Influenza vaccination in pregnant women:

Why do they get or not the shot?

Sacristan M, Alvarez-Pasquin MJ

Eurovaccine, Dec 2010

Introduction- Objectives Pregnancy is a risk group for complicated

influenza. The influenza vaccine is an effective, safe and efficient preventive measure.

However, pregnant women are a “hard to reach group” for influenza vaccination.

Our objective is to compare the rate of influenza vaccination among pregnant women compared to fertile non pregnant women with risk factors, and to describe why pregnant women get or don’t get influenza vaccination.

Material and methods Design: descriptive study using database and survey

Population: 430 women aged 18-45y, from an urban primary care centre in Madrid with risk factors for influenza in 2009. (130 pregnant, 300 not)

Variables demographic characteristics, risk factors, vaccination status, reasons for being vaccinated/not, professional advice received/not, general opinion about vaccination during pregnancy

Statistical analysis: we compared qualitative variables by chi square test. Results of our surveys by descriptive analysis

Results I: vaccination ratesGlobal vaccination rate

15%

85%

VaccinatedwomenNon vaccinatedwomen

Non pregnant

Pregnant

Vaccination rate according to pregnancy status

VaccinatedNon vaccinated

Global vaccination rate: 15%. (8,3% in pregnant, 18,1% in non pregnant)Vaccination rate Ratio (pregnant/not): 0,46 (0,25-0,85) p 0,008

RISK FACTOR TOTAL WOMEN

Vaccinated (%)

Not vaccinated (%)

Pregnancy only 118 6 94

Asthma 132 11.4 88.6

Pregnancy and asthma 5 40 60

Pregnancy and other 11 36.4 63.6

2 risk factors without pregnancy

25 56 44

Respiratory, not asthma

9 11 89

Diabetes 13 53.8 46.2

Cardiovascular 17 0 100

Immunosuppression 29 13.8 86.2

Other chronics 69 13 87

Professional risk 2 100 0

TOTAL 430 15.1 84.9

8,3%/91,7%

18,1%/81,9%

Total women: 430

132

298

Results II: reasons for getting or not the shot

Why these 29 women DID NOT get the shot?

Why these 14 women DID GET the shot?

a = I always get itb = I asked for itc = I was adviced by my doctor/nursed = Information from tv, campaingse = Information from internet

a = I never get itb = I dont need itc = I am afraid of needlesd = I am afraid of secondary effectse = No professional recommended me to get itf = Some professionals recommended me not to get itg = Negative information in tv, campaingsh = Negative information in interneti = I had no timej = I was afraid it could harm my baby

a b c d e f g h i j

a b c d e

5 4 7 0 1

15 6 0 2 11 4 1 2 0 2

Our survey was answered by 43 pregnant women (14 vaccinated, 29 not)

Our survey was answered by 43 pregnant women (14 vaccinated, 29 not)

Results III: professional advice

Professional POSITIVE advice in last 5 years

Professional NEGATIVE advice in last 5 years

12 8

2 21

Vaccination according to professional advice received

Vaccinated

Notvaccinated

With advice

Without advice

Women that had professional advice for vaccination were 6,9 times more vaccinated than those who didn’t received it (1,75-27,2) p=0,001Family doctor

Nurse MidwifeGynecologist

Other doctor

Nobody

Family doctor

NurseMidwife

Gynecologist

Other doctor

Nobody

26

12 5 6 4 4 23

0 0 0 2 3 36

Results IV: general knowledge

General opinion about vaccination during pregnancy

21%

0%

30%5%

44%

Vaccines should generally be avoided during pregnancyVaccines are recommended during pregnancyIt depends. Influenza vaccine is recommendedIt depends. Influenza vaccine should be avoidedI dont know

Discussion

Reasons for not getting the vaccine in our survey coincide with bibliography. Both show lack of advice from gynecologists to pregnant women.

Another important factor is insufficient knowledge among population about immunization and pregnancy.

There is the need for improving knowledge among professionals and general population.

Conclusions

Influenza vaccination rate is generally low in risk groups.

Rate decreases during pregnancy. Pregnant women receive little advice for

vaccination from professionals, specially from gynecologists.

There is little knowledge about recommendations about vaccination during pregnancy.