Maternal influenza vaccination: Making it a priority

Abstract

Background: Due to physiological and immunological changes, pregnant women are particularly susceptible to some infections (e.g. influenza). Infants (<6 months) can’t be vaccinated against influenza and their underdeveloped immune systems confer vulnerability to infection, they are therefore reliant on maternal antibodies (passed from the mother) for protection. Vaccination against influenza during pregnancy is recommended by national and international regulatory bodies worldwide, including the World Health Organization. Despite the known potential adverse outcomes of influenza during pregnancy, the rate of influenza vaccination uptake is suboptimal. Methods and materials: We reviewed available literature to understand the benefits and risks of vaccinating pregnant women against influenza. We examined the barriers to influenza vaccination uptake during pregnancy and propose solutions to overcome these. Results: It is estimated that influenza affects 11% of women during pregnancy and the risk of severe outcomes requiring hospitalisation are higher compared with non-pregnant women. Influenza during pregnancy may also have negative consequences for the foetus, including pre-term birth and, in the worst cases, mortality. Influenza can be severe in infants (<6 months) and may also result in hospitalisation and death. There is a large body of evidence supporting the effectiveness and safety of influenza immunisation of pregnant women and their foetuses, however national and international recommendations alone aren’t enough to achieve optimal rates of vaccination in this group. Several barriers to vaccination of pregnant women against influenza exist, originating from vaccine manufacturers, healthcare professionals (HCPs), pregnant women or the wider society. HCPs may not be offering influenza vaccination and pregnant women themselves may be unaware of the benefits it can bring. Solutions to these issues include improved regulatory processes, sensitisation of HCPs to the benefits of influenza vaccination in pregnant women and implementation of multichannel campaigns encompassing community and pharmacy awareness, education, social media and more. Conclusion: Influenza infection can be severe in pregnant women and infants. Vaccination of pregnant women has been shown to be effective and well-tolerated but is under prescribed due to a number of factors, including lack of awareness about its benefits. A concerted effort involving multiple stakeholders is needed to increase uptake of influenza vaccine during pregnancy.