Knowledge about influenza and compliance with the recommendations for influenza vaccination of pregnant women in Greece

Abstract

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.

Vaccinating pregnant women against influenza needs to be a priority for all countries: An expert commentary

“…However, education of HCPs alone is unlikely to be sufficient, as parental vaccine hesitancy also needs to be addressed through specific public awareness campaigns (Healy et al, 2015). The impact of education on vaccination uptake is exemplified by an educational intervention at a large maternity hospital in Greece, where education resulted in an increase in antenatal influenza vaccination rate from below 2% to 20% (Maltezou et al, 2019). Furthermore, a study from Brazil found that maternal acceptance of influenza vaccination in pregnancy improved following a government campaign and HCP endorsements during prenatal visits.…”

“…HCPs recommend vaccination to pregnant women (Wiley et al, 2013;Wilson et al, 2015) Enabling of HCPs through training, reimbursement, and management of workload (Wilson et al, 2015) Pregnant women having face-to-face consultations with HCPs (McCarthy et al, 2015) Internet and text messaging as information sources about influenza vaccination (McCarthy et al, 2015) Education on benefits of antenatal influenza vaccination Improved awareness of maternal immunisation among HCPs who do not traditionally administer vaccinations (Healy et al, 2015;Maltezou et al, 2019) Prenatal vaccine education of expectant mothers (Kfouri Rde and Richtmann, 2013;O'Leary et al, 2019;Vojtek et al, 2018)…”

Admissions due to vaccine preventable diseases in a large paediatric intensive care unit in Greece over a 10‐year period

“…[15][16][17] Nevertheless, vaccination rate of this vulnerable population is low. 15 Additionally, although immunisation of pregnant women against influenza has been recommended according to GNIP since 2008, 18 we recorded seven influenza cases in young infants in 2016-2017 and 2019 which might have been prevented by maternal immunisation. In accordance with our findings, a recent study has shown that knowledge and uptake of influenza vaccine among pregnant women in Greece are poor.…”