Coverage and determinants of influenza vaccine among pregnant women: a cross-sectional study

Abstract

Background Pregnant women are at increased risk of influenza-related complications. The World Health Organisation recommends influenza vaccination to this high-risk population as highest priority. However, achieving high influenza vaccine coverage among pregnant women remains challenging. We conducted a cross-sectional survey to estimate the coverage and determinants of influenza vaccination among pregnant women in Singapore. Methods Between September and November 2017, pregnant women aged ≥21 years were recruited at two public hospitals in Singapore. Participants completed an anonymous, self-administered online questionnaire assessing participants’ influenza vaccination uptake, knowledge of and attitudes towards influenza and the influenza vaccine, vaccination history, willingness to pay for the influenza vaccine, and external cues to vaccination. We estimated vaccine coverage and used multivariable Poisson models to identify factors associated with vaccine uptake. Results Response rate was 61% (500/814). Only 49 women (9.8, 95% Confidence Interval (CI): 7.3–12.7%) reported receiving the vaccine during their current pregnancy. A few misconceptions were identified among participants, such as the belief that influenza can be treated with antibiotics. The most frequent reason for not being vaccinated was lack of recommendation. Women who were personally advised to get vaccinated against influenza during pregnancy were 7 times more likely to be vaccinated (prevalence ratio (PR) = 7.11; 95% CI: 3.92–12.90). However, only 12% of women were personally advised to get vaccinated. Other factors associated with vaccine uptake were vaccination during a previous pregnancy (PR = 2.51; 95% CI: 1.54–4.11), having insurance to cover the cost of the vaccine (PR = 2.32; 95% CI: 1.43–3.76), and higher vaccine confidence (PR = 1.62; 95% CI: 1.30–2.01). Conclusions Influenza vaccination uptake among pregnant women in Singapore is low. There is considerable scope for improving vaccination coverage in this high-risk population through vaccination recommendations from healthcare professionals, and public communication targeting common misconceptions about influenza and influenza vaccines. Electronic supplementary material The online version of this article (10.1186/s12889-019-7172-8) contains supplementary material, which is available to authorized users.

Knowledge, attitudes and practices on influenza vaccine during pregnancy in Quito, Ecuador

“…Knowledge about in uenza and vaccination by health workers has an impact on the decisions made regarding the vaccination of their patients and themselves. Studies show that maternal care providers with high levels of knowledge and positive attitudes consistently discuss and recommend in uenza vaccine to their patients in greater proportion than other health providers [30][31][32][33]. Similarly, health professionals who know the national guidelines on in uenza vaccination are more likely to discuss and recommend the vaccine than those who do not know them [34].…”

Knowledge, attitudes and practices on influenza vaccine during pregnancy in Quito, Ecuador

“…Knowledge about in uenza and vaccination by health workers has an impact on the decisions made regarding the vaccination of their patients and themselves. Studies show that maternal care providers with high levels of knowledge and positive attitudes consistently discuss and recommend in uenza vaccine to their patients in greater proportion than other health providers (20,28,39,40). Similarly, health professionals who know the national guidelines on in uenza vaccination are more likely to discuss and recommend the vaccine than those who do not know them (41).…”

Influenza Vaccination Experiences of Pregnant Women as a Predictor of the Intention to Become Vaccinated in Future Pregnancies in Spain

“…This is why, it is important to know and understand the predictors or factors that affect the acceptance of maternal vaccines [ 3 ], as well as to evaluate the mother–fetus repercussions after the immunization itself, as women can have multiple pregnancies and therefore various options for vaccination [ 2 , 4 ].…”

“…[ 10 ]. Faced with the new option of adding new vaccines during pregnancy, it is interesting to know and assess the experiences of women after receiving vaccines and how they perceived the repercussions on their health and the child’s as well [ 4 ]. A key element for the success of a vaccination program is transmitting the future mothers a good opinion about the safety and efficiency of the vaccines, which are the most influential factors when deciding to vaccinate or not [ 11 ].…”

“…Given that women can become pregnant many times during their reproductive cycle, studying their predisposition for receiving or not the influenza vaccine during each pregnancy, as well as the factors that determine their decision, will allow detecting elements that could be improved upon in the coverage of the influenza vaccine. Previous research studies have evaluated the barriers or reasons for not being vaccinated against influenza [ 20 , 21 ], but not many studies have been found that aimed at assessing the intention of the pregnant women to become vaccinated in the future after their previous experience with the influenza vaccine or having suffered from the illness [ 4 ]. Different studies have observed that the advice and recommendations provided by a health professional during pregnancy are key for achieving a good vaccination coverage [ 4 , 11 ].…”