Factors associated with uptake of influenza and pertussis vaccines among pregnant women in South Australia

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Abstract

Background

Maternal immunization is an effective strategy to protect pregnant women and their infants from vaccine-preventable diseases. Despite the recommendation of maternal influenza and more recently pertussis immunization in Australia, uptake of these vaccines has been suboptimal. A midwife delivered immunization program for pregnant women at the Women’s and Children’s Hospital in South Australia commenced in April 2015. Monitoring the uptake of the current funded vaccine programs for pregnant women is limited. The study aimed to estimate maternal vaccine uptake and assess factors associated with influenza and pertussis vaccine uptake among pregnant women.

Methods

This prospective study was undertaken between November 2014 and July 2016 at the Women’s and Children’s Hospital. Following consent, demographic details and vaccination history for South Australian pregnant women who attended the antenatal clinic were collected. A standardised self-reported survey was completed during pregnancy with a follow up telephone interview at 8–10 weeks post-delivery.

Results

205 women consented and completed the self-reported survey. Of the 180 pregnant women who completed the study, 76% and 81% received maternal influenza and pertussis vaccines respectively. The adjusted odds of women receiving maternal vaccines during pregnancy were significantly higher for women delivering after the implementation of the midwife delivered program compared with women who delivered babies prior to the program for both pertussis vaccination (AOR 21.17, 95% CI 6.14–72.95; p<0.001) and influenza vaccination (AOR 5.95, 95% CI 2.13–16.61, p<0.001). Women receiving a recommendation from a health care provider and first time mothers were significantly more likely to receive influenza vaccination during pregnancy.

Conclusions

High uptake of influenza and pertussis vaccines during pregnancy can be attained with health care provider recommendation and inclusion of maternal immunization as part of standard antenatal care. A midwife delivered maternal immunization program is a promising approach to improve maternal vaccine uptake by pregnant women.

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Most cited references 29

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Understanding factors influencing vaccination acceptance during pregnancy globally: A literature review.

Caitlin Jarrett, Heidi Larson, Rose Wilson … (2015)

Maternal vaccination has been evaluated and found to be extremely effective at preventing illness in pregnant women and new-borns; however, uptake of such programmes has been low in some areas. To analyse factors contributing to uptake of vaccines globally, a systematic review on vaccine hesitancy was carried out by The Vaccine Confidence Project in 2012. In order to further analyse factors contributing to uptake of maternal immunisation, a further search within the broader systematic review was conducted using the terms 'Pregnan*' or 'Matern*'. Forty-two articles were identified. Pregnancy-related articles were further screened to identify those focused on concerns, trust and access issues regarding maternal vaccination reported by pregnant women and healthcare workers. Thirty-five relevant articles were included which were then searched using the snowballing technique to identify additional relevant references cited in these articles. A search alert was also conducted from February to April 2015 in PubMed to ensure that no new relevant articles were missed. A total of 155 relevant articles were included. Most of the literature which was identified on hesitancy surrounding vaccination during pregnancy reports on determinants of influenza vaccine uptake in North America. Research conducted in low-income countries focused primarily on tetanus vaccine acceptance. The main barriers cited were related to vaccine safety, belief that vaccine not needed or effective, not recommended by healthcare worker, low knowledge about vaacines, access issues, cost, conflicting advice. From the point of view of healthcare workers, barriers included inadequate training, inadequate reimbursement and increased workload. Twenty-seven out of 46 (59%) articles mentioning ethnicity reported lower rates of coverage among ethnic minorities. Barriers to vaccination in pregnancy are complex and vary depending on context and population. There are wide gaps in knowledge regarding the attitudes of healthcare workers and how ethnicity and gender dynamics influence a pregnant woman's decision to vaccinate.

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Influenza vaccine given to pregnant women reduces hospitalization due to influenza in their infants.

D Gracey, B. Esposito, Marietta Vazquez … (2010)

Infants aged <12 months are at high risk of hospitalization for influenza. Influenza vaccine is recommended for pregnant women and for most children; however, no vaccine is approved for infants aged <6 months. Effective approaches are needed to protect this vulnerable population. Vaccination of women during pregnancy may protect the infant through transfer of antibodies from the mother. Few studies have examined the effectiveness of this strategy, and those studies produced mixed results. In a matched case-control study, case patients were infants aged <12 months admitted to a large urban hospital in the northeastern United States because of laboratory-confirmed influenza from 2000 to 2009. For each case, we enrolled 1 or 2 control subjects who were infants who tested negative for influenza and matched cases by date of birth and date of hospitalization (within 4 weeks). Vaccine effectiveness was calculated on the basis of matched odds ratios and was adjusted for confounding. The mothers of 2 (2.2%) of 91 case subjects and 31 (19.9%) of 156 control subjects aged <6 months, and 1 (4.6%) of 22 case subjects and 2 (5.6%) of 36 control subjects aged ≥6 months, had received influenza vaccine during pregnancy. The effectiveness of influenza vaccine given to mothers during pregnancy in preventing hospitalization among their infants, adjusted for potential confounders, was 91.5% (95% confidence interval [CI], 61.7%-98.1%; P = .001) for infants aged <6 months. The unadjusted effectiveness was 90.7% (95% CI, 59.9%-97.8%; P = .001). Influenza vaccine given to pregnant women is 91.5% effective in preventing hospitalization of their infants for influenza in the first 6 months of life.

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Breastfeeding after maternal immunisation during pregnancy: providing immunological protection to the newborn: a review.

Elke Leuridan, Tessa Braeckman, Sara De Schutter … (2014)

Vaccination during pregnancy results in an augmentation of disease specific maternal antibodies. Immunoglobulin G (IgG) is mainly transferred through the placenta during the third trimester of pregnancy, while secretory Immunoglobulin A (sIgA) is passed through breast milk. At birth, newborns are partially protected against infectious diseases by these antibodies. This review aims to provide an overview of the effect of vaccination during pregnancy on the immunological protection of the newborn by the presence of disease specific sIgA antibodies in breast milk and their possible protective function against disease. Our search produced 11 relevant papers; 1 on pertussis, 7 on pneumococcus, 2 on influenza and 1 on meningococcus. All of the studies in this review that measured disease specific antibodies in breast milk (n=8 papers), stressed the beneficial effect of maternal vaccination during pregnancy on the amount of disease specific sIgA in breast milk. Only a few studies demonstrated a potential protective effect, particularly with influenza vaccines. In an era where maternal vaccination is increasingly considered as a valuable strategy to protect both the mother and infant, further research is needed to assess the effect on breast milk sIgA and to understand the potentially beneficial effects to the infant.

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Author and article information

Contributors

Hassen Mohammed:

ORCID: http://orcid.org/0000-0003-0189-3739

Role: Data curationRole: Formal analysisRole: MethodologyRole: Writing – original draftRole: Writing – review & editing

Michelle Clarke: Role: ConceptualizationRole: Formal analysisRole: MethodologyRole: SupervisionRole: Writing – review & editing

Ann Koehler: Role: Funding acquisitionRole: MethodologyRole: ValidationRole: Writing – review & editing

Maureen Watson: Role: ConceptualizationRole: MethodologyRole: ValidationRole: Writing – review & editing

Helen Marshall: Role: ConceptualizationRole: Funding acquisitionRole: MethodologyRole: Project administrationRole: ResourcesRole: ValidationRole: Writing – review & editing

Guy AM Berbers: Role: Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS ONE

Journal ID (publisher-id): plos

Journal ID (pmc): plosone

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, CA USA )

ISSN (Electronic): 1932-6203

Publication date (Electronic): 14 June 2018

Publication date Collection: 2018

Volume: 13

Issue: 6

Electronic Location Identifier: e0197867

Affiliations

[1 ] The Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia

[2 ] Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia

[3 ] Vaccinology and Immunology Research Trials Unit (VIRTU), Women's and Children's Hospital, North Adelaide, South Australia, Australia

[4 ] The Communicable Disease Control Branch (CDCB), South Australia, Australia

[5 ] School of Public Health, University of Adelaide, Adelaide, South Australia, Australia

RIVM, NETHERLANDS

Author notes

Competing Interests: The authors have declared that no competing interests exist.

* E-mail: hassen.mohammed@ 123456adelaide.edu.au

Author information

Hassen Mohammed http://orcid.org/0000-0003-0189-3739

Article

Publisher ID: PONE-D-18-02353

DOI: 10.1371/journal.pone.0197867

PMC ID: 6002099

PubMed ID: 29902184

SO-VID: d2535858-558c-4181-8f34-fc98e05b9123

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

History

Date received : 23 January 2018

Date accepted : 9 May 2018

Page count

Figures: 2, Tables: 4, Pages: 14

Funding

Funded by: Communicable Disease Control Branch - SA Health

Award Recipient : Helen Marshall

This research has been funded by the Communicable Disease Control Branch (CDCB)- SA Health, Government of South Australia.

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Data Availability All relevant data are within the paper and its Supporting Information files.

Factors associated with uptake of influenza and pertussis vaccines among pregnant women in South Australia

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Most cited references 29

Understanding factors influencing vaccination acceptance during pregnancy globally: A literature review.

Influenza vaccine given to pregnant women reduces hospitalization due to influenza in their infants.

Breastfeeding after maternal immunisation during pregnancy: providing immunological protection to the newborn: a review.

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