Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA 30322, United States.
Department of Gynecology and Obstetrics, Emory University School of Medicine, 69 Jesse Hill Jr. Drive SE, Atlanta, GA 30303, United States.
Vaccine. 2019 Sep 24;37(41):6054-6059. doi: 10.1016/j.vaccine.2019.08.044. Epub 2019 Aug 27.
To evaluate predictors of vaccination among women who received tetanus, diphtheria, and acellular pertussis vaccination (Tdap), influenza vaccination, and Tdap and influenza vaccinations.
In a retrospective cohort study of all full-term (≥37 weeks gestation) deliveries between July 1, 2016 and June 30, 2018 at a single, safety-net institution, we used multinomial logistic regression models to compare predictors of vaccination among women who received Tdap only, influenza only, and both Tdap and influenza vaccines.
Among 3132 full-term deliveries, women were primarily non-Hispanic black (67.5%), between the ages of 21-34 (65.3%), and multiparous (76.0%). The rates of only influenza or Tdap vaccination were 10.3% and 21.6%, respectively; 43.3% of women received both vaccines, and 24.9% of women did not receive either vaccine. In the adjusted models, Hispanic ethnicity was positively associated with receipt of all types of vaccination and non-Spanish language interpreter use was positively associated with receipt of Tdap vaccination and Tdap and influenza vaccination. A parity of greater than three and inadequate and unknown prenatal care adequacy were negative predictors of all types of vaccination. Pre-existing hypertension was negatively associated with Tdap vaccination, and HIV-positive status was negatively associated with influenza vaccination and Tdap and influenza vaccination.
Compared to the national rate of both Tdap and influenza vaccination (32.8%), a higher proportion of women received both vaccines in our study population. Vaccine uptake may be affected by race/ethnicity, use of interpreter services, parity, pre-existing comorbidities, and prenatal care adequacy. The lower rate of influenza vaccination compared to Tdap vaccination suggests that other factors, such as vaccine hesitancy and mistrust, may be differentially impacting influenza vaccination uptake in our predominantly minority population. Future provider and public health approaches to vaccine promotion should incorporate culturally appropriate strategies that address vaccine-related beliefs and misconceptions.
评估接种破伤风、白喉、无细胞百日咳（Tdap）疫苗、流感疫苗以及 Tdap 和流感疫苗的女性的疫苗接种预测因素。
在一项回顾性队列研究中，我们对 2016 年 7 月 1 日至 2018 年 6 月 30 日期间在一家单一的、以保障安全为重点的机构内分娩的所有足月（≥37 周妊娠）产妇进行了研究，使用多项逻辑回归模型比较了仅接种 Tdap、仅接种流感疫苗以及同时接种 Tdap 和流感疫苗的女性的疫苗接种预测因素。
在 3132 例足月分娩中，产妇主要为非西班牙裔黑人（67.5%），年龄在 21-34 岁之间（65.3%），多胎产妇（76.0%）。仅接种流感或 Tdap 疫苗的比例分别为 10.3%和 21.6%；43.3%的女性同时接种了两种疫苗，24.9%的女性两种疫苗都未接种。在调整后的模型中，西班牙裔种族与所有类型疫苗的接种呈正相关，使用非西班牙语翻译与 Tdap 疫苗和 Tdap 和流感疫苗的接种呈正相关。三胎以上的产次和不足及未知的产前保健充足度是所有类型疫苗接种的负预测因素。存在高血压病史与 Tdap 疫苗接种呈负相关，HIV 阳性状态与流感疫苗接种和 Tdap 和流感疫苗接种呈负相关。
与 Tdap 和流感疫苗同时接种的全国比例（32.8%）相比，在我们的研究人群中，更多的女性同时接种了两种疫苗。疫苗接种率可能受到种族/民族、翻译服务的使用、产次、并存的合并症和产前保健充足度的影响。与 Tdap 疫苗接种相比，流感疫苗接种率较低表明，在我们以少数族裔为主的人群中，其他因素（如疫苗犹豫和不信任）可能会对流感疫苗接种的接受程度产生不同的影响。未来的提供者和公共卫生方法在推广疫苗时应采用文化上适当的策略，解决与疫苗相关的信仰和误解。
