Immunization Unit, Robert Koch Institute, Berlin, Germany.
Standing Committee on Vaccination, Robert Koch Institute, Berlin, Germany, Munich, Germany.
BMC Health Serv Res. 2019 Sep 2;19(1):616. doi: 10.1186/s12913-019-4437-y.
In Germany, antenatal influenza vaccination is recommended since 2010, but uptake remains low. Several countries recently introduced antenatal pertussis vaccination, which is currently under consideration in Germany. We conducted a survey among gynaecologists on attitudes, practices and barriers regarding influenza and pertussis vaccination during pregnancy.
Gynaecologists were invited to complete a pre-tested, 24-item questionnaire published in the German Professional Association of Gynaecologists' journal in September 2017 within 2 months. Associations between variables were examined using Chi-Squared, Fischer's Exact or t-tests. Variables associated with gynaecologists' self-reported implementation of vaccination in pregnant women were identified using univariate and multivariate logistic regression analyses.
Of 867 participants (response 11%), 91.4 and 59.4% reported currently vaccinating pregnant women against influenza and pertussis, respectively. Gynaecologists who reported obtaining annual influenza vaccination and actively informing their patients about these vaccinations were significantly more likely to vaccinate pregnant women against influenza (96.5% vs. 65.7 and 95.1% vs. 62.2%) and pertussis (63.1% vs. 44.3 and 82.4% vs. 12.9%). Performing influenza vaccination was least likely among gynaecologists who perceived logistical difficulties as a vaccination barrier (35.9%), while pertussis vaccination was least likely if the lacking official recommendation (32.0%), logistical difficulties (27.1%), safety concerns (17.5%) and limited vaccine effectiveness (11.1%) were perceived as barriers. Of participants not yet vaccinating pregnant women against pertussis, 86.5% reported they would follow an official recommendation. Including vaccination recommendations in the maternity record (95.2%) and informing the public (88.7%) and health care professionals (86.6%) were considered the most suitable measures to achieve high pertussis vaccination coverage.
The large proportion reporting performance of influenza vaccination during pregnancy and high acceptance of a potential recommendation for pertussis vaccination reflected positive attitudes towards vaccination among participants. However, factors associated with failure to vaccinate may be more prevalent among non-participants. Results suggest that gynaecologists' confidence in vaccination is crucial for implementing vaccination in pregnancy. Thus, doubts on vaccine effectiveness and safety should be allayed among gynaecologists and pregnant women via various communication channels, and solutions for logistical barriers sought. Including antenatal vaccination recommendations in the maternity record would serve as an important reminder for both groups.
在德国，自 2010 年以来，已推荐孕妇接种流感疫苗，但接种率仍然较低。最近有几个国家开始为孕妇接种百日咳疫苗，德国目前也在考虑这一做法。我们对妇产科医生进行了一项调查，了解他们对孕妇接种流感和百日咳疫苗的态度、做法和障碍。
2017 年 9 月，德国妇产科医生专业协会的期刊发表了一份经过预先测试的 24 项问卷调查，邀请妇产科医生在 2 个月内完成。使用卡方检验、Fisher 确切概率法或 t 检验来检验变量之间的关联。使用单变量和多变量逻辑回归分析来确定与妇产科医生自我报告的孕妇疫苗接种实施相关的变量。
在 867 名参与者中（回应率为 11%），分别有 91.4%和 59.4%的参与者报告目前为孕妇接种流感疫苗和百日咳疫苗。报告每年接种流感疫苗并积极向患者告知这些疫苗的妇产科医生更有可能为孕妇接种流感疫苗（96.5%比 65.7%和 95.1%比 62.2%）和百日咳疫苗（63.1%比 44.3%和 82.4%比 12.9%）。认为接种存在后勤困难的妇产科医生最不可能进行流感疫苗接种（35.9%），而认为官方建议缺失（32.0%）、后勤困难（27.1%）、安全问题（17.5%）和疫苗效力有限（11.1%）是接种障碍的妇产科医生最不可能进行百日咳疫苗接种。在目前不为孕妇接种百日咳疫苗的参与者中，86.5%的人表示，如果有官方建议，他们将接种百日咳疫苗。将疫苗接种建议纳入产妇记录（95.2%）、向公众（88.7%）和卫生保健专业人员（86.6%）宣传被认为是实现高百日咳疫苗接种覆盖率的最有效措施。
报告在怀孕期间进行流感疫苗接种的比例较大，且对百日咳疫苗接种的潜在建议的接受程度较高，这反映了参与者对疫苗接种的积极态度。然而，在未参与的参与者中，可能存在更多与未能接种疫苗相关的因素。结果表明，妇产科医生对疫苗接种的信心对在孕期实施疫苗接种至关重要。因此，应通过各种沟通渠道消除妇产科医生和孕妇对疫苗效力和安全性的疑虑，并寻找解决后勤障碍的办法。将产前疫苗接种建议纳入产妇记录将成为两组人员的重要提醒。
