Low and inequitable influenza and COVID-19 vaccination coverage among pregnant women in Norway: Nationwide population-based cohort study.

BACKGROUND

Many countries recommend vaccination against influenza and COVID-19 during pregnancy, but surveillance of coverage is often lacking. We aim to quantify nationwide coverage of influenza and COVID-19 vaccination during pregnancy in Norway and identify its sociodemographic correlates.

METHODS

We combined nationwide individual-level registry data on childbirth, vaccinations and sociodemographic factors for all pregnancies in Norway between 1 September 2021 and 31 December 2022. We estimated maternal influenza and COVID-19 vaccination coverage and its correlates among women whose only indication for vaccination was pregnancy, i.e., during the second and third trimester.

RESULTS

Among 52,833 women eligible for influenza vaccination during pregnancy in the 2021/2022 influenza season, 27.7 % (n = 14,646) received the influenza vaccine. Similarly, among 50,108 women eligible for COVID-19 vaccination during pregnancy in the study period, 31.8 % (n = 15,951) received the COVID-19 vaccine. Coverage estimates were lower among mothers with immigrant background, low education, low income, low maternal age, multiple children, those living rurally and those outside the workforce. The lowest coverage was observed among immigrant women (14.5 % for influenza, 16.0 % for COVID-19 vaccination), with corresponding relative risks (RR) compared to native Norwegian women of 0.44 (95 % CI: 0.42, 0.46) and 0.41 (95 % CI: 0.39, 0.43). The highest coverage was observed among women with the highest education (38.2 % for influenza, 43.6 % for COVID-19), with corresponding RRs compared to women with the lowest education of 2.47 (95 % CI: 2.33, 2.62) and 2.36 (95 % CI: 2.24, 2.49).

CONCLUSION

The coverage of maternal vaccination against influenza and COVID-19 is insufficient. Additionally, there is high and consistent inequity in uptake. Timely and comprehensive surveillance of maternal vaccination programs should be prioritized to ensure that program performance can be adequately assessed and improved.