Failure of the vaccination campaign against A(H1N1) influenza in pregnant women in France: Results from a national survey

Abstract

Background and objective: Pregnant women were a priority group for vaccination during the 2009 A(H1N1) influenza pandemic. In France, vaccination was organized in ad hoc centers. Women received vouchers by mail and were given a non-adjuvanted vaccine. Our objective was to assess the national vaccination rate among pregnant women and to determine the association of vaccination with maternal characteristics, prenatal care, and pregnancy-related health behaviors. Method: Data came from a national representative sample of women who gave birth in March 2010 (N=13 453) and were interviewed in the hospital before discharge; they were in the second trimester of pregnancy during the vaccination campaign. Associations between vaccination and sociodemographic and medical characteristics, region of residence, care providers, and preventive behaviors were assessed with bivariable analyses and logistic regression models. Results: Vaccine coverage was 29.3% (95% CI: 28.6-30.1). The main reason for not being vaccinated was that women did not want this immunization (91%). In adjusted analyses, vaccination was more frequent in women who were older, employed, born in France, with a parity of 1 or 2 and specific favourable health behaviors. The adjusted odds ratio for women with a postgraduate educational level was 4.1 (95% CI: 3.5-4.8) compared to those who did not complete high school. Women with additional risk factors for complications from A(H1N1) infection had a vaccination rate similar to that of other women. Conclusion: The vaccination campaign resulted in poor vaccination coverage, strong social inequalities, and no special protection for pregnant women at the highest risk of complications. These findings provide essential information for the organization of future vaccination campaigns.

2010 A(H1N1) vaccination in pregnant women in Brazil: identifying coverage and associated factors

“…In line with previous studies, we found that younger pregnant women were less likely to have been vaccinated 13,19,32 . This phenomenon occurred not only in pregnant women but also in other groups, such as hospital workers and the general population 14 .…”

“…On the other hand, studies performed in developed countries showed better results than the former countries but still below the values reached in Brazil. In France, Blondel et al 19 found 29.3%, in the USA, Centers for Disease Control and Prevention (CDC) 23 found a rate of 40.4%, in the Netherlands 24 63% and in Canada 25 76.4%.…”

“…Moreover, we only included women who had given birth during the end of the vaccination campaign (May 2010) and seven months after (October 2010), minimizing the probability of including mothers who were not vaccinated during the campaign. Studies in other countries reported that influenza A(H1N1) vaccination coverage in the general population and in specific groups varies between 4.8% and 92%, depending on the country and the group studied 14 , with participation being consistently lower among pregnant women 8,18,19 . The 77% vaccination coverage observed in our study is higher than in other countries and is reliable based on official national figures 20 .…”

“…In addition to health behaviors, considering reasons that might inhibit people from receiving vaccines, studies have shown that demographic and socioeconomic factors can reduce coverage among pregnant women 13,14,19,30,31 . In line with previous studies, we found that younger pregnant women were less likely to have been vaccinated 13,19,32 .…”

“…Socioeconomic factors (income and education) have been reported to be barriers to vaccination 14,19,30,31,33,34 . In contrast, our study showed that the poorest quartile had higher vaccination rates than did the richest quartile and that ethnicity and education, in contrast to what happened in other countries 19,33 , did not influence vaccination coverage.…”