Influenza vaccination uptake in an Irish obstetric cohort

Abstract

BackgroundInfluenza infection during pregnancy can lead to significant maternal morbidity. There are limited data on influenza vaccination uptake and determinants of uptake in Irish obstetric populations.AimThe objectives of this study were to determine: the uptake of influenza vaccination during pregnancy; the determinants of vaccination uptake; knowledge, attitudes and concerns of postnatal women surrounding vaccination during pregnancy; and the recommendations of healthcare workers. Pertussis vaccination uptake was also determined.MethodA standardised 24 item questionnaire was distributed to postnatal women between January and June 2016. Questions focused on maternal characteristics, vaccination status, sources of information, and reasons for receiving / declining the vaccine. The role of the healthcare professional in recommending and offering vaccination was addressed.Results330 surveys were disseminated, there was a 60% response rate. Of the 198 surveys, 109 (55.1%) respondents were vaccinated against Influenza and 64 (32.3%) against Pertussis. Women in the professional/manager/employer socioeconomic group were more likely to be vaccinated (aOR 3.4; 95% CI 1.11–10.42). There was a strong association between vaccination uptake and receiving information during pregnancy (aOR 12.8; 95% CI 2.65–62.5) and receiving the vaccine in a previous pregnancy (aOR 5.15; 95% CI 1.70–15.62). Unvaccinated women had concerns about the harm it may cause to their baby (53%; n=30) and concerns about side effects for themselves (55%; n=33).ConclusionA key determinant of vaccination was provision of information and a recommendation to vaccinate by a healthcare professional. Uncertainty over safety of the vaccine was evident. Consistent patient education by healthcare professionals could increase vaccine uptake.

A scoping review of the reasons for and approaches to non-uptake of pertussis and influenza vaccinations in pregnant women in the United Kingdom and Ireland

“…Healthcare professional recommendation affects the decision to accept vaccination and several reports implied aspects of vaccination discussion may be lacking; 59% of participants of one study described inadequate information from the healthcare professional as a reason for non-uptake [ 10 , 20 ]. This is important as it has been reported that mothers’ lack of knowledge and engagement with antenatal vaccination campaigns also contributed to non-uptake [ 10 , 30 , 31 ]. The possibility of disparity in information has been alluded to, in another study, where despite information offered by healthcare workers, large numbers of women were unvaccinated [ 26 ].…”

“…In the UK, there isn't consensus among midwives about vaccination during pregnancy with 69% in agreement with it [ 30 ], 76% of midwives feeling they should routinely advise about vaccines in pregnancy and only 25% feel adequately prepared for that role [ 30 ]. A potential explanation for this is limited knowledge of risks to the foetus in pregnancy amongst health professionals which may be attributed to training variation and self-directed knowledge update requirements among midwives and doctors [ 31 ]. An alternative explanation may be that the healthcare professional's views on vaccination may be an influence.…”

“…Reports validated the influence of GP recommendations on vaccine uptake and offered insight into healthcare professional knowledge on vaccination [ 31 , 32 ]. Incorrect knowledge of maternal and fetal consequences of infection, particularly when compared to the mother, as well as knowledge of flu vaccination in pregnancy has been identified [ 32 ], affirming findings from an earlier study [ 31 ].…”

“…Reports validated the influence of GP recommendations on vaccine uptake and offered insight into healthcare professional knowledge on vaccination [ 31 , 32 ]. Incorrect knowledge of maternal and fetal consequences of infection, particularly when compared to the mother, as well as knowledge of flu vaccination in pregnancy has been identified [ 32 ], affirming findings from an earlier study [ 31 ]. Vaccine recommendation by the healthcare professional was associated with acceptance and as mentioned, those vaccinated themselves are more likely to assume responsibility for discussion [ 32 ].…”

“…This draws attention to vaccination status of healthcare professionals themselves. One report found that 75% of GPs and 58% of pharmacists were vaccinated [ 31 ]. In Quattrochi’s research, 76% of healthcare professionals, including midwives and hospital doctors, had not received the influenza vaccination and had no plans to receive it [ 9 ].…”