Department of Pediatrics, University of Rochester Medical Center, Rochester, New York, USA.
Department of Pediatrics, University of Missouri Kansas City School of Medicine and Children's Mercy Kansas City, Kansas City, Missouri, USA.
J Womens Health (Larchmt). 2022 Sep;31(9):1246-1254. doi: 10.1089/jwh.2022.0030. Epub 2022 Jul 28.
Although maternal vaccination with influenza and tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccines improve health outcomes for pregnant individuals and infants, maternal vaccination rates are low. This study assessed obstetric providers' attitudes and practices related to influenza and Tdap vaccination in four large health systems in New York (NY) and California (CA). We conducted a cross-sectional survey of all obstetric providers within four health systems (two in NY, two in CA) to evaluate provider attitudes and office systems used for Tdap and influenza vaccination. The survey assessed perceptions of influenza and Tdap vaccination based on the Health Belief Model, and assessed office systems (reminders, prompts, standing orders, and patient education) and communication with pregnant patients related to influenza and Tdap vaccines. We had 112 responses (52% response rate) for analyses. Respondents strongly supported vaccination during pregnancy but viewed influenza disease as less of a concern for newborns than for pregnant individuals (40% vs. 67% considered influenza disease to be very significant, < 0.001). Only 84% agreed that giving influenza vaccine in the first trimester is very safe. Patient vaccine refusal was the most commonly named barrier for both influenza and Tdap vaccination. Providers frequently used office system prompts, but did not frequently use standing orders, patient educational materials, vaccine champions, and feedback on vaccination rates. While most providers consider influenza and Tdap vaccination important during pregnancy, there is room for improvement in focusing on the importance of maternal vaccination to the health of the infant, and increasing the use of office systems to improve vaccination during pregnancy.
虽然孕妇接种流感和破伤风类毒素、白喉类毒素和无细胞百日咳（Tdap）疫苗可以改善孕妇和婴儿的健康状况，但孕妇疫苗接种率仍然很低。本研究评估了纽约（NY）和加利福尼亚（CA）四个大型卫生系统中产科医务人员与流感和 Tdap 疫苗接种相关的态度和实践。我们对四个卫生系统（两个在 NY，两个在 CA）内的所有产科医务人员进行了横断面调查，以评估 Tdap 和流感疫苗接种的提供者态度和办公室系统。该调查根据健康信念模型评估了对流感和 Tdap 疫苗接种的看法，并评估了与流感和 Tdap 疫苗接种相关的办公室系统（提醒、提示、常规医嘱和患者教育）和与孕妇的沟通。我们有 112 份回复（52%的回复率）进行分析。受访者强烈支持孕妇接种疫苗，但认为流感对新生儿的影响不如对孕妇的影响大（40%认为流感对新生儿的影响非常严重，而 67%认为流感对孕妇的影响非常严重， < 0.001）。只有 84%的人同意在妊娠早期接种流感疫苗非常安全。患者拒绝接种疫苗是流感和 Tdap 疫苗接种的最常见障碍。医务人员经常使用办公室系统提示，但不经常使用常规医嘱、患者教育材料、疫苗拥护者和接种率反馈。虽然大多数提供者认为流感和 Tdap 疫苗接种在怀孕期间很重要，但在强调母亲接种疫苗对婴儿健康的重要性以及增加使用办公室系统来改善怀孕期间的疫苗接种方面还有改进的空间。
