A T Chamberlain1, K Seib2, K A Ault3, E S Rosenberg4, P M Frew5, M Cortés6, E A S Whitney7, R L Berkelman8, W A Orenstein9, S B Omer10. 1. Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, CNR Room 3040Z, Atlanta, GA 30322, USA. Electronic address: allison.chamberlain@emory.edu. 2. Division of Infectious Diseases, School of Medicine, Emory University, 1462 Clifton Rd. NE, Room 446, Atlanta, GA 30322, USA. Electronic address: kseib@emory.edu. 3. Department of Gynecology and Obstetrics, School of Medicine, Emory University, 1365 Clifton Road, Building A, 4th Floor, Atlanta, GA 30322, USA. Electronic address: kault2@kumc.edu. 4. Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, GCR Room 472, Atlanta, GA 30322, USA. Electronic address: esrose2@emory.edu. 5. Department of Medicine, Division of Infectious Diseases, 500 Irvin Court, Decatur, GA 30030, USA. Electronic address: pfrew@emory.edu. 6. Hubert Department of Global Health, Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, GA 30322, USA. Electronic address: marielysse@aol.com. 7. Department of Epidemiology, Rollins School of Public Health, 1518 Clifton Rd. NE, CNR Room 3047, Atlanta, GA 30322, USA. Electronic address: ewhitn2@emory.edu. 8. Department of Epidemiology, Rollins School of Public Health, 1518 Clifton Road NE, CNR Room 3045, Atlanta, GA 30322, USA. Electronic address: rberkel@emory.edu. 9. Division of Infectious Diseases, School of Medicine, Emory University, 1462 Clifton Rd. NE, Room 446, Atlanta, GA 30322, USA. Electronic address: worenst@emory.edu. 10. Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, CNR Room 7017, Atlanta, GA 30322, USA. Electronic address: somer@emory.edu.
Abstract
BACKGROUND: Evidence-based interventions to improve influenza vaccine coverage among pregnant women are needed, particularly among those who remain unvaccinated late into the influenza season. Improving rates of antenatal tetanus, diphtheria and acellular pertussis (Tdap) vaccination is also needed. PURPOSE: To test the effectiveness of a practice-, provider-, and patient-focused influenza and Tdap vaccine promotion package on improving antenatal influenza and Tdap vaccination in the obstetric setting. METHODS: A cluster-randomized trial among 11 obstetric practices in Georgia was conducted in 2012-2013. Intervention practices adopted the intervention package that included identification of a vaccine champion, provider-to-patient talking points, educational brochures, posters, lapel buttons, and iPads loaded with a patient-centered tutorial. Participants were recruited from December 2012-April 2013 and included 325 unvaccinated pregnant women in Georgia. Random effects regression models were used to evaluate primary and secondary outcomes. RESULTS: Data on antenatal influenza and Tdap vaccine receipt were obtained for 300 (92.3%) and 291 (89.5%) women, respectively. Although antenatal influenza and Tdap vaccination rates were higher in the intervention group than the control group, improvements were not significant (For influenza: risk difference (RD)=3.6%, 95% confidence interval (CI): -4.0%, 11.2%; for Tdap: RD=1.3%, 95% CI: -10.7%, 13.2%). While the majority of intervention package components were positively associated with antenatal vaccine receipt, a provider's recommendation was the factor most strongly associated with actual receipt, regardless of study group or vaccine. CONCLUSIONS: The intervention package did not significantly improve antenatal influenza or Tdap vaccine coverage. More research is needed to determine what motivates women remaining unvaccinated against influenza late into the influenza season to get vaccinated. Future research should quantify the extent to which clinical interventions can bolster a provider's recommendation for vaccination. This study is registered with clinicaltrials.gov, study ID NCT01761799.
RCT Entities:
BACKGROUND: Evidence-based interventions to improve influenza vaccine coverage among pregnant women are needed, particularly among those who remain unvaccinated late into the influenza season. Improving rates of antenatal tetanus, diphtheria and acellular pertussis (Tdap) vaccination is also needed. PURPOSE: To test the effectiveness of a practice-, provider-, and patient-focused influenza and Tdap vaccine promotion package on improving antenatal influenza and Tdap vaccination in the obstetric setting. METHODS: A cluster-randomized trial among 11 obstetric practices in Georgia was conducted in 2012-2013. Intervention practices adopted the intervention package that included identification of a vaccine champion, provider-to-patient talking points, educational brochures, posters, lapel buttons, and iPads loaded with a patient-centered tutorial. Participants were recruited from December 2012-April 2013 and included 325 unvaccinated pregnant women in Georgia. Random effects regression models were used to evaluate primary and secondary outcomes. RESULTS: Data on antenatal influenza and Tdap vaccine receipt were obtained for 300 (92.3%) and 291 (89.5%) women, respectively. Although antenatal influenza and Tdap vaccination rates were higher in the intervention group than the control group, improvements were not significant (For influenza: risk difference (RD)=3.6%, 95% confidence interval (CI): -4.0%, 11.2%; for Tdap: RD=1.3%, 95% CI: -10.7%, 13.2%). While the majority of intervention package components were positively associated with antenatal vaccine receipt, a provider's recommendation was the factor most strongly associated with actual receipt, regardless of study group or vaccine. CONCLUSIONS: The intervention package did not significantly improve antenatal influenza or Tdap vaccine coverage. More research is needed to determine what motivates women remaining unvaccinated against influenza late into the influenza season to get vaccinated. Future research should quantify the extent to which clinical interventions can bolster a provider's recommendation for vaccination. This study is registered with clinicaltrials.gov, study ID NCT01761799.
Authors: A T Chamberlain; R J Limaye; S T O'Leary; P M Frew; S E Brewer; C I Spina; M K Ellingson; M Z Dudley; W A Orenstein; M A Donnelly; L E Riley; K A Ault; D A Salmon; S B Omer Journal: Vaccine Date: 2019-04-05 Impact factor: 3.641
Authors: Paula M Frew; Laura A Randall; Fauzia Malik; Rupali J Limaye; Andrew Wilson; Sean T O'Leary; Daniel Salmon; Meghan Donnelly; Kevin Ault; Matthew Z Dudley; Vincent L Fenimore; Saad B Omer Journal: Hum Vaccin Immunother Date: 2018-02-15 Impact factor: 3.452
Authors: Jennifer L Kriss; Paula M Frew; Marielysse Cortes; Fauzia A Malik; Allison T Chamberlain; Katherine Seib; Lisa Flowers; Kevin A Ault; Penelope P Howards; Walter A Orenstein; Saad B Omer Journal: Vaccine Date: 2017-02-16 Impact factor: 3.641
Authors: Paula M Frew; Jennifer L Kriss; Allison T Chamberlain; Fauzia Malik; Yunmi Chung; Marielysse Cortés; Saad B Omer Journal: Hum Vaccin Immunother Date: 2016-08-02 Impact factor: 3.452
Authors: Mallory K Ellingson; Matthew Z Dudley; Rupali J Limaye; Daniel A Salmon; Sean T O'Leary; Saad B Omer Journal: Expert Rev Vaccines Date: 2019-01-28 Impact factor: 5.217
Authors: Allison T Chamberlain; Katherine Seib; Kevin A Ault; Eli S Rosenberg; Paula M Frew; Marielysse Cortes; Ellen A S Whitney; Ruth L Berkelman; Walter A Orenstein; Saad B Omer Journal: Hum Vaccin Immunother Date: 2016-04-15 Impact factor: 3.452
Authors: Nora B Henrikson; Melissa L Anderson; Douglas J Opel; John Dunn; Edgar K Marcuse; David C Grossman Journal: Public Health Rep Date: 2017-06-06 Impact factor: 2.792