Gökce CELEP, Aysu Duyan ÇAMURDAN, Fatma Nur Baran AKSAKAL, Osman Fadıl KARA

Different perspectives of immunizations during pregnancy

Background/aim: Pregnant women and infants are at risk of severe lower respiratory tract infections induced by influenza or pertussis. The uptake of both vaccines is poor in spite of proven benefits and safety. We aimed to determine the knowledge and attitude of pregnant women and their primary healthcare providers towards immunization during pregnancy. Materials and methods: This cross-sectional and interventional study was conducted in northern Turkey in 2016. It had 3 different groups including 786 pregnant women, 146 primary healthcare staff, and 97 family practitioners. Different questionnaires were filled by each group. The intervention phase of the study consisted of education of the expectant mothers about immunizations during pregnancy. Results: 786 pregnant women aged between 17-44 years were enrolled to the study. Most of the participants had favourable attitude about vaccination, but only 1.1% had influenza immunization, none had Tdap immunization. None of the participants joining the intervention stage were immunized. The healthcare staff and family physicians had knowledge about vaccinations, but had abstention for administration. Postexposure prophylaxis was also provided by referral centres. Conclusions: Most of the participants either pregnant women or healthcare workers were not vaccinated against pertussis and influenza. Dissemination of maternal immunization must be supported by the team work of healthcare professionals, authorities, universities, professional associations, stake holders, media and patients with current, evidence based knowledge.

Keywords:

Immunization pregnancy, influenza, adult type pertussis vaccine Tdap, postexposure prophylaxis,

PDF

___

1. Barss VA. Immunizations during pregnancy-UptoDate; 2016.
2. Karçaaltıncaba D, Aydoğmuş S, İskender C, Avşar AF. Immunization during pregnancy. Journal of Clinical Sciences & Doctor 2005; 11 (5): 225-230.
3. Bruhn K, Tillett J. Administration of vaccinations in pregnancy and postpartum. MCN: The American Journal of Maternal/Child Nursing. 2009; 34 (2): 98-105. doi: 10.1097/01. NMC.0000347303.62585.65
4. Hacettepe University Institute of Population Studies. Turkey Demographic and Health Survey (main report). Ankara, Turkey: HIPS; 2013.
5. Healy CM, Rench MA, Montesinos DP, Ng N, Swaim LS. Knowledge and attitiudes of pregnant women and their providers towards recommendations for immunization during pregnancy. Vaccine 2015; 33 (41): 5445-5451. doi: 10.1016/j. vaccine.2015.08.028
6. World Health Organization. Maternal and neonatal tetanus (MNT) elimination. Geneva, Switzerland; 2015.
7. Munoz FM, Bond NH, Maccato M, Pinell P, Hammill HA et al. Safety and immunogenicity of tetanus diphtheria and acellular pertussis (Tdap) immunization during pregnancy in mothers and infants: a randomized clinical trial. JAMA 2014; 311 (17): 1760-1769. doi: 10.1001/jama.2014.3633
8. Steinhoff MC, Omer SB. A review of fetal and infant protection associated with antenatal influenza immunization. American Journal of Obstetrics and Gynecology 2012; 207 (3 Suppl): S21-27. doi: 10.1016/j.ajog.2012.06.071
9. Centers for Disease Control and Prevention. Updated recommendations for use of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap) in pregnant women—Advisory Committee on Immunization Practices ACIP; 2012. MMWR Morbidity and Mortality Weekly Report 2012; 62: 131-135.
10. Centers for Disease Control and Prevention. Prevention and control of seasonal influenza with vaccines. Recommendations of the Advisory Committee on Immunization Practices— United States, 2013–2014. ACIP; 2013 MMWR Morbidity and Mortality Weekly Report 2013; 62:1-43.
11. World Health Organization. Influenza (Seasonal) Fact Sheets. Geneva, Switzerland; 2015.
12. World Health Organization. Pertussis vaccines: WHO position paper - August 2015. Geneva, Switzerland; 2015.
13. Gebe Bilgilendirme Sınıfı Eğitim Kitabı. Ankara, Turkey: T.C. Sağlık Bakanlığı, Yayın No: 955; 2014 (in Turkish).
14. Mese S, Uyanik A, Ozakay A, Ozturk S, Badur S. Influenza surveillance in Western Turkey in the era of quadrivalent vaccines: A 2003-2016 retrospective analysis. Human Vaccines and Immunotherapeutics 2018; 14 (8): 1899-1908. doi: 10.1080/21645515.2018.1452577
15. Ball S, Donahue S, Izrael D, Walker D, Martonik R, et al. Influenza vaccination coverage among pregnant women— United States, 2012–13 influenza season. MMWR Morbidity and Mortality Weekly Report. 2013; 62: 787-92.
16. Centers for Disease Control Prevention. Influenza vaccination coverage among pregnant women – 2011-12 influenza season, United States. CDC; 2012 MMWR Morbidity and Mortality Weekly Report 2012; 61: 758-763.
17. Eppes C, Wu A, You W, Cameron KA, Garcia P et al. Barriers to influenza vaccination among pregnant women. Vaccine. 2013; 31 (27): 2874-2878. doi: 10.1016/j.vaccine.2013.04.031
18. Wiley KE, Massey PD, Cooper SC, Wood NJ, Ho J et al. Uptake of influenza vaccine by pregnant women: a cross-sectional survey. Medical Journal of Australia 2013; 198 (7): 373-375. doi: 10.5694/mja12.11849
19. Celikel A, Ustunsoz A, Guvenc G. Determination of vaccination status of pregnant women during pregnancy and the affecting factors. Journal of Clinical Nursing 2014; 23 (15-16): 2142- 2150. doi: 10.1111/jocn.12351
20. Turkish Republic Ministry of Health. General Directorate of Primary Health Care 2009 Pandemic A(H1N1) Vaccination Report. Ankara, Turkey: Turkish Republic Ministry of Health; 2009.
21. Kennedy ED, Ahluwalia IB, Ding H, Lu PJ, Singleton JA et al. Monitoring seasonal influenza vaccination coverage among pregnant women in the United States. American Journal of Obstetrics and Gynecology 2012; 207 (3 Suppl): S9-16. doi: 10.1016/j.ajog.2012.06.069
22. O’Flanagan D, Cotter S, Mereckiene J. Seasonal influenza vaccination in EU/EEA, influenza season 2011-12 2013.
23. Centers for Disease Control Prevention. Prevention and control of influenza rec-ommendations of the advisory committee on immunization practices ACIP; 1997 MMWR Morbidity and Mortality Weekly Report 1997; 46: 1-425.
24. Turkish Advisory Committee on Immunization. Advisory Fact Sheets Immunization of premature and low birth weight babies; 2015.
25. Henninger M, Naleway A, Crane B, Donahue J, Irving S. Predictors of seasonal influenza vaccination during pregnancy. Obstetetrics and Gynecology. 2013; 121 (4): 741-749. doi: 10.1097/AOG.0b013e3182878a5a
26. Maertens K, Braeckman T, Top G, Van Damme P, Leuridan E. Maternal pertussis and influenza immunization coverage and attitude of health care workers towards these recommendations in Flanders, Belgium. Vaccine. 2016; 34 (47): 5785-5791. doi: 10.1016/j.vaccine.2016.09.055
27. Camurdan MO, Camurdan AD, Beyazova U, Bideci A. The rate of seasonal influenza vaccination in diabetic children, the effect of recommendation and the factors influencing the acceptance of recommendation: an interventional study. Balkan Medical Journal 2012; 29 (4): 434-439. doi: 10.5152/ balkanmedj.2012.066
28. de Martino M. Dismantling the Taboo against Vaccines in Pregnancy. International Journal of Molecular Sciences 2016; 17 (6). doi: 10.3390/ijms17060894
29. Tong A, Biringer A, Ofner-Agostini M, Upshur R, McGeer A. A cross-sectional study of maternity care providers’ and women’s knowledge, attitudes, and behaviours towards influenza vaccination during pregnancy. Journal of Obstetrics and Gynaecology Canada, JOGC 2008; 30 (5): 404-410.
30. Vila-Candel R, Navarro-Illana P, Navarro-Illana E, CastroSanchez E, Duke K et al. Determinants of seasonal influenza vaccination in pregnant women in Valencia, Spain. BMC Public Health 2016; 16 (1): 1173. doi: 10.1186/s12889-016- 3823-1
31. Agricola E, Gesualdo F, Alimenti L, Pandolfi E, Carloni E et al. Knowledge attitude and practice toward pertussis vaccination during pregnancy among pregnant and postpartum Italian women. Human Vaccines Immunotherapeutics 2016; 12 (8): 1982-1988. doi: 10.1080/21645515.2016.1188242
32. Amirthalingam G, Andrews N, Campbell H, Ribeiro S, Kara E et al. Effectiveness of maternal pertussis vaccination in England: an observational study. Lancet 2014; 384 (9953): 1521-1528. doi: 10.1016/S0140-6736(14)60686-3
33. Grizas AP, Camenga D, Vazquez M. Cocooning: a concept to protect young children from infectious diseases. Current Opinion in Pediatrics 2012; 24 (1): 92-97. doi: 10.1097/ MOP.0b013e32834e8fe9
34. Munoz F, Englund J. Infant pertussis: is cocooning the answer? Clinical Infectious Diseases 2011; 53 (9): 893-896. doi: 10.1093/ cid/cir542