Examination of Pregnant Women's Anti-Vaccine Opinions and Reasons for Not Getting Vaccinated in the Context of Influenza Vaccines: A Systematic Review

Abstract

Objective: This systematic review; The aim of this study was to examine the opinions of pregnant women against influenza vaccination and the reasons for not vaccinating. Material and Method: In this study, which is a systematic review, the data were obtained by retrospectively scanning the cross-sectional and qualitative studies published in Turkish and English between 2011-2021 in the databases of "PubMed, Cochrane, EBSCOhost, ULAKBİM and Google Scholar". The screening was carried out between December 2021 and March 2022. PRISMA method was used in the preparation of the systematic review. Results: Of the studies included in the systematic review, 3 were published in Turkish and 32 in English, 35 studies were reached, 32 of them cross-sectional and 3 qualitative. In studies, it was determined that changing the rate of pregnant women who hesitated about influenza vaccines ranged from 4.3 to 98.8%. The determining factors who encounter in the influenza vaccination hesitancy of pregnant women; The thought that influenza vaccines will harm herself and/or her baby and that they are risky during pregnancy, concern about the safety and efficacy of vaccines, not accepting the seriousness of influenza infection and perceiving vaccines as unnecessary, insufficient level of knowledge about influenza and vaccines, reasons originating from healthcare professionals, financial/temporal, negative attitudes and thoughts towards logistics barriers and vaccines have been identified. Conclusion: It was concluded that pregnant women had hesitations about influenza vaccination and did not receive influenza vaccinations during pregnancy.

Keywords

• Vaccination
• anti-vaccine
• vaccine hesitancy
• pregnancy
• influenza

Gebelerin Aşı Karşıtı Düşünceleri ve Aşı Yaptırmama Nedenlerinin Influenza Aşıları Özelinde İncelenmesi: Sistematik Derleme

Abstract

Amaç: Bu sistematik derleme; gebelerin influenza aşılarına yönelik karşıt düşünceleri ve aşı yaptırmama nedenlerinin incelenmesi amacıyla yapılmıştır. Gereç ve Yöntem: Sistematik derleme niteliğindeki bu araştırmada veriler, “PubMed, Cochrane, EBSCOhost, ULAKBİM ve Google Akademik” veri tabanlarında, 2011-2021 yılları arasında, Türkçe ve İngilizce olarak yayınlanan kesitsel ve kalitatif araştırmaların geriye dönük taraması yapılarak elde edilmiştir. Tarama, Aralık 2021-Mart 2022 tarihleri arasında gerçekleştirilmiştir. Sistematik derlemenin hazırlanmasında PRISMA metodu kullanılmıştır. Bulgular: Sistematik derleme kapsamına dâhil edilen araştırmaların 32’si İngilizce, üçü Türkçe, olarak yayınlanmış olup, 32’si kesitsel, üçü kalitatif nitelikte 35 araştırmaya ulaşılmıştır. Araştırmalarda influenza aşılarına yönelik tereddüt yaşayan gebelerin oranının %4,3-98,8 arasında değiştiği tespit edilmiştir. Gebelerin influenza aşı tereddüdü yaşamalarındaki belirleyici faktörlerin; influenza aşılarının, kendine ve/ veya bebeğine zarar vereceği ve gebelikte riskli olduğu düşüncesi, aşıların güvenliği ve etkinliğine yönelik endişe, influenza enfeksiyonunun ciddiyetini kabul etmeme ve aşıları gereksiz olarak algılama, influenza ve aşılara yönelik yetersiz bilgi düzeyi, sağlık çalışanlarından kaynaklı nedenler, finansal/zamansal/lojistik engeller ve aşılara yönelik olumsuz tutum ve düşünceler olduğu belirlenmiştir. Sonuç: Gebelerin influenza aşısı yaptırma konusunda tereddüt yaşadıkları ve gebelik döneminde influenza aşılarını yaptırmadıkları sonucuna ulaşılmıştır.

Keywords

• Aşı
• aşı karşıtlığı
• aşı tereddütü
• gebe
• grip.
• Vaccination
• anti-vaccine
• vaccine hesitancy
• pregnancy
• influenza

References

1. Centers for Disease Control and Prevention. National Center for Immunization and Respiratory Diseases (NCIRD) Key facts about ınfluenza (Flu) [homepage on the Internet]. 2021 [cited 2022 March 16]. Available from https://www.cdc.gov/flu/about/keyfacts. htm#:~:text=Flu%20is%20a%20contagious%20respiratory,a%20 flu%20vaccine%20each%20year
2. World Health Organization Regional. Up to 650 000 people die of respiratory diseases linked to seasonal flu each year. [homepage on the Internet]. 2017 [cited 2022 August 4]. Avaible from https://www.who. int/news/item/13-12-2017-up-to-650-000-people-die-of-respiratory-diseases-linked-to-seasonal-flu-each-year#:~:text=Up%20to%20 650%20000%20deaths,Organization%20and%20global%20health%20 partners.
3. Mertz D, Geraci J, Winkup J, Gessner BD, Ortiz JR, Loeb M. Pregnancy as a risk factor for severe outcomes from influenza virus infection: A systematic review and meta-analysis of observational studies. Vaccine, 2017 Jan 23;35(4):521–8. DOI: 10.1016/j.vaccine.2016.12.012
4. Fell DB, Savitz DA, Kramer MS, Gessner BD, Katz MA, Knight M et al. Maternal influenza and birth outcomes: Systematic review of comparative studies. BJOG. 2017 Jan 1;24(1):48-59. DOI: 10.1111/1471- 0528.14143.
5. Somerville LK, Basile K, Dwyer DE, Kok J. The impact of influenza virus infection in pregnancy. Future Microbiol. 2018 Feb;13:263-74. DOI: 10.2217/fmb-2017-0096.
6. Baselga-Moreno V, Trushakova S, McNeil S, Sominina A, Nunes MC, Draganescu A, et al. Influenza epidemiology and influenza vaccine effectiveness during the 2016-2017 season in the Global Influenza Hospital Surveillance Network (GIHSN). BMC Public Health. 2019 May 2;19(1):487. DOI: 10.1186/s12889-019-6713-5.
7. He J, Liu ZW, Lu YP, Li TY, Liang XJ, Arck PC, et al. A systematic review and meta-analysis of influenza a virus infection during pregnancy associated with an increased risk for stillbirth and low birth weight. Kidney Blood Press Res. 2017 May 15;42(2):232-43. DOI: 10.1159/000477221.
8. Al-Husban N, Obeidat N, Al-Kuran O, Al Oweidat K, Bakri F. H1N1 infection in pregnancy; A retrospective study of feto-maternal outcome and impact of the timing of antiviral therapy. Mediterr J Hematol Infect Dis. 2019 Mar 1;11(1):e2019020. DOI: 10.4084/MJHID.2019.020.

9. World Health Organization. Influenza (seasonal) [homepage on the Internet]. 2018 [cited 2022 March 9]. Available from https://www.who. int/news-room/fact-sheets/detail/influenza-(seasonal)
10. Offeddu V, Tam CC, Yong TT, Tan LK, Thoon KC, Lee N, et al. Coverage and determinants of influenza vaccine among pregnant women: A cross-sectional study. BMC Public Health. 2019 July 5;890:1- 12. DOI:10.1186/s12889-019-7172-8.
11. World Health Organization. WHO preferred product characteristics for influenza vaccines [homepage on the Internet]. 2017 [cited 2022 Marc 13]. Available from https://apps.who.int/iris/bitstream/hand le/10665/258767/9789241512466-eng.pdf;sequence=1
12. Wilson RJ, Paterson P, Jarrett C, Larson HJ. Understanding factors influencing vaccination acceptance during pregnancy globally: A literature review. Vaccine. 2015 November 33;47: 6420-6429. DOI: 10.1016/j.vaccine.2015.08.046.
13. Henninger ML, Irving SA, Thompson M, Avalos LA, Ball SW, Shifflett P, Naleway AL; Influenza Project (PIP) Working Group. Factors associated with seasonal influenza vaccination in pregnant women. J Womens Health (Larchmt). 2015 May; 24(5): 394-402.
14. MacDonald NE; SAGE Working Group on Vaccine Hesitancy. Vaccine hesitancy: Definition, scope and determinants. Vaccine. 2015 Aug 14;33(34):4161-4. DOI: 10.1016/j.vaccine.2015.04.036.
15. Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group. Reprint-preferred reporting items for sytematic reviews and meta-analyses: The PRISMA statement. Phys Ther. 2009 Sep;89(9):873-80.
16. Moola S, Munn Z, Tufanaru C, Aromataris E, Sears K, Sfetcu R, et al. Checklist for analytical cross sectional studies. Joanna Briggs Inst. 2017; Rev. Man. 6. Avaiable from: https://doi.org/10.17221/96/2009-CJGPB.
17. Lockwood C, Munn Z, Porritt K. Qualitative research synthesis: Methodological guidance for systematic reviewers utilizing meta-aggregation. Int J Evid Based Healthc. 2015 Sep;13(3):179-87. DOI: 10.1097/XEB.0000000000000062.
18. AlMusailhi SA, AlShehri NM, AlHarbi WM. Knowledge, utilization and barriers of pregnant women to influenza vaccine in primary health care centers in Dammam and Al Khobar, Saudi Arabia, 2017-2018. Int J Womens Health. 2019 Mar 26;11:207-11. DOI:10.2147/IJWH.S194061.
19. Bettinger JA, Greyson D, Money D. Attitudes and beliefs of pregnant women and new mothers regarding influenza vaccination in British Columbia. J Obstet Gynaecol Can. September 2016;38(11):1045-52. DOI: 10.1016/j.jogc.2016.08.004.
20. Bhaskar E, Thobias S, Anthony S, Kumar V, Navaneethan. Vaccination rates for pandemic influenza among pregnant women: An early observation from Chennai, South India. 2012 Jul-Sep;29(3):232–5. DOI:10.4103/0970-2113.99105.
21. Bishop K, McMorrow M, Meiring S, Walaza S, Rossi L, Mhlanga S, et al. An evaluation of an influenza vaccination campaign targeting pregnant women in 27 clinics in two provinces of South Africa, 2015 - 2018. BMC Health Serv Res. 2021 Sep 9;21(1):941. DOI: 10.1186/s12913-021-06962-8.
22. Chang YW, Tsai SM, Lin PC, Chou FH. Willingness to receive influenza vaccination during pregnancy and associated factors among pregnant women in Taiwan. Public Health Nurs. 2019 May;36(3):284-95. DOI: 10.1111/phn.
23. Descamps A, Launay O, Bonnet C, Blondel B. Seasonal influenza vaccine uptake and vaccine refusal among pregnant women in France: Results from a national survey. Hum Vaccin Immunother. 2020 May 3;16(5):1093-100. DOI: 10.1080/21645515.2019.1688035.
24. Ditsungnoen, D, Greenbaum A, Praphasiri P, Dawood FS, Thompson MG, Yoocharoen P, et al. Knowledge, attitudes and beliefs related to mevsimsel influenza vaccine among pregnant women in Thailand. Vaccine. 2016 Apr 19;34(18):2141-6. DOI:10.1016/j.vaccine.2016.01.056.
25. Erazo CE, Erazo CV, Grijalva MJ, Moncayo AL. Knowledge, attitudes and practices on influenza vaccination during pregnancy in Quito, Ecuador. BMC Public Health. 2021 January 21;72:1-11. DOI:10.1186/ s12889-020-10061-4.
26. Honarvar B, Odoomi N, Mahmoodi M, Kashkoli GS, Khavandegaran F, Bagheri Lankarani K, et al. Acceptance and rejection of influenza vaccination by pregnant women in southern Iran: Physicians' role and barriers. Human vaccines & immunotherapeutics. 2012 Dec 1;8(12):1860–6. DOI:10.4161/hv.22008.
27. Hu Y, Wang Y, Liang H, Chen Y. Mevsimsel influenza vaccine acceptance among pregnant women in Zhejiang province, China: Evidence based on health belief model. Int J Environ Res Public Health. 2017 Dec 11;14(12):1551. DOI:10,3390/ijerph14121551.
28. Kfouri R, Richtmann R. Influenza vaccine in pregnant women: Immunization coverage and associated factors. Einstein (Sao Paulo). 2013 Jan-Mar 1;11(1):53-7. DOI: 10.1590/s1679-45082013000100010
29. Khan AA, Varan AK, Esteves-Jaramillo A, Siddiqui M, Sultana S, Ali AS, et al. Influenza vaccine acceptance among pregnant women in urban slum areas, Karachi, Pakistan. Vaccine. 2015 Sep 22;33(39):5103-9. DOI: 10.1016/j.vaccine.2015.08.014.
30. King JP, Hanson KE, Donahue JG, Glanz JM, Klein NP, Naleway AL, et al. Survey of influenza vaccine knowledge, attitudes, and beliefs among pregnant women in the 2016-17 season. Vaccine. 2020 Feb 24;38(9):2202-8. DOI:10.1016/j.vaccine.2020.01.039.
31. Kouassi DP, Coulibaly D, Foster L, Kadjo H, N'Zussuouo T, Traoré Y, et al. Vulnerable groups within a vulnerable population: Awareness of the A(H1N1)pdm09 pandemic and willingness to be vaccinated among pregnant women in Ivory Coast. The Journal of İnfectious Diseases. 2012 Dec 15;206(Suppl 1):114–20. DOI:10.1093/infdis/jis532
32. Kul G, Erdoğan N. Gebelerin mevsimsel influenza aşısı ile ilgili bilgi, tutum ve davranışları. Anadolu Kliniği Tıp Bilimleri Dergisi, 2020 Eylül 20(3):258-63. DOI: 10.21673/anadoluklin.747921.
33. Leewongtrakul T, Kunpalin Y, Ingviya Y, Chaithongwongwatthana S. Acceptance of influenza vaccination among pregnant women attending the antenatal care clinic, King Chulalongkorn Memorial Hospital. TJOG. 2020 Eylül 25(3): 75-82.
34. Lohiniva AL, Barakat A, Dueger E, Restrepo S, El Aouad R. A Qualitative Study of Vaccine Acceptability and Decision Making among Pregnant Women in Morocco during the A (H1N1) pdm09 Pandemic. PLoS ONE. 2014 Oct 11;9(10):e96244. DOI:10.1371/journal. pone.0096244
35. Maurici M, Dugo V, Zaratti L, Paulon L, Pellegrini MG, Baiocco E, et al. Knowledge and attitude of pregnant women toward flu vaccination: A cross-sectional survey. J Matern Fetal Neonatal Med. 2016 Oct 12;29(19):3147-50. DOI: 10.3109/14767058.2015.1118033.
36. Mendoza-Sassi RA, Almeida Cesar J, Maria Cagol J, Almeida Duarte I, Mostardeiro Friedrich L, Dos Santos VK, et al. 2010 A(H1N1) vaccination in pregnant women in Brazil: identifying coverage and associated factors. Cad. Saúde Pública, Rio de Janeiro. 2015 Jun 31(6):1247-56. DOI: 10.1590/0102-311X00084514.
37. Meharry PM, Colson ER, Grizas AP, Stiller R, Vázquez M. Reasons why women accept or reject the trivalent inactivated influenza vaccine (TIV) during pregnancy. Matern Child Health J. 2013 Jan;17(1):156-64. DOI:10.1007/s10995-012-0957-3.
38. Moukarram H, Nargund A, Photiou A, Kiran TS. Awareness and acceptance of the pandemic influenza (H1N1v 2009) vaccination among antenatal patients in a district general hospital. J Obstet Gynaecol. 2012 Aug;32(6):537-9. DOI:10.3109/01443615.2012.692738.
39. Napolitano F, Napolitano P, Angelillo IF. Mevsimsel influenza vaccination in pregnant women: knowledge, attitudes, and behaviors in Italy. BMC infectious diseases. 2017 Jan 9; 17(48):1-7. DOI:10.1186/ s12879-016-2138-2.
40. Offeddu V, Tam CC, Yong TT, et al. Coverage and determinants of influenza vaccine among pregnant women: A cross-sectional study. BMC Public Health. 2019 July 5; 19(890):1-12. DOI:10.1186/s12889- 019-7172-8.
41. Otieno NA, Nyawanda B, Otiato F, Adero M, Wairimu WN, Atito R, et al. Knowledge and attitudes towards influenza and influenza vaccination among pregnant women in Kenya. Vaccine. 2020 Oct 7;38(43):6832-8. DOI:10.1016/j.vaccine.2020.08.015.
42. Özkaya Parlakay A, Kara Ö, Kara A, Özyüncü Ö. Bir salgın öncesinde gebelerin pandemik grip aşısına bakış açıları. Turkiye Klinikleri J Med Sei 2012;32(6): 1618-22.
43. Prospero E, Galmozzi S, Paris V, Felici G, Barbadoro P, D'Alleva A, et al. Factors influencing refusing of flu vaccination among pregnant women in Italy: Healthcare workers' role. Influenza and Other Respiratory Viruses. 2019 Mar;13(2):201-7. DOI: 10.1111/irv.12600
44. Pulatoğlu Ç, Turan G. Women's knowledge and beliefs towards vaccination for influenza during pregnancy in Turkey and underlying factors of misinformation: a single-centre cross-sectional study. Cent Eur J Public Health. 2020 Jun;28(2):124-9. DOI: 10.21101/cejph.a5907.
45. Rodríguez-Blanco N, Tuells J. Knowledge and Attitudes about the Flu Vaccine among Pregnant Women in the Valencian Community (Spain). Medicina (Kaunas, Lithuania), 2019 Aug; 55(8): 467. DOI: 10.3390/medicina55080467
46. Sel G, Balcı S, Aynalı B, Novruzova K, Akdemir AY, Harma M, et al. Gebelerin grip aşısı yaptırmama nedenleri üzerine kesitsel çalışma. Sürekli Tıp Eğitimi Dergisi. 2020; 29(4):281-6.
47. Shono A, Hoshi S, Kondo M. Maternal influenza vaccination relates to receiving relevant information among pregnant women in Japan. Hum Vaccin Immunother. 2019 Dec 2;16(6):1364-70. DOI:10.1080/21 645515.2019.1697109.
48. Tarrant M, Wu KM, Yuen CY, Cheung KL, Chan VH. Determinants of 2009 A/H1N1 influenza vaccination among pregnant women in Hong Kong. Matern Child Health J. 2013 Jan;17(1):23-32. DOI:10.1007/ s10995-011-0943-1.
49. Van Lier A, Steens A, Ferreira JA, van der Maas NA, de Melker HE. Acceptance of vaccination during pregnancy: Experience with 2009 influenza A (H1N1) in the Netherlands. Vaccine. 2012 Apr 16;30(18):2892-9. DOI:10.1016/j.vaccine.2012.02.030.
50. Vila-Candel R, Navarro-Illana P, Navarro-Illana E, Castro-Sánchez E, Duke E, Soriano-Vidal FJ. Determinants of maternal influenza vaccination in the context of low- and middle-income countries: A systematic review. BMC Public Health. 2016 Nov 21;16(1173):1-12. DOI:10.1186/s12889-016-3823-1.
51. Wang R, Tao L, Han N, Liu J, Yuan C, Deng L, et al. Acceptance of mevsimsel influenza vaccination and associated factors among pregnant women in the context of COVID-19 pandemic in China: A multi-center cross-sectional study based on health belief model. BMC Pregnancy Childbirth. 2021 Nov 3;21(1):745. DOI: 10.1186/s12884- 021-04224-3.
52. Zerbo O, Ray GT, Zhang L, Goddard K, Fireman B, Adams A, et al. Individual and neighborhood factors associated with failure to vaccinate against ınfluenza during pregnancy. Am J Epidemiol. 2020 Nov 2;189(11):1379-88. DOI: 10.1093/aje/kwaa165.
53. Shih SF, Wagner AL, Masters NB, Prosser LA, Lu Y, Zikmund- Fisher BJ. Vaccine hesitancy and rejection of a vaccine for the novel Coronavirus in the United States. Front Immunol. 2021 Jun 14;12:558270. DOI:10.3389/fimmu.2021.558270.
54. Vojtek I, Dieussaert TM, Doherty V, Franck L, Hanssens J, Miller R, et al. Maternal immunization: Where are we now and how to move forward? Ann Med. 2017 Aug 30;50(3):193-208. DOI:10.1080/078538 90.2017.1421320.
55. Argondizo-Correia AKS, Rodrigues CA, De Brito. Neonatal immunity to bordetella pertussis infection and current prevention strategies. J Immunol Res. 2019 Feb 10;7134168:1-10. DOI:10.1155/2019/7134168.
56. Morales KF, Menning L, Lambach P. The faces of influenza vaccine recommendation: A Literature review of the determinants and barriers to health providers’ recommendation of influenza vaccine in pregnancy. Vaccine. 2020 Jun 38;31:4805-4815.
57. Bödeker B, Walter D, Reiter S, Wichmann O. Cross-sectional study on factors associated with influenza vaccine uptake and pertussis vaccination status among pregnant women in Germany. Vaccine. 2014;32(33):4131–9. DOI:10.1016/j.vaccine.2014.06.007.
58. Butler R, MacDonald NE. Diagnosing the determinants of vaccine hesitancy in specific subgroups: The Guide to Tailoring Immunization Programmes (TIP). Vaccine. 2015;33(34):4176–9.
59. Rémy V, Zöllner Y, Heckmann U. Vaccination: The cornerstone of an efficient healthcare system. J Mark Access Health Policy. 2015 Aug 12;3:1-6. DOI: 10.3402/jmahp.v3.27041.
60. Paterson P, Meurice F, Stanberry LR, Glismann S, Rosenthal SL, Larson HJ. Vaccine hesitancy and healthcare providers. Vaccine. 2016 December 34;15; 6700-6706. DOI: 10.1016/j.vaccine.2016.10.042.
61. Kay MK, Koelemay KG, Kwan-Gett TS, Cadwell BL, Duchin JS. 2009 pandemic influenza A vaccination of pregnant women: King County, Washington State, 2009–2010. Am J Prev Med. 2012 June 102;3:368- 374. DOI: 10.2105/AJPH.2012.300676.
62. Sehung Yuen CY, Tarrant M. Determinants of uptake of influenza vaccination among pregnant women – A systematic review. Vaccine. 2014 August 32;36:4602-4613.
63. Lane S, MacDonald ME, Marti M, Dumolard L. Vaccine hesitancy around the globe: Analysis of three years of WHO/UNICEF Joint Reporting Form data-2015–2017. Vaccine.