Antigen Specific Vaccine Hesitancy in Pregnancy

Vaccinations in pregnancy are recommended for the potential benefits of preventing severe pertussis disease in newborns and for preventing the impact of influenza on the pregnant woman, her foetus in utero, and the newborn in the first 6 months of life. Pregnancy vaccine coverage studies in Australia suggest that despite the availability of national recommendations and free vaccine, coverage rates are less than optimal, and some women are unaware of the need for vaccine in pregnancy. Thus, an intervention programme was commenced involving education sessions for doctors, the production of videos for antenatal women, and the use of fluorescent stickers on handheld pregnancy records to ensure that obstetric caregivers are reminded of the importance of vaccine. After this, a study was implemented to assess antenatal knowledge of disease importance, knowledge of availability and benefit of vaccine, and the factors that influenced women to accepting pertussis and influenza vaccination in pregnancy.

A cross-sectional survey of postnatal women, aged 18 years and older, was undertaken at public vaccination clinics on the Gold Coast in Queensland, Australia from April to October 2017. Participants completed a brief questionnaire on provided smart tablets, over the phone, or online.

Of the 1,014 women who completed the pertussis questionnaire, 864 had been vaccinated, a vaccine coverage rate of 85.2%. In the multivariate regression analysis, only awareness of the recommendation for pertussis vaccine was important, with this group 27 times more likely to be vaccinated when age education and income were controlled for in the analysis.

Of the 968 women who completed the influenza questionnaire, only 355 had been vaccinated a vaccine coverage rate of 36.7%. A recommendation by a doctor made it 14 times more likely that the mother would receive vaccine.

Reflecting on the findings, the researchers explain the high antenatal pertussis coverage seen in the study in part by pointing to a series of continuing public and social media campaigns across Australia, such as the "Light for Riley" campaign supported by various pro-vaccine organisations. Locally, a short Facebook video made by a vaccine skeptic whose neonate spent 4 weeks in hospital with pertussis after she declined antenatal boosting went viral, achieving over one million hits and being reported around the world.

According to the researchers, the provision of vaccine in hospital antenatal clinics has been critical to improving the coverage rates overall. Previous studies highlighted the improvement in rates when vaccine was available at the time of a recommendation to have it. This, coupled with fluorescent stickers in pregnancy records requiring a signature after completion of the vaccine discussion, ensures few women are unaware of the recommendation.

In contrast, the influenza vaccine coverage was "disappointing". The poor level of recommendations by physicians comes despite education campaigns designed to reach them. Some even actively dissuaded women from receiving the influenza vaccine. The influenza vaccine coverage rate in staff in the "Women's and Children's" network of the local Gold Coast public hospital was 30%, suggesting a strong lack of belief in the benefits of influenza vaccination among this core influencing group.

Perhaps as a result, reviews of public perceptions of influenza vaccine have continuously identified prevailing views of influenza not being an important issue, influenza vaccine not being safe (including giving people influenza infection), and influenza vaccine being ineffective. "Research is required into approaches to altering practitioner attitudes as well as how to alter public perceptions."

The study results will be used to assist altered education strategies for expectant mothers and clinicians in the future to improve vaccination uptakes.