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Determinants of Influenza and Pertussis Vaccination Uptake in Pregnancy

A Multicenter Questionnaire Study of Pregnant Women and Healthcare Professionals

Wilcox, Christopher R., MB BCh*; Calvert, Anna, MRCPH; Metz, Jane, MB BS; Kilich, Eliz, BM BCh; MacLeod, Rachael, MB ChB; Beadon, Kirsten, BSc§; Heath, Paul T., FRCPH; Khalil, Asma, MD¶,‖; Finn, Adam, PhD; Snape, Matthew D., MD§; Vandrevala, Tushna, PhD**; Nadarzynski, Tom, PhD††; Coleman, Matthew A., MD‡‡; Jones, Christine E., PhD§§

The Pediatric Infectious Disease Journal: June 2019 - Volume 38 - Issue 6 - p 625–630
doi: 10.1097/INF.0000000000002242
Maternal-Neonatal Reports
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Introduction: Uptake rates of antenatal vaccination remain suboptimal. Our aims were to determine (1) the acceptability of routine vaccination among pregnant women, (2) the confidence of maternity healthcare professionals (HCPs) discussing vaccination and (3) HCP opinion regarding the optimum healthcare site for vaccine administration.

Methods: Separate questionnaires for pregnant women and HCPs were distributed within 4 national health service (NHS) trusts in South England (July 2017 to January 2018).

Results: Responses from 314 pregnant women and 204 HCPs (18% obstetricians, 75% midwives, 7% unidentified) were analyzed. Previous/intended uptake of influenza and pertussis vaccination was 78% and 92%, respectively. The commonest reason for declining vaccination was feared side effects for their child. White British women (79%) were significantly more accepting of influenza [85% vs. 61%; odds ratio (OR) 3.25; 95% confidence interval [CI], 1.67–6.32] and pertussis vaccination (96% vs. 83%; OR 4.83; 95% CI: 1.77–13.19) compared with nonwhite British women. Among HCPs, 25% were slightly or not at all confident discussing vaccination. Obstetricians felt significantly more confident discussing pertussis vaccination than midwives (68% vs. 55% were very/moderately confident; OR 2.05; 95% CI: 1.02–4.12). Among HCPs, 53%, 25% and 16% thought vaccines should be administered in primary care (general practice), community midwifery and in hospital, respectively.

Conclusion: Misconceptions exist regarding safety/efficacy of antenatal vaccination, and framing information towards the child’s safety may increase uptake. Education of HCPs is essential, and vaccine promotion should be incorporated into routine antenatal care, with an emphasis on women from ethnic minorities. Administration of vaccines in primary care presents logistical barriers; however, support for alternative sites appears low among HCPs.

From the *NIHR Clinical Research Facility, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom

Vaccine Institute, St George’s, University of London, London, United Kingdom

Bristol Children’s Vaccine Centre, University of Bristol, Bristol, United Kingdom

§Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom

Fetal Medicine Unit, Department of Obstetrics and Gynaecology, St George’s University Hospitals NHS Foundation Trust

Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George’s, University of London

**School of Social and Behavioural Sciences, Faculty of Business & Social Sciences, Kingston University, Kingston

††Department of Psychology, University of Westminster, London, United Kingdom

‡‡Department of Fetal Medicine, Princess Anne Hospital, University Hospital Southampton NHS Foundation Trust

§§Faculty of Medicine and Institute for Life Sciences, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.

Accepted for publication October 25, 2018.

Supported by a grant from the British Paediatric Allergy Immunity and Infection Group.

C.R.W., A.C., J.M., K.B., P.T.H., A.K., A.F., M.D.S. and C.E.J. are investigators for clinical trials done on behalf of their respective institutions, sponsored by various vaccine manufacturers, but receive no personal funding for these activities. The other authors have no conflicts of interest to disclose.

C.R.W. drafted the article. All authors contributed to questionnaire design and critically revised the article. C.R.W., A.C., J.M., E.K., R.M., K.B., P.T.H., A.K., A.F., M.D.S., T.V., T.N., M.A.C. and C.E.J. were involved in study set-up and data collection at the participating sites. C.R.W., T.N. and C.E.J. performed the data analysis. C.E.J. conceived the study and was the chief investigator. All authors approved the final version of the article.

Clinical trial registration: The questionnaire study was registered on ClinicalTrials.gov before recruitment (NCT03096574).

Ethical approval: Ethical approval was granted from the West London & GTAC NHS Research Ethics Committee (reference 17/LO/0537) on April 6, 2017.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (www.pidj.com).

Address for correspondence: Christopher Wilcox, MB BCh, NIHR Clinical Research Facility, Southampton Centre for Biomedical Research, C Level West Wing, Mailpoint 218, Southampton General Hospital, Tremona Road, Southampton, SO16 6DY, United Kingdom. E-mail: christopher.wilcox@soton.ac.uk.

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