Implementation of the Recommendation to Vaccinate Pregnant Women against Seasonal Influenza – Vaccination Rates and Acceptance

 

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Abstract

Introduction In Germany vaccination recommendations are revised annually and published by the Standing Committee on Vaccination at the Robert Koch Institute (STIKO). In 2010 the vaccination recommendations were amended to include the proposal that pregnant women in the 2nd trimester of pregnancy and pregnant women with additional underlying disease in the 1st trimester of pregnancy should be vaccinated against seasonal influenza. This paper reports on vaccination rates and the factors influencing them.

Method A cross-sectional study was carried out in two level 1 perinatal centers in two different German federal states (Saarland and Rhineland-Palatinate) during the influenza seasons of 2012/2013 and 2013/2014. A total of 253 pregnant women were included in the study. Pregnant women were interviewed using a standardized, pre-tested questionnaire and asked whether they were aware of the recommendation to vaccinate against seasonal influenza and about possible factors which might influence their decision to be vaccinated. In addition, data from their vaccination certificates and pregnancy passports were evaluated.

Results Overall, the records of only 19.5 % of the pregnant women showed that they had been vaccinated against influenza in pregnancy. Among the group of pregnant women who had a previous history of vaccinations against influenza the willingness to be vaccinated was high (43.3 %) and this figure was statistically significant. The vaccination rate was even higher (49.9 %) and even more statistically significant among pregnant women whose gynecologist or family physician had recommended that they should be vaccinated. In contrast, only 3.3 % of pregnant women who had not been given the recommendation to vaccinate by their physicians were vaccinated against influenza.

Discussion The failure to recommend that pregnant women be vaccinated against influenza and womenʼs lack of any previous experience of influenza vaccination were the main reasons for the inadequate influenza vaccination coverage in pregnancy.

Conclusion One of the key points to increase the influenza vaccination rate is to intensify the counselling of the pregnant women through the gynecologist.

• References/Literatur

• 1 Robert Koch-Institut (RKI), Ständige Impfkommission. Aufgaben und Methodik. 2013 Online: http://www.rki.de/DE/Content/Kommissionen/STIKO/Aufgaben_Methoden/methoden_node.html last access: 07.03.2013
  PubMedGoogle Scholar
• 2 Robert Koch-Institut (RKI). Epidemiologisches Bulletin 30/2010 (30).
  PubMedGoogle Scholar
• 3 Robert Koch-Institut. Saisonale Influenzaimpfung: Häufig gestellte Fragen und Antworten. Online: http://www.rki.de/SharedDocs/FAQ/Impfen/Influenza/faq_ges.html?nn=2375548 last access: 26.01.2017
  PubMedGoogle Scholar
• 4 Doyle TJ, Goodin K, Hamilton JJ. et al. Maternal and neonatal outcomes among pregnant women with 2009 pandemic influenza A (H1N1) illness in Florida, 2009–2010: a population-based cohort study. PLoS One 2013; 8: e79040
  CrossrefPubMedGoogle Scholar
• 5 Knuf M. Influenzainfektion in der Gravidität. Gynäkologe 2011; 44: 593-600
  CrossrefPubMedGoogle Scholar
• 6 Laibl VR, Sheffield JS. Influenza and pneumonia in pregnancy. Clin Perinatol 2005; 32: 727-738
  CrossrefPubMedGoogle Scholar
• 7 Jamieson DJ, Honein MA, Rasmussen SA. et al. H1N1 2009 influenza virus infection during pregnancy in the USA. Lancet 2009; 374: 451-458
  CrossrefPubMedGoogle Scholar
• 8 Rasmussen SA, Jamieson DJ, Uyeki TM. Effects of influenza on pregnant women and infants. Am J Obstet Gynecol 2012; 207: S3-S8
  CrossrefPubMedGoogle Scholar
• 9 Ortiz JR, Englund JA, Neuzil KM. Influenza vaccine for pregnant women in resource-constrained countries: a review of the evidence to inform policy decisions. Vaccine 2011; 29: 4439-4452
  CrossrefPubMedGoogle Scholar
• 10 Haberg SE, Trogstad L, Gunnes N. et al. Risk of fetal death after pandemic influenza infection or vaccination during pregnancy. N Engl J Med 2013; 368: 333-340
  CrossrefPubMedGoogle Scholar
• 11 Hardy JM, Azarowicz EN, Mannini A. et al. The effect of Asian influenza on the outcome of pregnancy, Baltimore, 1957–1958. Am J Public Health Nations Health 1961; 51: 1182-1188
  CrossrefPubMedGoogle Scholar
• 12 Mosby LG, Rasmussen SA, Jamieson DJ. 2009 pandemic influenza A (H1N1) in pregnancy: a systematic review of the literature. Am J Obstet Gynecol 2011; 205: 10
  CrossrefPubMedGoogle Scholar
• 13 Harris JW. Influenza occurring in pregnant women. JAMA 1919; 72: 978
  CrossrefPubMedGoogle Scholar
• 14 Centers for Disease Control and Prevention (CDC). Maternal and infant outcomes among severely ill pregnant and postpartum women with 2009 pandemic influenza A (H1N1)–United States, April 2009-August 2010. MMWR Morb Mortal Wkly Rep 2011; 60: 1193-1196
  PubMedGoogle Scholar
• 15 Bloom-Feshbach K, Simonsen L, Viboud C. et al. Natality decline and miscarriages associated with the 1918 influenza pandemic: the Scandinavian and United States experiences. J Infect Dis 2011; 204: 1157-1164
  CrossrefPubMedGoogle Scholar
• 16 McNeil SA, Dodds LA, Fell DB. et al. Effect of respiratory hospitalization during pregnancy on infant outcomes. Am J Obstet Gynecol 2011; 204: S54-S57
  CrossrefPubMedGoogle Scholar
• 17 Mendez-Figueroa H, Raker C. et al. Neonatal characteristics and outcomes of pregnancies complicated by influenza infection during the 2009 pandemic. Am J Obstet Gynecol 2011; 204: S58-S63
  PubMedGoogle Scholar
• 18 Yates L, Pierce M, Stephens S. et al. Influenza A/H1N1v in pregnancy: an investigation of the characteristics and management of affected women and the relationship to pregnancy outcomes for mother and infant. Health Technol Assess 2010; 14: 109-182
  PubMedGoogle Scholar
• 19 Bland PB. Influenza in its relation to pregnancy and labor. Am J Obstet Dis Women Child 1919; 79: 184-197
  PubMedGoogle Scholar
• 20 Harris JW. Influenza occurring in pregnant women. JAMA 1919; 72: 978-980
  CrossrefPubMedGoogle Scholar
• 21 Mortimer P. Influenza-related death rates for pregnant women. Emerging Infect Dis J 2006; 12: 1805-1806
  PubMedGoogle Scholar
• 22 Freeman DW, Barno A. Deaths from Asian influenza associated with pregnancy. Am J Obstet Gynecol 1959; 78: 1172-1175
  CrossrefPubMedGoogle Scholar
• 23 DEATHS from Asian influenza, 1957; a report by the Public Health Laboratory Service based on records from hospital and public health laboratories. Br Med J 1958; 1: 915-919
  CrossrefPubMedGoogle Scholar
• 24 Kort BA, Cefalo RC, Baker VV. Fatal influenza A pneumonia in pregnancy. Am J Perinatol 1986; 3: 179-182
  Article in Thieme ConnectPubMedGoogle Scholar
• 25 Kirshon B, Faro S, Zurawin RK. et al. Favourable outcome after amantadine and ribaviron in a pregnancy complicated by influenza pneumonia. J Reprod Med 1988; 33: 399-401
  PubMedGoogle Scholar
• 26 Schoenbaum SC, Weinstein L. Respiratory infection in pregnancy. Clin Obstet Gynecol 1979; 22: 293-300
  CrossrefPubMedGoogle Scholar
• 27 Siston AM, Rasmussen SA, Honein MA. et al. Pandemic 2009 influenza A (H1N1) virus illness among pregnant women in the United States. JAMA 2010; 303: 1517-1525
  CrossrefPubMedGoogle Scholar
• 28 Kelly H, Mercer G, Cheng A. Quantifying the risk of pandemic influenza in pregnancy and indigenous people in Australia in 2009. Euro Surveill 2009; 14: pii:19441
  PubMedGoogle Scholar
• 29 ANZIC Influenza Investigators and Australasian Maternity Outcomes Surveillance System. Critical illness due to 2009 A/H1N1 influenza in pregnant and postpartum women: population based cohort study. BMJ 2010; 340: c1279
  CrossrefPubMedGoogle Scholar
• 30 Jain S, Kamimoto L, Bramley AM. et al. Hospitalized patients with 2009 H1N1 influenza in the United States, April-June 2009. N Engl J Med 2009; 361: 1935-1944
  CrossrefPubMedGoogle Scholar
• 31 Donaldson LJ, Rutter PD, Ellis BM. et al. Mortality from pandemic A/H1N1 2009 influenza in England: public health surveillance study. BMJ 2009; 339: b5213
  CrossrefPubMedGoogle Scholar
• 32 Van Kerkhove MD, Vandemaele KA, Shinde V. et al. Risk factors for severe outcomes following 2009 influenza A (H1N1) infection: a global pooled analysis. PLoS Med 2011; 8: e1001053
  CrossrefPubMedGoogle Scholar
• 33 Mertz D, Geraci J, Winkup J. et al. Pregnancy as a risk factor for severe outcomes from influenza virus infection: a systematic review and meta-analysis of observational studies. Vaccine 2017; 35: 521-528
  CrossrefPubMedGoogle Scholar
• 34 Neuzil KM, Reed GW, Mitchel EF. et al. Impact of influenza on acute cardiopulmonary hospitalizations in pregnant women. Am J Epidemiol 1998; 148: 1094-1102
  CrossrefPubMedGoogle Scholar
• 35 Cox S, Posner SF, McPheeters M. et al. Influenza and pregnant women: hospitalization burden, United States, 1998-2002. J Womens Health (Larchmt) 2006; 15: 891-893
  CrossrefPubMedGoogle Scholar
• 36 Dodds L, McNeil SA, Fell DB. et al. Impact of influenza exposure on rates of hospital admissions and physician visits because of respiratory illness among pregnant women. CMAJ 2007; 176: 463-468
  CrossrefPubMedGoogle Scholar
• 37 Legge A, Dodds L, MacDonald NE. et al. Rates and determinants of seasonal influenza vaccination in pregnancy and association with neonatal outcomes. CMAJ 2014; 186: E157-E164
  CrossrefPubMedGoogle Scholar
• 38 Mak TK, Mangtani P, Leese J. et al. Influenza vaccination in pregnancy: current evidence and selected national policies. Lancet Infect Dis 2008; 8: 44-52
  CrossrefPubMedGoogle Scholar
• 39 Manske JM. Efficacy and effectiveness of maternal influenza vaccination during pregnancy: a review of the evidence. Matern Child Health J 2014; 18: 1599-1609
  CrossrefPubMedGoogle Scholar
• 40 Munoz FM. Safety of influenza vaccines in pregnant women. Am J Obstet Gynecol 2009; 207: S33-S37
  PubMedGoogle Scholar
• 41 Munoz FM, Greisinger AJ, Wehmanen OA. et al. Safety of influenza vaccination during pregnancy. Am J Obstet Gynecol 2005; 192: 1098-1106
  CrossrefPubMedGoogle Scholar
• 42 Omer SB, Goodman D, Steinhoff MC. et al. Maternal influenza immunization and reduced likelihood of prematurity and small for gestational age births: a retrospective cohort study. PLoS Med 2011; 8: e1000441
  CrossrefPubMedGoogle Scholar
• 43 Skowronski DM, De Serres G. Is routine influenza immunization warranted in early pregnancy?. Vaccine 2009; 27: 4754-4770
  CrossrefPubMedGoogle Scholar
• 44 Tamma PD, Ault KA, del Rio C. et al. Safety of influenza vaccination during pregnancy. Am J Obstet Gynecol 2009; 201: 547-552
  CrossrefPubMedGoogle Scholar
• 45 Zaman K, Roy E, Arifeen SE. et al. Effectiveness of maternal influenza immunization in mothers and infants. N Engl J Med 2008; 359: 1555-1564
  CrossrefPubMedGoogle Scholar
• 46 Eick AA, Uyeki TM, Klimov A. et al. Maternal influenza vaccination and effect on influenza virus infection in young infants. Arch Pediatr Adolesc Med 2011; 165: 104-111
  PubMedGoogle Scholar
• 47 WHO. BMI classification. Online: http://apps.who.int/bmi/index.jsp?introPage=intro_3.html last access: 28.03.2017
  PubMedGoogle Scholar
• 48 World Health Organization. Influenza vaccines – WHO position paper. Weekly Epidemiological Record 2005; 33: 279-287
  PubMedGoogle Scholar
• 49 Poethko-Müller C, Schmitz R. Impfstatus von Erwachsenen in Deutschland. Bundesgesundheitsbl 2013; 56: 845-857
  CrossrefPubMedGoogle Scholar
• 50 OʼFlanagan D, Cotter S, Mereckiene J. Seasonal influenza vaccination in EU/EEA, influenza season 2011–12. 2013 Online: http://venice.cineca.org/VENICE%20Seasonal%20Influenza%202011?12%201.0v.pdf last access: 15.11.2013
  PubMedGoogle Scholar
• 51 Böhmer MM. Impfquoten, Impfverhalten und Impfakzeptanz bei Erwachsenen in Deutschland [Dissertation]. Berlin: FU-Berlin; 2013
  PubMedGoogle Scholar
• 52 Robert Koch-Institut. GBE Kompakt – 1/2011 – Grippeschutzimpfung in Deutschland – Ergebnisse der Studie „Gesundheit in Deutschland aktuell“ (GEDA). 2009 Online: http://www.rki.de/DE/Content/Gesundheitsmonitoring/Gesundheitsberichterstattung/GBEDownloadsK/2011_1_Grippeschutzimpfung.html?nn=2531734 last access: 03.02.2011
  PubMedGoogle Scholar
• 53 Bödeker B, Walter D, Reiter S. et al. Cross-sectional study on factors associated with influenza vaccine uptake and pertussis vaccination status among pregnant women in Germany. Vaccine 2014; 32: 4131-4139
  CrossrefPubMedGoogle Scholar
• 54 Advisory Committee on Immunization Practices (ACIP). Morbidity and mortality weekly report. Updated interim influenza vaccination recommendations. 2004–05 Influenza season. Online: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5350a7.htm last access: 16.03.2014
  PubMedGoogle Scholar
• 55 The American College of Obstetricians and Gynecologists. Committee Opinion. (Replaces No. 305, November 2004). 2010. 2010 468: 1–2
  PubMedGoogle Scholar
• 56 Vanessen G, Palache A, Forleo E. et al. Influenza vaccination in 2000: recommendations and vaccine use in 50 developed and rapidly developing countries. Vaccine 2003; 21: 1780-1785
  CrossrefPubMedGoogle Scholar
• 57 Kennedy ED, Ahluwalia IB, Ding H. et al. Monitoring seasonal influenza vaccination coverage among pregnant women in the United States. Am J Obstet Gynecol 2012; 207: S9-S16
  CrossrefPubMedGoogle Scholar
• 58 Centers for Disease Control and Prevention (CDC). Influenza vaccination coverage among pregnant women - 29 Sates and New York City, 2009-10 season. MMWR Morb Mortal Wkly Rep 2012; 61: 113-118
  PubMedGoogle Scholar
• 59 Centers for Disease Control and Prevention (CDC). Influenza vaccination coverage among pregnant women—United States, 2012-13 influenza season. MMWR Morb Mortal Wkly Rep 2013; 62: 787-792
  PubMedGoogle Scholar
• 60 Cedergren MI. Maternal morbid obesity and the risk of adverse pregnancy outcome. Obstet Gynecol 2004; 103: 219-224
  CrossrefPubMedGoogle Scholar
• 61 Sebire NJ, Jolly M, Harris JP. et al. Maternal obesity and pregnancy outcome: a study of 287,213 pregnancies in London. Int J Obes Relat Metab Disord 2001; 25: 1175-1182
  CrossrefPubMedGoogle Scholar
• 62 Eppes C, Wu A, You W. et al. Barriers to influenza vaccination among pregnant women. Vaccine 2013; 31: 2874-2878
  CrossrefPubMedGoogle Scholar
• 63 Centers for Disease Control and Prevention (CDC). Influenza vaccination coverage among pregnant women: 2011-12 influenza season, United States. MMWR Morb Mortal Wkly Rep 2012; 61: 758-763
  PubMedGoogle Scholar
• 64 Wiley KE, Massey PD, Cooper SC. et al. Uptake of influenza vaccine by pregnant women: a cross-sectional survey. Med J Aust 2013; 198: 373-375
  CrossrefPubMedGoogle Scholar
• 65 Yudin MH, Salaripour M, Sgro MD. Pregnant womenʼs knowledge of influenza and the use and safety of the influenza vaccine during pregnancy. J Obstet Gynaecol Can 2009; 31: 120-125
  PubMedGoogle Scholar
• 66 Meyer C, Reiter S. [Vaccine opponents and sceptics. History, background, arguments, interaction]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2004; 47: 1182-1188
  CrossrefPubMedGoogle Scholar
• 67 Riegger A. Pressegespräch anlässlich des 4. Deutschen Influenza-Kongresses. Die Influenza – eine immer währende Bedrohung. Donnerstag, 27. September 2012.
  PubMedGoogle Scholar
• 68 Honkanen PO, Keistinen T, Kivela S. Factors associated with influenza vaccination coverage among the elderly: role of health care personnel. Public Health 1996; 110: 163-168
  CrossrefPubMedGoogle Scholar
• 69 Blank PR, Schwenkglenks M, Szucs TD. Influenza vaccination coverage rates in five European countries during season 2006/07 and trends over six consecutive seasons. BMC Public Health 2008; 8: 272
  CrossrefPubMedGoogle Scholar
• 70 Blank PR, Schwenkglenks M, Szucs TD. Disparities in influenza vaccination coverage rates by target group in five European countries: trends over seven consecutive seasons. Infection 2009; 37: 390-400
  CrossrefPubMedGoogle Scholar
• 71 Wortberg S, Walter D, Knesebeck M. et al. Niedergelassene Ärzte als Multiplikatoren der Influenzaimpfung bei älteren Menschen, chronisch Kranken und medizinischem Personal. Bundesgesundheitsbl 2009; 52: 945-952
  CrossrefPubMedGoogle Scholar
• 72 Maher L, Hope K, Torvaldsen S. et al. Influenza vaccination during pregnancy: coverage rates and influencing factors in two urban districts in Sydney. Vaccine 2013; 31: 5557-5564
  CrossrefPubMedGoogle Scholar
• 73 Taksdal SE, Mak DB, Joyce S. et al. Predictors of uptake of influenza vaccination—a survey of pregnant women in Western Australia. Aust Fam Physician 2013; 42: 582-586
  PubMedGoogle Scholar
• 74 Yuet Sheung Yuen C, Yee Tak Fong D, Lai Yin Lee I. et al. Prevalence and predictors of maternal seasonal influenza vaccination in Hong Kong. Vaccine 2013; 31: 5281-5288
  CrossrefPubMedGoogle Scholar
• 75 eltern.de Schwangerschaft. Grippe-Impfung für werdende Mütter? – Gesundheit & Fitness – Eltern.de. Online: http://www.eltern.de/schwangerschaft/gesundheit-und-fitness/schwangerschaft-grippe-impfung.html last access: 16.03.2014
  PubMedGoogle Scholar
• 76 Forum goFeminin. Grippeimpfung in der Schwangerschaft. 2009 Online: http://forum.gofeminin.de/forum/matern1/__f101941_matern1-Grippeimpfung-in-der-Schwangerschaft.html last access: 16.03.2014
  PubMedGoogle Scholar
• 77 Bödeker B, Seefeld L, Buck S. et al. [Implementation of seasonal influenza and human papillomavirus vaccination recommendations in gynecological practices in Germany]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2016; 59: 396-404
  CrossrefPubMedGoogle Scholar