Review Ar cle Seasonal influenza vaccina on in antenatal women: Views of health care workers and barriers in the delivery of the vaccine Surabhi Khosla Fourth Year Medicine (Undergraduate) James Cook University
Surabhi undertook this research project as part of the General Prac ce Student Network First Wave Academic Scholarship. She has a growing interest in maternal health research and infec ous disease, and has been involved in a couple of research projects in the fields of Primary Health Care and Vascular Biology. In second year, she received the Norway Bursary and did a four week rural placement in Northern Norway. Other than research, she enjoys working as the President of the Rural Health Club - RHINO and a ending conferences around Australia.
Background: Pregnant women are at an increased risk of developing influenza. The Na onal Health and Medical Research Council recommends seasonal influenza vaccina on for all pregnant women who will be in their second or third trimester during the influenza season. The aim of this review is to explore the views of health care workers regarding seasonal influenza vaccina on in antenatal women and describe the barriers in the delivery of the vaccine. Methods: A literature search was conducted using MEDLINE for the terms: “influenza,” “pregnancy,” “antenatal,” “vaccina ons,” “recommenda ons,” “a tudes,” “knowledge” and “opinions”. The review describes findings of publica ons concerning the inac vated influenza vaccina on only, which has been proven safe and is widely recommended. Results: No studies have addressed the knowledge and a tudes of Australian primary health care providers towards influenza vaccina on despite their essen al role in immunisa ons in Australia. Overseas studies indicate that factors that contribute to the low vaccina on rates are 1) the lack of general knowledge of influenza and its preven on amongst health care workers (HCWs) 2) variable opinions and a tude regarding the vaccine 3) lack of awareness of the na onal guidelines 4) and lack of discussion of the vaccine by the HCW. Lack of maternal knowledge regarding the safety of the vaccine and the cost-burden of the vaccine are significant barriers in the uptake of the vaccina on. Conclusion: Insufficient a en on has been given to the topic of influenza vaccina ons in pregnancy. Significant efforts are required in Australia to obtain data about the rates of influenza vaccina on of pregnant women.
Introduc on Seasonal influenza results in annual epidemics of respiratory diseases. Influenza epidemics and pandemics increase hospitalisa on rates and mortality, par cularly among the elderly and high risk pa ents with underlying condi ons. [1-3] All pregnant women are at an increased risk of developing influenza due to progressive suppression of Th1cell-mediated immunity and other physiological changes that cause culmina on of morbidity towards the end of pregnancy. [4-7] Annual influenza vaccina on is the most effec ve method for preven ng influenza virus infec on and its complica ons [8] Trivalent inac vated influenza vaccine (TIV) has been proven safe and is recommended for person aged ≥6 months, including those with highrisk condi ons such as pregnancy. [8-10] A randomised controlled study in Bangladesh demonstrated that TIV administered in the third trimester of pregnancy resulted in reduced maternal respiratory illness and reduced infant influenza infec on. [11, 12] Another randomised controlled trial has shown that influenza immunisa on of pregnant women reduced influenza-like illness by more than 30% in both the mothers and the infants, and reduced laboratory-proven influenza infec ons in 0- to 6-month-old infants by 63%. [13] The current Australian Immunisa on Guidelines recommend rou ne administra on of influenza vaccina on for all pregnant women who will be in the second or third trimester during the influenza season, including those in the first trimester at the me of vaccina on. [4,14,15] The seasonal influenza vaccina on has been made available
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for free to all pregnant women in Australia since 2010. [4] However, The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZOG) statement for ‘Pre-pregnancy Counselling and rou ne Antenatal Assessment in the absence of pregnancy Complica ons’ does not explicitly men on rou ne delivery of influenza vaccina on to healthy pregnant women. [16] RANZCOG recently published the college statement on swine flu vaccina on during pregnancy; advising that pregnant women without complica ons and recent travel history must weigh the risk-benefit ra o before deciding to uptake the H1N1 influenza immunisa on. [17] Therefore, it is evident that there is conflic ng advice in Australia about the rou ne delivery of influenza vaccina on to healthy pregnant women. In contrast, firm recommenda on for rou ne influenza vaccina on for pregnant women was established in 2007, by the Na onal Advisory Commi ee on Immunisa ons (NACI) in Canada, with minimal conflict from The Society of Obstetricians and Gynaecologists of Canada (SOGC). [6] Succeeding the 1957 influenza pandemic, the rate of influenza immunisa ons increased significantly with greater than 100,000 women receiving the vaccina on annually between 1959-1965 in the United States. [8] Since 2004 the American Advisory Commi ee on Immunisa on Prac ce (ACIP) has recommended influenza vaccina on for all pregnant women, at any stage of gesta on. [9] This is supported by The American College of Obstetricians and Gynaecologists’ Commi ee on Obstetric Prac ce. [18] A recent literature review performed by Skowronski et al. (2009) found that TIV is warranted to protect women against influenzarelated hospitalisa on during the second half of normal pregnancy, but evidence is otherwise insufficient to recommend rou ne TIV as the standard of prac ce for all healthy women beginning in early pregnancy. [6] Similarly, another review looked at the evidence for the risks of influenza and the risks and benefits of seasonal influenza vaccina on in pregnancy and concluded that data on influenza vaccine safety in pregnancy is inadequate. [19] However, based on the available literature, there was no evidence of serious side effects in women or their infants, including no indica on of harm from vaccina on in the first trimester. [19] We aim to review the literature published on the delivery and uptake of