Different perspectives of immunizations during pregnancy
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 pregnantwomen 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 differentgroups including 786 pregnant women, 146 primary healthcare staff, and 97 family practitioners. Different questionnaires were filled byeach 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 attitudeabout vaccination, but only 1.1% had influenza immunization, none had Tdap immunization. None of the participants joining theintervention stage were immunized. The healthcare staff and family physicians had knowledge about vaccinations, but had abstentionfor 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.
___
- 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, Castro-
Sanchez 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