J Korean Med Sci.  2016 Jul;31(7):1063-1068. 10.3346/jkms.2016.31.7.1063.

Perception and Attitudes of Korean Obstetricians about Maternal Influenza Vaccination

• Noh JY
• Seo YB
• Song JY
• Choi WS
• Lee J
• Jung E
• Kang S
• Choi MJ
• Jun J
• Yoon JG
• Lee SN
• Hyun H
• Lee JS
• Cheong H
• Cheong HJ
• Kim WJ

• KMID: 2373724
• DOI: http://doi.org/10.3346/jkms.2016.31.7.1063

Abstract

Pregnant women are prioritized to receive influenza vaccination. However, the maternal influenza vaccination rate has been low in Korea. To identify potential barriers for the vaccination of pregnant women against influenza, a survey using a questionnaire on the perceptions and attitudes about maternal influenza vaccination was applied to Korean obstetricians between May and August of 2014. A total of 473 respondents participated in the survey. Most respondents (94.8%, 442/466) recognized that influenza vaccination was required for pregnant women. In addition, 92.8% (410/442) respondents knew that the incidence of adverse events following influenza vaccination is not different between pregnant and non-pregnant women. However, 26.5% (124/468) obstetricians strongly recommended influenza vaccination to pregnant women. The concern about adverse events following influenza vaccination was considered as a major barrier for the promotion of maternal influenza vaccination by healthcare providers. Providing professional information and education about maternal influenza vaccination will enhance the perception of obstetricians about influenza vaccination to pregnant women and will be helpful to improve maternal influenza vaccination coverage in Korea.

Keyword

Influenza Vaccines; Maternal Welfare; Pregnant Women

MeSH Terms

Asian Continental Ancestry Group
Cross-Sectional Studies
Female
*Health Knowledge, Attitudes, Practice
Humans
Influenza Vaccines/*immunology
Influenza, Human/*prevention & control
Maternal Welfare
*Perception
Physicians/*psychology
Pregnancy
Pregnant Women
Republic of Korea
Surveys and Questionnaires
Vaccination
Influenza Vaccines

Figure

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  Fig. 1 Current attitudes and consecutive willingness of obstetricians to recommend influenza vaccination to pregnant women were presented. Information about influenza and influenza vaccination in pregnant women was sequentially provided: information 1, increased severity in pregnant women with influenza; information 2, influenza vaccine effectiveness in pregnant women and infants up to 6 months of age; information 3, safety of influenza vaccination in pregnant women.

Reference

1. Kourtis AP, Read JS, Jamieson DJ. Pregnancy and infection. N Engl J Med. 2014; 370:2211–2218.

2. Jamieson DJ, Honein MA, Rasmussen SA, Williams JL, Swerdlow DL, Biggerstaff MS, Lindstrom S, Louie JK, Christ CM, Bohm SR, et al. H1N1 2009 influenza virus infection during pregnancy in the USA. Lancet. 2009; 374:451–458.

3. Siston AM, Rasmussen SA, Honein MA, Fry AM, Seib K, Callaghan WM, Louie J, Doyle TJ, Crockett M, Lynfield R, et al. Pandemic 2009 influenza A(H1N1) virus illness among pregnant women in the United States. JAMA. 2010; 303:1517–1525.

4. Vaccines against influenza WHO position paper - November 2012. Wkly Epidemiol Rec. 2012; 87:461–476.

5. Kim MJ, Lee SY, Lee KS, Kim A, Son D, Chung MH, Park SG, Park JH, Lee BI, Lee JS. Influenza vaccine coverage rate and related factors on pregnant women. Infect Chemother. 2009; 41:349–354.

6. Kim IS, Seo YB, Hong KW, Noh JY, Choi WS, Song JY, Cho GJ, Oh MJ, Kim HJ, Hong SC, et al. Perception on influenza vaccination in Korean women of childbearing age. Clin Exp Vaccine Res. 2012; 1:88–94.

7. Mak DB, Regan AK, Joyce S, Gibbs R, Effler PV. Antenatal care provider’s advice is the key determinant of influenza vaccination uptake in pregnant women. Aust N Z J Obstet Gynaecol. 2015; 55:131–137.

8. Mertz D, Kim TH, Johnstone J, Lam PP, Science M, Kuster SP, Fadel SA, Tran D, Fernandez E, Bhatnagar N, et al. Populations at risk for severe or complicated influenza illness: systematic review and meta-analysis. BMJ. 2013; 347:f5061.

9. Zaman K, Roy E, Arifeen SE, Rahman M, Raqib R, Wilson E, Omer SB, Shahid NS, Breiman RF, Steinhoff MC. Effectiveness of maternal influenza immunization in mothers and infants. N Engl J Med. 2008; 359:1555–1564.

10. Madhi SA, Cutland CL, Kuwanda L, Weinberg A, Hugo A, Jones S, Adrian PV, van Niekerk N, Treurnicht F, Ortiz JR, et al. Influenza vaccination of pregnant women and protection of their infants. N Engl J Med. 2014; 371:918–931.

11. Blanchard-Rohner G, Siegrist CA. Vaccination during pregnancy to protect infants against influenza: why and why not? Vaccine. 2011; 29:7542–7550.

12. Bratton KN, Wardle MT, Orenstein WA, Omer SB. Maternal influenza immunization and birth outcomes of stillbirth and spontaneous abortion: a systematic review and meta-analysis. Clin Infect Dis. 2015; 60:e11–9.

13. Chambers CD, Johnson D, Xu R, Luo Y, Louik C, Mitchell AA, Schatz M, Jones KL; OTIS Collaborative Research Group. Risks and safety of pandemic H1N1 influenza vaccine in pregnancy: birth defects, spontaneous abortion, preterm delivery, and small for gestational age infants. Vaccine. 2013; 31:5026–5032.

14. Takeda S, Hisano M, Komano J, Yamamoto H, Sago H, Yamaguchi K. Influenza vaccination during pregnancy and its usefulness to mothers and their young infants. J Infect Chemother. 2015; 21:238–246.

15. Kee SY, Lee JS, Cheong HJ, Chun BC, Song JY, Choi WS, Jo YM, Seo YB, Kim WJ. Influenza vaccine coverage rates and perceptions on vaccination in South Korea. J Infect. 2007; 55:273–281.

16. Seo YB, Choi WS, Baek JH, Lee J, Song JY, Lee JS, Cheong HJ, Kim WJ. Effectiveness of the influenza vaccine at preventing hospitalization due to acute exacerbation of cardiopulmonary disease in Korea from 2011 to 2012. Hum Vaccin Immunother. 2014; 10:423–427.

17. Seo YB, Hong KW, Kim IS, Choi WS, Baek JH, Lee J, Song JY, Lee JS, Cheong HJ, Kim WJ. Effectiveness of the influenza vaccine at preventing hospitalization due to acute lower respiratory infection and exacerbation of chronic cardiopulmonary disease in Korea during 2010-2011. Vaccine. 2013; 31:1426–1430.

18. Kennedy ED, Ahluwalia IB, Ding H, Lu PJ, Singleton JA, Bridges CB. Monitoring seasonal influenza vaccination coverage among pregnant women in the United States. Am J Obstet Gynecol. 2012; 207:Suppl. S9–16.

19. Harper SA, Fukuda K, Uyeki TM, Cox NJ, Bridges CB; Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP). Prevention and control of influenza: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2004; 53:1–40.

20. Kissin DM, Power ML, Kahn EB, Williams JL, Jamieson DJ, MacFarlane K, Schulkin J, Zhang Y, Callaghan WM. Attitudes and practices of obstetrician-gynecologists regarding influenza vaccination in pregnancy. Obstet Gynecol. 2011; 118:1074–1080.

21. The Office of Disease Prevention and Health Promotion (US). Healthy People 2020 [Internet]. accessed on 11 March 2015. Available at http://www.healthypeople.gov/node/3527/data-details.