Improving rates of maternal immunization: Challenges and opportunities

Abstract

Objectives: An increasing number of vaccines are recommended or are being developed for use during pregnancy to protect women, fetuses, and/or newborns. For vaccines that are already recommended, vaccine uptake is variable and well below desired target. We reviewed the literature related to factors that affect a healthcare provider's recommendation and a woman's willingness to be vaccinated during pregnancy. Design: A scoping review of published literature from 2005 to 2015 was undertaken and all relevant articles were abstracted, summarized, and organized thematically. Results: Barriers and facilitators were identified that either decreased or increased the likelihood of a healthcare provider offering and a pregnant woman accepting vaccination during pregnancy. Concern about the safety of vaccines given during pregnancy was the most often cited barrier among both the public and healthcare providers. Other barriers included doubt about the effectiveness of the vaccine, lack of knowledge about the burden of disease, and not feeling oneself to be at risk of the infection. Major facilitators for maternal immunization included specific safety information about the vaccine in pregnant women, strong national recommendations, and healthcare providers who both recommended and provided the vaccine to their patients. Systems barriers such as inadequate facilities and staffing, vaccine purchase and storage, and reimbursement for vaccination were also cited. Evidence-based interventions were few, and included text messaging reminders, chart reminders, and standing orders. Conclusions: In order to have an effective vaccination program, improvements in the uptake of recommended vaccines during pregnancy are needed. A maternal immunization platform is required that normalizes vaccination practice among obstetrical care providers and is supported by basic and continuing education, communication strategy, and a broad range of research.

Antenatal vaccination against Group B streptococcus: attitudes of pregnant women and healthcare professionals in the UK towards participation in clinical trials and routine implementation

“…However, a significant number of women reported they had not been offered information and fears persist about the perceived risk of miscarriage or harm to the baby. Similar concerns have been highlighted in other studies exploring attitudes to maternal immunization, among different populations such as in the USA and Australia . Our data suggest that emphasizing the protection for the baby and the potential severity of the infections, rather than benefit for mother or protection from a common illness, could be more effective at promoting vaccine uptake.…”

Maternal immunization: where are we now and how to move forward?

“…Also, 67% of the midwives reported that they would welcome better access to evidence of effectiveness. Similar findings were reported by other studies [110]. Lack of knowledge about disease risks and vaccine safety and efficacy was also frequently cited as barriers by pregnant women, which underscores the need for clearer education in this area [110].…”

Influenza and pertussis vaccination of women during pregnancy in Victoria, 2015–2017

“…Commencing antenatal care late was associated with lower coverage, and recommendations by health care providers have a strong influence on the likelihood of vaccination during pregnancy. 23 Further, we found that GP-led care was associated with higher rates of vaccination than obstetrician-led care, possibly reflecting the expertise of GPs in delivering a range of vaccines. It may also indicate attitudinal, logistic or other barriers to obstetricians offering vaccines, such as the lack of systems and processes for their ordering or storing vaccines.…”

“…Our results suggest several steps for improving vaccination coverage among pregnant women (Box 6). Commencing antenatal care late was associated with lower coverage, and recommendations by health care providers have a strong influence on the likelihood of vaccination during pregnancy . Further, we found that GP‐led care was associated with higher rates of vaccination than obstetrician‐led care, possibly reflecting the expertise of GPs in delivering a range of vaccines.…”