Valerie W Y Wong1, Kris Y W Lok2, Marie Tarrant2. 1. School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region. Electronic address: valw@connect.hku.hk. 2. School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region.
Abstract
BACKGROUND: Pregnant women and their infants under 6 months of age infected with influenza have a high risk of serious morbidity and mortality. Influenza vaccine during pregnancy offers 3-for-1 benefits to pregnant women, fetuses and newborn infants. Current vaccination uptake rates during pregnancy, however, are often lower than other high-risk groups and the general population. METHODS: We systematically reviewed evidence on the effectiveness of interventions to improve influenza vaccination coverage in pregnant women. Risk differences (RDs) were calculated from the included studies. RESULTS: Eleven studies were included in the review, of which four were randomized controlled trials (RCTs). Three cohort studies assessed provider-focused interventions while four RCTs and one cohort study evaluated pregnant women-focused interventions. Two cohort studies and a prospective intervention study assessed the effectiveness of bundled interventions. No study solely assessed the effectiveness of interventions to enhance access to influenza vaccination. One moderate quality RCT showed that an influenza pamphlet, with or without a verbalized benefit statement, improved the vaccination rate (RD=0.26; RD=0.39). The other reviewed RCTs showed discordant results, with RDs ranging from -0.15 to 0.03. Although all observational studies significantly improved vaccination rates (RDs ranged from 0.03 to 0.44), the quality of the evidence varied. CONCLUSIONS: There is a lack of effective interventions to increase the influenza vaccination rate in pregnant women. Based on the existing research, we recommend that clinicians provide influenza pamphlets to pregnant women with a verbalized statement about the benefits of influenza vaccine to newborns. Further high-quality RCTs are needed to develop successful maternal influenza vaccination programs. Increased clarity in reporting the content of interventions would help to improve the comparability and generalizability of the published studies.
BACKGROUND: Pregnant women and their infants under 6 months of age infected with influenza have a high risk of serious morbidity and mortality. Influenza vaccine during pregnancy offers 3-for-1 benefits to pregnant women, fetuses and newborn infants. Current vaccination uptake rates during pregnancy, however, are often lower than other high-risk groups and the general population. METHODS: We systematically reviewed evidence on the effectiveness of interventions to improve influenza vaccination coverage in pregnant women. Risk differences (RDs) were calculated from the included studies. RESULTS: Eleven studies were included in the review, of which four were randomized controlled trials (RCTs). Three cohort studies assessed provider-focused interventions while four RCTs and one cohort study evaluated pregnant women-focused interventions. Two cohort studies and a prospective intervention study assessed the effectiveness of bundled interventions. No study solely assessed the effectiveness of interventions to enhance access to influenza vaccination. One moderate quality RCT showed that an influenza pamphlet, with or without a verbalized benefit statement, improved the vaccination rate (RD=0.26; RD=0.39). The other reviewed RCTs showed discordant results, with RDs ranging from -0.15 to 0.03. Although all observational studies significantly improved vaccination rates (RDs ranged from 0.03 to 0.44), the quality of the evidence varied. CONCLUSIONS: There is a lack of effective interventions to increase the influenza vaccination rate in pregnant women. Based on the existing research, we recommend that clinicians provide influenza pamphlets to pregnant women with a verbalized statement about the benefits of influenza vaccine to newborns. Further high-quality RCTs are needed to develop successful maternal influenza vaccination programs. Increased clarity in reporting the content of interventions would help to improve the comparability and generalizability of the published studies.
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: 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: Mark G Thompson; Min Z Levine; Silvia Bino; Danielle R Hunt; Tareq M Al-Sanouri; Eric A F Simões; Rachael M Porter; Holly M Biggs; Lionel Gresh; Artan Simaku; Illham Abu Khader; Veronica L Tallo; Jennifer K Meece; Meredith McMorrow; Edelwisa S Mercado; Sneha Joshi; Nicholas P DeGroote; Iris Hatibi; Felix Sanchez; Marilla G Lucero; Samir Faouri; Stacie N Jefferson; Numila Maliqari; Angel Balmaseda; Diozele Sanvictores; Crystal Holiday; Cristina Sciuto; Zachary Owens; Eduardo Azziz-Baumgartner; Aubree Gordon Journal: Lancet Child Adolesc Health Date: 2019-09-03