Health care providers’ recommendations and influenza vaccination during pregnancy: A Québec survey

Abstract

Background: Seasonal influenza is associated with high morbidity and mortality among pregnant women. Inactivated influenza vaccine is recommended for all pregnant women. Our study evaluated health care providers’ compliance with current Québec guidelines and their estimation of vaccine acceptance among the pregnant women they care for. Methods: An electronic survey was distributed to 1,084 health care providers, including general practitioners (GP), obstetrician-gynecologists (OBGYN), midwives, and nurse practitioners (NP), in Québec who followed at least one pregnant woman in the past year and who could be reached by their professional association by email. The survey was available online (via SurveyMonkey) between January 15 and February 15, 2015. Results: A total of 344/1,084 health care providers (32%) answered the survey: 134/250 GPs (54%), 91/497 OBGYNs (18%), 76/186 midwives (40%), and 43/150 NPs (29%). Overall, 60% of participants reported following current recommendations. Provider’s age <40 years old (54% versus 67%; p=0.02), low number of pregnancies followed per year (<50: 35% versus ≥50: 73%; p<0.001), and having a non-academic practice (54% vs 66%; p=0.03) were associated with lower compliance with guidelines. Compliance with vaccination recommendations differed between professions (OBGYNs: 80%, NPs: 72%, GPs: 67%, midwives: 12%; p<0.001). According to participants, about 40% of women accept vaccination when offered, and their reasons for refusing vaccination were mostly efficacy and safety issues. Conclusions: Québec faces major barriers to influenza vaccination of pregnant women: health care professionals report low compliance with guidelines, and they perceive and report that women are reluctant to accept vaccination. Action should be taken to increase vaccination offers by health care workers to pregnant women, with the aim of increasing the influenza immunization rate in this population.