Enhancing uptake of influenza maternal vaccine

ABSTRACT

Introduction: Influenza vaccination during pregnancy can offer many benefits to both mother and infant. Despite recommendations from the Advisory Committee on Immunization Practices, vaccine coverage rates among pregnant women during pregnancy are below 40% in the United States. There is a need for a greater understanding of what interventions can improve vaccine uptake among pregnant women.

Areas covered: This review synthesizes the existing evidence on the effectiveness of interventions to improve maternal influenza vaccine uptake. These interventions are examined within the framework of the three psychological propositions: thoughts and feelings, social processes and changing behavior directly.

Expert commentary: A number of promising and effective interventions were identified in this review. Nudge-based interventions that build on favorable intentions to vaccinate such as provider prompts and standing orders have demonstrated significant success in improving influenza vaccine uptake. However, substantial gaps in the literature still exist. Provider recommendations are the most important predictor of vaccine receipt among pregnant women, yet few studies evaluated intervening to improve the dialogue between patient and provider. With the potential for even more vaccines to be added to the maternal immunization schedule, it is vitally important to understand how to improve uptake.

KEYWORDS:

• Influenza
• interventions
• maternal immunization
• pregnancy
• vaccination
• vaccine

Article highlights

• Interventions that primarily aim to change vaccine attitudes are generally not effective in isolation. However, content that emphasizes the benefits of the vaccine for the infant has demonstrated greater impact.

• Despite a provider recommendation being the best predictor of vaccine receipt among pregnant women, few studies have evaluated interventions that focus on improving the provider-patient interaction or the provision of information or communication training to providers from public health officials.

• Nudge-based interventions, such as provider prompts and standing orders, that build on favorable intentions to vaccinate without attempting to change attitudes about vaccines have demonstrated substantial success in improving uptake.

• Most providers list the primary barriers to providing the vaccine to patients as financial. More work is needed to assist providers in overcoming the logistical barriers to providing vaccine to their pregnant patients, such as navigating reimbursements and stocking the vaccine in clinic.

Declaration of interest

D. Salmon received research support and consulting funds from Crucell, Pfizer and Merck. D. Salmon has also received additional travel funds and honorarium from the National Foundation of Infectious Diseases (NFID). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This work was in part supported by the National Institutes of Health [grant number: R01AI110482].