An evaluation of an influenza vaccination campaign targeting pregnant women in 27 clinics in two provinces of South Africa, 2015 – 2018

Abstract

Introduction Despite prioritization, routine antenatal influenza vaccine coverage is < 16% in South Africa. We aimed to describe maternal influenza vaccine coverage in 27 antenatal clinics (ANCs) in Gauteng and Western Cape (WC) Provinces, where in collaboration with the Department of Health (DoH), we augmented the annual influenza vaccination programme among pregnant women. Methods From 2015 through 2018, 40,230 additional doses of influenza vaccine were added to the available stock and administered as part of routine antenatal care. Educational talks were given daily and data were collected on women attending ANCs. We compared characteristics of vaccinated and unvaccinated women using multivariable logistic regression. Results We screened 62,979 pregnant women during the period when Southern Hemisphere influenza vaccines were available (27,068 in Gauteng and 35,911 in WC). Vaccine coverage at the targeted clinics was 78.7% (49,355/62682), although pregnant women in WC were more likely to be vaccinated compared to those in the Gauteng (Odds ratio (OR) =3.7 p < 0.001). Women aged 25—29 and > 35 years were less likely to be vaccinated than women aged 18—24 years (OR = 0.9 p = 0.053; OR = 0.9 p < 0.001). HIV positive status was not associated with vaccination (OR = 1.0 p = 0.266). Reasons for not vaccinating included: vaccine stock-outs where ANCs depleted available stock of vaccines and/or were awaiting delivery of vaccines (54.6%, 6949/12723), refusal/indecision (25.8%, 3285), and current illness that contraindicated vaccination (19.6%, 2489). Conclusion Antenatal vaccination uptake was likely improved by the increased vaccine supply and vaccine education offered during our campaign.

Sharp increase in influenza A infections in Limpopo: A call for increased influenza vaccinations

“…[2] South Africa's influenza season typically occurs during the winter months (~May September). [3] The 2021 influenza season coincided with the country's third COVID 19 epidemic wave, raising the possibility of intersecting incidences of COVID19 and influenza. Influenza and COVID19 infections cause similar symptoms, yet have vastly different treatment and management approaches.…”

Maternal vaccination: A narrative review

“…5,7,26 Pregnant women are at an increased risk for severe illness from COVID-19 compared to age-matched women who are not pregnant. 5,19,26 Severe illness includes an increased risk of respiratory failure, requiring hospitalisation, intensive care unit admissions and mechanical ventilation, or illness that results in death. 5,19,26 Pregnant women are also at increased risk for stillbirths and preterm labour and in some cases, thrombotic events and pre-eclampsia.…”

“…However, recent studies have shown that dedicated antenatal influenza vaccination campaigns in selected sites in SA can reduce the severity of influenza while remaining cost-effective. 19 , 20 …”

“… 5 , 19 , 26 Severe illness includes an increased risk of respiratory failure, requiring hospitalisation, intensive care unit admissions and mechanical ventilation, or illness that results in death. 5 , 19 , 26 Pregnant women are also at increased risk for stillbirths and preterm labour and in some cases, thrombotic events and pre-eclampsia. 37 These high rates of maternal and perinatal complications associated with COVID-19 infections highlight the need for strategies to minimise risks.…”

“…1,2 Vaccination uptake by pregnant women has varied greatly worldwide, with rates of < 16% in low-income countries (LICs) to levels of up to 90% for some vaccines in high-income countries (HICs). 2,4 Maternal vaccination rates in developing countries declined greatly during the coronavirus disease 2019 (COVID- 19) pandemic, possibly because of the lack of vaccine supplies, restricted population movements due to the lockdown and health facilities concentrating on providing emergency services. 4 baby in the first few months of life through placental transfer of neutralising antibodies (immunoglobulin G [IgG]) and/or immunoglobulin A (IgA) antibodies through breast milk, conferring passive immunity on the newborn during the first few months of life.…”