinary Research Group in Health and Society (GREMSAS), Barcelona, Spain
| | - María Isabel Fernández-Cano
- Department of Nursing, Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.,Multidisciplinary Research Group in Health and Society (GREMSAS), Barcelona, Spain
| | - Laura Montero-Pons
- Atenció a la Salut Sexual i Reproductiva de Santa Coloma de Gramenet, Direcció d'Atenció Primària Metropolitana Nord, Institut Català de la Salut, Barcelona, Spain.,Research Group Atenció a la Salut Sexual i Reproductiva (GRASSIR), Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
| | - Maria Feijoo-Cid
- Department of Nursing, Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.,Multidisciplinary Research Group in Health and Society (GREMSAS), Barcelona, Spain
| | - Azahara Reyes-Lacalle
- Research Group Atenció a la Salut Sexual i Reproductiva (GRASSIR), Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain.,Atenció a la Salut Sexual i Reproductiva de Sabadell, Direcció d'Atenció Primària Metropolitana Nord, Institut Català de la Salut, Barcelona, Spain
| | - Rosa Maria Cabedo-Ferreiro
- Research Group Atenció a la Salut Sexual i Reproductiva (GRASSIR), Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain.,Atenció a la Salut Sexual i Reproductiva de Granollers, Direcció d'Atenció Primària Metropolitana Nord, Institut Català de la Salut, Barcelona, Spain
| | - Josep Maria Manresa-Domínguez
- Department of Nursing, Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.,Multidisciplinary Research Group in Health and Society (GREMSAS), Barcelona, Spain.,Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAPJGol), Barcelona, Spain
| | - Gemma Falguera-Puig
- Research Group Atenció a la Salut Sexual i Reproductiva (GRASSIR), Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain.,Atenció a la Salut Sexual i Reproductiva Metropolitana Nord, Direcció d'Atenció Primària Metropolitana Nord, Institut Català de la Salut, Barcelona, Spain
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23
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Cullen J, Stone S, Phipps MG, Cypher R. Immunization for Pregnant Women: A Call to Action. J Midwifery Womens Health 2021; 65:713-715. [PMID: 33108063 DOI: 10.1111/jmwh.13163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 07/31/2020] [Indexed: 11/28/2022]
Affiliation(s)
| | | | | | - Rebecca Cypher
- Association of Women's Health, Obstetric and Neonatal Nurses
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24
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Ethical Issues With Vaccination in Obstetrics and Gynecology: ACOG Committee Opinion, Number 829. Obstet Gynecol 2021; 138:e16-e23. [PMID: 33799311 DOI: 10.1097/aog.0000000000004390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT The goals of vaccination are to preserve the health of individual patients as well as the health of the general public. Although interventions to promote individual and public health are usually aligned, ethical challenges may arise that require a balancing or compromise between these two objectives. Major challenges to increasing vaccine uptake and acceptance include widespread misinformation and disinformation on social media regarding safety; limited knowledge and awareness about recommended vaccinations; lack of trust in the medical system, especially in communities of color because of historic and ongoing injustices and systemic racism; prioritization of personal freedoms over collective health; and vaccination delay and refusal through nonmedical exemptions from state-mandated vaccination requirements. Obstetrician-gynecologists are in a unique position to help address these barriers by educating and counseling patients throughout their lifespan, administering recommended vaccinations, and serving as role models in public health initiatives. This document includes updated guidance on the management of ethical issues related to routine vaccination, including vaccination hesitation and refusal by patients, nonmedical exemptions, vaccination during pregnancy and lactation, and physician vaccination. Clinical guidance on vaccination and vaccination during public health emergencies is provided in separate publications and resources from the American College of Obstetricians and Gynecologists.
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25
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Avni-Singer L, Oliveira CR, Torres A, Shapiro ED, Niccolai LM, Sheth SS. Inpatient Immunization With HPV Vaccine: A Qualitative Study With Postpartum Women. Womens Health Issues 2021; 31:384-391. [PMID: 33715924 DOI: 10.1016/j.whi.2021.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 01/25/2021] [Accepted: 02/08/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Rates of immunization with human papillomavirus (HPV) vaccine among adolescent and young adult females remain suboptimal. There is a continued need to focus on catch-up immunization. Some hospitals in the United States have implemented inpatient postpartum HPV immunization programs (IPP-HPV) as part of a strategy to improve rates of catch-up immunization. Patients' perspectives are critical to facilitating broad adoption of IPP-HPV. The objectives of this study were to understand the experiences and perspectives of postpartum women recommended to receive HPV vaccine before hospital discharge and to identify facilitators of and barriers to program implementation. METHODS We conducted in-depth semistructured interviews with postpartum women eligible for IPP-HPV. We used purposive sampling to ensure representation across race, ethnicity, and language. Interviews were analyzed using an iterative thematic approach. RESULTS The median age of participants (n = 24) was 22 years (range, 15-26 years), and six had declined the inpatient dose of HPV vaccine. Overall, women viewed IPP-HPV favorably. Facilitators of program implementation included viewing HPV vaccine as prevention, normalization of the vaccine, convenience of IPP-HPV, and the experience of a patient-centered approach. Barriers included the peripartum environment and associated stress, vaccine hesitancy, and a lack of both awareness of and knowledge about HPV vaccine. CONCLUSIONS IPP-HPV immunization is a strategy well-received by women for improving rates of catch-up immunization. The implementation of such programs may be optimized by increasing awareness that the vaccine is available and recommended for postpartum women, and by using a patient-centered approach that is sensitive to the needs of postpartum patients.
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Affiliation(s)
- Lital Avni-Singer
- Department of Obstetrics, Gynecology, & Reproductive Sciences, School of Medicine, Yale University, New Haven, Connecticut
| | - Carlos R Oliveira
- Department of Pediatrics, School of Medicine, Yale University, New Haven, Connecticut
| | - Ashlynn Torres
- Department of Epidemiology of Microbial Diseases, School of Public Health, Yale University, New Haven, Connecticut
| | - Eugene D Shapiro
- Department of Pediatrics, School of Medicine, Yale University, New Haven, Connecticut
| | - Linda M Niccolai
- Department of Epidemiology of Microbial Diseases, School of Public Health, Yale University, New Haven, Connecticut
| | - Sangini S Sheth
- Department of Obstetrics, Gynecology, & Reproductive Sciences, School of Medicine, Yale University, New Haven, Connecticut.
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26
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Forinash AB, Yancey AM, Shyken J. Pharmacist led vaccination rates in opioid addicted obstetric patients. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2021. [DOI: 10.1002/jac5.1364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Alicia B. Forinash
- Department of Pharmacy Practice St. Louis College of Pharmacy St. Louis Missouri USA
- WISH Center St. Louis Missouri USA
- SSM Health St. Mary's St. Louis Missouri USA
| | - Abigail M. Yancey
- Department of Pharmacy Practice St. Louis College of Pharmacy St. Louis Missouri USA
- SSM Health St. Mary's St. Louis Missouri USA
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Avni-Singer L, Oliveira CR, Torres A, Shapiro ED, Niccolai LM, Sheth SS. Evaluation of an Inpatient Postpartum Human Papillomavirus Immunization Program. Obstet Gynecol 2020; 136:1006-1015. [PMID: 33030866 DOI: 10.1097/aog.0000000000004097] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the result of an inpatient postpartum human papillomavirus (HPV) immunization pilot program in a diverse, low-income patient population from an urban, hospital-based obstetrics and gynecology clinic. METHODS In this cohort study, we present results from the first 2 years of the inpatient postpartum HPV immunization program, in which vaccine-eligible postpartum women were identified and immunized during their hospital stays. The program was implemented after educational outreach with prenatal and postpartum clinicians and nurses. Associations between receipt of the HPV vaccine as an inpatient and the characteristics of patients, and the likelihood of and missed opportunities for receiving a subsequent dose of the HPV vaccine as an outpatient were determined using logistic regression, time-to-event analyses, chi-squared tests and t-tests. RESULTS From April 11, 2017, to April 10, 2019, 394 (59.2%) of 666 postpartum women were eligible for the inpatient postpartum HPV immunization program. The majority (265/394, 67.3%) received the immunization pilot program HPV dose; 36 of those 265 (13.6%) completed the series with that dose. Among women due for additional doses after hospital discharge, those who received the inpatient dose were more likely to receive a subsequent outpatient dose (138/229) than were those who did not receive an inpatient dose (39/129; hazard ratio 2.51, 95% CI 1.76-3.58). On average, there were 30.7 fewer (95% CI 5.8-55.6, P<.02) missed opportunities for subsequent outpatient doses for every 100 eligible visits among women who received the inpatient dose, compared with women who did not. By the end of the study, the proportion of women who had completed the vaccine series was higher among women who received the inpatient dose (95/265, 35.8%) than in those who did not (12 out 129, 9.3%; odds ratio 5.45, 95% CI 2.86-10.38). CONCLUSION The inpatient postpartum HPV immunization program was associated with increased rates of immunization and addressed a previously missed opportunity. Inpatient immunization programs can serve as a critical way to address gaps in vaccine uptake.
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Affiliation(s)
- Lital Avni-Singer
- Department of Obstetrics, Gynecology & Reproductive Sciences and the Department of Pediatrics, Yale School of Medicine, and the Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut
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28
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Schieber A, O'Gurek D. Vaccinating in Pregnancy: Opportunities and Challenges. Prim Care 2020; 47:443-452. [PMID: 32718442 DOI: 10.1016/j.pop.2020.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The continuum of preconception, antenatal period, fourth trimester, and interconception period are a critical time for comprehensive care to advance maternal-child health and deliver family-centered care. Immunizations are a key component of this care delivery; however, there are intricacies around indications of vaccinations during this key period. Both active immunity to the individual receiving the vaccine as well as passive immunity passed to the fetus during pregnancy highlight the benefits of this care. Understanding the indications and benefits of vaccine administration during this continuum is critical for providers caring for individuals of reproductive age.
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Affiliation(s)
- Alexandra Schieber
- Department of Family & Community Medicine, Lewis Katz School of Medicine at Temple University, Jones Hall, 3rd Floor, 1316 West Ontario Street, Philadelphia, PA 19140, USA.
| | - David O'Gurek
- Department of Family & Community Medicine, Lewis Katz School of Medicine at Temple University, Jones Hall, 3rd Floor, 1316 West Ontario Street, Philadelphia, PA 19140, USA
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29
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Contardo MV. Vacunación de la embarazada. REVISTA MÉDICA CLÍNICA LAS CONDES 2020. [DOI: 10.1016/j.rmclc.2020.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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30
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Rasmussen SA, Kancherla V, Conover E. Joint position statement on vaccines from the Society for Birth Defects Research and Prevention and the Organization of Teratology Information Specialists. Birth Defects Res 2020; 112:527-534. [PMID: 32270605 DOI: 10.1002/bdr2.1674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 03/11/2020] [Accepted: 03/11/2020] [Indexed: 11/08/2022]
Affiliation(s)
- Sonja A Rasmussen
- Department of Pediatrics, University of Florida College of Medicine, Gainesville, Florida, USA.,Department of Epidemiology, University of Florida College of Public Health and Health Professions and College of Medicine, Gainesville, Florida, USA
| | - Vijaya Kancherla
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Elizabeth Conover
- Department of Genetic Medicine, Munroe Meyer Institute, University of Nebraska Medical Center Omaha, Omaha, Nebraska, USA
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Sompagdee N, Anuwutnavin S, Phongsamart W, Senawong S, Umrod P, Robkhonburi A. Seroprevalence of Bordetella pertussis antibodies and anti-pertussis antibody response after a single dose of reduced-antigen combined diphtheria, tetanus, and acellular pertussis vaccine (Tdap) in pregnant Thai women. Vaccine 2020; 38:2725-2733. [PMID: 32070680 DOI: 10.1016/j.vaccine.2020.01.074] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 01/06/2020] [Accepted: 01/23/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Maternal immunization with tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap) has recently been implemented to prevent infant pertussis. Tdap is still not routinely recommended in Thailand, and there are limited data to support or challenge this strategy. OBJECTIVES The primary aim was to determine the seroprevalence of anti-pertussis toxin antibodies (anti-PT IgG) among pregnant Thai women. The secondary aims were to evaluate antibodies response after Tdap vaccination between seronegative and seropositive mothers and to compare the different antibody titers at delivery among seropositive mothers who received Tdap to those who received tetanus-diphtheria vaccine (Td). METHODS This randomized clinical trial was conducted during April 2018 to April 2019 at Siriraj Hospital, Bangkok, Thailand. A total of 129 pregnant women were included. Paired blood samples for anti-PT IgG levels were obtained during the first antenatal visit and at delivery. A baseline cut-off value of <5 IU/ml indicated seronegativity. There were 29 exclusions from the original 129 enrollment. All seronegative participants (n = 69) received Tdap, while the seropositive group were randomized 1:1 to receive either Tdap (n = 18) or Td (n = 13) during 27-36 weeks' gestation. The antibody levels from both sera were compared between groups. RESULTS The seroprevalence of maternal anti-PT IgG was 33.3% (43/129). There was no significant difference in the increment of antibody levels after Tdap vaccination between the seronegative and seropositive groups (30.2 vs. 42 IU/ml; p = 0.183). Among seropositive groups, all Tdap recipients had increased antibody titers at delivery, while all Td recipients showed waning of immunity throughout gestation. (42 IU/ml vs. -7.4 IU/ml; p < 0.001). CONCLUSION Most pregnant Thai women have seronegative against pertussis. Most seropositive mothers had initial low antibody titers and their immunity significantly decreased before delivery. Our findings highlight the need for universal pertussis immunization in pregnancy regardless of individual baseline immunity.
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Affiliation(s)
- Nalat Sompagdee
- Department of Obstetrics and Gynaecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sanitra Anuwutnavin
- Department of Obstetrics and Gynaecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| | - Wanatpreeya Phongsamart
- Division of Infectious Diseases, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sansnee Senawong
- Department of Immunology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pinklow Umrod
- Department of Immunology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Amporn Robkhonburi
- Department of Obstetrics and Gynaecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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ACOG Committee Opinion No. 772: Immunization Implementation Strategies for Obstetrician-Gynecologists. Obstet Gynecol 2020; 133:e254-e259. [PMID: 30801479 DOI: 10.1097/aog.0000000000003130] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Immunization against vaccine-preventable diseases is an essential component of women's primary and preventive health care. Many studies have shown that a recommendation from an obstetrician-gynecologist or other health care provider for a vaccine is one of the strongest influences on patient acceptance. Obstetrician-gynecologists and other health care providers should develop a standard process for assessing and documenting the vaccination status of patients and for recommending and administering vaccines. If allowed by state law, obstetrician-gynecologists and other health care providers are encouraged to institute standing orders for indicated immunizations. Obstetrician-gynecologists and other health care providers are encouraged to stock and, ideally, administer commonly recommended vaccines in their offices. Studies show that immunization rates are higher when a health care provider can offer and administer the vaccine during the same visit, as opposed to recommending vaccination and referring the patient elsewhere to receive the vaccine. Given the demonstrated efficacy and safety of vaccines and the large potential for prevention of many infectious diseases that affect adolescents, adults, pregnant women, and newborns, obstetrician-gynecologists should include immunizations as an integral part of their practice. This Committee Opinion has been revised to incorporate additional strategies for obstetrician-gynecologists to consider implementing to enhance their immunization programs.
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Hunter P, Fryhofer SA, Szilagyi PG. Vaccination of Adults in General Medical Practice. Mayo Clin Proc 2020; 95:169-183. [PMID: 31902413 DOI: 10.1016/j.mayocp.2019.02.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 01/31/2019] [Accepted: 02/14/2019] [Indexed: 01/04/2023]
Abstract
In vaccinating adults, clinicians face 2 types of challenges: (1) staying current on recommendations for influenza, pneumococcal, hepatitis A and B, zoster, and other vaccines and (2) addressing systemic barriers to implementing practices that increase vaccination rates. Although adult immunization rates remain suboptimal, there has been much good news in adult vaccination recently. New high-dose and adjuvanted influenza vaccines help improve immune response and may reduce influenza complications in older adults. The new recombinant zoster vaccine offers significantly more efficacy against zoster outbreaks and postherpetic neuralgia than zoster vaccine live. Pertussis vaccine given during the third trimester of pregnancy may prevent between 50% and 90% of pertussis infections in infants. Shorter time for completion (1 vs 6 months) of new, adjuvanted hepatitis B vaccine may increase adherence. Clinicians can address systemic barriers to increasing vaccination rates in their clinics and health care systems by following the Centers for Disease Control and Prevention's Standards for Adult Immunization Practice. Clinicians can help increase vaccination rates by writing standing orders and by advocating for nurses or medical assistants to receive training and protected time for assessing and documenting vaccination histories and administration. Strong recommendations that presume acceptance of vaccination are effective with most patients. Communication techniques similar to motivational interviewing can help with vaccine-hesitant patients. Clinicians, as experts on providing preventive services, can educate community leaders about the benefits of immunization and can inform vaccine experts about challenges of implementing vaccination recommendations in clinical practice and strategies that can work to raise vaccination rates.
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Affiliation(s)
- Paul Hunter
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI; City of Milwaukee Health Department, WI.
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Ounnavong P, Chanthavilay P, Khampanisong P, Reinharz D, Muller CP, Black AP. Seroprevalence of anti-tetanus antibodies in mothers and cord blood and associated factors in health-care settings in Lao People's Democratic Republic. Vaccine 2019; 38:1234-1240. [PMID: 31735506 DOI: 10.1016/j.vaccine.2019.11.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 10/30/2019] [Accepted: 11/05/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Maternal neonatal tetanus (MNT) was eliminated from Lao People's Democratic Republic (PDR) in 2014. WHO recommends 80% coverage of 2 or more tetanus vaccinations (TT2+) in pregnancy to maintain MNT control. Vaccination coverage in Lao PDR varies among regions although the reasons are not clear. METHODS 185 pregnant women giving birth in three district hospitals in Savannakhet province, Lao PDR were recruited. A questionnaire was administered to determine factors associated with seroprotection and blood was taken from mother and cord blood to be tested for anti-tetanus antibodies by ELISA. RESULTS 77% of mothers and 79% of newborns had sufficiently protective antibody titres (>0.5 IU/ml) against tetanus. Only 70% of the mothers received one dose of TT vaccination during antenatal care (ANC) consultation and 45% received the recommended two injections. Although most of the vaccination took place during ANC 1 and 2, many were missed at these time-points. Anti-tetanus seroprotection in the mothers was associated with maternal age, number of ANC visits, number of TT vaccinations during and before pregnancy and gestational age. CONCLUSION Seroprevalence of anti-tetanus antibodies in mothers and newborns was intermediate but TT2+ coverage was low in healthcare settings in Lao PDR. TT2+ coverage during ANC is likely to be significantly lower in settings with less robust ANC practices. Missed opportunities to vaccinate in ANC 1 and 2 suggest a need to promote vaccine awareness and vaccination at first ANC visit. A booster dose of TT containing vaccine should be considered for children aged between 4 and 7 years old.
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Affiliation(s)
- Phoumsavath Ounnavong
- Institut de la Francophonie pour la Medecine Tropicale, Lao Democratic People's Republic
| | | | | | - Daniel Reinharz
- Institut de la Francophonie pour la Medecine Tropicale, Lao Democratic People's Republic; Department of Social and Preventive Medicine, Laval University, Canada(2)
| | - Claude P Muller
- Lao-Lux Laboratory, Institut Pasteur du Laos, Vientiane, Lao Democratic People's Republic; Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg; Laboratoire Nationale de Santé, Dudelange, Luxembourg
| | - Antony P Black
- Lao-Lux Laboratory, Institut Pasteur du Laos, Vientiane, Lao Democratic People's Republic.
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Abstract
Immunization is an essential part of care for adults, including pregnant women. Influenza vaccination for pregnant women is especially important because pregnant women who contract influenza are at greater risk of maternal morbidity and mortality in addition to fetal morbidity, including congenital anomalies, spontaneous abortion, preterm birth, and low birth weight. Other vaccines provide maternal protection from severe morbidity related to specific pathogens such as pneumococcus, meningococcus, and hepatitis for at-risk pregnant women. Obstetrician-gynecologists and other obstetric care providers should routinely assess their pregnant patients' vaccination status. Based on this assessment they should recommend and, when possible, administer needed vaccines to their pregnant patients. There is no evidence of adverse fetal effects from vaccinating pregnant women with inactivated virus, bacterial vaccines, or toxoids, and a growing body of data demonstrate the safety of such use. Women who are or will be pregnant during influenza season should receive an annual influenza vaccine. All pregnant women should receive a tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine during each pregnancy, as early in the 27-36-weeks-of-gestation window as possible.
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Abstract
Immune status during pregnancy is an important consideration, and all women who are pregnant should be screened for immunity to certain diseases. Women who are pregnant are at higher risk of contracting infections, and many infections can cause serious problems for a growing fetus. For this reason, remaining up-to-date on immunizations throughout life and especially leading up to pregnancy is important. In addition, there are certain vaccines that provide added benefit if given during pregnancy. The Tdap (tetanus toxoid, reduced diphtheria toxoid, acellular pertussis) and inactivated influenza vaccines can provide protection not only for the pregnant mother but also for the newborn baby by passing immunity through the placenta. All pregnant women should be encouraged to receive the appropriate vaccines and be treated according to their immune status to ensure the best possible protection for this population. [Pediatr Ann. 2019;48(7):e251-e254.].
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Psarris A, Sindos M, Daskalakis G, Chondrogianni ME, Panayiotou S, Antsaklis P, Loutradis D. Immunizations during pregnancy: How, when and why. Eur J Obstet Gynecol Reprod Biol 2019; 240:29-35. [PMID: 31226574 DOI: 10.1016/j.ejogrb.2019.06.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 06/13/2019] [Indexed: 12/25/2022]
Abstract
Maternal immunization during pregnancy provide protection for the mother and the fetus against certain pathogens. Immunizations during pregnancy are divided to routine immunizations recommended for all pregnant women, immunizations for certain medical indications and vaccines that are potentially harmful during pregnancy and should be avoided. We conducted a comprehensive review of the literature regarding immunizations during pregnancy. The search terms used were immunization, vaccine, pregnancy, influenza, pertussis, safety and efficacy. We gathered all available guidelines on vaccination during pregnancy. Generally, vaccines are allowed during pregnancy when the benefits outweigh the risks. Tdap and inactivated flu vaccines are routinely recommended during pregnancy. Vaccines containing live attenuated viruses are contraindicated during pregnancy. These are LAIV influenza, MMR, Varicella, Zoster, BCG and smallpox pre-exposure. All other vaccines are given when medically indicated and the possible benefits outweigh the risks. Obstetricians and gynecologists should be familiar with the indications of vaccination during pregnancy. Vaccination coverage of pregnant women with routinely recommended vaccines has increased but further efforts are needed. Our aim is to review vaccination practices during pregnancy, demonstrate the benefits and dangers of different vaccines, evaluate their effectiveness and define the proper timing of vaccination.
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Affiliation(s)
- Alexandros Psarris
- 1st Department of Obstetrics and Gynecology, "Alexandra" Maternity Hospital, National and Kapodistrian University of Athens, 80 Vas. Sophias Av., 115 28, Athens, Greece.
| | - Michael Sindos
- 1st Department of Obstetrics and Gynecology, "Alexandra" Maternity Hospital, National and Kapodistrian University of Athens, 80 Vas. Sophias Av., 115 28, Athens, Greece
| | - Georgios Daskalakis
- 1st Department of Obstetrics and Gynecology, "Alexandra" Maternity Hospital, National and Kapodistrian University of Athens, 80 Vas. Sophias Av., 115 28, Athens, Greece
| | - Maria Eleni Chondrogianni
- 1st Department of Obstetrics and Gynecology, "Alexandra" Maternity Hospital, National and Kapodistrian University of Athens, 80 Vas. Sophias Av., 115 28, Athens, Greece
| | - Stefani Panayiotou
- 1st Department of Obstetrics and Gynecology, "Alexandra" Maternity Hospital, National and Kapodistrian University of Athens, 80 Vas. Sophias Av., 115 28, Athens, Greece
| | - Panagiotis Antsaklis
- 1st Department of Obstetrics and Gynecology, "Alexandra" Maternity Hospital, National and Kapodistrian University of Athens, 80 Vas. Sophias Av., 115 28, Athens, Greece
| | - Dimitrios Loutradis
- 1st Department of Obstetrics and Gynecology, "Alexandra" Maternity Hospital, National and Kapodistrian University of Athens, 80 Vas. Sophias Av., 115 28, Athens, Greece
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Danziger P, Skoczylas M, Laventhal N. Parental Refusal of Standard-of-Care Prophylactic Newborn Practices: In One Center's Experience, Many Refuse One but Few Refuse All. Hosp Pediatr 2019; 9:429-433. [PMID: 31061136 DOI: 10.1542/hpeds.2019-0029] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVES Several interventions to reduce neonatal morbidity and mortality are universally recommended: intramuscular (IM) vitamin K (VK), erythromycin ophthalmic prophylaxis, and hepatitis B vaccine for newborns, and maternal pertussis vaccine. Despite robust efficacy and safety evidence, parental refusal of these practices is increasing. We sought to define the current declination rate and characterize the association between declination of 1 intervention and declination of the others. METHODS A retrospective cohort study was performed of all inborn singletons admitted to the well newborn nursery over a 12-month period (November 15, 2015 through November 15, 2016) at a large quaternary center. RESULTS In total, 3758 infants met inclusion criteria. 25% (n = 921) did not receive at least 1 of the 4 interventions. 13.6% (n = 511) did not receive the hepatitis B vaccine, 2.3% (n = 85) did not receive IM VK, 5.9% (n = 223) did not receive erythromycin, and 7.2% (n = 271) of mothers did not receive the prenatal tetanus, diphtheria, pertussis vaccine. Odds of refusal of IM VK were 6.2 times greater for infants delivered by a certified nurse midwife versus physician (95% confidence interval 3.3-11.6). Pattern of declination was variable; of 921 mother-infant dyads who did not receive at least 1 intervention, only 2 dyads received none of the interventions. CONCLUSIONS Our study is one of the first in which patterns of refusal of standard-of-care perinatal practices are characterized. Alarmingly, one-fourth of our cohort did not receive at least 1 core infant health intervention. Our finding of only modest overlap in declination of each intervention carries implications for the development of targeted interventions.
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Affiliation(s)
| | | | - Naomi Laventhal
- Division of Neonatal-Perinatal Medicine
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, Michigan
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Jina A, Wang TL, Seyferth ER, Cohen A, Bernstein HH. Increasing antepartum Tdap vaccine administration: A quality improvement initiative. Vaccine 2019; 37:3654-3659. [PMID: 31122862 DOI: 10.1016/j.vaccine.2019.05.045] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 05/02/2019] [Accepted: 05/13/2019] [Indexed: 11/29/2022]
Abstract
The Centers for Disease Control and Prevention (CDC) recommends antepartum Tdap vaccination for women with each pregnancy to protect themselves and their vulnerable infants through transplacental transfer of maternal antibodies. Our aim was to increase the rate of antepartum Tdap vaccine administration by 20%. Obstetricians were surveyed to identify their present approaches and barriers to antepartum Tdap vaccine administration to help guide the development of our intervention. Limited staff training, lack of vaccine on site, and cost were the most commonly identified barriers. Using these survey responses, existing literature, and brainstorming conversations with colleagues, an interdisciplinary workgroup then created a fishbone analysis and developed a 5-step intervention to address these barriers: (1) educate providers and patients on Tdap and pertussis; (2) increase Tdap availability to all pregnant women; (3) remind staff of the established Tdap standing order to facilitate administration; (4) encourage obstetricians to offer Tdap; (5) transfer documentation of Tdap administration from office to hospital. To monitor changes in the process over 15 months of pre- and post-intervention, data were collected from monthly chart audits and a two-phase control chart was created. The main outcome measure was proportion of eligible women who received Tdap during current pregnancy. In the pre-intervention period, 362 of 636 eligible women (56.9%) received Tdap during their current pregnancy; in the post-intervention period, 457 of 708 eligible women (64.5%) received Tdap during their current pregnancy. This absolute difference of 7.6% (64.5% vs. 56.9%, p < 0.01) represents a 13.4% relative increase (64.5%/56.9%) in the proportion of clinically eligible pregnant women who received Tdap. This represents a clinically and statistically significant increase in the rate of antepartum Tdap immunization. More research is needed to further understand obstetric barriers and maternal refusal of antepartum Tdap administration.
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Affiliation(s)
- Asmita Jina
- General Pediatrics, Cohen Children's Medical Center, New Hyde Park, NY, United States
| | - Tiffany L Wang
- General Pediatrics, Cohen Children's Medical Center, New Hyde Park, NY, United States
| | - Elisabeth R Seyferth
- General Pediatrics, Cohen Children's Medical Center, New Hyde Park, NY, United States
| | - Amy Cohen
- Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Henry H Bernstein
- General Pediatrics, Cohen Children's Medical Center, New Hyde Park, NY, United States; Harvard T.H. Chan School of Public Health, Boston, MA, United States; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States.
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Agrawal A, Singh S, Kolhapure S, Kandeil W, Pai R, Singhal T. Neonatal Pertussis, an Under-Recognized Health Burden and Rationale for Maternal Immunization: A Systematic Review of South and South-East Asian Countries. Infect Dis Ther 2019; 8:139-153. [PMID: 31054089 PMCID: PMC6522626 DOI: 10.1007/s40121-019-0245-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Indexed: 12/18/2022] Open
Abstract
Pertussis is an under-recognized cause of neonatal morbidity and mortality. To review information on the epidemiology and disease burden of neonatal pertussis in South and Southeast Asian countries, a systematic literature review of three bibliographic databases was undertaken. Peer-reviewed original studies on neonatal pertussis epidemiology and burden published since 2000, with a geographical scope limited to South and Southeast Asian countries, were included. Data were systematically extracted based on parameters defined a priori. Our findings show that the burden of neonatal pertussis and its complications is substantial. An increase in the number of pertussis cases has been noted since early 2000, ranging from 61 to 92.9% in infants 0-3 months old. The most common symptoms an infant is likely to present with are cough with or without paroxysms, cyanosis, apnea, tachypnea, difficulty in breathing and leukocytosis. In addition, it can lead to hospitalization (length of stay: 5-7 days), complications (e.g., pneumonia, seizures) and mortality ranging from 5.6 to 14.7%. Other observations indicate that diagnosis is challenging because of non-specific clinical symptoms. Specifically, for obstetricians and gynecologists, the information available for making informed decisions on the prevention of neonatal pertussis is unreliable. Maternal immunization against pertussis during late stages of pregnancy has proven to be efficacious and well tolerated. A high burden of neonatal pertussis, as well as its complications, is observed in South and Southeast Asian countries. There is a need to intensify efforts to protect this vulnerable population with maternal vaccination.Funding: GlaxoSmithKline Biologicals SAPlain Language Summary: Plain language summary available for this article. Please see Fig. 1 and the following link: https://doi.org/10.6084/m9.figshare.7951187 .
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Affiliation(s)
| | | | | | | | - Rishma Pai
- Lilavati, Jaslok, and Hinduja Hospitals, Mumbai, India
| | - Tanu Singhal
- Kokilaben Dhirubhai Ambani Hospital, Mumbai, India
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Fuchs EL, Starkey JM, Rupp RE, Berenson AB. Prenatal vaccination of mothers and hepatitis B vaccination of their infants. Prev Med 2019; 121:68-73. [PMID: 30763628 PMCID: PMC6399050 DOI: 10.1016/j.ypmed.2019.02.013] [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: 08/09/2018] [Revised: 01/02/2019] [Accepted: 02/08/2019] [Indexed: 10/27/2022]
Abstract
Tetanus, diphtheria, and acellular pertussis (Tdap) vaccination and influenza vaccination are recommended during pregnancy primarily to prevent influenza and pertussis in mothers and their infants. This study examines associations between prenatal Tdap vaccination and influenza vaccination of mothers and hepatitis B vaccination of their infants. A retrospective cohort study was conducted using data from electronic medical records from 15,468 deliveries to 14,925 mothers occurring April 2, 2014-December 3, 2016 at a university hospital in Texas. Hepatitis B vaccine receipt in the first 3 days of life was dichotomized. Margins post-estimation commands in Stata SE 15.1 were used to obtain predicted probabilities and risk differences after estimating odds ratios in logistic regression with robust variance estimates. Adjusted models included maternal age, race/ethnicity, Medicaid use, year of delivery, parity, and gravidity. Infants of mothers who received prenatal influenza vaccination in the 2014-2015 and 2015-2016 influenza seasons were more likely than those of mothers who did not to receive a hepatitis B vaccine in their first 3 days of life (adjusted risk difference (RD) 2.8%, 95% confidence interval (CI) 1.5-4.1% and RD 2.2%, 95% CI 0.9-3.5%, respectively). Hepatitis B vaccination was also higher among infants of Tdap-eligible mothers who received prenatal Tdap vaccination during pregnancy compared to those of mothers who did not (adjusted RD 9.1%, 95% CI 7.6-10.5%). Overall, prenatal vaccination was significantly associated with uptake of infant hepatitis B vaccine.
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Affiliation(s)
- Erika L Fuchs
- Center for Interdisciplinary Research in Women's Health, Department of Obstetrics and Gynecology, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555-0587, USA.
| | - Jonathan M Starkey
- Institute for Translational Sciences & Preventive Medicine and Community Health, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555-0587, USA.
| | - Richard E Rupp
- Sealy Institute for Vaccine Sciences, Department of Pediatrics, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555-0587, USA.
| | - Abbey B Berenson
- Center for Interdisciplinary Research in Women's Health, Department of Obstetrics and Gynecology, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555-0587, USA.
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Bechini A, Moscadelli A, Pieralli F, Sartor G, Seravalli V, Panatto D, Amicizia D, Bonanni P, Boccalini S. Impact assessment of an education course on vaccinations in a population of pregnant women: a pilot study. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2019; 60:E5-E11. [PMID: 31041404 PMCID: PMC6477562 DOI: 10.15167/2421-4248/jpmh2019.60.1.1093] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 02/20/2019] [Indexed: 11/24/2022]
Abstract
Introduction Although the benefits of vaccinations have been extensively demonstrated, vaccination coverage remains unsatisfactory as result of many people’s poor knowledge and negative perception of vaccination. We evaluated the impact of an education course on vaccinations in a population of pregnant women. Methods A total of 214 pregnant women were invited to participate in this project, which was undertaken at the Obstetrics and Gynaecology Department of Careggi University Hospital in Florence (Italy). Anonymous questionnaires were administered to women before and after the intervention. A descriptive and statistical analysis was carried out in order to compare the responses obtained before and after the intervention. Results Adherence to the initiative was good (98%): initially, the respondents were not hostile to vaccinations, though many (43%) were poorly or insufficiently informed. The educational intervention had a positive impact. After the intervention, the number of women who rated their level of knowledge of vaccinations as poor or insufficient had decreased by 30% and the number of “hesitant” respondents had decreased with respect to all aspects of the study, especially the decision to be vaccinated during pregnancy. Conclusions Hesitancy stems from a lack of accurate information. Healthcare professionals need to improve their communication skills. Appropriate education during pregnancy, when women are more receptive, may have a highly positive impact. These observations need to be considered in the planning of courses to prepare pregnant women for delivery also in other maternal-foetal centres in Italy.
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Affiliation(s)
- A Bechini
- Department of Health Sciences, University of Florence, Italy
| | - A Moscadelli
- Department of Health Sciences, University of Florence, Italy
| | - F Pieralli
- Department of Health Sciences, University of Florence, Italy
| | - G Sartor
- Department of Health Sciences, University of Florence, Italy
| | - V Seravalli
- Department of Health Sciences, University of Florence, Italy
| | - D Panatto
- Department of Health Sciences, University of Genoa, Italy
| | - D Amicizia
- Department of Health Sciences, University of Genoa, Italy
| | - P Bonanni
- Department of Health Sciences, University of Florence, Italy
| | - S Boccalini
- Department of Health Sciences, University of Florence, Italy
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Vaccine recommendations in pregnancy and lactation. J Am Pharm Assoc (2003) 2018; 59:137-140. [PMID: 30580926 DOI: 10.1016/j.japh.2018.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Rac H, Gould AP, Eiland LS, Griffin B, McLaughlin M, Stover KR, Bland CM, Bookstaver PB. Common Bacterial and Viral Infections: Review of Management in the Pregnant Patient. Ann Pharmacother 2018; 53:639-651. [PMID: 30556401 DOI: 10.1177/1060028018817935] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To review the treatment of common bacterial and viral infections occurring in the pregnant patient. DATA SOURCES A literature search of MEDLINE was performed (inception to October 2018). The Centers for Disease Control and Prevention website was utilized for additional information. STUDY SELECTION AND DATA EXTRACTION Relevant English-language studies and those conducted in humans were considered. DATA SYNTHESIS β-Lactams alone or in combination are the preferred treatment for many common infections in pregnancy, such as urinary tract infections, pelvic inflammatory disease (PID), gonococcal infections, syphilis, chancroid, upper- and lower-respiratory-tract infections, certain gastrointestinal infections, Group B Streptococcus, listeriosis, and intrauterine inflammation or infection. Macrolides, particularly azithromycin, are also utilized for the treatment of PID, chlamydia, gonococcal infections, chancroid, community-acquired pneumonia, and certain gastrointestinal infections. Other antibiotics or antivirals such as vancomycin, aminoglycosides, metronidazole, nitrofurantoin, fosfomycin, acyclovir, valacyclovir, and oseltamivir are included in the preferred therapy for some common bacterial and viral infections in pregnant patients as well. Relevance to Patient Care and Clinical Practice: This review synthesizes available evidence of treatments of common infections in pregnancy and provides a concise summary to guide clinicians on empirical treatment during pregnancy. CONCLUSIONS There are limited data on clinical outcomes in pregnant patients with common bacterial and viral infections. Empirical management decisions require balance of benefit and risk to both mother and infant. Although few clinical practice guidelines have quality evidence for strong recommendations in this population, clinicians should weigh antimicrobial dosing, pharmacokinetics, safety, and established effectiveness to optimize antimicrobial therapy in pregnancy.
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Affiliation(s)
- Hana Rac
- 1 University of South Carolina College of Pharmacy, Columbia, SC, USA
| | | | - Lea S Eiland
- 3 Auburn University Harrison School of Pharmacy, Meridian, MS, USA
| | - Brooke Griffin
- 4 Midwestern University Chicago College of Pharmacy, Downers Grove, IL, USA
| | - Milena McLaughlin
- 4 Midwestern University Chicago College of Pharmacy, Downers Grove, IL, USA
| | - Kayla R Stover
- 5 University of Mississippi School of Pharmacy, Jackson, MS, USA
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Lutz CS, Carr W, Cohn A, Rodriguez L. Understanding barriers and predictors of maternal immunization: Identifying gaps through an exploratory literature review. Vaccine 2018; 36:7445-7455. [PMID: 30377064 PMCID: PMC10431095 DOI: 10.1016/j.vaccine.2018.10.046] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 10/05/2018] [Accepted: 10/10/2018] [Indexed: 01/05/2023]
Abstract
BACKGROUND The Advisory Committee for Immunization Practices recommends that all pregnant women receive the seasonal influenza vaccine and the tetanus toxoid, diphtheria toxoid, and acellular pertussis (Tdap) vaccine during every pregnancy. However, vaccination coverage rates are suboptimal among pregnant women in the United States, leaving these women and their unborn children at risk of vaccine-preventable diseases and their complications. OBJECTIVES We sought to understand the current landscape of published literature regarding maternal immunization, including barriers to and predictors of vaccine acceptance, and identify gaps in the research in order to inform strategies for future programmatic improvement. METHODS We conducted a literature search using MEDLINE (OVID), PsychINFO, and CINAHL (Ebsco) databases. The search included published, English-language manuscripts that identified patient, provider, or system-level barriers to, predictors of, or interventions that improved uptake of maternal vaccines among pregnant women in the US. Studies were reviewed using an inductive thematic analysis approach. RESULTS We included 75 studies in our review. Pregnant women identified 25 different barriers to accepting recommended maternal immunizations; barriers related to vaccine safety perceptions were the most common. Healthcare providers identified 24 different barriers to vaccinating their pregnant patients. The most commonly cited barriers among healthcare providers were financial concerns. Eighteen different predictors of vaccine acceptance were identified. Receipt of a healthcare provider's recommendation was the factor most frequently reported as a reason for vaccination among pregnant women. CONCLUSIONS We were able to identify gaps in the literature regarding maternal immunization and make recommendations for future research. Efforts to address the challenges of maternal immunization in the United States should include increasing the focus on Tdap, implementing more high-level assessments of safety perceptions and associated concerns, and determining most effective interventions.
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Affiliation(s)
- Chelsea S Lutz
- Oak Ridge Institute for Science and Education, United States Department of Energy, Washington DC, United States; Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Wendy Carr
- Office of the Director, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Amanda Cohn
- Office of the Director, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Leslie Rodriguez
- Office of the Director, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
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46
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Madhi SA, Nunes MC. Experience and challenges on influenza and pertussis vaccination in pregnant women. Hum Vaccin Immunother 2018; 14:2183-2188. [PMID: 30024822 PMCID: PMC6183140 DOI: 10.1080/21645515.2018.1483810] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Young infants contribute to relatively high burden of vaccine-preventable diseases, including infections by influenza virus and Bordetella pertussis. Vaccination of pregnant women can enhance transplacental transfer of protective antibody to the fetus and protect the infant against disease during the first few months of life. Pregnant women are a priority group for seasonal influenza vaccination, due to third-trimester pregnancy being a risk-factor for severe influenza illness. Furthermore, randomized controlled trials confirmed that influenza vaccination during pregnancy confers protection against influenza-confirmed illness in the women, and their infants up to 3 months of age; and is also associated with 20% reduction in all-cause pneumonia among young-infants. Maternal influenza vaccination might also reduce the risk of low-birth weight, preterm births, and stillbirths however, data on this is conflicting. Vaccination of pregnant women with acellular pertussis vaccines reduces pertussis in their young infants by up to 93%. The increase in specific pertussis antibody among the infants born to vaccinated women might, however, interfere with the active pertussis vaccination of the infant following the primary series of vaccines. The clinical implication of this is yet to be ascertained, particularly since immune responses following the booster vaccine are unaffected. Vaccination of pregnant women with inactivated influenza vaccine and acellular pertussis vaccine have been demonstrated to confer protection to their young infants, and warrants consideration for inclusion into public health immunization programs, including in low and middle income countries.
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Affiliation(s)
- Shabir A Madhi
- a Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty Health Sciences , University of the Witwatersrand , Johannesburg , South Africa.,b Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, Faculty Health Sciences , University of the Witwatersrand , Johannesburg , South Africa
| | - Marta C Nunes
- a Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty Health Sciences , University of the Witwatersrand , Johannesburg , South Africa.,b Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, Faculty Health Sciences , University of the Witwatersrand , Johannesburg , South Africa
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47
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Gulumser C, Engin-Ustun Y, Keskin L, Celen S, Sanisoglu S, Karaahmetoglu S, Ozcan A, Sencan I. Maternal mortality due to hemorrhage: population-based study in Turkey. J Matern Fetal Neonatal Med 2018; 32:3998-4004. [PMID: 29890882 DOI: 10.1080/14767058.2018.1481029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Objective: The aim of this study was to determine the epidemiological characteristics of maternal mortality due to postpartum hemorrhage, and to investigate whether national preventative measures of the Maternal Mortality Program have been successful in Turkey. Design: A population-based cohort study. Setting: Turkish National Maternal Mortality Data collected by the Turkish Ministry of Health. Participants: Women who died due to hemorrhage during pregnancy or after delivery within the initial 42 days, from 2012 to 2015, throughout Turkey (N = 812/146). Main outcome measures: The preventability and problems in each maternal death due to hemorrhage. Results: A total of 779 maternal deaths were identified during the study period. Our estimate of the Maternal Mortality Ratio (MMR) in the 3-year period was 19.7 per 100,000 live births. Of the 779 deaths, the report listed 411 as direct and 285 as indirect deaths. Direct obstetric complications were the leading causes of maternal deaths, the most common of which was maternal cardiovascular diseases (21%) and obstetric hemorrhage (20.6%). Conclusion: Improving data surveillance and implementing national guidelines for the prevention and management of major complications of pregnancy, childbirth, and puerperium is necessary to reduce MMR. The healthcare authorities of Turkey should continue to set a sustainable development goal of ≤70 maternal deaths per 100,000 live births by 2030. We believe our results may provide useful information for other developing countries that are aiming to reduce maternal mortality, as well as mobilize global efforts to improve women's health.
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Affiliation(s)
- Cagri Gulumser
- Department of Obstetrics and Gynecology, University of Health and Science , Istanbul , Turkey.,General Directorate of Mother and Child Health and Family Planning, Ministry of Health of Turkey , Ankara , Turkey
| | - Yaprak Engin-Ustun
- Department of Obstetrics and Gynecology, University of Health and Science , Istanbul , Turkey.,General Directorate of Mother and Child Health and Family Planning, Ministry of Health of Turkey , Ankara , Turkey
| | - Levent Keskin
- Department of Obstetrics and Gynecology, Atatürk Education and Research Hospital , Ankara , Turkey
| | - Sevki Celen
- Dr Zekai Tahir Burak Training and Research Hospital , Ankara , Turkey
| | - Sema Sanisoglu
- General Directorate of Mother and Child Health and Family Planning, Ministry of Health of Turkey , Ankara , Turkey
| | - Selma Karaahmetoglu
- General Directorate of Mother and Child Health and Family Planning, Ministry of Health of Turkey , Ankara , Turkey
| | - Ayse Ozcan
- General Directorate of Mother and Child Health and Family Planning, Ministry of Health of Turkey , Ankara , Turkey
| | - Irfan Sencan
- General Directorate of Mother and Child Health and Family Planning, Ministry of Health of Turkey , Ankara , Turkey
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48
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Bergin N, Murtagh J, Philip RK. Maternal Vaccination as an Essential Component of Life-Course Immunization and Its Contribution to Preventive Neonatology. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E847. [PMID: 29693575 PMCID: PMC5981886 DOI: 10.3390/ijerph15050847] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 04/13/2018] [Accepted: 04/21/2018] [Indexed: 12/16/2022]
Abstract
Maternal immunisation schedules are increasingly coming under the spotlight as part of the development of lifetime immunisation programmes for the role that they play in improving maternal, foetal, and neonatal health. Maternally-acquired antibodies are critical in protecting infants during the first months of their lives. Maternal immunisation was previously overlooked owing to concerns regarding vaccinations in this untested and high-risk population but is now acknowledged for its potential impact on the outcomes in many domains of foetal and neonatal health, aside from its maternal benefits. This article highlights the role that maternal immunisation may play in reducing infections in preterm and term infants. It explores the barriers to antenatal vaccinations and the optimisation of the immunisation uptake. This review also probes the part that maternal immunisation may hold in the reduction of perinatal antimicrobial resistance and the prevention of non-infectious diseases. Both healthcare providers and expectant mothers should continue to be educated on the importance and safety of the appropriate immunizations during pregnancy. Maternal vaccination merits its deserved priority in a life-course immunization approach and it is perhaps the only immunization whereby two generations benefit directly from a single input. We outline the current recommendations for antenatal vaccinations and highlight the potential advances in the field contributing to “preventive neonatology”.
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Affiliation(s)
- Naomi Bergin
- Division of Neonatology, Department of Paediatrics, University Maternity Hospital Limerick (UMHL), Limerick V94 C566, Ireland.
| | - Janice Murtagh
- MSD Ireland Ltd., South County Business Park, Leopardstown, Dublin D18 X5K7, Ireland.
| | - Roy K Philip
- Division of Neonatology, Department of Paediatrics, University Maternity Hospital Limerick (UMHL), Limerick V94 C566, Ireland.
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