Kilich Eliz, Dada Sara, Francis Mark R, Tazare John, Chico R Matthew, Paterson Pauline, Larson Heidi J
Department of Infectious Diseases Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Topical Medicine, London, United Kingdom.
Department of Medical Statistics, Faculty of Epidemiology and Population Health, London School of Hygiene & Topical Medicine, London, United Kingdom.
PLoS One. 2020 Jul 9;15(7):e0234827. doi: 10.1371/journal.pone.0234827. eCollection 2020.
The most important factor influencing maternal vaccination uptake is healthcare professional (HCP) recommendation. However, where data are available, one-third of pregnant women remain unvaccinated despite receiving a recommendation. Therefore, it is essential to understand the significance of other factors and distinguish between vaccines administered routinely and during outbreaks. This is the first systematic review and meta-analysis (PROSPERO: CRD 42019118299) to examine the strength of the relationships between identified factors and maternal vaccination uptake.
We searched MEDLINE, Embase Classic & Embase, PsycINFO, CINAHL Plus, Web of Science, IBSS, LILACS, AfricaWideInfo, IMEMR, and Global Health databases for studies reporting factors that influence maternal vaccination. We used random-effects models to calculate pooled odds ratios (OR) of being vaccinated by vaccine type.
We screened 17,236 articles and identified 120 studies from 30 countries for inclusion. Of these, 49 studies were eligible for meta-analysis. The odds of receiving a pertussis or influenza vaccination were ten to twelve-times higher among pregnant women who received a recommendation from HCPs. During the 2009 influenza pandemic an HCP recommendation increased the odds of antenatal H1N1 vaccine uptake six times (OR 6.76, 95% CI 3.12-14.64, I2 = 92.00%). Believing there was potential for vaccine-induced harm had a negative influence on seasonal (OR 0.22, 95% CI 0.11-0.44 I2 = 84.00%) and pandemic influenza vaccine uptake (OR 0.16, 95% CI 0.09-0.29, I2 = 89.48%), reducing the odds of being vaccinated five-fold. Combined with our qualitative analysis the relationship between the belief in substantial disease risk and maternal seasonal and pandemic influenza vaccination uptake was limited.
The effect of an HCP recommendation during an outbreak, whilst still powerful, may be muted by other factors. This requires further research, particularly when vaccines are novel. Public health campaigns which centre on the protectiveness and safety of a maternal vaccine rather than disease threat alone may prove beneficial.
影响孕产妇疫苗接种率的最重要因素是医疗保健专业人员（HCP）的建议。然而，在有数据的情况下，尽管收到了建议，仍有三分之一的孕妇未接种疫苗。因此，了解其他因素的重要性并区分常规接种疫苗和疫情期间接种疫苗至关重要。这是第一项系统评价和荟萃分析（PROSPERO：CRD 42019118299），旨在研究已确定因素与孕产妇疫苗接种率之间关系的强度。
我们检索了MEDLINE、Embase Classic & Embase、PsycINFO、CINAHL Plus、Web of Science、IBSS、LILACS、AfricaWideInfo、IMEMR和全球健康数据库，以查找报告影响孕产妇疫苗接种因素的研究。我们使用随机效应模型计算按疫苗类型接种疫苗的合并比值比（OR）。
我们筛选了17236篇文章，确定了来自30个国家的120项研究纳入分析。其中，49项研究符合荟萃分析的条件。在接受HCP建议的孕妇中，接种百日咳或流感疫苗的几率高出十至十二倍。在2009年流感大流行期间，HCP的建议使产前接种H1N1疫苗的几率增加了六倍（OR 6.76，95% CI 3.12 - 14.64，I² = 92.00%）。认为疫苗可能造成伤害对季节性流感疫苗接种（OR 0.22，95% CI 0.11 - 0.44，I² = 84.00%）和大流行性流感疫苗接种（OR 0.16，95% CI 0.09 - 0.29，I² = 89.48%）有负面影响，使接种疫苗的几率降低了五倍。结合我们的定性分析，认为存在重大疾病风险与孕产妇季节性和大流行性流感疫苗接种率之间的关系有限。
疫情期间HCP建议的效果虽然仍然强大，但可能会受到其他因素的影响。这需要进一步研究，特别是当疫苗是新型疫苗时。以孕产妇疫苗的保护性和安全性而非仅以疾病威胁为中心的公共卫生运动可能会被证明是有益的。
