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Oguz MM, Senel S. Effectiveness of cocoon strategy vaccination on prevention of influenza-like illness in young infants. Hum Vaccin Immunother 2024; 20:2350090. [PMID: 38738691 DOI: 10.1080/21645515.2024.2350090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 04/26/2024] [Indexed: 05/14/2024] Open
Abstract
During the initial half-year of their existence, infants cannot receive the influenza vaccine, yet they face the greatest susceptibility to severe influenza complications. In this study, we seek to determine whether influenza vaccination of maternal and household contacts is associated with a reduced risk of influenza-like illness (ILI) and severe acute respiratory infection (SARI) in infants. This work was prospectively conducted during the influenza season. A total of 206 infants were included in this study. The percentage of infants with only the mother vaccinated is 12.6% (n:26), and the percent of infants with all household contacts vaccinated is 16% (n:33). Among the infants with only the mother vaccinated, the effectiveness of influenza vaccine is estimated as 35.3% for ILI and 41.3% for SARI. Among infants with all household contacts vaccinated, the effectiveness is estimated as 48.9% for ILI and 76.9% for SARI. Based on the results of multivariate logistic regression analysis, all-household vaccination is a protective factor against SARI (OR: 0.07 95% CI [0.01-0.56]), household size (OR: 1.75, 95% CI [1.24-2.48]) and presence of secondhand smoke (OR: 2.2, 95% CI [1.12-4.45]) significant risk factors for SARI in infants. The mother alone being vaccinated is not a statistically significant protective factor against ILI (OR: 0.46, 95% CI [0.19-1.18]) or SARI (OR: 0.3, 95% CI [0.11-1.21]). Along with the obtained results and analysis, this study provides clear evidence that influenza vaccination of all household contacts of infants aged 0-6 months is significantly associated with protecting infants from both ILI and SARI.
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Affiliation(s)
- Melahat Melek Oguz
- Department of Pediatrics, Dr. Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Saliha Senel
- Department of Pediatrics, Yildirim Beyazit University, Ankara, Turkey
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2
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Kortsmit K, Oduyebo T, Simeone RM, Kahn KE, Razzaghi H, Galang RR, Ellington S, Ruffo N, Barfield WD, Warner L, Cox S. Influenza and Tetanus, Diphtheria, and Acellular Pertussis Vaccination Coverage During Pregnancy: Pregnancy Risk Assessment Monitoring System, 2020. Public Health Rep 2024; 139:218-229. [PMID: 37386826 PMCID: PMC10851903 DOI: 10.1177/00333549231179252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023] Open
Abstract
OBJECTIVES Estimates of vaccination coverage during pregnancy and identification of disparities in vaccination coverage can inform vaccination campaigns and programs. We reported the prevalence of being offered or told to get the influenza vaccine by a health care provider (hereinafter, provider); influenza vaccination coverage during the 12 months before delivery; and tetanus, diphtheria, and acellular pertussis (Tdap) vaccination coverage during pregnancy among women with a recent live birth in the United States. METHODS We analyzed 2020 data from the Pregnancy Risk Assessment Monitoring System from 42 US jurisdictions (n = 41 673). We estimated the overall prevalence of being offered or told to get the influenza vaccine by a provider and influenza vaccination coverage during the 12 months before delivery. We estimated Tdap vaccination coverage during pregnancy from 21 jurisdictions with available data (n = 22 020) by jurisdiction and select characteristics. RESULTS In 2020, 84.9% of women reported being offered or told to get the influenza vaccine, and 60.9% received it, ranging from 35.0% in Puerto Rico to 79.7% in Massachusetts. Influenza vaccination coverage was lower among women who were not offered or told to get the influenza vaccine (21.4%) than among women who were offered or told to get the vaccine (68.1%). Overall, 72.7% of women received the Tdap vaccine, ranging from 52.8% in Mississippi to 86.7% in New Hampshire. Influenza and Tdap vaccination coverage varied by all characteristics examined. CONCLUSIONS These results can inform vaccination programs and strategies to address disparities in vaccination coverage during pregnancy and may inform vaccination efforts for other infectious diseases among pregnant women.
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Affiliation(s)
- Katherine Kortsmit
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Titilope Oduyebo
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Regina M. Simeone
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Katherine E. Kahn
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Leidos, Atlanta, GA, USA
| | - Hilda Razzaghi
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Romeo R. Galang
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sascha Ellington
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Nan Ruffo
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Full Circle Computing, Inc, Exton, PA, USA
| | - Wanda D. Barfield
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lee Warner
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Shanna Cox
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
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3
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Meaney-Delman D, Carroll S, Polen K, Jatlaoui TC, Meyer S, Oliver S, Gee J, Shimabukuro T, Razzaghi H, Riley L, Galang RR, Tong V, Gilboa S, Ellington S, Cohn A. Planning for the future of maternal immunization: Building on lessons learned from the COVID-19 pandemic. Vaccine 2024:S0264-410X(24)00081-1. [PMID: 38423818 PMCID: PMC11349930 DOI: 10.1016/j.vaccine.2024.01.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 01/07/2024] [Accepted: 01/22/2024] [Indexed: 03/02/2024]
Abstract
As the worldwide COVID-19 pandemic unfolded, the clinical and public health community raced to understand SARS-CoV-2 infection and develop life-saving vaccines. Pregnant persons were disproportionately impacted, experiencing more severe illness and adverse pregnancy outcomes. And yet, when COVID-19 vaccines became available in late 2020, safety and efficacy data were not available to inform their use during pregnancy because pregnant persons were excluded from pre-authorization clinical trials. Concerns about vaccine safety during pregnancy and misinformation linking vaccination and infertility circulated widely, creating a lack of vaccine confidence. Many pregnant people initially chose not to get vaccinated, and while vaccination rates rose after safety and effectiveness data became available, COVID-19 vaccine acceptance was suboptimal and varied across racial and ethnic distribution of the pregnant population. The COVID-19 pandemic experience provided valuable insights that can inform current and future approaches to maternal vaccination against.
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Affiliation(s)
- Dana Meaney-Delman
- Division of Birth Defects and Infant Disorders, Centers for Disease Control and Prevention, Atlanta, GA, United States.
| | - Sarah Carroll
- American College of Obstetricians and Gynecologists, Washington, D.C, United States
| | - Kara Polen
- Division of Birth Defects and Infant Disorders, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Tara C Jatlaoui
- National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Sarah Meyer
- National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Sara Oliver
- National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Julianne Gee
- Immunization Safety Office, Division of Healthcare Quality and Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Tom Shimabukuro
- Immunization Safety Office, Division of Healthcare Quality and Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Hilda Razzaghi
- National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Laura Riley
- Department of Obstetrics and Gynecology, Weill Cornell School of Medicine, New York, NY, United States
| | - Romeo R Galang
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Van Tong
- Division of Birth Defects and Infant Disorders, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Suzanne Gilboa
- Division of Birth Defects and Infant Disorders, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Sascha Ellington
- National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Amanda Cohn
- Division of Birth Defects and Infant Disorders, Centers for Disease Control and Prevention, Atlanta, GA, United States
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4
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Sienicka A, Pisula A, Pawlik KK, Dobrowolska-Redo A, Kacperczyk-Bartnik J, Romejko-Wolniewicz E. The Obstetrician's Role in Pregnant Women's Decision-Making Process Regarding Influenza and COVID-19 Vaccination. Vaccines (Basel) 2023; 11:1608. [PMID: 37897010 PMCID: PMC10610802 DOI: 10.3390/vaccines11101608] [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: 07/30/2023] [Revised: 10/14/2023] [Accepted: 10/16/2023] [Indexed: 10/29/2023] Open
Abstract
Pregnant women are considered to be a population vulnerable to influenza and COVID-19 infections, and the latest guidelines consistently recommend that they receive influenza and COVID-19 vaccinations. A cross-sectional questionnaire-based study was conducted among pregnant women in Poland to determine which factors have the greatest impact on their decision to vaccinate against influenza and COVID-19. A total of 515 pregnant women participated in the study. Among them, 38.4% (n = 198) demonstrated a positive attitude toward influenza vaccination, and 64.3% (n = 331) demonstrated a positive attitude toward COVID-19 vaccination. Logistic regression analysis revealed that the strongest influence on positive attitudes toward COVID-19 vaccination is having it recommended by an obstetrician-gynecologist (OR = 2.439, p = 0.025). The obstetrician-gynecologist's recommendation to vaccinate against influenza also significantly influences the decision to vaccinate (OR = 5.323). The study results also show a strong correlation between the obstetrician-gynecologist as a source of information on influenza and vaccination and participants' positive attitudes toward vaccination (OR = 4.163). Obstetricians have a significant influence on pregnant women's decisions regarding vaccinations. Further recommendations to vaccinate and awareness-raising among obstetricians may be needed to increase the vaccination rate of pregnant women in Poland.
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Affiliation(s)
- Agnieszka Sienicka
- Students’ Scientific Group Affiliated to 2nd Department of Obstetrics and Gynecology, Medical University of Warsaw, 00-315 Warsaw, Poland; (A.S.); (K.K.P.)
| | - Agata Pisula
- Students’ Scientific Group Affiliated to 2nd Department of Obstetrics and Gynecology, Medical University of Warsaw, 00-315 Warsaw, Poland; (A.S.); (K.K.P.)
| | - Katarzyna Karina Pawlik
- Students’ Scientific Group Affiliated to 2nd Department of Obstetrics and Gynecology, Medical University of Warsaw, 00-315 Warsaw, Poland; (A.S.); (K.K.P.)
| | - Agnieszka Dobrowolska-Redo
- 2nd Department of Obstetrics and Gynecology, Medical University of Warsaw, 00-315 Warsaw, Poland; (A.D.-R.); (J.K.-B.); (E.R.-W.)
| | - Joanna Kacperczyk-Bartnik
- 2nd Department of Obstetrics and Gynecology, Medical University of Warsaw, 00-315 Warsaw, Poland; (A.D.-R.); (J.K.-B.); (E.R.-W.)
| | - Ewa Romejko-Wolniewicz
- 2nd Department of Obstetrics and Gynecology, Medical University of Warsaw, 00-315 Warsaw, Poland; (A.D.-R.); (J.K.-B.); (E.R.-W.)
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5
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Aldoosari A, Alosaimi B, Khalaf M. Improving Tdap maternal immunization rate in Saudi Arabia. Hum Vaccin Immunother 2023; 19:2253585. [PMID: 37706510 PMCID: PMC10503444 DOI: 10.1080/21645515.2023.2253585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 08/09/2023] [Accepted: 08/26/2023] [Indexed: 09/15/2023] Open
Abstract
Pertussis is a serious and potentially fatal disease in infants too young for vaccination. Despite a high vaccine coverage in children, pertussis continues to occur in unvaccinated infants in the Kingdom of Saudi Arabia (KSA). Available data supports the use of maternal pertussis immunization for preventing pertussis in young infants. In June 2019, the Saudi Ministry of Health recommended maternal pertussis immunization with combined tetanus-diphtheria-acellular pertussis vaccine (Tdap) during every pregnancy. To understand barriers to maternal immunization and identify strategies to improve maternal immunization, we conducted an online survey in November and December 2020, asking 60 obstetricians/gynecologists about their attitudes to maternal pertussis immunization. Fewer than 50% survey respondents considered maternal immunization as part of their role, and only 47% were aware of the national recommendation. Consequently, the uptake of maternal vaccination in KSA may be sub-optimal. The key barriers that hinder obstetricians/gynecologists from recommending maternal Tdap immunization were the anticipation of patient refusal, and their own need for more information/experience about the disease and the national recommendation. Vaccine availability and supply were important barriers, whereas cost/reimbursement and resource issues were of lesser concern. Disseminating evidence based information to physicians, educating pregnant women and addressing public misconceptions.
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6
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Ferrari A, Moretti G, Corazza I, Mannella P, Simoncini T, Bonciani M. Pregnancy vaccination predictive factors and uptake profiles among Italian women: A cross-sectional survey study on a large population. Int J Gynaecol Obstet 2023. [PMID: 37096291 DOI: 10.1002/ijgo.14797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 04/03/2023] [Accepted: 04/05/2023] [Indexed: 04/26/2023]
Abstract
OBJECTIVES To assess influenza and Tdap (tetanus, diphtheria, pertussis) vaccine coverage during pregnancy, explore key socioeconomic and maternity pathway-related predictors of vaccination, and detect specific patterns of vaccination uptake. METHODS The authors cross-sectionally analyzed self-reported data obtained from the systematic survey on the maternity pathways of Tuscany. They selected all pregnant women that completed from March 2019 to June 2022 the third-trimester questionnaire (n = 25 160), which included two dichotomous items on influenza and Tdap vaccination, as well as socioeconomic and pathway-related questions. Multilevel logistic models were performed to assess vaccination predictors and cluster analysis to identify vaccination patterns. RESULTS Vaccination coverage was higher for pertussis (56.5%) than for influenza (18.9%). The main predictors of vaccination were high socioeconomic status, attending private gynecologists, and receiving vaccine information. Three clusters were identified: cluster 1 included women receiving both Tdap and influenza vaccines; cluster 2 included women receiving no vaccinations; and cluster 3 included women receiving only the pertussis vaccine. Although women from cluster 3 were of middle to low education status, vaccine information was the main adherence determinant also in this group. CONCLUSIONS Health workers and policymakers should focus on groups of pregnant women less prone to vaccination to promote vaccination information and encourage wider uptake and coverage.
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Affiliation(s)
- Amerigo Ferrari
- Institute of Management, MeS (Management and Health) Laboratory, Sant'Anna School of Advanced Studies, Pisa, Italy
| | - Giaele Moretti
- Institute of Management, MeS (Management and Health) Laboratory, Sant'Anna School of Advanced Studies, Pisa, Italy
| | - Ilaria Corazza
- Institute of Management, MeS (Management and Health) Laboratory, Sant'Anna School of Advanced Studies, Pisa, Italy
| | - Paolo Mannella
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Tommaso Simoncini
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Manila Bonciani
- Institute of Management, MeS (Management and Health) Laboratory, Sant'Anna School of Advanced Studies, Pisa, Italy
- Meyer Center for Health and Happiness, A. Meyer Children's Hospital, Florence, Italy
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7
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Abstract
The American College of Obstetrics and Gynecology recommends influenza vaccine annually, Tdap with each pregnancy, and COVID-19 vaccine for those not previously vaccinated or who are due for boosters. The influenza and COVID-19 vaccines are safe during pregnancy and are effective in reducing morbidity in both the pregnant person and infant. The Tdap vaccine is given primarily to protect the newborn from pertussis through transplacental antibody transfer. Methods to enhance vaccination rates include stocking and giving vaccines in the obstetric office, recommending eligible vaccines at each visit, and focusing on the health of the infant in conversations with patients.
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Affiliation(s)
- Cynthia M Rand
- Department of Pediatrics, University of Rochester Medical Center, 601 Elmwood Avenue, Box 777, Rochester, NY 14642, USA.
| | - Courtney Olson-Chen
- Department of Obstetrics & Gynecology, University of Rochester Medical Center, 601 Elmwood Avenue, Box 668, Rochester, NY 14642, USA
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8
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Zhou F, Lindley MC, Lee JT, Jatlaoui TC. Association Between Influenza Vaccination During Pregnancy and Infant Influenza Vaccination. Obstet Gynecol 2023; 141:563-569. [PMID: 36728080 PMCID: PMC11259230 DOI: 10.1097/aog.0000000000005101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 12/22/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To examine the association between influenza vaccination during pregnancy and infant influenza vaccination. METHODS We conducted a retrospective analysis of individuals aged 15-49 years who were continually privately insured from August 2017 to May 2019 and had singleton live births between September 2017 and February 2018 and their infants. Influenza vaccination coverage was assessed for pregnant people during the 2017-2018 influenza season and for their infants during the 2018-2019 season using the 2017-2019 MarketScan data. Multivariate log-binomial regressions were conducted to examine the association between influenza vaccination during pregnancy and infant influenza vaccination. RESULTS Of the 34,919 pregnant people in this analysis, 14,168 (40.6%) received influenza vaccination during pregnancy. Of the infants born to people vaccinated during pregnancy, 90.0% received at least one dose of influenza vaccine during the 2018-2019 season and 75.5% received at least two doses. Of the infants born to those not vaccinated during pregnancy, 66.3% received at least one dose of influenza vaccine and 51.8% received at least two doses. At-least-one-dose coverage was 35.7% higher (adjusted risk ratio [aRR] 1.34, 95% CI 1.33-1.36) and at-least-two-dose coverage was 45.8% higher (aRR 1.43, 95% CI 1.41-1.46) for infants born to people who received influenza vaccination during pregnancy compared with infants born to people who did not. CONCLUSION Our results show a positive and statistically significant relationship between influenza vaccination during pregnancy and infant influenza vaccination status in their first season eligible for vaccination. Interventions to increase influenza vaccination coverage among pregnant people may also increase infant influenza vaccination coverage, offering greater protection against serious complications of influenza in both vulnerable populations.
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Affiliation(s)
- Fangjun Zhou
- Immunization Service Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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9
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Scendoni R, Fedeli P, Cingolani M. The State of Play on COVID-19 Vaccination in Pregnant and Breastfeeding Women: Recommendations, Legal Protection, Ethical Issues and Controversies in Italy. Healthcare (Basel) 2023; 11:healthcare11030328. [PMID: 36766904 PMCID: PMC9913898 DOI: 10.3390/healthcare11030328] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/16/2023] [Accepted: 01/20/2023] [Indexed: 01/24/2023] Open
Abstract
To date, extensive research has been conducted on vaccination against COVID-19 during pregnancy to verify the safety and efficacy of the vaccines, despite the fact that pregnant women were excluded from the initial clinical trials. The ever-increasing number of scientific publications has confirmed the absence of biological mechanisms associating mRNA vaccines with adverse effects in pregnancy and breastfeeding, although few studies have been carried out on their effect on fertility. While the Italian legal system provides for maternity protection measures and indemnity for vaccination damages pursuant to law no. 210/1992, it is not exempt from controversy. This contribution describes the state of play on COVID-19 vaccination in pregnant and lactating women, including: current recommendations for pregnant and lactating women; ethical issues related to vaccination hesitancy among pregnant women; the legislative paradox whereby sanctions may be imposed on women in certain professional categories who refuse vaccination because they are pregnant; and the possible legal consequences in the event of harm to the unborn child due to vaccination. All of this is considered in accordance with the principles of medical ethics, taking into account the national legislation.
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Affiliation(s)
- Roberto Scendoni
- Department of Law, Institute of Legal Medicine, University of Macerata, 62100 Macerata, Italy
| | | | - Mariano Cingolani
- Department of Law, Institute of Legal Medicine, University of Macerata, 62100 Macerata, Italy
- Correspondence:
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Cataldi JR, Fisher ME, Brewer SE, Spina CI, Glasgow RE, Perreira C, Cochran F, O’Leary ST. Motivational interviewing for maternal Immunizations: Intervention development. Vaccine 2022; 40:7604-7612. [PMID: 36371367 PMCID: PMC9729433 DOI: 10.1016/j.vaccine.2022.10.091] [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: 06/19/2022] [Revised: 10/19/2022] [Accepted: 10/26/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND AND OBJECTIVE Vaccine uptake during pregnancy remains low. Our objectives were to describe 1) development and adaptation of a clinician communication training intervention for maternal immunizations and 2) obstetrics and gynecology (ob-gyn) clinician and staff perspectives on the intervention and fit for the prenatal care context. METHODS Design of the Motivational Interviewing for Maternal Immunizations (MI4MI) intervention was based on similar communication training interventions for pediatric settings and included presumptive initiation of vaccine recommendations ("You're due for two vaccines today") combined with motivational interviewing (MI) for hesitant patients. Interviews and focus group discussions were conducted with ob-gyn clinicians and staff in five Colorado clinics including settings with obstetric physicians, certified nurse midwives (CNMs), and clinician-trainees. Participants were asked about adapting training to the ob-gyn setting and their implementation experiences. Feedback was incorporated through iterative changes to training components. RESULTS Interview and focus group discussion results from participants before (n = 3), during (n = 11) and after (n = 25) implementation guided intervention development and adaptation. Three virtual, asynchronous training components were created: a video and two interactive modules. This virtual format was favored due to challenges attending group meetings; however, participants noted opportunities to practice skills through role-play were lacking. Training modules were adapted to include common challenging vaccine conversations and live-action videos. Participants liked interactive training components and use of adult learning strategies. Some participants initially resisted the presumptive approach but later found it useful after applying it in their practices. Overall, participants reported that MI4MI training fit well with the prenatal context and recommended more inclusion of non-clinician staff. CONCLUSIONS MI4MI training was viewed as relevant and useful for ob-gyn clinicians and staff. Suggestions included making training more interactive, and including more complex scenarios and non-clinician staff.
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Affiliation(s)
- Jessica R. Cataldi
- Adult and Child Center for Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children’s Hospital Colorado, Aurora, CO,Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Mary E. Fisher
- Adult and Child Center for Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children’s Hospital Colorado, Aurora, CO,Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Sarah E. Brewer
- Adult and Child Center for Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children’s Hospital Colorado, Aurora, CO,Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Christine I. Spina
- Adult and Child Center for Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children’s Hospital Colorado, Aurora, CO
| | - Russell E. Glasgow
- Adult and Child Center for Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children’s Hospital Colorado, Aurora, CO,Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Cathryn Perreira
- Adult and Child Center for Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children’s Hospital Colorado, Aurora, CO
| | - Fiona Cochran
- Adult and Child Center for Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children’s Hospital Colorado, Aurora, CO
| | - Sean T. O’Leary
- Adult and Child Center for Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children’s Hospital Colorado, Aurora, CO,Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO
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11
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Limaye RJ, Erchick DJ, Balgobin K, Michel A, Schulz G. Message testing in India for COVID-19 vaccine uptake: What appeal and what messenger are most persuasive? Hum Vaccin Immunother 2022; 18:2091864. [PMID: 35829738 DOI: 10.1080/21645515.2022.2091864] [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: 12/15/2022] Open
Abstract
Few studies have examined the relationships between the different aspects of vaccination communication and vaccine attitudes. We aimed to evaluate the influence of three unique messaging appeal framings of vaccination from two types of messengers on COVID-19 vaccine acceptance in India. We surveyed 534 online participants in India using Amazon Mechanical Turk (MTurk) from December 2021 through January 2022. We assessed participants' perception of three messaging appeals of vaccination - COVID-19 disease health outcomes, social norms related to vaccination, and economic impact of COVID-19 - from two messengers, healthcare providers (HCP) and peers. Using a multivariable multinomial logistic regression, we examined participants' ad preference and vaccine hesitancy. Participants expressed a high level of approval for all of the ads, with >80% positive responses for all questions across ads. Overall ads delivered by health care workers were preferred by a majority of participants in our study (n = 381, 71.4%). Ad preference ranged from 3.6% (n = 19) social norm/peer ad to 32.4% (n = 173) health outcome/HCP ad and half of participants preferred the health outcome ad (n = 279, 52.3%). Additionally, vaccine hesitancy was not related to preference (p = .513): HCP vs. peer ads (p = .522); message type (p = .284). The results suggest that all three appeals tested were generally acceptable, as well as the two messenger types, although preference was for the health care provider messenger and health outcome appeal. Individuals are motivated and influenced by a multitude of factors, requiring vaccine messaging that is persuasive, salient, and induces contextually relevant action.
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Affiliation(s)
- Rupali J Limaye
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Daniel J Erchick
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kristian Balgobin
- Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Alexandra Michel
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Gretchen Schulz
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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12
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Rand CM, Bender R, Humiston SG, Albertin C, Olson-Chen C, Chen J, Hsu YSJ, Vangala S, Szilagyi PG. Obstetric Provider Attitudes and Office Practices for Maternal Influenza and Tdap Vaccination. J Womens Health (Larchmt) 2022; 31:1246-1254. [PMID: 35904933 DOI: 10.1089/jwh.2022.0030] [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: 11/13/2022] Open
Abstract
Background: Although maternal vaccination with influenza and tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccines improve health outcomes for pregnant individuals and infants, maternal vaccination rates are low. This study assessed obstetric providers' attitudes and practices related to influenza and Tdap vaccination in four large health systems in New York (NY) and California (CA). Methods: We conducted a cross-sectional survey of all obstetric providers within four health systems (two in NY, two in CA) to evaluate provider attitudes and office systems used for Tdap and influenza vaccination. The survey assessed perceptions of influenza and Tdap vaccination based on the Health Belief Model, and assessed office systems (reminders, prompts, standing orders, and patient education) and communication with pregnant patients related to influenza and Tdap vaccines. Results: We had 112 responses (52% response rate) for analyses. Respondents strongly supported vaccination during pregnancy but viewed influenza disease as less of a concern for newborns than for pregnant individuals (40% vs. 67% considered influenza disease to be very significant, p < 0.001). Only 84% agreed that giving influenza vaccine in the first trimester is very safe. Patient vaccine refusal was the most commonly named barrier for both influenza and Tdap vaccination. Providers frequently used office system prompts, but did not frequently use standing orders, patient educational materials, vaccine champions, and feedback on vaccination rates. Conclusions: While most providers consider influenza and Tdap vaccination important during pregnancy, there is room for improvement in focusing on the importance of maternal vaccination to the health of the infant, and increasing the use of office systems to improve vaccination during pregnancy.
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Affiliation(s)
- Cynthia M Rand
- Department of Pediatrics, University of Rochester Medical Center, Rochester, New York, USA
| | - Robin Bender
- Department of Pediatrics, University of Rochester Medical Center, Rochester, New York, USA
| | - Sharon G Humiston
- Department of Pediatrics, University of Missouri Kansas City School of Medicine and Children's Mercy Kansas City, Kansas City, Missouri, USA
| | - Christina Albertin
- Department of Pediatrics, University of California Los Angeles, UCLA Mattel Children's Hospital, Los Angeles, California, USA
| | - Courtney Olson-Chen
- Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, New York, USA
| | - Judy Chen
- Los Angeles County Department of Health Services, Los Angeles, California, USA
| | - Yung-Shee J Hsu
- Department of Obstetrics and Gynecology, UCLA Health, Los Angeles, California, USA
| | - Sitaram Vangala
- Department of Medicine Statistics Core, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Peter G Szilagyi
- Department of Pediatrics, University of California Los Angeles, UCLA Mattel Children's Hospital, Los Angeles, California, USA
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13
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Oliveira ISD, Cardoso LS, Ferreira IG, Alexandre-Silva GM, Jacob BDCDS, Cerni FA, Monteiro WM, Zottich U, Pucca MB. Anti-vaccination movements in the world and in Brazil. Rev Soc Bras Med Trop 2022; 55:e05922021. [PMID: 35613224 PMCID: PMC9131779 DOI: 10.1590/0037-8682-0592-2021] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 03/29/2022] [Indexed: 11/26/2022] Open
Abstract
Over the years, vaccinations have provided significant advances in public health, because they substantially reduce the morbimortality of vaccine-preventable diseases. Nevertheless, many people are still hesitant to be vaccinated. Brazil is a region of many anti-vaccine movements, and several outbreaks of vaccine-preventable diseases, such as yellow fever and measles, have occurred in the country during the last few years. To avoid new outbreaks, immunization coverage must be high; however, this is a great challenge to achieve due to the countless anti-vaccine movements. The World Health Organization has suggested new actions for the next decade via the Immunization Agenda 2030 to control, reduce, or eradicate vaccine-preventable diseases. Nonetheless, the vaccination coverage has decreased recently. To resolve the anti-vaccine issue, it is necessary to propose a long-term approach that involves innovative education programs on immunization and critical thinking, using different communication channels, including social media. Cooperation among biology and health scientists, ethicists, human scientists, policymakers, journalists, and civil society is essential for an in-depth understanding of the social action of vaccine refusal and planning effective education measures to increase the vaccine coverage.
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Affiliation(s)
- Isadora Sousa de Oliveira
- Universidade de São Paulo, Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Departamento de Ciências BioMoleculares, Ribeirão Preto, SP, Brasil
| | | | - Isabela Gobbo Ferreira
- Universidade de São Paulo, Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Departamento de Ciências BioMoleculares, Ribeirão Preto, SP, Brasil
| | | | - Beatriz de Cássia da Silva Jacob
- Universidade de São Paulo, Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Departamento de Ciências BioMoleculares, Ribeirão Preto, SP, Brasil
| | - Felipe Augusto Cerni
- Universidade Federal de Roraima, Programa de Pós-Graduação em Ciências da Saúde, Boa Vista, RR, Brasil
| | - Wuelton Marcelo Monteiro
- Universidade do Estado do Amazonas, Faculdade de Ciências da Saúde, Departamento de Medicina e Enfermagem, Manaus, AM, Brasil.,Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Departamento de Ensino e Pesquisa, Manaus, AM, Brasil
| | - Umberto Zottich
- Universidade Federal de Roraima, Faculdade de Medicina, Boa Vista, RR, Brasil
| | - Manuela Berto Pucca
- Universidade Federal de Roraima, Faculdade de Medicina, Boa Vista, RR, Brasil.,Universidade Federal de Roraima, Programa de Pós-Graduação em Ciências da Saúde, Boa Vista, RR, Brasil
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14
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Shamshirsaz AA, Hessami K, Morain S, Afshar Y, Nassr AA, Arian SE, Asl NM, Aagaard K. Intention to Receive COVID-19 Vaccine during Pregnancy: A Systematic Review and Meta-analysis. Am J Perinatol 2022; 39:492-500. [PMID: 34670322 DOI: 10.1055/a-1674-6120] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE This meta-analysis aimed to assess the level of intent to receive coronavirus disease 2019 (COVID-19) vaccination and demographical factors influencing vaccine uptake among pregnant individuals. STUDY DESIGN PubMed, Scopus, and archive/pre-print servers were searched up to May 22nd, 2021. Cross sectional surveys reporting the percentage of the pregnant individuals intending to get a COVID-19 vaccine were considered eligible for meta-analysis. This review was registered with PROSPERO (CRD42021254484). The primary outcome was to estimate the prevalence of COVID-19 vaccination intent among pregnant population. The secondary outcome was to evaluate the factors influencing the intention for vaccination. RESULTS Twelve studies sourcing data of 16,926 individuals who were identified as pregnant were eligible. The estimated intention for the receipt of COVID-19 vaccine among women who were pregnant was 47% (95% CI: 38-57%), with the lowest prevalence in Africa 19% (95% CI: 17-21%) and the highest in Oceania 48.0% (95% CI: 44.0-51.0%). Uptake of other vaccines (influenza and/or TdaP) during pregnancy was associated with higher rate of intent to receive the COVID-19 vaccine (OR = 3.03; 95% CI: 1.37-6.73; p = 0.006). CONCLUSION The intent to receive COVID-19 vaccine is relatively low among women who are pregnant and substantially varies based on the country of residence. In our meta-analysis, intent of women who were pregnant to receive the COVID-19 vaccine was significantly associated with the history of receiving influenza or TdaP vaccine during pregnancy. Given that in every country only a minority of gravidae have received the COVID-19 vaccine, despite known risks of maternal morbidity and mortality with no evidence of risks of vaccination, it highlights the importance of revised approaches at shared decision making and focused public health messaging by national and international advisories. KEY POINTS · The estimated global intention for COVID-19 vaccination among pregnant women was 47%.. · The lowest intention was in Africa and the highest in Oceania.. · These findings highlight the importance of public health messaging by by different agencies..
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Affiliation(s)
- Alireza A Shamshirsaz
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Kamran Hessami
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Stephanie Morain
- Department of Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas
| | - Yalda Afshar
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Ahmed A Nassr
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Sara E Arian
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| | - Nazlisadat Meshinchi Asl
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Kjersti Aagaard
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
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15
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Saleh OA, Halperin O. Influenza virus vaccine compliance among pregnant women during the COVID-19 pandemic (pre-vaccine era) in Israel and future intention to uptake BNT162b2 mRNA COVID-19 vaccine. Vaccine 2022; 40:2099-2106. [PMID: 35193794 PMCID: PMC8843331 DOI: 10.1016/j.vaccine.2022.02.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 01/17/2022] [Accepted: 02/04/2022] [Indexed: 11/21/2022]
Abstract
The influenza virus vaccine, used worldwide as an annual preventive measure, is especially recommended for at-risk populations. Older adults and pregnant women are therefore offered the flu shot free of charge in Israel. The Israel Ministry of Health's rationale for giving the influenza vaccine to pregnant women is to avoid serious complications that could harm both mother and foetus. In Israel, the winter of 2020/2021 was marked by a third surge of COVID-19, raising the risk of contracting the SARS-CoV-2 virus and the level of fear among the population. The influenza vaccine protects individuals from the flu and thus helps prevent an additional burden on medical centres treating COVID-19 patients. The aim of the present study was to assess compliance of pregnant and postpartum women to influenza vaccine uptake during winter 20/21 period. A survey questionnaire was distributed to examine factors predicting women's attitudes toward the influenza vaccine. Questionnaire items based on the Heath Belief Model examined participants' perceptions regarding influenza and the vaccine. The questionnaire also evaluated participants' hypothetical willingness to get immunized with the Pfizer COVID-19 vaccine upon its arrival in Israel. The results showed a higher prevalence of influenza vaccine uptake among Jewish women than Arab women, while level of trust in healthcare providers was stronger among Arab participants than among Jewish participants. The findings indicate that the pregnant and postpartum community needs better information dissemination and education regarding the importance of the influenza vaccine. Decisions regarding uptake of the COVID-19 vaccine upon future availability were found to be unrelated to influenza vaccine perceptions. The results call for raising public awareness regarding influenza immunization in addition to offering the vaccine at routine pregnancy follow-up appointments.
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Affiliation(s)
- Ola Ali Saleh
- Yezreel Valley Academic College, Emek Yezreel 1930600, Israel.
| | - Ofra Halperin
- Yezreel Valley Academic College, Emek Yezreel 1930600, Israel
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16
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Costantino C, Mazzucco W, Bonaccorso N, Cimino L, Conforto A, Sciortino M, Catalano G, D’Anna MR, Maiorana A, Venezia R, Corsello G, Vitale F. Educational Interventions on Pregnancy Vaccinations during Childbirth Classes Improves Vaccine Coverages among Pregnant Women in Palermo's Province. Vaccines (Basel) 2021; 9:vaccines9121455. [PMID: 34960202 PMCID: PMC8707644 DOI: 10.3390/vaccines9121455] [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: 10/21/2021] [Revised: 12/02/2021] [Accepted: 12/06/2021] [Indexed: 12/02/2022] Open
Abstract
Maternal immunization is considered the best intervention in order to prevent influenza infection of pregnant women and influenza and pertussis infection of newborns. Despite the existing recommendations, vaccination coverage rates in Italy remain very low. Starting from August 2018, maternal immunization against influenza and diphtheria-tetanus-pertussis were strongly recommended by the Italian Ministry of Health. We conducted a cross sectional study to estimate the effectiveness of an educational intervention, conducted during childbirth classes in three general hospitals in the Palermo metropolitan area, Italy, on vaccination adherence during pregnancy. To this end, a questionnaire on knowledge, attitudes, and immunization practices was structured and self-administered to a sample of pregnant women attending childbirth classes. Then, an educational intervention on maternal immunization, followed by a counseling, was conducted by a Public Health medical doctor. After 30 days following the interventions, the adherence to the recommended vaccinations (influenza and pertussis) was evaluated. At the end of the study 326 women were enrolled and 201 responded to the follow-up survey. After the intervention, among the responding pregnant women 47.8% received influenza vaccination (+44.8%), 57.7% diphtheria-tetanus-pertussis vaccination (+50.7%) and 64.2% both the recommended vaccinations (+54.8%). A significant association was found between pregnant women that received at least one vaccination during pregnancy and higher educational level (graduation degree/master’s degree), employment status (employed part/full-time) and influenza vaccination adherence during past seasons (at least one during last five years). The implementation of vaccination educational interventions, including counseling by healthcare professionals (HCPs), on maternal immunization during childbirth courses improved considerably the vaccination adherence during pregnancy.
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Affiliation(s)
- Claudio Costantino
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) “G. D’Alessandro”, University of Palermo, 90127 Palermo, Italy; (W.M.); (N.B.); (L.C.); (A.C.); (M.S.); (G.C.); (R.V.); (G.C.); (F.V.)
- Correspondence:
| | - Walter Mazzucco
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) “G. D’Alessandro”, University of Palermo, 90127 Palermo, Italy; (W.M.); (N.B.); (L.C.); (A.C.); (M.S.); (G.C.); (R.V.); (G.C.); (F.V.)
| | - Nicole Bonaccorso
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) “G. D’Alessandro”, University of Palermo, 90127 Palermo, Italy; (W.M.); (N.B.); (L.C.); (A.C.); (M.S.); (G.C.); (R.V.); (G.C.); (F.V.)
| | - Livia Cimino
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) “G. D’Alessandro”, University of Palermo, 90127 Palermo, Italy; (W.M.); (N.B.); (L.C.); (A.C.); (M.S.); (G.C.); (R.V.); (G.C.); (F.V.)
| | - Arianna Conforto
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) “G. D’Alessandro”, University of Palermo, 90127 Palermo, Italy; (W.M.); (N.B.); (L.C.); (A.C.); (M.S.); (G.C.); (R.V.); (G.C.); (F.V.)
| | - Martina Sciortino
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) “G. D’Alessandro”, University of Palermo, 90127 Palermo, Italy; (W.M.); (N.B.); (L.C.); (A.C.); (M.S.); (G.C.); (R.V.); (G.C.); (F.V.)
| | - Gabriele Catalano
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) “G. D’Alessandro”, University of Palermo, 90127 Palermo, Italy; (W.M.); (N.B.); (L.C.); (A.C.); (M.S.); (G.C.); (R.V.); (G.C.); (F.V.)
| | - Maria Rosa D’Anna
- HCU Obstetrics and Gynecology, Buccheri La Ferla—Fatebenefratelli Hospital, 90100 Palermo, Italy;
| | - Antonio Maiorana
- HCU Obstetrics and Gynecology, ARNAS Ospedale Civico Di Cristina-Benfratelli Hospital, 90127 Palermo, Italy;
| | - Renato Venezia
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) “G. D’Alessandro”, University of Palermo, 90127 Palermo, Italy; (W.M.); (N.B.); (L.C.); (A.C.); (M.S.); (G.C.); (R.V.); (G.C.); (F.V.)
| | - Giovanni Corsello
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) “G. D’Alessandro”, University of Palermo, 90127 Palermo, Italy; (W.M.); (N.B.); (L.C.); (A.C.); (M.S.); (G.C.); (R.V.); (G.C.); (F.V.)
| | - Francesco Vitale
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) “G. D’Alessandro”, University of Palermo, 90127 Palermo, Italy; (W.M.); (N.B.); (L.C.); (A.C.); (M.S.); (G.C.); (R.V.); (G.C.); (F.V.)
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17
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Vilca LM, Sarno L, Cesari E, Vidiri A, Antonazzo P, Ravennati F, Cavaliere AF, Guida M, Cetin I. Differences between influenza and pertussis vaccination uptake in pregnancy: a multi-center survey study in Italy. Eur J Public Health 2021; 31:1150-1157. [PMID: 34580721 DOI: 10.1093/eurpub/ckab095] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND A suboptimal maternal vaccination coverage in 2017-18 has been reported in Italy. The study aims were to (i) assess changes in maternal influenza and tetanus, diphtheria and acellular pertussis vaccination coverage during 2018-19 influenza season compared to the previous season (ii) estimate influenza vaccine coverage among maternal care providers (MCPs) and (iii) explore the characteristics of vaccine delivery to pregnant women. METHODS We conducted a cross-sectional survey among pregnant women and MCPs about influenza and pertussis immunization during pregnancy. We also collected information regarding prenatal care characteristics and vaccine delivery among four centers in Italy. RESULTS We recruited 483 pregnant women and 452 MCPs. The influenza and pertussis vaccine uptake among pregnant women for the season 2018-19 was 14.9% and 60.9%, respectively. MCPs' influenza vaccine uptake was 33.6%. Knowing that the flu vaccine was safe for mothers and their infants and being vaccinated in the previous influenza season were associated with higher vaccine uptake. Regarding pertussis, being a housewife was associated to lower vaccine uptake, while knowing the vaccine is effective and safe for mothers and newborns were associated with higher pertussis vaccine uptake. The single most important factor associated to higher coverage of both influenza and pertussis vaccines was receiving a health-care provider's vaccine advice. Most pregnant women (69.4%) stated that they preferred to be vaccinated in their same prenatal care setting. CONCLUSIONS Receiving a health-care provider's vaccine advice and the availability of vaccines during prenatal care visits might improve vaccination coverage among pregnant women.
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Affiliation(s)
- Luz Maria Vilca
- Unit of Obstetrics and Gynecology, Buzzi Hospital-ASST Fatebenefratelli Sacco, University of Milan, Milan, Italy
| | - Laura Sarno
- Department of Neurosciences, Reproductive Science and Dentistry, University of Naples Federico II, Naples, Italy
| | - Elena Cesari
- Unit of Obstetrics and Gynecology, Buzzi Hospital-ASST Fatebenefratelli Sacco, University of Milan, Milan, Italy
| | - Annalisa Vidiri
- Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario "A. Gemelli" IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | - Patrizio Antonazzo
- Unit of Obstetrics and Gynecology, Bufalini Hospital-AUSL Romagna, Cesena, Italy
| | - Francesca Ravennati
- Unit of Obstetrics and Gynecology, Bufalini Hospital-AUSL Romagna, Cesena, Italy.,University of Ferrara, Ferrara, Italy
| | - Anna Franca Cavaliere
- Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario "A. Gemelli" IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maurizio Guida
- Department of Neurosciences, Reproductive Science and Dentistry, University of Naples Federico II, Naples, Italy
| | - Irene Cetin
- Unit of Obstetrics and Gynecology, Buzzi Hospital-ASST Fatebenefratelli Sacco, University of Milan, Milan, Italy
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18
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Rottenstreich M, Sela HY, Rotem R, Kadish E, Wiener-Well Y, Grisaru-Granovsky S. Covid-19 vaccination during the third trimester of pregnancy: rate of vaccination and maternal and neonatal outcomes, a multicentre retrospective cohort study. BJOG 2021; 129:248-255. [PMID: 34554630 PMCID: PMC8652528 DOI: 10.1111/1471-0528.16941] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 09/05/2021] [Accepted: 09/21/2021] [Indexed: 11/29/2022]
Abstract
Objective To evaluate the impact of Covid‐19 vaccination (Pfizer–BioNTech BNT162b2) during the third trimester of pregnancy on maternal and neonatal outcomes. Design A multicentre, retrospective computerised database. Population Women who gave birth at >24 weeks of gestation in Israel, between January and April 2021, with full records of Covid‐19 disease and vaccination status. Methods Women who received two doses of the vaccine were compared with unvaccinated women. Women who were recorded as having disease or a positive Covid‐19 polymerase chain reaction (PCR) swab during pregnancy or delivery were excluded from both study groups. Univariate analysis was followed by multivariate logistic regression. Main outcome measures Composite adverse maternal outcomes. Secondary outcomes were vaccination rate and composite adverse neonatal outcomes. Results The overall uptake of one or both vaccines was 40.2%; 712 women who received two doses of the Covid‐19 vaccine were compared with 1063 unvaccinated women. Maternal composite outcomes were comparable between the groups; however, women who received the vaccine had higher rates of elective caesarean deliveries (CDs) and lower rates of vacuum deliveries. An adjusted multivariable logistic regression analysis demonstrated that Covid‐19 vaccination was not associated with maternal composite adverse outcome (aOR 0.8, 95% CI 0.61–1.03); a significant reduction in the risk for neonatal composite adverse outcomes was observed (aOR 0.5, 95% CI 0.36–0.74). Conclusions In a motivated population covered by a National Health Insurance Plan, we found a 40.2% rate of vaccination for the Covid‐19 vaccine during the third trimester of pregnancy, which was not associated with adverse maternal outcomes and, moreover, decreased the risk for neonatal adverse outcomes. Tweetable abstract Covid‐19 vaccine during pregnancy is safe for both mother and fetus. Covid‐19 vaccine during pregnancy is safe for both mother and fetus.
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Affiliation(s)
- M Rottenstreich
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.,Department of Nursing, Jerusalem College of Technology, Jerusalem, Israel
| | - H Y Sela
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - R Rotem
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - E Kadish
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Y Wiener-Well
- Infectious Disease Unit, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - S Grisaru-Granovsky
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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19
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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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20
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SteelFisher GK, Caporello HL, Broussard CS, Schafer TJ, Ben-Porath EN, Blendon RJ. Seasonal Influenza Vaccine in Pregnant Women: Views and Experiences of Obstetrician-Gynecologists. J Womens Health (Larchmt) 2021; 30:1086-1094. [PMID: 33533697 DOI: 10.1089/jwh.2020.8700] [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] [Indexed: 11/13/2022] Open
Abstract
Background: Seasonal influenza vaccination rates among pregnant women remain well below the Healthy People 2020 target of 80%. Obstetrician-gynecologist (OB/GYN) recommendations are a critical means of encouraging pregnant women to get vaccinated, but there are limited data about their views. Materials and Methods: A nationally representative survey of 506 practicing OB/GYNs was completed between October 26, 2015, and May 8, 2016. Analyses included univariate distributions and comparisons based on age, size of practice, and academic affiliation using all-pairs, dependent t-tests. Results: A majority of OB/GYNs report they "strongly recommend" seasonal influenza vaccination for their pregnant patients in the first (79%) or second and third trimesters (81%). Among those who do not strongly recommend the flu vaccine in the first trimester, many say this is because of their own concerns (28%) or their patients' concerns (44%) about safety. Older OB/GYNs, those in smaller practices, and those without academic affiliation were less likely to recommend the vaccine and more likely to have safety concerns. For example, 72% of those age 60+ strongly recommended the vaccine in the second and third trimester, compared with 86% of those ages 30-44 and 83% of those ages 45-59 (p < 0.05 for all comparisons). Conclusions: OB/GYNs across the country largely support seasonal flu vaccination among pregnant women. Nonetheless, safety is a concern for them and their patients. Outreach to support clinician decisions and conversations with pregnant patients may be most needed among older physicians, those in smaller practices, and those without academic affiliation.
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Affiliation(s)
- Gillian K SteelFisher
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Hannah L Caporello
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Cheryl S Broussard
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Thomas J Schafer
- National Public Health Information Coalition, Marietta, Georgia, USA
| | | | - Robert J Blendon
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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Goggins ER, Williams R, Kim TG, Adams JC, Davis MJ, McIntosh M, Uzor M, Geary F, Jamieson DJ, Boulet SL. Assessing Influenza Vaccination Behaviors Among Medically Underserved Obstetric Patients. J Womens Health (Larchmt) 2020; 30:52-60. [PMID: 33095095 DOI: 10.1089/jwh.2020.8582] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Despite recommendations, maternal influenza vaccine acceptance has stagnated around 50%. Materials and Methods: A prospective cohort study was conducted of pregnant women seen in the clinic from September 2018 to April 2019. Primary outcomes included influenza vaccine uptake and reasons for vaccine refusal, categorized based on the Health Belief Model. We compared characteristics between three vaccination groups (never refused, refused and vaccinated, and refused and not vaccinated) by using chi-square and one-way analysis of variance. We used multivariate logistic regression to calculate adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for associations between patient characteristics and vaccine acceptance. Mixed-effects logistic regression models were used to explore the impact of provider-patient race concordance on influenza vaccine uptake. Results: Among 1666 women, 902 (54.1%) were vaccinated. Of these, 183 (20.3%) initially refused. Those who refused and were never vaccinated were more likely to be non-Hispanic black (aOR: 1.64, 95% CI: 1.05-2.56) and less likely to be Hispanic (aOR: 0.44, 95% CI: 0.24-0.81). Overall, perceived barriers were the most common reason for refusal (52.4%). Women who refused consistently were more likely to cite reasons related to perceived benefits (38.5% vs. 7.6%). Those who eventually accepted were more likely to cite cue to action (22.4% vs. 12.6%). Women who were race discordant with their provider were more likely to be vaccinated compared with those who were race concordant (57.9% vs. 52.9%, aOR: 1.16, 95% CI: 1.07-1.27). Conclusions: Women who refuse influenza vaccination in pregnancy may later choose to be vaccinated. Continued promotion of vaccination throughout pregnancy is crucial for vaccine uptake.
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Affiliation(s)
- Emily R Goggins
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Rachel Williams
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Tesia G Kim
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Jenna C Adams
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Miah J Davis
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Michelle McIntosh
- Department of Obstetrics and Gynecology, Grady Health System, Atlanta, Georgia, USA
| | - Michelle Uzor
- Department of Obstetrics and Gynecology, Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Franklyn Geary
- Department of Obstetrics and Gynecology, Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Denise J Jamieson
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Sheree L Boulet
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia, USA
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Abstract
PURPOSE OF REVIEW To offer healthcare providers current, evidence-based approaches for addressing vaccine hesitancy to increase vaccine coverage and reduce the frequency of vaccine-preventable disease outbreaks. RECENT FINDINGS Vaccine hesitancy is a growing problem with profound societal, economic, and medical consequences. Understanding the complexity of vaccine hesitancy can inform approaches to increasing vaccine uptake on both the individual and population levels. Notably, pediatricians play a critical role in increasing vaccine uptake due to their relationships with families. This doctor-patient relationship establishes trust and allows evidence-based intervention strategies to be effective in the office. Understanding potential solutions outside the office, such as media campaigns and policy changes, also provide insight into vaccine hesitancy and potential directions for future research. While pediatricians' attempts in the clinic to increase coverage remain crucial, vaccine hesitancy remains a formidable public health problem that requires attention on both the micro and macro levels to be addressed successfully. SUMMARY Providers have an opportunity to increase both confidence in and uptake of vaccines. Public health interventions would effectively complement strategies in the clinic to increase overall coverage.
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23
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O'Leary ST, Cataldi JR, Lindley MC, Hurley LP, Riley LE, Brtnikova M, Crane LA, Beaty B, Stokley S, Fisher A, Kempe A. Impact of media reports regarding influenza vaccine on obstetricians' vaccination practices. Vaccine 2020; 38:3474-3479. [PMID: 32204941 PMCID: PMC9987339 DOI: 10.1016/j.vaccine.2020.02.051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 02/14/2020] [Accepted: 02/18/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND In 2017, three media stories regarding influenza vaccine may have impacted obstetricians' (OB) influenza vaccination practices: reports of reduced influenza vaccine effectiveness, a severe influenza season, and a possible increased risk of miscarriage among pregnant women receiving 2009 H1N1 vaccine in the 1st trimester who had received H1N1 vaccine the previous season (later disproven). OBJECTIVE Describe OB's: (1) awareness of; (2) attitudes and experiences related to; and (3) reported alterations in practice as a result of these reports. METHODS A survey among a nationally representative sample of OBs April to June 2018. RESULTS Response rate was 65% (302/468). 88% of OBs were "very aware" of the severe season, 74% of lower effectiveness, and 25% of the miscarriage study (47% "completely unaware" of miscarriage study). Among those aware, 58%, 57%, and 16% reported ≥10% of pregnant patients initiated discussions about the severe season, lower effectiveness, and miscarriage study, respectively. Most (83%) agreed reports about increased severity increased their enthusiasm for recommending influenza vaccine; fewer agreed reports about the miscarriage study (18%) and lower vaccine effectiveness (12%) decreased their enthusiasm for recommending influenza vaccine. Providers were more likely to initiate discussion with patients about increased severity of the season than the other reports. However, 35% agreed the miscarriage study reports increased their concerns about influenza vaccine safety; 18% (n = 48) reported changing the way they recommended influenza vaccine. Of those, 17 (6% of all respondents) reported not recommending influenza vaccine to women during the 1st trimester and 26 (10% of all respondents) recommended it but were willing to delay until the 2nd trimester. CONCLUSIONS During a season in which media stories could have influenced OB influenza vaccination behaviors in different directions, reports underscoring importance of influenza vaccine may have had more impact on OBs' recommendations than reports questioning vaccine safety or effectiveness.
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Affiliation(s)
- Sean T O'Leary
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO, United States; Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.
| | - Jessica R Cataldi
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO, United States; Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Megan C Lindley
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Laura P Hurley
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO, United States; Division of General Internal Medicine, Denver Health, Denver, CO, United States
| | - Laura E Riley
- The American College of Obstetricians and Gynecologists, Washington, DC, United States
| | - Michaela Brtnikova
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO, United States; Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Lori A Crane
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO, United States; Department of Community and Behavioral Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Brenda Beaty
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO, United States
| | - Shannon Stokley
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Allison Fisher
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Allison Kempe
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO, United States; Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
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24
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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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25
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Buchy P, Badur S, Kassianos G, Preiss S, Tam JS. Vaccinating pregnant women against influenza needs to be a priority for all countries: An expert commentary. Int J Infect Dis 2019; 92:1-12. [PMID: 31863875 DOI: 10.1016/j.ijid.2019.12.019] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 12/12/2019] [Accepted: 12/13/2019] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND In 2012, the World Health Organization recommended influenza vaccination for all pregnant women worldwide and the prioritisation of pregnant women in national influenza vaccination programmes. Nevertheless, vaccination rates in pregnant women often remain much lower than national targets. OBJECTIVES To assess the benefits and risks associated with influenza infection and vaccination during pregnancy, and to consider obstacles that work against influenza vaccine uptake during pregnancy. RESULTS There is strong evidence that maternal and foetal outcomes can be compromised if women develop influenza infections during pregnancy. Influenza vaccines have been administered to millions of pregnant women and have demonstrated benefits in terms of disease prevention in mothers and their infants. There is a consensus amongst several recommending authorities that influenza vaccines may be safely administered during all stages of pregnancy. Healthcare professionals are recognised as the most important influencers of vaccine uptake, being well placed to recommend vaccination and directly address safety concerns. CONCLUSIONS Despite data supporting the value of influenza vaccination during pregnancy, vaccine uptake remains low globally. Low uptake appears to be largely due to ineffective communication with pregnant women about the risks and benefits of influenza vaccination. A graphical abstract is available online.
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Affiliation(s)
| | - Selim Badur
- GSK, Büyükdere Caddesi No:173 1. Levent Plaza B Blok, 34394 Istanbul, Turkey
| | - George Kassianos
- President of the British Global & Travel Health Association, Chairman of RAISE Pan- European Committee on Influenza, National Immunisation Lead Royal College of General Practitioners, United Kingdom, Board Director of the European Working Group on Influenza
| | | | - John S Tam
- Chairman of the Asia Pacific Alliance for the control of influenza (APACI); Adjunct Professor, Department of Applied Biology and Chemical Technology, Hong Kong Polytechnic University, 11 Yuk Choi Rd, Hung Hom, Hong Kong
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26
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Misra RS, Nayak JL. The Importance of Vaccinating Children and Pregnant Women against Influenza Virus Infection. Pathogens 2019; 8:pathogens8040265. [PMID: 31779153 PMCID: PMC6963306 DOI: 10.3390/pathogens8040265] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 11/20/2019] [Accepted: 11/22/2019] [Indexed: 12/21/2022] Open
Abstract
Influenza virus infection is responsible for significant morbidity and mortality in the pediatric and pregnant women populations, with deaths frequently caused by severe influenza-associated lower respiratory tract infection and acute respiratory distress syndrome (ARDS). An appropriate immune response requires controlling the viral infection through activation of antiviral defenses, which involves cells of the lung and immune system. High levels of viral infection or high levels of inflammation in the lower airways can contribute to ARDS. Pregnant women and young children, especially those born prematurely, may develop serious complications if infected with influenza virus. Vaccination against influenza will lead to lower infection rates and fewer complications, even if the vaccine is poorly matched to circulating viral strains, with maternal vaccination offering infants protection via antibody transmission through the placenta and breast milk. Despite the health benefits of the influenza vaccine, vaccination rates around the world remain well below targets. Trust in the use of vaccines among the public must be restored in order to increase vaccination rates and decrease the public health burden of influenza.
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Affiliation(s)
- Ravi S Misra
- Department of Pediatrics Division of Neonatology, The University of Rochester Medical Center, Rochester, NY 14623, USA
- Correspondence:
| | - Jennifer L Nayak
- Department of Pediatrics Division of Pediatric Infectious Diseases, The University of Rochester Medical Center, Rochester, NY 14623, USA;
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27
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Doraivelu K, Boulet SL, Biswas HH, Adams JC, Haddad LB, Jamieson DJ. Predictors of tetanus, diphtheria, acellular pertussis and influenza vaccination during pregnancy among full-term deliveries in a medically underserved population. Vaccine 2019; 37:6054-6059. [PMID: 31471152 DOI: 10.1016/j.vaccine.2019.08.044] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 08/14/2019] [Accepted: 08/19/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate predictors of vaccination among women who received tetanus, diphtheria, and acellular pertussis vaccination (Tdap), influenza vaccination, and Tdap and influenza vaccinations. STUDY DESIGN In a retrospective cohort study of all full-term (≥37 weeks gestation) deliveries between July 1, 2016 and June 30, 2018 at a single, safety-net institution, we used multinomial logistic regression models to compare predictors of vaccination among women who received Tdap only, influenza only, and both Tdap and influenza vaccines. RESULTS Among 3132 full-term deliveries, women were primarily non-Hispanic black (67.5%), between the ages of 21-34 (65.3%), and multiparous (76.0%). The rates of only influenza or Tdap vaccination were 10.3% and 21.6%, respectively; 43.3% of women received both vaccines, and 24.9% of women did not receive either vaccine. In the adjusted models, Hispanic ethnicity was positively associated with receipt of all types of vaccination and non-Spanish language interpreter use was positively associated with receipt of Tdap vaccination and Tdap and influenza vaccination. A parity of greater than three and inadequate and unknown prenatal care adequacy were negative predictors of all types of vaccination. Pre-existing hypertension was negatively associated with Tdap vaccination, and HIV-positive status was negatively associated with influenza vaccination and Tdap and influenza vaccination. CONCLUSION Compared to the national rate of both Tdap and influenza vaccination (32.8%), a higher proportion of women received both vaccines in our study population. Vaccine uptake may be affected by race/ethnicity, use of interpreter services, parity, pre-existing comorbidities, and prenatal care adequacy. The lower rate of influenza vaccination compared to Tdap vaccination suggests that other factors, such as vaccine hesitancy and mistrust, may be differentially impacting influenza vaccination uptake in our predominantly minority population. Future provider and public health approaches to vaccine promotion should incorporate culturally appropriate strategies that address vaccine-related beliefs and misconceptions.
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Affiliation(s)
- Kamini Doraivelu
- Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA 30322, United States
| | - Sheree L Boulet
- Department of Gynecology and Obstetrics, Emory University School of Medicine, 69 Jesse Hill Jr. Drive SE, Atlanta, GA 30303, United States
| | - Hope H Biswas
- Department of Gynecology and Obstetrics, Emory University School of Medicine, 69 Jesse Hill Jr. Drive SE, Atlanta, GA 30303, United States
| | - Jenna C Adams
- Emory University School of Medicine, 201 Dowman Dr, Atlanta, GA 30322, United States
| | - Lisa B Haddad
- Department of Gynecology and Obstetrics, Emory University School of Medicine, 69 Jesse Hill Jr. Drive SE, Atlanta, GA 30303, United States
| | - Denise J Jamieson
- Department of Gynecology and Obstetrics, Emory University School of Medicine, 69 Jesse Hill Jr. Drive SE, Atlanta, GA 30303, United States.
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28
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Chamberlain AT, Limaye RJ, O'Leary ST, Frew PM, Brewer SE, Spina CI, Ellingson MK, Dudley MZ, Orenstein WA, Donnelly MA, Riley LE, Ault KA, Salmon DA, Omer SB. Development and acceptability of a video-based vaccine promotion tutorial for obstetric care providers. Vaccine 2019; 37:2532-2536. [PMID: 30962093 PMCID: PMC6472923 DOI: 10.1016/j.vaccine.2019.03.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 03/04/2019] [Accepted: 03/06/2019] [Indexed: 12/17/2022]
Abstract
A prenatal care provider's recommendation for maternal vaccines is one of the strongest predictors of vaccine acceptance during pregnancy. Aside from basic talking points, few resources exist to help obstetric care providers effectively navigate conversations with vaccine hesitant patients. This paper describes the development and acceptability of "VaxChat," an hour-long, evidence-based video tutorial aimed at improving obstetric care providers' ability to promote maternal vaccines. Between June and November 2017, 62 obstetric care providers registered to receive continuing medical education credit for viewing VaxChat. Of the post-tutorial responses received, over 90% said VaxChat increased their knowledge of what to say to vaccine hesitant patients, increased their confidence in addressing vaccinations with their pregnant patients, and will help them improve their practice culture regarding maternal vaccine promotion. Eighty percent intend to change how they approach vaccine conversations. These data suggest VaxChat may be a welcome complement to existing provider-to-patient talking points.
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Affiliation(s)
- A T Chamberlain
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd. NE, Atlanta, GA 30322, United States.
| | - R J Limaye
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, United States; Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, United States; Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, United States
| | - S T O'Leary
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital, 13199 E Montview Blvd, Suite 300, Aurora, CO 80045, United States; Department of Pediatrics, University of Colorado Anschutz Medical Campus, 13123 E 16th Ave, Aurora, CO 80045, United States
| | - P M Frew
- School of Community Health Sciences, University of Nevada, Las Vegas, 4505 S Maryland Pkwy, Las Vegas, NV 89154, United States
| | - S E Brewer
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital, 13199 E Montview Blvd, Suite 300, Aurora, CO 80045, United States
| | - C I Spina
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital, 13199 E Montview Blvd, Suite 300, Aurora, CO 80045, United States
| | - M K Ellingson
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Rd. NE, Atlanta, GA 30322, United States
| | - M Z Dudley
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, United States; Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, United States
| | - W A Orenstein
- Department of Pediatrics, School of Medicine, Emory University, 2015 Uppergate Dr, Atlanta, GA 30322, United States; Emory Vaccine Center, Emory University, 201 Dowman Drive, Atlanta, GA 30322, United States
| | - M A Donnelly
- Department of Obstetrics and Gynecology, School of Medicine, University of Colorado, 12631 E. 17th Avenue, Academic Office 1, Room 4010, Aurora, CO 80045, United States; Denver Health Hospital Authority, 777 Bannock St, Denver, CO 80204, United States
| | - L E Riley
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, Cornell University, 156 William St 7th Floor, New York, NY 10038, United States
| | - K A Ault
- Department of Obstetrics and Gynecology, School of Medicine, University of Kansas, 3901 Rainbow Boulevard, Kansas City, KS 66160, United States
| | - D A Salmon
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, United States; Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, United States
| | - S B Omer
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd. NE, Atlanta, GA 30322, United States; Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Rd. NE, Atlanta, GA 30322, United States; Department of Pediatrics, School of Medicine, Emory University, 2015 Uppergate Dr, Atlanta, GA 30322, United States; Emory Vaccine Center, Emory University, 201 Dowman Drive, Atlanta, GA 30322, United States
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