Determinants of influenza vaccination uptake in pregnancy: a large single-Centre cohort study

Abstract

BackgroundAlthough vaccination of pregnant women against influenza is recommended, the vaccination rate remains low. We conducted a study to identify determinants of influenza vaccination uptake in pregnancy in order to identify strategies to improve seasonal influenza vaccination rates.MethodsProspective observational hospital-based study in the French hospital performing the highest number of deliveries, located in the city of Lille, among all women who had given birth during the 2014–2015 influenza season. Data were collected through a self-completed questionnaire and from medical files. The vaccination uptake was self-reported. Determinants of vaccination uptake were identified using logistic regression analysis.ResultsOf the 2045 women included in the study, 35.5% reported that they had been vaccinated against influenza during their pregnancy. The principal factors significantly associated with greater vaccination uptake were previous influenza vaccination (50.9% vs 20.2%, OR 4.1, 95% CI 3.1–5.5), nulliparity (41.0% vs 31.3%, OR 2.5, 95% CI 1.7–3.7), history of preterm delivery < 34 weeks (43.4% vs 30.3%, OR 2.3, 95% CI 1.1–4.9), the mother’s perception that the frequency of vaccine complications for babies is very low (54.6% vs 20.6%, OR 1.1, 95% CI 0.5–2.2), the mother’s good knowledge of influenza and its vaccine (61.7% vs 24.4%, OR 3.1, 95% CI 2.2–4.4), hospital-based prenatal care in their first trimester of pregnancy (55.0% vs 30.2%, OR 2.1, 95% CI 1.2–3.7), vaccination recommendations during pregnancy by a healthcare worker (47.0% vs 2.7%, OR 18.8, 95% CI 10.0–35.8), receipt of a vaccine reimbursement form (52.4% vs 18.6%, OR 2.0, 95% CI 1.5–2.7), and information from at least one healthcare worker about the vaccine (43.8% vs 19.1%, OR 1.8, 95% CI 1.3–2.6).ConclusionsOur findings suggest that in order to increase flu vaccination compliance among pregnant women, future public health programmes must ensure cost-free access to vaccination, and incorporate education about the risks of influenza and the efficacy/safety of vaccination and clear recommendations from healthcare professionals into routine antenatal care.

Exploring modifiable risk-factors for premature birth in the context of COVID-19 mitigation measures: A discussion paper

“…Campaigns directed at pregnant women to be vaccinated against influenza are needed. Bartolo et al (2019) found that 35.5% of the 2045 pregnant women in their study reported they had been vaccinated against influenza during their pregnancy; the factor significantly associated with vaccination uptake was previous influenza vaccination. Other influences included, to a lesser degree, were first pregnancy, history of preterm birth, the mother's knowledge of the influenza vaccine (and the perception that complications associated with the vaccine were low).…”

“…Possibly more worrying for the premature baby is those who were born during influenza season had a significantly higher risk of periventricular leukomalacia, a brain injury that creates holes in the white matter ( Härtel et al, 2016 ). The World Health Organization (WHO) has recommended influenza vaccination for all pregnant women since 2012, but the vaccination rate has been low ( Bartolo et al, 2019 ).…”

“…Influenza vaccination of pregnant women is associated with a decreased risk of adverse pregnancy outcomes including preterm birth ( Fell et al, 2017 ) and confers effective protection up to the age of 6 months for newborns whose mother was vaccinated during pregnancy ( Bartolo et al, 2019 ). Campaigns directed at pregnant women to be vaccinated against influenza are needed.…”

“…Other influences included, to a lesser degree, were first pregnancy, history of preterm birth, the mother's knowledge of the influenza vaccine (and the perception that complications associated with the vaccine were low). Health professionals need to advocate for the influenza vaccination because Bartolo et al (2019) found that health care worker vaccination recommendations, evidence-based information and hospital-based prenatal care in the first trimester of pregnancy were positively associated with vaccine uptake by pregnant women. Indeed, the primary motivating factor was protecting the baby against influenza.…”

Knowledge, attitudes and practices on influenza vaccine during pregnancy in Quito, Ecuador

“…Many studies have tried to determine the factors in uencing coverage of vaccination against in uenza during pregnancy. Different authors have highlighted that vaccination recommendation by health professionals is the main reason why pregnant women chose to be vaccinated against in uenza [16][17][18][19][20]. Other studies have identi ed additional in uences such as: socio-economic characteristics, fear of side effects, doubts about the safety and effectiveness of the vaccine, fear of needles/pain or under-estimation of personal risk [21][22][23][24].…”