University Children's Hospital (UKBB), Paediatric Infectious Diseases and Vaccinology Unit, Basel University of Basel, Spitalstrasse 33, 4056 Basel, Switzerland; Center for Congenital Heart Disease, Department of Cardiology, Pediatric Cardiology, Inselspital, Berne University Hospital, University of Berne, Freiburgstrasse 15, 3010 Berne, Switzerland.
University Children's Hospital (UKBB), Department of Neonatology, University of Basel, Spitalstrasse 33, 4056 Basel, Switzerland.
Eur J Obstet Gynecol Reprod Biol. 2024 Apr;295:201-209. doi: 10.1016/j.ejogrb.2024.02.019. Epub 2024 Feb 14.
Pertussis and influenza are endemic infections and associated with relevant morbidity and mortality in newborns and young infants. The Swiss Federal Office of Public Health has recommended influenza vaccination since 2011 and pertussis vaccination in pregnancy (ViP) since 2013 and expanded to repetition in each pregnancy since 2017. ViP is safe and effective in preventing severe diseases, but implementation is a challenge. We hypothesized that the proportion of women receiving ViP is persistently low despite existing national recommendations. Our primary objective was to compare the proportion of pertussis and influenza vaccine recommendations for and its acceptance by pregnant women before and after an information campaign tailored to obstetricians. Secondly, we aimed to identify reasons for missing or declining ViP.
We conducted a prospective, single-center, single-arm implementation study in the maternity ward at the University Women's Hospital Basel. We performed standardized interviews with women hospitalized for postpartum care before (October to December 2019, Phase 1, n = 262) and after an information campaign (October to December 2020, Phase 2, n = 233) and compared categorical variables using chi-squared or Fisher's exact test and continuous variables using Whitney Mann U test.
We found no significant differences in the proportion of recommendation for pertussis ViP (80 % vs. 84 %, p = 0.25) and implementation (76 % vs. 78 %, p = 0.63) between Phase 1 and 2. Main reasons for missing or declining vaccinations were lack of recommendation (62.8 %) and safety concerns regarding the unborn child (17.7 %). In contrast, the proportion of recommendation for influenza ViP (45 % vs. 63 %, p < 0.001) and implementation (29 % vs. 43 %, p < 0.001) increased significantly.
Proactive recommendations by obstetricians play a key role in the implementation of ViP but is still insufficient in our setting. We believe that future efforts should aim to explore possible hurdles that impede recommendations by obstetricians for ViP. The focus should be on the needs and experiences of obstetricians in private practice, but also other health care professionals involved in care of pregnant women. Local campaigns do not seem effective enough, therefore national campaigns with new strategies are desirable.
百日咳和流感是地方性感染，与新生儿和婴儿的相关发病率和死亡率有关。瑞士联邦公共卫生办公室自 2011 年以来建议接种流感疫苗，自 2013 年以来建议孕妇接种百日咳疫苗（ViP），并自 2017 年起扩大到每次妊娠重复接种。ViP 可安全有效地预防严重疾病，但实施起来具有挑战性。我们假设，尽管存在国家建议，但接受 ViP 的孕妇比例仍然很低。我们的主要目标是比较针对孕妇的百日咳和流感疫苗建议的比例及其接受程度，在针对妇产科医生的信息宣传活动前后。其次，我们旨在确定错过或拒绝 ViP 的原因。
我们在巴塞尔大学女子医院的产科病房进行了一项前瞻性、单中心、单臂实施研究。我们对因产后护理住院的妇女进行了标准化访谈，分别在信息宣传活动前（2019 年 10 月至 12 月，第 1 阶段，n=262）和之后（2020 年 10 月至 12 月，第 2 阶段，n=233）进行，并使用卡方或 Fisher 精确检验比较分类变量，使用 Whitney Mann U 检验比较连续变量。
我们发现，第 1 阶段和第 2 阶段 ViP 的百日咳推荐比例（80%对 84%，p=0.25）和实施比例（76%对 78%，p=0.63）没有显著差异。错过或拒绝接种疫苗的主要原因是缺乏推荐（62.8%）和对胎儿安全的担忧（17.7%）。相比之下，流感 ViP 的推荐比例（45%对 63%，p<0.001）和实施比例（29%对 43%，p<0.001）显著增加。
妇产科医生的积极建议在 ViP 的实施中起着关键作用，但在我们的环境中仍然不够。我们认为，未来的努力应旨在探索阻碍妇产科医生推荐 ViP 的可能障碍。重点应放在私营执业妇产科医生的需求和经验上，但也应放在参与孕妇护理的其他卫生保健专业人员上。地方运动似乎效果不够，因此需要制定新策略的全国运动。
