What patients think about flu and Tdap vaccination in pregnancy


Fear of vaccines and potential adverse events isn’t just a problem in the world of pediatrics. This session looked at what can be done to increase acceptance of vaccines that can greatly improve outcomes for mother and baby.

An e-poster presented at the 2016 meeting of the American College of Obstetricians and Gynecologists (ACOG) dealt with the importance of increasing patient acceptance for receiving Tdap [tetanus, diphtheria, and pertussis] and flu vaccinations during pregnancy.

Presented with the Blue Ribbon among the e-poster presentations at ACOG, Dr. Emmie Strassberg led the team of study investigators from the Geisinger Health System in Danville, Pennsylvania. Their results point to the need for greater education among pregnant patients to improve their acceptance of influenza vaccination. In regard to the Tdap vaccination, however, the researchers concluded that direct physician recommendation to their patients on getting this vaccination would do much to improve acceptance.

Because both vaccines are recommended for women who are pregnant to help prevent infection that can result in poor maternal, fetal, and neonatal outcomes, Dr. Strassberg and coworkers sought to identify barriers to vaccination acceptance through surveying pregnant women on their attitudes, experiences, and vaccination history in pregnancy. Their survey was completed by 338 women who had received prenatal care at a tertiary care center from December 2014 to April 2015.

Findings from the survey showed that the Tdap vaccination was viewed more positively by this cohort of pregnant women than was the influenza vaccination. The rate of acceptance for the influenza vaccination was 70.1%, compared with 76.3% for the Tdap vaccination.

Using a bivariate logistic regression model, the researchers determined that patient attitude and a previous history of vaccination were the predictors of vaccine acceptance during pregnancy. Some factors, however, such as age, race, ethnicity, and level of education attained were found to not be predictive.

The study findings also showed that a strong predictor of Tdap vaccine acceptance is provider recommendation (P<.001). At the same time, this had no effect on acceptance of the flu vaccine. Instead, educational materials disseminated to patients were found to predict influenza vaccine acceptance (P<.001). But again, such materials had no effect on Tdap vaccine acceptance.

Regarding the resistance of pregnant women to receiving the flu vaccine, the Centers for Disease Control and Prevention (CDC) affirms that pregnant women who get vaccinated for the flu not only receive protection personally but also so do their babies for up to 6 months after their birth. Further, for those pregnant women who have been given the flu vaccine, it has been demonstrated to be 92% effective in preventing the hospitalization of their infants for influenza (http://www.cdc.gov/flu/about/qa/misconceptions.htm).

As to the Tdap vaccine, providers can also share information from the CDC on its benefits with their pregnant patients. CDC recommends that women get vaccinated in the third trimester of each pregnancy between 27 and 36 weeks of gestation, most particularly to protect their neonates from pertussis. In June 2013, ACOG weighed in on this issue in a Committee Opinion (#566) from its Committee on Obstetric Practice, agreeing on the importance of a Tdap vaccination for pregnant women due to the safety concerns about pertussis. 

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