Abstract
BackgroundIn Germany, antenatal influenza vaccination is recommended since 2010, but uptake remains low. Several countries recently introduced antenatal pertussis vaccination, which is currently under consideration in Germany. We conducted a survey among gynaecologists on attitudes, practices and barriers regarding influenza and pertussis vaccination during pregnancy.MethodsGynaecologists were invited to complete a pre-tested, 24-item questionnaire published in the German Professional Association of Gynaecologists’ journal in September 2017 within 2 months. Associations between variables were examined using Chi-Squared, Fischer’s Exact or t-tests. Variables associated with gynaecologists’ self-reported implementation of vaccination in pregnant women were identified using univariate and multivariate logistic regression analyses.ResultsOf 867 participants (response 11%), 91.4 and 59.4% reported currently vaccinating pregnant women against influenza and pertussis, respectively. Gynaecologists who reported obtaining annual influenza vaccination and actively informing their patients about these vaccinations were significantly more likely to vaccinate pregnant women against influenza (96.5% vs. 65.7 and 95.1% vs. 62.2%) and pertussis (63.1% vs. 44.3 and 82.4% vs. 12.9%). Performing influenza vaccination was least likely among gynaecologists who perceived logistical difficulties as a vaccination barrier (35.9%), while pertussis vaccination was least likely if the lacking official recommendation (32.0%), logistical difficulties (27.1%), safety concerns (17.5%) and limited vaccine effectiveness (11.1%) were perceived as barriers. Of participants not yet vaccinating pregnant women against pertussis, 86.5% reported they would follow an official recommendation. Including vaccination recommendations in the maternity record (95.2%) and informing the public (88.7%) and health care professionals (86.6%) were considered the most suitable measures to achieve high pertussis vaccination coverage.ConclusionsThe large proportion reporting performance of influenza vaccination during pregnancy and high acceptance of a potential recommendation for pertussis vaccination reflected positive attitudes towards vaccination among participants. However, factors associated with failure to vaccinate may be more prevalent among non-participants. Results suggest that gynaecologists’ confidence in vaccination is crucial for implementing vaccination in pregnancy. Thus, doubts on vaccine effectiveness and safety should be allayed among gynaecologists and pregnant women via various communication channels, and solutions for logistical barriers sought. Including antenatal vaccination recommendations in the maternity record would serve as an important reminder for both groups.
Highlights
In Germany, antenatal influenza vaccination is recommended since 2010, but uptake remains low
We asked about possible vaccination barriers and what measures gynaecologists might consider effective for achieving high pertussis vaccination coverage in pregnant women in case of a Standing Committee on Vaccination (STIKO) recommendation
Compared to all privately practicing gynaecologists registered with the German Medical Association (BÄK), a higher proportion of survey participants was female, aged 50–59 years and from eastern federal states; a lower proportion was 60 years or older and from western federal states (Table 1)
Summary
In Germany, antenatal influenza vaccination is recommended since 2010, but uptake remains low. A recent review of randomized clinical trials found evidence that maternal vaccination reduced the incidence of laboratory confirmed influenza both in mothers and their infants [9]. Despite these benefits, according to the most recent data available from Germany, influenza vaccination uptake remained low at 11 to 23% in women who were pregnant during the influenza seasons of 2012/13 and 2013/14 [10,11,12,13]. This was similar to the 24% median vaccination coverage for the influenza season 2014/15 among eight reporting EU member states, but lower to the reported coverage in the United Kingdom (44–56%) [14]
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