O'Leary Sean T, Pyrzanowski Jennifer, Brewer Sarah E, Barnard Juliana, Beaty Brenda, Donnelly Meghan, Mazzoni Sara, Dempsey Amanda F
From the *Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado; †The Children's Outcomes Research Program, Children's Hospital Colorado, Aurora, Colorado; †Colorado Health Outcomes Research, University of Colorado Anschutz Medical Campus, Aurora, Colorado; §Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, Colorado; and ¶Department of Obstetrics and Gynecology, Denver Health and Hospital Authority, Denver, Colorado.
Pediatr Infect Dis J. 2015 Nov;34(11):1244-9. doi: 10.1097/INF.0000000000000873.
Our objectives were to describe the receipt of influenza and tetanus-diphtheria-acellular pertussis (Tdap) vaccines among postpartum women and their close contacts and the factors associated with cocooning.
A survey between February 2013 and April 2013 of 613 postpartum women from 9 obstetrics practices assessed vaccine receipt among respondents and close contacts, demographics and 5 domains of health beliefs (benefits, barriers, susceptibility, severity and social norms). Multivariable models assessed the association of these factors with Tdap or influenza "cocooning," defined as the mother plus at least 1 close contact of her newborn receiving the vaccine.
The response rate was 45%; 61% of mothers reported that they and at least 1 close contact of their newborn had received influenza vaccine, and 67% reported this for Tdap. Infants whose mothers received influenza vaccine had a mean of 2.8 close contacts who also received influenza vaccine versus a mean of 0.9 contacts for infants whose mothers did not receive influenza vaccine (P < 0.0001). Infants whose mothers received Tdap vaccine had an average of 2.4 contacts who also received it versus 0.8 for infants whose mothers did not receive Tdap (P < 0.0001). Factors associated with influenza and Tdap cocooning included obstetrician recommendation, high perceived benefits, low perceived barriers and perceived susceptibility to disease. For Tdap, race/ethnicity was associated with cocooning (Hispanic/Latino, adjusted odds ratio 0.26, 95% confidence interval: 0.10-0.64 referent to White).
Maternal vaccination and obstetrician recommendation are associated with infant cocooning. Interventions to increase cocooning of infants should focus on encouraging strong provider recommendations, increasing maternal knowledge of disease risk and addressing identified barriers. Reasons for possible racial/ethnic differences should be further explored.
我们的目标是描述产后妇女及其密切接触者接种流感疫苗和破伤风-白喉-无细胞百日咳（Tdap）疫苗的情况以及与“围裹式免疫”相关的因素。
2013年2月至2013年4月期间，对来自9家产科诊所的613名产后妇女进行了一项调查，评估了受访者及其密切接触者的疫苗接种情况、人口统计学特征以及健康信念的5个方面（益处、障碍、易感性、严重性和社会规范）。多变量模型评估了这些因素与Tdap或流感“围裹式免疫”的关联，“围裹式免疫”定义为母亲及其新生儿的至少1名密切接触者接种疫苗。
应答率为45%；61%的母亲报告她们及其新生儿的至少1名密切接触者接种了流感疫苗，67%的母亲报告了Tdap疫苗的这种情况。母亲接种流感疫苗的婴儿平均有2.8名密切接触者也接种了流感疫苗，而母亲未接种流感疫苗的婴儿平均有0.9名密切接触者接种（P<0.0001）。母亲接种Tdap疫苗的婴儿平均有2.4名密切接触者也接种了该疫苗，而母亲未接种Tdap疫苗的婴儿平均有0.8名密切接触者接种（P<0.0001）。与流感和Tdap围裹式免疫相关的因素包括产科医生的建议、较高的感知益处、较低的感知障碍以及对疾病的感知易感性。对于Tdap，种族/族裔与围裹式免疫相关（西班牙裔/拉丁裔，调整后的优势比为0.26，95%置信区间：0.10-0.64，以白人为参照）。
母亲接种疫苗和产科医生的建议与婴儿围裹式免疫相关。增加婴儿围裹式免疫的干预措施应侧重于鼓励医生给出有力建议、增加母亲对疾病风险的认识并解决已发现的障碍。应进一步探究可能存在种族/族裔差异的原因。
