Pregnant women and young infants are at increased risk for influenza-associated severe disease, complications and hospitalizations. In Greece influenza vaccination during pregnancy remains extremely low. We studied the knowledge about influenza and the adherence to the recommendations for influenza vaccination of pregnant women following an educational intervention in a large maternity hospital. A standardized questionnaire was used. A knowledge score was calculated for each woman. A total of 304 pregnant women were studied [mean age: 31.5 years (standard deviation (SD): 5.4 years), mean gestational age: 27.8 weeks (SD: 9.6 weeks)]. Their mean knowledge score was 87%. Sixty pregnant women (19.5%) were vaccinated against influenza at a mean gestational age of 24.6 weeks (SD: 7.5 weeks). Multiple regression analysis revealed that previous influenza vaccination and information about the need to get vaccinated were the only significant factors associated with an increased probability for influenza vaccination during pregnancy (47% versus 17% in women with and without a history of influenza vaccination in the past, respectively; odds ratio = 3.6; p-value = 0.016, and 32% versus 4% in women informed compared to those uninformed about the need for vaccination during pregnancy, respectively; odds ratio = 17.8; p-value<0.001). Seventy women provided a reason for refusing influenza vaccination. "Fear of adverse events" (for them or the fetus) was the prevalent reason for refusing influenza vaccination (19 women; 27%), followed by the statements "influenza vaccination is not necessary" (13; 18.5%) and "not at risk to get influenza" (9; 13%). In conclusion, an educational intervention was associated with an influenza vaccination rate of 19.5% among pregnant women compared to <2% the past years. In order to improve vaccine uptake by pregnant women and protect them and their babies, more intensified interventions should be explored.

Purpose: Avian influenza A(H7N9) is considered an important zoonotic pathogen, human cases of which have been increasing in multiple epidemics waves since it was idnetified in 2013. Characterising the temporal pattern of mortality or clinical severity of human infection can identify changes in viral pathogenicity and help inform emergence and pandemic risk assessments. Here, we consider how the severity of A(H7N9) in humans has changed by epidemic wave, after adjusting for demographic and spatial factors, and including cases up to June 2018.Methods & Materials: Using data published by the Hong Kong Centre for Health Protection, the association of epidemic wave with death and being clinically severe (defined as a case being characterised as fatal or critical) was estimated using generalised additive models, adjusting for age, sex and province of cases.Results: We found significant changes in case fatality between waves, but no evidence that the largest epidemic wave (2016-17) was associated with increased mortality compared to previous waves. Mortality was significantly associated with age, with older ages tending to have higher mortality, and with province. The risk of being clinically severe in more recent waves (2015-16 and 2016-17) was significantly lower than during the previous two waves; there was a significant association with age, and significant differences between provinces. Conclusion:We found no evidence of an increase in mortality of human cases of A(H7N9) in the most recent waves, despite a marked increase in the number of cases between 2016 and 2017 and the emergence of a highly pathogenic viral varient, suggesting that the average pathogenicity of the virus has not changed. However, the risk of being a clinically severe case was lower in more recent waves, possibly due to improved clinical care or more rapid diagnosis and treatment.