Factors Associated with Intention to Receive Influenza and Tetanus, Diphtheria, and Acellular Pertussis (Tdap) Vaccines during Pregnancy: A Focus on Vaccine Hesitancy and Perceptions of Disease Severity and Vaccine Safety

PLOS Currents: Outbreaks, Feb 2015

BACKGROUND: Improving influenza and tetanus, diphtheria and acellular pertussis (Tdap) vaccine coverage among pregnant women is needed. PURPOSE: To assess factors associated with intention to receive influenza and/or Tdap vaccinations during pregnancy with a focus on perceptions of influenza and pertussis disease severity and influenza vaccine safety. METHODS: Participants were 325 pregnant women in Georgia recruited from December 2012 - April 2013 who had not yet received a 2012/2013 influenza vaccine or a Tdap vaccine while pregnant. Women completed a survey assessing influenza vaccination history, likelihood of receiving antenatal influenza and/or Tdap vaccines, and knowledge, attitudes and beliefs about influenza, pertussis, and their associated vaccines. RESULTS: Seventy-three percent and 81% of women believed influenza and pertussis, respectively, would be serious during pregnancy while 87% and 92% believed influenza and pertussis, respectively, would be serious to their infants. Perception of pertussis severity for their infant was strongly associated with an intention to receive a Tdap vaccine before delivery (p=0.004). Despite perceptions of disease severity for themselves and their infants, only 34% and 44% intended to receive antenatal influenza and Tdap vaccines, respectively. Forty-six percent had low perceptions of safety regarding the influenza vaccine during pregnancy, and compared to women who perceived the influenza vaccine as safe, women who perceived the vaccine as unsafe were less likely to intend to receive antenatal influenza (48% vs. 20%; p < 0.001) or Tdap (53% vs. 33%; p < 0.001) vaccinations. CONCLUSIONS: Results from this baseline survey suggest that while pregnant women who remain unvaccinated against influenza within the first three months of the putative influenza season may be aware of the risks influenza and pertussis pose to themselves and their infants, many remain reluctant to receive influenza and Tdap vaccines antenatally. To improve vaccine uptake in the obstetric setting, our findings support development of evidence-based vaccine promotion interventions which emphasize vaccine safety during pregnancy and mention disease severity in infancy.

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Factors Associated with Intention to Receive Influenza and Tetanus, Diphtheria, and Acellular Pertussis (Tdap) Vaccines during Pregnancy: A Focus on Vaccine Hesitancy and Perceptions of Disease Severity and Vaccine Safety

February Factors Associated with Intention to Receive Influenza and Tetanus, Diphtheria, and Acellular Pertussis (Tdap) Vaccines during Pregnancy: A Focus on Vaccine Hesitancy and Perceptions of Disease Severity and Vaccine Safety BACKGROUND: Improving influenza and tetanus, diphtheria and acellular pertussis (Tdap) vaccine coverage among pregnant women is needed. PURPOSE: To assess factors associated with intention to receive influenza and/or Tdap vaccinations during pregnancy with a focus on perceptions of influenza and pertussis disease severity and influenza vaccine safety. METHODS: Participants were 325 pregnant women in Georgia recruited from December 2012 - April 2013 who had not yet received a 2012/2013 influenza vaccine or a Tdap vaccine while pregnant. Women completed a survey assessing influenza vaccination history, likelihood of receiving antenatal influenza and/or Tdap vaccines, and knowledge, attitudes and beliefs about influenza, pertussis, and their associated vaccines. RESULTS: Seventy-three percent and 81% of women believed influenza and pertussis, respectively, would be serious during pregnancy while 87% and 92% believed influenza and pertussis, respectively, would be serious to their infants. Perception of pertussis severity for their infant was strongly associated with an intention to receive a Tdap vaccine before delivery (p=0.004). Despite perceptions of disease severity for themselves and their infants, only 34% and 44% intended to receive antenatal influenza and Tdap vaccines, respectively. Forty-six percent had low perceptions of safety regarding the influenza vaccine during pregnancy, and compared to women who perceived the influenza vaccine as safe, women who perceived the vaccine as unsafe were less likely to intend to receive antenatal influenza (48% vs. 20%; p < 0.001) or Tdap (53% vs. 33%; p < 0.001) vaccinations. CONCLUSIONS: Results from this baseline survey suggest that while pregnant women who remain unvaccinated against influenza within the first three months of the putative influenza season may be aware of the risks influenza and pertussis pose to themselves and their infants, many remain reluctant to receive influenza and Tdap vaccines antenatally. To improve vaccine uptake in the obstetric setting, our findings support development of evidence-based vaccine promotion interventions which emphasize vaccine safety during pregnancy and mention disease severity in infancy. The article is part of the PLOS Currents Outbreaks “Vaccine Hesitancy Collection“. - Allison Chamberlain, Katherine Seib, Paula Frew, Marielysse Cortés, Ellen Whitney, Ruth Berkelman, and Saad Omer were supported by the Centers for Disease Control and Prevention (CDC), grant # 5P01TP000300 and supplemental funding from the Rollins School of Public Health for their work on this project. Introduction Respiratory infections like influenza and pertussis during pregnancy can pose serious risks to mother and infant.1,2,3,4,5,6,7,8 Pregnant women are at increased risk of complications from influenza, and infants are not recommended to receive an influenza vaccine until 6 months of age.9 For pertussis, infants under 2 months of age, prior to the recommended age for vaccination, have the highest rates of hospitalization and death.10 Antenatal vaccination against these diseases not only protects mothers, but studies have suggested protection can be conferred to infants through maternal-fetal transfer of antibodies through the placenta.12,13 Influenza vaccination during pregnancy can also protect against adverse fetal outcomes like preterm birth and small for gestational age as well as respiratory illnesses during infancy.14,15 Antenatal influenza vaccination recommendations have been in place since the 1960’s16 , and in the U.S., the Centers for Disease Control and Prevention (CDC) began recommending tetanus, diphtheria, and acellular pertussis (Tdap) vaccination during pregnancy, preferably in the third or late second trimester, in 2011.17 Based on previous research among pregnant women and healthy adults, both vaccines are considered safe during pregnancy.18,19,20,21,22,23,24 Despite CDC recommendations, coverage estimates for both vaccines remain suboptimal in the U.S. The influenza vaccine coverage rate estimated by CDC among pregnant women is the U.S. for the 2012 – 2013 season was 50.5%, and while coverage rates for antenatal Tdap vaccination are not yet available, estimates range between 2.6% – 10% (CDC, unpublished data, 2012). Vaccinating pregnant women is a challenge. Studies exploring barriers to vaccinating women in the obstetric setting suggest that logistic barriers such as lack of storage space, knowledge gaps regarding vaccine safety or vaccine recommendations, and vaccine hesitancy all contribute to immunization decision-making.25 The aim of this descriptive analysis is to identify factors associated with an intention to receive influenza and/or Tdap vaccines during pregnancy among women who (...truncated)


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Allison T. Chamberlain, Katherine Seib, Kevin A. Ault, Walter A. Orenstein, Paula M. Frew, Fauzia Malik, Marielysse Cortés, Pat Cota, Ellen A. S. Whitney, Lisa C. Flowers, Ruth L. Berkelman, Saad B. Omer. Factors Associated with Intention to Receive Influenza and Tetanus, Diphtheria, and Acellular Pertussis (Tdap) Vaccines during Pregnancy: A Focus on Vaccine Hesitancy and Perceptions of Disease Severity and Vaccine Safety, PLOS Currents: Outbreaks, 2015, DOI: 10.1371/currents.outbreaks.d37b61bceebae5a7a06d40a301cfa819