Coverage and determinants of influenza vaccine among pregnant women: a cross-sectional study

Vittoria Offeddu,George S H Yeo,Lay Kok Tan,Chee Fu Yung,Koh Cheng Thoon,Tze Tein Yong,Nicole Lee,Clarence C Tam,Thiam Chye Tan

doi:10.1186/s12889-019-7172-8

Abstract

BackgroundPregnant women are at increased risk of influenza-related complications. The World Health Organisation recommends influenza vaccination to this high-risk population as highest priority. However, achieving high influenza vaccine coverage among pregnant women remains challenging. We conducted a cross-sectional survey to estimate the coverage and determinants of influenza vaccination among pregnant women in Singapore.MethodsBetween September and November 2017, pregnant women aged ≥21 years were recruited at two public hospitals in Singapore. Participants completed an anonymous, self-administered online questionnaire assessing participants’ influenza vaccination uptake, knowledge of and attitudes towards influenza and the influenza vaccine, vaccination history, willingness to pay for the influenza vaccine, and external cues to vaccination. We estimated vaccine coverage and used multivariable Poisson models to identify factors associated with vaccine uptake.ResultsResponse rate was 61% (500/814). Only 49 women (9.8, 95% Confidence Interval (CI): 7.3–12.7%) reported receiving the vaccine during their current pregnancy. A few misconceptions were identified among participants, such as the belief that influenza can be treated with antibiotics. The most frequent reason for not being vaccinated was lack of recommendation. Women who were personally advised to get vaccinated against influenza during pregnancy were 7 times more likely to be vaccinated (prevalence ratio (PR) = 7.11; 95% CI: 3.92–12.90). However, only 12% of women were personally advised to get vaccinated. Other factors associated with vaccine uptake were vaccination during a previous pregnancy (PR = 2.51; 95% CI: 1.54–4.11), having insurance to cover the cost of the vaccine (PR = 2.32; 95% CI: 1.43–3.76), and higher vaccine confidence (PR = 1.62; 95% CI: 1.30–2.01).ConclusionsInfluenza vaccination uptake among pregnant women in Singapore is low. There is considerable scope for improving vaccination coverage in this high-risk population through vaccination recommendations from healthcare professionals, and public communication targeting common misconceptions about influenza and influenza vaccines.

Highlights

Pregnant women are at increased risk of influenza-related complications
Respondents were comparable to the national population of women giving birth to live children in the same time period in terms of age, women of Chinese ethnicity were under-represented and women of Malay ethnicity were over-represented in our sample
Among 49 women vaccinated during their current pregnancy, about two thirds (63%) were vaccinated at a hospital, while the remainder were vaccinated at a private general practice or polyclinic

Summary

Introduction

Pregnant women are at increased risk of influenza-related complications. Achieving high influenza vaccine coverage among pregnant women remains challenging. We conducted a cross-sectional survey to estimate the coverage and determinants of influenza vaccination among pregnant women in Singapore. Pregnant women [1, 2] and new-borns [3,4,5] are at increased risk of complications from influenza infection. Immunisation with seasonal influenza vaccine during pregnancy is associated with lower incidence of influenza infection among pregnant women [6,7,8,9,10] and their new-borns up to six months of age [6,7,8,9,10,11]. Coverage among other influenza high-risk groups, such as elderly [16] and children under five years [17], is low (< 15%)

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Discussion

Conclusion