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Jiang F, Tang N, Gao Y, Feng J, Wang Y, Qu B. Knowledge and Willingness toward Vaccination among Pregnant Women: Comparison between Pertussis and Influenza. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14082. [PMID: 36360959 PMCID: PMC9658401 DOI: 10.3390/ijerph192114082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 10/24/2022] [Accepted: 10/24/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Our study sought to characterize the knowledge and willingness levels regarding vaccinations against pertussis and seasonal influenza (influenza) among pregnant women in Guizhou province, China, which have previously been unclear. METHODS In total, 11 hospitals that carried out obstetrics and antenatal examination services were randomly included in the target organizations, and 564 questionnaires completed by the pregnant women were collected and analyzed in Guizhou province. The questionnaires contained questions addressing awareness and knowledge of pertussis and influenza, willingness to be vaccinated at different life stages, and the basic statuses of subjects. A two-paired McNemar test was used to compare the knowledge levels on pertussis and influenza. A Friedman test was used to compare the willingness to be vaccinated at different life stages. To explore the factors influencing knowledge levels, a chi-square test and binary logistic regression were used with stepwise backward regression. RESULTS In total, 11.9 percent of the pregnant women had received influenza vaccines in the year prior to their pregnancy in Guizhou province. The pregnant women had poorer knowledge of pertussis than of influenza. Given a vaccine was available, the willingness of pregnant women to partake in the following vaccination-related actions could be ranked, from highest to lowest: free vaccination of babies, recommend vaccination to family members, postpartum vaccination, vaccination of babies at mothers' expense, and vaccination during pregnancy. Knowledge levels played different roles in the women's willingness to receive vaccinations at different life stages. Common knowledge of pertussis and influenza played a limited role in the willingness to receive maternal vaccinations. Among the pregnant women, the factors influencing the low levels of pertussis knowledge were occupation as nonmedical-institution staff, lower educational level, pregnancy stage past the first trimester, and not bearing children; for influenza, the factors were occupation as nonmedical-institution staff, lower educational level, denial of pregnancy-induced disease, and lower monthly household income per capita. CONCLUSIONS Pregnant women have poorer levels of knowledge on pertussis than influenza, whereas there was no significant difference in their willingness to be vaccinated against these conditions. Health education on pertussis should be strengthened and we called for vaccines given at birth.
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Affiliation(s)
- Feng Jiang
- Institute of Expanded Programme on Immunization, Guizhou Provincial Center for Disease Control and Prevention, Guiyang 550004, China
| | - Ning Tang
- Institute of Expanded Programme on Immunization, Guizhou Provincial Center for Disease Control and Prevention, Guiyang 550004, China
| | - Yuanxue Gao
- Institute of Expanded Programme on Immunization, Guizhou Provincial Center for Disease Control and Prevention, Guiyang 550004, China
| | - Jun Feng
- Institute of Expanded Programme on Immunization, Guizhou Provincial Center for Disease Control and Prevention, Guiyang 550004, China
| | - Ying Wang
- School of Public Health, Fudan University, Shanghai 200032, China
| | - Bin Qu
- Zunyi Prefectural Center for Disease Control and Prevention, Zunyi 563000, China
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Cappozzo F, Dal Zotto A, Scollo M, Bernardini D, Maria Dal Zotto A, Bonvecchio L, Tognetto G, Marinangeli S, Negrello C, Lanza P, Cocco A, Falivene P, Vianello L, Di Caprio A, Gabutti G, Saugo M. dTap vaccination uptake during pregnancy: Pregnant women-focused and health professionals-focused predictors in the Veneto Region (Italy). Vaccine 2021; 39:6913-6919. [PMID: 34711438 DOI: 10.1016/j.vaccine.2021.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 09/08/2021] [Accepted: 10/07/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Despite recommendations, the uptake of dTap maternal vaccination is still low in many countries. The reasons for this must be investigated both on the patient's and the healthcare professionals' sides. METHODS A record linkage study was performed linking Birth Assitance Certificates and dTap mothers' vaccination records (5183 deliveries) to describe the influence of socioeconomical and obstetrical-gynecological factors after the recommendations concerning dTap vaccination in pregnancy issued by the Italian Ministry of Health (August 2018). An interview was also administered to a subgroup of 656 new mothers on the occasion of the first vaccination of their newborns, in order to assess the dTap vaccination advice received from maternal care providers during pregnancy. A generalized linear model (binomial family, log link) was implemented to give a correct estimate of the mother's relative risk of being vaccinated. RESULTS Several pregnant women-focused factors are evident, but the most important ones are related to maternal care providers' practices: after mutual adjustment, the explicit advice towards dTap maternal vaccination given by the Obstetrician-Gynecologist or the Midwife is associated with a 12-fold increase in the dTap coverage. CONCLUSIONS Multiprofessional training is essential to make Obstetricians-Gynecologists and Midwives more confident in recommending dTaP maternal immunization.
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Affiliation(s)
- Francesco Cappozzo
- Obstetric and Gynecology Department, Local Health Unit 7, Bassano del Grappa, Italy
| | | | - Marcello Scollo
- Obstetric and Gynecology Department, Local Health Unit 7, Bassano del Grappa, Italy
| | - Daniele Bernardini
- Department of Prevention, Local Health Unit 7, Bassano del Grappa, Italy
| | | | - Lucia Bonvecchio
- Department of Prevention, Local Health Unit 7, Bassano del Grappa, Italy
| | - Gabriella Tognetto
- Department of Prevention, Local Health Unit 7, Bassano del Grappa, Italy
| | | | - Chiara Negrello
- Family Counseling Center, Local Health Unit 7, Bassano del Grappa, Italy
| | - Paola Lanza
- Obstetric and Gynecology Department, Local Health Unit 7, Bassano del Grappa, Italy
| | - Andrea Cocco
- Obstetric and Gynecology Department, Local Health Unit 7, Bassano del Grappa, Italy
| | - Patrizia Falivene
- Department of Prevention, Local Health Unit 7, Bassano del Grappa, Italy
| | - Liviano Vianello
- Department of Prevention, Local Health Unit 7, Bassano del Grappa, Italy
| | - Antonio Di Caprio
- Health Services Director, Local Health Unit 7, Bassano del Grappa, Italy
| | - Giovanni Gabutti
- Department of Medical Sciences,University of Ferrara, Ferrara, Italy
| | - Mario Saugo
- Department of Prevention, Local Health Unit 7, Bassano del Grappa, Italy.
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Campbell PT, Geard N, Hogan AB. Modelling the household-level impact of a maternal respiratory syncytial virus (RSV) vaccine in a high-income setting. BMC Med 2020; 18:319. [PMID: 33176774 PMCID: PMC7661211 DOI: 10.1186/s12916-020-01783-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 09/15/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Respiratory syncytial virus (RSV) infects almost all children by the age of 2 years, with the risk of hospitalisation highest in the first 6 months of life. Development and licensure of a vaccine to prevent severe RSV illness in infants is a public health priority. A recent phase 3 clinical trial estimated the efficacy of maternal vaccination at 39% over the first 90 days of life. Households play a key role in RSV transmission; however, few estimates of population-level RSV vaccine impact account for household structure. METHODS We simulated RSV transmission within a stochastic, individual-based model framework, using an existing demographic model, structured by age and household and parameterised with Australian data, as an exemplar of a high-income country. We modelled vaccination by immunising pregnant women and explicitly linked the immune status of each mother-infant pair. We quantified the impact on children for a range of vaccine properties and uptake levels. RESULTS We found that a maternal immunisation strategy would have the most substantial impact in infants younger than 3 months, reducing RSV infection incidence in this age group by 16.6% at 70% vaccination coverage. In children aged 3-6 months, RSV infection was reduced by 5.3%. Over the first 6 months of life, the incidence rate for infants born to unvaccinated mothers was 1.26 times that of infants born to vaccinated mothers. The impact in older age groups was more modest, with evidence of infections being delayed to the second year of life. CONCLUSIONS Our findings show that while individual benefit from maternal RSV vaccination could be substantial, population-level reductions may be more modest. Vaccination impact was sensitive to the extent that vaccination prevented infection, highlighting the need for more vaccine trial data.
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Affiliation(s)
- Patricia T. Campbell
- Epidemiology, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria Australia
- School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Nicholas Geard
- Epidemiology, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria Australia
- School of Computing and Information Systems, Melbourne School of Engineering, The University of Melbourne, Melbourne, Australia
| | - Alexandra B. Hogan
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, Imperial College London, London, UK
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Howe AS, Pointon L, Gauld N, Paynter J, Willing E, Turner N. Pertussis and influenza immunisation coverage of pregnant women in New Zealand. Vaccine 2020; 38:6766-6776. [PMID: 32868133 DOI: 10.1016/j.vaccine.2020.08.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 08/11/2020] [Accepted: 08/14/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Immunisation is an important public health policy and measuring coverage is imperative to identify gaps and monitor trends. New Zealand (NZ), like many countries, does not routinely publish coverage of immunisations given during pregnancy. Therefore, this study examined pregnancy immunisation coverage of all pregnant NZ women between 2013 and 2018, and what factors affected uptake. METHODS A retrospective cohort study of pregnant women who delivered between 2013 and 2018 was undertaken using administrative datasets. Maternity and immunisation data were linked to determine coverage of pertussis and influenza vaccinations in pregnancy. Generalised estimating equations were used to estimate the odds of receiving a vaccination during pregnancy. RESULTS From 2013 to 2018 data were available for 323,622 pregnant women, of whom 21.7% received maternal influenza immunisations and 25.7% maternal pertussis immunisations. Coverage for both vaccines increased over time, pertussis increased from 10.2% to 43.6% and influenza from 11.2% to 30.8%. The odds of being vaccinated, with either vaccine, during pregnancy increased with increasing age and decreasing deprivation. Compared to NZ European or Other women, Māori and Pacific women had lower odds of receiving a maternal pertussis (OR:0.55, 95% CI: 0.54, 0.57; OR:0.60, 95% CI: 0.58, 0.62, respectively) and influenza (OR: 0.69, 95% CI: 0.67, 0.71; OR:0.90, 95% CI: 0.87, 0.94, respectively) immunisations during pregnancy. Women were also more likely to be vaccinated against pertussis if they received antenatal care from a General Practitioner or Obstetrician compared to a Midwife. A similar pattern was seen for influenza vaccination. CONCLUSION Gaps in maternal coverage for pertussis and influenza exist and work is needed to reduce immunisation inequities.
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Affiliation(s)
- Anna S Howe
- Department of General Practice and Primary Health Care, School of Population Health, University of Auckland, New Zealand.
| | - Leah Pointon
- Department of General Practice and Primary Health Care, School of Population Health, University of Auckland, New Zealand.
| | - Natalie Gauld
- Department of Paediatrics: Child and Youth Health, University of Auckland, New Zealand; School of Pharmacy, University of Auckland, New Zealand.
| | - Janine Paynter
- Department of General Practice and Primary Health Care, School of Population Health, University of Auckland, New Zealand.
| | - Esther Willing
- Kōhatu - Centre for Hauora Māori, Division of Health Sciences, University of Otago, New Zealand.
| | - Nikki Turner
- Department of General Practice and Primary Health Care, School of Population Health, University of Auckland, New Zealand; Immunisation Advisory Centre, University of Auckland, New Zealand.
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Kaufman J, Attwell K, Hauck Y, Leask J, Omer SB, Regan A, Danchin M. Designing a multi-component intervention (P3-MumBubVax) to promote vaccination in antenatal care in Australia. Health Promot J Austr 2020; 32:391-398. [PMID: 32619032 DOI: 10.1002/hpja.382] [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: 10/14/2019] [Accepted: 06/29/2020] [Indexed: 02/04/2023] Open
Abstract
ISSUE ADDRESSED Coverage of maternal influenza and pertussis vaccines remains suboptimal in Australia, and pockets of low childhood vaccine coverage persist nationwide. Maternal vaccine uptake is estimated to be between 35% and 60% for influenza vaccination and between 65% and 80% for pertussis vaccination. Australian midwives are highly trusted and ideally placed to discuss vaccines with expectant parents, but there are no evidence-based interventions to optimise these discussions and promote maternal and childhood vaccine acceptance in the Australian public antenatal setting. METHODS We gathered qualitative data from Australian midwives, reviewed theoretical models, and adapted existing vaccine communication tools to develop the multi-component P3-MumBubVax intervention. Through 12 interviews at two Australian hospitals, we explored midwives' vaccination attitudes and values, perceived role in vaccine advocacy and delivery, and barriers and enablers to intervention implementation. Applying the theory-based P3 intervention model, we designed intervention components targeting the Practice, Provider and Parent levels. Midwives provided feedback on prototype intervention features through two focus groups. RESULTS The P3-MumBubVax intervention includes practice-level prompts and identification of a vaccine champion. Provider-level components are a vaccine communication training module, learning exercise, and website with printable fact sheets. Parent-level intervention components include text message reminders to receive influenza and pertussis vaccines in pregnancy, as well as online information on vaccine safety, effectiveness and disease severity. CONCLUSIONS The P3-MumBubVax intervention is the first Australian antenatal intervention designed to support both maternal and childhood vaccine uptake. A pilot study is underway to inform a planned cluster randomised controlled trial. SO WHAT?: Barriers to vaccine acceptance and uptake are complex. The P3 model is a promising evidence-informed multi-component intervention strategy targeting all three levels influencing health care decision-making.
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Affiliation(s)
- Jessica Kaufman
- Murdoch Children's Research Institute, Parkville, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Katie Attwell
- School of Social Sciences, University of Western Australia, Perth, Australia.,Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Australia
| | - Yvonne Hauck
- School of Nursing, Midwifery & Paramedicine, Curtin University, Perth, Australia.,Department of Nursing and Midwifery Education and Research, King Edward Memorial Hospital, Subiaco, Australia
| | - Julie Leask
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Saad B Omer
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Annette Regan
- School of Public Health, Texas A&M University, College Station, TX, USA
| | - Margie Danchin
- Murdoch Children's Research Institute, Parkville, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Australia
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Canibaño B, Deleu D, Mesraoua B, Melikyan G, Ibrahim F, Hanssens Y. Pregnancy-related issues in women with multiple sclerosis: an evidence-based review with practical recommendations. J Drug Assess 2020; 9:20-36. [PMID: 32128285 PMCID: PMC7034025 DOI: 10.1080/21556660.2020.1721507] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Accepted: 01/21/2020] [Indexed: 12/18/2022] Open
Abstract
Objective: To review the current evidence regarding pregnancy-related issues in multiple sclerosis (MS) and to provide recommendations specific for each of them. Research design and methods: A systematic review was performed based on a comprehensive literature search. Results: MS has no effect on fertility, pregnancy or fetal outcomes, and pregnancies do not affect the long-term disease course and accumulation of disability. There is a potential risk for relapse after use of gonadotropin-releasing hormone agonists during assisted reproduction techniques. At short-term, pregnancy leads to a reduction of relapses during the third trimester, followed by an increased risk of relapses during the first three months postpartum. Pregnancies in MS are not per se high risk pregnancies, and MS does not influence the mode of delivery or anesthesia unless in the presence of significant disability. MRI is not contraindicated during pregnancy; however, gadolinium contrast media should be avoided whenever possible. It is safe to use pulse dose methylprednisolone infusions to manage acute disabling relapses during pregnancy and breastfeeding. However, its use during the first trimester of pregnancy is still controversial. Women with MS should be encouraged to breastfeed with a possible favorable effect of exclusive breastfeeding. Disease-modifying drugs can be classified according to their potential for pregnancy-associated risk and impact on fetal outcome. Interferon beta (IFNβ) and glatiramer acetate (GA) may be continued until pregnancy is confirmed and, after consideration of the individual risk-benefit if continued, during pregnancy. The benefit of continuing natalizumab during the entire pregnancy may outweigh the risk of recurring disease activity, particularly in women with highly active MS. GA and IFNβ are considered safe during breastfeeding. The use of natalizumab during pregnancy or lactation requires monitoring of the newborn. Conclusions: This review provides current evidence and recommendations for counseling and management of women with MS preconception, during pregnancy and postpartum.
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Affiliation(s)
- Beatriz Canibaño
- Department of Neurology, Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Dirk Deleu
- Department of Neurology, Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Boulenouar Mesraoua
- Department of Neurology, Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Gayane Melikyan
- Department of Neurology, Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Faiza Ibrahim
- Department of Neurology, Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Yolande Hanssens
- Clinical Services Unit, Pharmacy, Hamad Medical Corporation, Doha, Qatar
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Rozbroj T, Lyons A, Lucke J. Vaccine-Hesitant and Vaccine-Refusing Parents’ Reflections on the Way Parenthood Changed Their Attitudes to Vaccination. J Community Health 2019; 45:63-72. [DOI: 10.1007/s10900-019-00723-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Park HJ, Kim SJ, Song R, Chen J, Kim JH, Devadiga R, Kang HC. A 6-year Prospective, Observational, Multi-Center Post-Marketing Surveillance of the Safety of Tetanus Toxoid, Reduced Diphtheria Toxoid, and Acellular Pertussis (Tdap) Vaccine in Korea. J Korean Med Sci 2019; 34:e105. [PMID: 30940999 PMCID: PMC6439203 DOI: 10.3346/jkms.2019.34.e105] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 03/10/2019] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Incidence of whooping cough is increasing in Korea. Since 2011, occurrence among adolescents and adults has risen putting vulnerable neonates at risk. National immunization guidelines now include Tdap (tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis) vaccination during pregnancy and as a cocooning strategy (i.e., vaccinating adults and adolescents in contact with neonates). This study assessed post-marketing Tdap (Boostrix®, GSK, Belgium) vaccine safety in subjects ≥ 10 years. METHODS This open, non-comparative multi-center study was conducted over six years at 10 hospitals in Korea. Subjects received Tdap in normal clinical practice according to local prescribing information. All adverse events (AEs) were recorded, classified as expected or unexpected, and severity and relationship to Tdap were assessed. RESULTS The analysis included 672 Korean subjects (mean age, 44 years; range, 11-81), 451 were women and 211 were pregnant. Ninety subjects experienced 124 AEs (incidence 13.39%) of which six were serious AEs (SAEs) assessed as not related to vaccination, and 51 were non-SAEs related to vaccination (mostly administration site reactions). Overall 65/124 AEs were unexpected; the most common were 14 constipation, 5 dyspepsia, 4 common cold and 4 premature labor cases. One case of common cold was assessed as possibly related to vaccination. Pregnancy outcome was 'live infant, no apparent congenital anomaly' in 195 subjects (92.42%) or 'lost to follow-up' in 16 subjects. CONCLUSION Tdap administration to Korean subjects ≥ 10 years, including pregnant women, for the prevention of diphtheria, tetanus and pertussis was shown to have a well-tolerated safety profile. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01929291.
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Affiliation(s)
- Hee-Jin Park
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, Seoul, Korea
| | | | | | | | | | | | - Hee-Cheol Kang
- Department of Family Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Fragoso YD, Adoni T, Brooks JBB, Finkelsztejn A, da Gama PD, Grzesiuk AK, Marques VD, Parolin MFK, Sato HK, Varela DL, Vasconcelos CCF. Practical Evidence-Based Recommendations for Patients with Multiple Sclerosis Who Want to Have Children. Neurol Ther 2018; 7:207-232. [PMID: 30167914 PMCID: PMC6283793 DOI: 10.1007/s40120-018-0110-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Indexed: 12/14/2022] Open
Abstract
Multiple sclerosis (MS) management presently aims to reach a state of no (or minimal) evidence of disease activity. The development and commercialization of new drugs has led to a renewed interest in family planning, since patients with MS may face a future with reduced (or no) disease-related neurological disability. The advice of neurologists is often sought by patients who want to have children and need to know more about disease control at conception and during pregnancy and the puerperium. When MS is well controlled, the simple withdrawal of drugs for patients who intend to conceive is not an option. On the other hand, not all treatments presently recommended for MS are considered safe during conception, pregnancy and/or breastfeeding. The objective of the present study was to summarize the practical and evidence-based recommendations for family planning when our patients (women and men) have MS.Funding TEVA Pharmaceutical Brazil.
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Affiliation(s)
| | - Tarso Adoni
- Hospital Sirio-Libanes de Sao Paulo, São Paulo, SP, Brazil
| | | | | | | | | | | | | | - Henry K Sato
- Instituto de Neurologia de Curitiba, Curitiba, PR, Brazil
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Maisa A, Milligan S, Quinn A, Boulter D, Johnston J, Treanor C, Bradley DT. Vaccination against pertussis and influenza in pregnancy: a qualitative study of barriers and facilitators. Public Health 2018; 162:111-117. [DOI: 10.1016/j.puhe.2018.05.025] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 05/14/2018] [Accepted: 05/30/2018] [Indexed: 11/25/2022]
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