Knowledge,attitudes and beliefs related to seasonal influenza vaccine among pregnant women in Thailand

BackgroundIn 2009, Thailand recommended pregnant women be prioritized for influenza vaccination. Vaccine uptake among Thai pregnant women is lower than other high-risk groups.MethodsDuring December 2012–April 2013, we conducted a cross-sectional survey of a convenience sample of Thai pregnant women aged ≥15 years attending antenatal clinics at public hospitals in 8 of 77 provinces. A self-administered questionnaire covered knowledge, attitudes, and beliefs related to influenza vaccination using the Health Belief Model. We examined factors associated with willingness to be vaccinated using log-binomial regression models.ResultsThe survey was completed by 1031 (96%) of 1072 pregnant women approached. A total of 627 (61%) women had heard about influenza vaccine and were included in the analysis, of whom 262 (42%) were willing to be vaccinated, 155 (25%) had received a healthcare provider recommendation for influenza vaccination and 25 (4%) had received the influenza vaccine during the current pregnancy. In unadjusted models, high levels of perceptions of susceptibility (prevalence ratio [PR] 1.5, 95% CI 1.2–2.0), high levels of belief in the benefits of vaccination (PR 2.3, 95% CI 1.7–3.1), moderate (PR 1.7, 95% CI 1.2–2.3) and high (PR 3.4, 95% CI 2.6–4.5) levels of encouragement by others to be vaccinated (i.e., cues to action) were positively associated with willingness to be vaccinated. Moderate (PR 0.5, 95% CI 0.4–0.7) and high levels of (PR 0.5, 95% CI 0.4–0.8) perceived barriers were negatively associated with willingness to be vaccinated. In the final adjusted model, only moderate (PR 1.5, 95% CI 1.1–2.0) and high levels of cues to action (PR 2.7, 95% CI 2.0–3.6) were statistically associated with willingness to be vaccinated.ConclusionCues to action were associated with willingness to be vaccinated and can be used to inform communication strategies during the vaccine campaign to increase influenza vaccination among Thai pregnant women.     

Identifying ways to increase seasonal influenza vaccine uptake among pregnant women in China: A qualitative investigation of pregnant women and their obstetricians

BackgroundPregnant women are at higher risk for complications from influenza infection. Nevertheless, seasonal influenza vaccination among pregnant women in China is low. A better understanding of perceptions of pregnant women and their physicians, and factors influencing decisions about receiving seasonal influenza vaccine could be used to develop effective strategies for improving seasonal influenza vaccine uptake during pregnancy.MethodsWe recruited pregnant women from 9 hospitals located in 5 cities across China to participate in focus group interviews. Obstetricians from the same hospitals were recruited for one on one in-depth interviews. We collected information about perceptions of barriers and motivating factors for utilizing seasonal influenza vaccine during pregnancy. We systematically analyzed the information using qualitative methods.ResultsWe conducted 18 focus groups with 108 pregnant women and interviewed 18 obstetricians. Awareness about the use of influenza vaccine during pregnancy was minimal in both subject groups. None of the pregnant women had received influenza vaccine during pregnancy and none of the obstetricians had recommended influenza vaccine for their patients. Both groups noted insufficient knowledge about influenza infection and benefits of the vaccine, concerns about vaccine safety, and lack of local data related to vaccine use in Chinese pregnant women. Obstetricians cited the lack of a national policy as a major barrier to recommending seasonal influenza vaccine to pregnant women. Pregnant women cited not receiving a recommendation for vaccination from healthcare workers as an additional barrier.ConclusionOur findings highlight the immediate need to increase awareness and knowledge about the risks of influenza infection and the benefits and safety of seasonal influenza vaccination among both pregnant women and obstetricians in China. Obstetricians interviewed stated that the development and implementation of a national policy prioritizing pregnant women for seasonal influenza vaccination would facilitate their willingness to recommend seasonal influenza vaccine to pregnant women.     

Safety and immunogenicity of seasonal trivalent inactivated influenza vaccines in pregnant women

BackgroundIn the United States, seasonal inactivated influenza vaccine (IIV) is recommended for pregnant women; however, in early 2009, immunization rates were low, partly due to limited prospective data and concerns about vaccine safety.ObjectiveWe conducted a randomized study of two licensed seasonal trivalent IIVs (IIV3) to assess their safety and immunogenicity in pregnant women.Study DesignIn this prospective, randomized clinical study, 100 pregnant women, 18–39 years of age and ≥14 weeks gestation received a single intramuscular dose of 2008–2009 Fluzone® or Fluarix®. Injection site and systemic reactions were recorded for 7 days after vaccination and serious adverse events (SAEs) and pregnancy outcomes were documented. Serum samples collected before and 28 days after vaccination were tested for hemagglutination inhibition (HAI) antibody levels.ResultsThe majority of the injection site and systemic reactions were mild and self-limited after both vaccines. No fever ≥100 °F was reported. There were no vaccine-associated SAEs. Immune responses to influenza vaccine antigens were similar for the two study vaccines, with robust HAI responses against influenza A strains, and relatively lower responses for influenza B strains.ConclusionSeasonal inactivated influenza vaccines were well tolerated and immunogenic in pregnant women.

• ClinicalTrials.gov identifier NCT00905125.

Synopsis: In this prospective clinical trial, we demonstrated that immunization with seasonal trivalent, inactivated influenza vaccine in the second and third trimester of pregnancy is immunogenic and safe.     

COVID-19 vaccine decision-making among pregnant and lactating women in Bangladesh

Pregnant and lactating women’s vaccine decision-making process is influenced by many factors. Pregnant women were at increased risk for severe disease and poor health outcomes from COVID-19 at various time points during the pandemic. COVID-19 vaccines have been found to be safe and protective during pregnancy and while breastfeeding. In this study, we sought to examine key factors that informed the decision-making process among pregnant and lactating women in Bangladesh. We conducted 24 in-depth interviews, with 12 pregnant and 12 lactating women. These women were from three communities in Bangladesh: one urban community, and two rural communities. We used a grounded theory approach to identify emerging themes and organized emerging themes using a socio-ecological model. The socio-ecological model suggests that individuals are influenced by many levels, including individual-level influences, interpersonal-level influences, health care system-level influences, and policy-level influences. We found key factors at each socio-ecological level that influenced the decision-making process of pregnant and lactating women, including perceived benefits of vaccines and vaccine safety (individual-level), the influence of husbands and peers (interpersonal-level), health care provider recommendations and vaccine eligibility (health care system-level), and vaccine mandates (policy-level). As vaccination can reduce the effect of COVID-19 disease in mothers, infants, and unborn children, targeting critical factors that inform the decision-making process is paramount for improving vaccine acceptance. We hope the results of this study will inform vaccine acceptance efforts to ensure that pregnant and lactating women take advantage of this life-saving intervention.     

Knowledge and attitudes towards influenza and influenza vaccination among pregnant women in Kenya

BackgroundInfluenza vaccination during pregnancy benefits mothers and children. Kenya and other low- and middle-income countries have no official influenza vaccination policies to date but are moving towards issuing such policies. Understanding determinants of influenza vaccine uptake during pregnancy in these settings is important to inform policy decisions and vaccination rollout.MethodsWe interviewed a convenience sample of women at antenatal care facilities in four counties (Nairobi, Mombasa, Marsabit, Siaya) in Kenya. We described knowledge and attitudes regarding influenza vaccination and assessed factors associated with willingness to receive influenza vaccine.ResultsWe enrolled 507 pregnant women, median age was 26 years (range 15–43). Almost half (n = 240) had primary or no education. Overall, 369 (72.8%) women had heard of influenza. Among those, 288 (78.1%) believed that a pregnant woman would be protected if vaccinated, 252 (68.3%) thought it was safe to receive a vaccine while pregnant, and 223 (60.4%) believed a baby would be protected if mother was vaccinated. If given opportunity, 309 (83.7%) pregnant women were willing to receive the vaccine. Factors associated with willingness to receive influenza vaccine were mothers’ belief in protective effect (OR 3.87; 95% CI 1.56, 9.59) and safety (OR 5.32; 95% CI 2.35, 12.01) of influenza vaccines during pregnancy.ConclusionApproximately one third of pregnant women interviewed had never heard of influenza. Willingness to receive influenza vaccine was high among women who had heard about influenza. If the Kenyan government recommends influenza vaccine for pregnant women, mitigation of safety concerns and education on the benefits of vaccination could be the most effective strategies to improve vaccine acceptance.     

孕妇对孕妇学校教育模式及课程内容需求

目的:探讨孕妇对孕妇学校授课模式及课程内容需求情况。方法:对在汕头市妇幼保健院孕妇学校听课的200名孕妇进行问卷调查。结果:①对孕妇学校授课的模式需求是多样化的,需求最高的为听讲座,其他依次为观看录像、与医护人员一对一交流、现场示范、模仿操作、参观产房、角色扮演等。②对孕妇学校课程内容需求最高的是新生儿喂养及新生儿的护理方面,其次是分娩知识及产褥期保健知识、胎儿发育过程及自我监护知识、孕产期营养、孕期常见问题应对知识方面。结论:顺应孕妇的需求,多安排孕妇最迫切需求的课程内容,设置多元化的授课方式,更有效地为孕产妇服务。     

Insurance status predicts self-reported influenza vaccine coverage among pregnant women in the United States: A cross-sectional analysis of the National Health Interview Study Data from 2012 to 2018

While the influenza vaccine is recommended for all pregnant women, influenza vaccine coverage among this high-risk population remains inadequate. Factors associated with vaccine coverage among pregnant women, including insurance status, are poorly understood. In a cross-sectional study of the National Health Interview Survey (NHIS) data from 2012 to 2018, we evaluated predictors of self-reported influenza vaccine coverage in pregnant women. Among 1,942 pregnant women surveyed, 39% reported receiving the influenza vaccine in accordance with national recommendations. Influenza vaccine coverage increased by 8 percentage points from 2012 to 2018. Only 15% of uninsured pregnant women received the influenza vaccine, compared to 41% of those with insurance (design-corrected F-test, p-value < 0.001). In the multivariate Poisson regression analysis, significant predictors of influenza vaccine coverage were health insurance (prevalence ratio [PR] 1.90, 95% confidence interval [CI] 1.23–2.93), ratio of household income to federal poverty level (FPL) threshold greater than 400% (PR 1.54, 95% CI 1.20–1.96), graduate school education (PR 1.52, 95% CI 1.04–2.23), and the 2015–2018 survey year period (PR 1.27, 95% CI 1.08–1.49). While previous literature focuses heavily on demographics, our research underscores the need to further explore modifiable factors that impact vaccine uptake during pregnancy, particularly the interplay between health insurance and access to care.     

孕妇心理对妊娠结局的影响

目的了解孕妇心理状况和妊娠结局之间的关系,为孕期保健提供依据。方法应用症状自评量表(SCL-90)和自评抑郁量表(SDS)对243例妊娠中期孕妇进行调查,在其分娩时记录各产程时间和产时出血量,并对新生儿记录Apgar评分。结果243例孕妇的SCL-90总分均值为(25.16±20.58)分,其中躯体化、强迫、抑郁、焦虑、敌对、恐怖、偏执7个因子以及SCL阳性项目数得分显著高于常模;SCL-90评价指标和妊娠结局之间无相关性;SDS量表总均分高于我国女性常模;SDS单项分18项高于女性常模;抑郁组的产程、产后出血以及新生儿评分Apgar与对照组比较,差异有统计学意义(P<0.05)。结论妊娠中期孕妇心理健康可以影响到胎儿,导致新生儿Apgar评分改变,因此,应加强围生期保健工作,以提高妊娠质量,使妊娠和分娩顺利进行,以促进母子的身心健康。     

Effectiveness of an influenza A (H1N1) 2009 monovalent vaccine among Japanese pregnant women: A prospective observational study assessing antibody efficacy

In order to estimate the effectiveness of an influenza A (H1N1) 2009 monovalent vaccine among pregnant women, we prospectively observed 135 Japanese pregnant women who received an influenza A (H1N1) 2009 monovalent vaccine during November 2009. We calculated an index of “antibody efficacy”, in which the medical visits for respiratory illnesses were compared between those with and without post-vaccination hemagglutination inhibition (HI) titer ≥1:40. The product of antibody efficacy and achievement rate is theoretically equivalent to the vaccine effectiveness. Among all subjects, an inverse but non-significant relationship during the epidemic period was observed between post-vaccination HI titer ≥1:40 and medical visits for respiratory illnesses. After stratification by trimester at recruitment, a significant inverse association during the epidemic period was found among subjects in the first or second trimester (antibody efficacy: 91%, vaccine effectiveness: 79%). The influenza A (H1N1) 2009 monovalent vaccine administered in the first or second trimester reduced medical visits for respiratory illnesses among Japanese pregnant women.     

Influenza vaccine acceptance among pregnant women in urban slum areas,Karachi, Pakistan

BackgroundFacilitators and barriers to influenza vaccination among pregnant women in the developing world are poorly understood, particularly in South Asia. We assessed intention to accept influenza vaccine among ethnically diverse low-income pregnant women in Pakistan.MethodsFrom May to August 2013, we conducted a cross-sectional survey of pregnant women who visited health centers in urban slums in Karachi city. We assessed intention to accept influenza vaccine against socio-demographic factors, vaccination history, vaccine recommendation sources, and other factors.ResultsIn an unvaccinated study population of 283 respondents, 87% were willing to accept the vaccine, if offered. All except two participants were aware of symptoms typically associated with influenza. Perceived vaccine safety, efficacy, and disease susceptibility were significantly associated with intention to accept influenza vaccine (p < 0.05). Regardless of intention to accept influenza vaccine, 96% rated healthcare providers as highly reliable source of vaccine information. While a recommendation from a physician was critical for influenza vaccine acceptance, parents-in-law and husbands were often considered the primary decision-makers for pregnant women seeking healthcare including vaccination.ConclusionsMaternal influenza vaccination initiatives in South Asia should strongly consider counseling of key familial decision-makers and inclusion of healthcare providers to help implement new vaccination programs.     

浙江省温州地区妊娠妇女睡眠障碍流行病学调查

睡眠障碍可对人体多系统产生影响,也是妊娠妇女常见的症状[1].睡眠障碍是先兆子痫的危险因素,可以造成胎儿宫内生长受限、产程延长、剖腹产概率增加、早产,甚至使胎儿窒息、死亡[2].为了解我国妊娠妇女睡眠障碍发生情况及相关因素,对温州地区2000名孕妇睡眠状况进行问卷调查.     

孕妇流感疫苗接种相关研究进展

流感是由流感病毒引起的急性呼吸道传染病, 妊娠期间因生理和免疫功能的变化, 孕妇罹患流感及发生相关并发症的风险较高。接种流感疫苗是预防流感的有效手段。WHO和许多国家均将孕妇列为流感疫苗接种的优先推荐人群, 但目前我国孕妇流感疫苗接种率偏低, 且部分产品使用说明将孕妇列为接种禁忌人群, 推动孕妇流感疫苗接种工作仍存在诸多挑战。本文就近年来国内外流感对孕妇及其胎儿的影响以及孕妇接种流感疫苗研究进展进行综述, 并针对目前孕妇流感疫苗接种的现状, 提出促进孕妇接种流感疫苗的策略并进行探讨, 以期为我国相关工作的开展和政策制定提供参考。     

孕产妇产科出血原因分析

目的 了解医院孕产妇产科出血原因,为今后采取针对性的预防和干预措施提供依据.方法 收集某院2007 ～2010年108例因产科出血病例的资料,分析孕产妇产科出血的相关原因.结果 孕妇产科出血的原因构成比顺位依次为:产后出血(76.85％)、子宫破裂(10.19％)、前置胎盘(8.33％)、异位妊娠(4.63％);而导致孕产妇产后出血的原因顺位依次为:胎盘因素(61.45％)、软产道裂伤(20.48％)、产后宫缩乏力(10.84％)、凝血障碍(7.23％).年龄(x2=117.0,P＜ 0.001)、文化程度(x2=103.3,P＜0.001)、产检次数(x2=55.21,P＜0.001)及产后出血时间(x2=81.15,P＜0.001)与产科出血的发生有一定的关联性.结论 各级妇幼保健机构应加强孕产妇管理及高危孕产妇的筛查、转诊,产后24 h内加强对产妇的监护及观察,及时处理异常将会减少产后出血的发生.     

Inflammatory responses to trivalent influenza virus vaccine among pregnant women

Objective

In the U.S., seasonal trivalent influenza virus vaccine (TIV) is currently universally recommended for all pregnant women. However, data on the maternal inflammatory response to vaccination is lacking and would better delineate the safety and clinical utility of immunization. In addition, for research purposes, vaccination has been used as a mild immune trigger to examine in vivo inflammatory responses in nonpregnant adults. The utility of such a model in pregnancy is unknown. Given the clinical and empirical justifications, the current study examined the magnitude, time course, and variance in inflammatory responses following seasonal influenza virus vaccination among pregnant women.

Methods

Women were assessed prior to and at one day (n = 15), two days (n = 10), or approximately one week (n = 21) following TIV. Serum interleukin (IL)-6, tumor necrosis factor (TNF)-α, C-reactive protein (CRP), and macrophage migration inhibitory factor (MIF) were determined by high sensitivity immunoassay.

Results

Significant increases in CRP were seen at one and two days post-vaccination (ps < 05). A similar effect was seen for TNF-α, for which an increase at two days post-vaccination approached statistical significance (p = .06). There was considerable variability in magnitude of response; coefficients of variation for change at two days post-vaccination ranged from 122% to 728%, with the greatest variability in IL-6 responses at this timepoint.

Conclusions

Trivalent influenza virus vaccination elicits a measurable inflammatory response among pregnant women. There is sufficient variability in response for testing associations with clinical outcomes. As adverse perinatal health outcomes including preeclampsia and preterm birth have an inflammatory component, a tendency toward greater inflammatory responding to immune triggers may predict risk of adverse outcomes, providing insight into biological mechanisms underlying risk. The inflammatory response elicited by vaccination is substantially milder and more transient than seen in infectious illness, arguing for the clinical value of vaccination. However, further research is needed to confirm that the mild inflammatory response elicited by vaccination is benign in pregnancy.     

Intention to accept pertussis vaccine among pregnant women in Karachi,Pakistan

BackgroundMaternal immunization against pertussis is a potential strategy to protect young infants from severe disease. We assessed factors associated with intention to accept pertussis vaccination among pregnant women in Karachi, Pakistan.MethodsWe conducted a cross-sectional survey between May and August 2013 in pregnant women who visited healthcare centers in urban slums of Karachi city. Women completed a survey examining socio-demographic factors, vaccination history, knowledge on pertussis disease, perception of vaccine recommendation sources, and potential influences on vaccine decision-making.ResultsOf the 283 participants, 259 (92%) provided their intention to either accept or decline pertussis vaccination. Eighty-three percent women were willing to accept the pertussis vaccine if offered during pregnancy. About half (53%) of the participants had ever heard of pertussis disease. Perceptions of pertussis vaccine efficacy, safety, and disease susceptibility were strongly associated with intention to accept pertussis vaccine (p < 0.01). Healthcare providers, Ministry of Health, and mass media were considered as highly reliable sources of vaccine recommendation and associated with intention to accept antenatal pertussis vaccination (p < 0.001). Healthcare provider recommendation was a common reason cited by respondents for pregnant women to accept antenatal pertussis vaccination (p = 0.0005). However, opinion of primary decision-makers in the family (husbands and in-laws) was a crucial reason cited by respondents for pregnant women to reject pertussis vaccination in pregnancy (p = 0.003).ConclusionAntenatal pertussis vaccination initiatives in South Asia should strongly consider inclusion of family members, healthcare providers, national health ministries, and mass media to help implement new vaccination programs.     

孕妇的成人依恋与应对方式

目的:探讨孕妇的依恋类型、应对方式以及两者之间的关系。方法:采用关系问卷(RQ)、亲密关系经历量表(ECR)中文版以及应对方式量表对510名孕妇进行问卷调查。结果:孕妇的依恋类型分布情况:安全型59.9%、轻视型19.0%、倾注型14.6%、害怕型6.4%。4种依恋类型的孕妇"针对问题积极应对"和"否认与心理解脱"得分比较差异无统计学意义,但在"情感求助与宣泄"得分上,安全型(2.67±0.35)和倾注型(2.69±0.35)得分显著高于轻视型(2.56±0.35)和害怕型(2.45±0.28)(F3.479=5.975,P<0.01)。在"回避问题转移注意"得分上,安全型(2.06±0.46)显著低于害怕型(2.29±0.55)(F3.479=2.63,P<0.05)。依恋回避与"针对问题积极应对"(γ=-0.193,P<0.01)和"情感求助与宣泄"(γ=-0.213,P<0.01)呈显著负相关。依恋回避及依恋焦虑与"否认与心理解脱"、"回避问题转移注意"均呈显著正相关(γ=0.207～0.304,P<0.01)。结论:对孕妇实施健康教育具有一定的参考意义,对孕妇进行围产保健宣传时应尽量帮助孕妇建立起良好的自我模型和他人模型,并重点针对消极应对方式进行宣教,使孕妇尽量减少采取消极应对方式的频率,从而顺利地度过妊娠期,提高其心理健康水平。     

300例孕妇孕产期保健知识现状调查与分析

目的:了解本地区孕妇孕产期保健知识知晓情况。方法:以唐山市路北区各期妊娠妇女300人为调查对象,采用问卷方式进行面对面调查,所得数据用SPSS 12.0统计软件进行t检验、方差分析。结果:孕产期保健知识平均得分17.2±3.9,得分率为66.1%,其中早孕知识、影响胎儿质量有关知识、孕期营养及保健知识得分率分别为81.0%、65.9%、54.8%。孕妇本人及丈夫文化程度高,从事科教、管理工作、产检过程中接受过健康教育的孕妇,其保健知识知晓率较高。结论:孕妇孕产期保健知识水平较低,有待于进一步加强孕产期保健知识教育。     

1778例母婴梅毒血清学分析

目的:为深圳市预防与控制梅毒母婴传播项目提供新的临床依据。方法:对深圳市宝安区各个医院送检标本同时进行甲苯胺红不加热血清试验(TRUST)和梅毒螺旋体颗粒凝集试验(TPPA)。结果:从2008年1月1日～2009年12月31日共收集孕妇和新生儿血清标本1 778份,其中孕妇TRUST和TPPA的血清阳性率分别为89.32%(920/1 030)和79.80%(822/1 030),新生儿TRUST和TPPA的血清阳性率分别为50.00%(374/748)和60.56%(453/748);新生儿TRUST滴度大于1∶8(包括1∶8)者为3.07%,明显低于孕妇的20.10%。另外,2009年全年的真阳性率低于2008年。结论:母婴梅毒控制工作有效地控制了梅毒的母婴垂直传播,需进一步在孕早期加大对梅毒的筛查力度。     

昌平区1152名孕妇尿碘水平监测结果分析

目的：掌握昌平区孕妇碘营养状况.方法：随机抽取昌平区东、南、西、北、中五个方位所在镇的孕妇共1152名,进行尿碘水平检测.结果：昌平区1152名孕妇尿碘中位数为159.5 μg/L;不同年度、不同地区居民合格碘盐食用率与孕妇尿碘中位数有正相关关系.结论：昌平区孕妇尿碘水平已达到碘缺乏病消除标准;在碘缺乏病防治工作中应将孕妇尿碘水平监测纳入常规工作;加强碘盐监管力度,提高居民合格碘盐食用率.     

降钙素原对孕妇宫内感染的诊断价值研究

目的探讨降钙素原(PCT)对孕妇宫内感染的诊断价值,为孕妇宫内感染的早期诊断提供依据。方法选择2007年3月-2012年2月孕妇妊娠期宫内细菌感染82例、病毒感染84例、正常孕妇85名,分别为细菌感染组、病毒感染组与对照组,比较3组孕妇血清白细胞(WBC)计数、C-反应蛋白(CRP)、白细胞介素6(IL-6)、中性粒细胞(N)水平及PCT检测结果,数据采用SPSS13.0统计软件进行处理。结果细菌感染组孕妇WBC、CRP、IL-6、N均显著高于对照组与病毒组,病毒感染组显著高于对照组,差异有统计学意义(P<0.05);细菌感染组孕妇PCT阳性率86.6%显著高于病毒感染组的17.9%与对照组的5.9%,差异有统计学意义(P<0.05);PCT对细菌感染诊断敏感度、准确度、特异度、阳性预测值均高于其他检测项目。结论 PCT对孕妇细菌感染检测具有较高的敏感度与特异度,且速度快,准确度高,可作为孕妇宫内感染的早期诊断指标。