The determinants of vaccination against pertussis in pregnancy: a survey at the Obstetrics and Gyneacology Unit of the University Hospital of Parma

Cesira; Paola Affanni; Maria Eugenia Colucci; Silvia Marozzi; Rocco Luigi Bitondo; Luca Somenzi; Licia Veronesi; Roberto Albertini; Roberta Zoni; Roberta Fini; Enny Gambazza; Serena Neri; Francesca Frati; Matteo Goldoni; Cesira Pasquarella

doi:10.23750/abm.v96i1.16807

Authors

Cesira Department of Medicine and Surgery, University of Parma, Italy
Paola Affanni Department of Medicine and Surgery, University of Parma, Italy
Maria Eugenia Colucci Department of Medicine and Surgery, University of Parma, Italy
Silvia Marozzi Department of Medicine and Surgery, University of Parma, Italy
Rocco Luigi Bitondo Department of Medicine and Surgery, University of Parma, Italy
Luca Somenzi Department of Medicine and Surgery, University of Parma, Italy
Licia Veronesi Department of Medicine and Surgery, University of Parma, Italy
Roberto Albertini Department of Medicine and Surgery, University of Parma, Italy; Geriatric-Rehabilitation Department, University Hospital of Parma, Italy
Roberta Zoni Department of Medicine and Surgery, University of Parma, Italy
Roberta Fini Department of Medicine and Surgery, University of Parma, Italy
Enny Gambazza Midwifery School, Department of Medicine and Surgery, University of Parma, Italy
Serena Neri Midwifery School, Department of Medicine and Surgery, University of Parma, Italy
Francesca Frati Midwifery School, Department of Medicine and Surgery, University of Parma, Italy
Matteo Goldoni Department of Physics, University of Parma, Italy
Cesira Pasquarella Department of Medicine and Surgery, University of Parma, Italy

Keywords:

pertussis, pregnancy, vaccination, healthcare professional

Abstract

Background and aim of the work:Vaccination of pregnant women against pertussis is highly effective in decreasing the risk of pertussis among them and their infants. This study aimed to assess the determinants of pertussis vaccination uptake in pregnant women.

Research design and Methods: A monocentric study was conducted at the Obstetrics and Gyneacology Unit of the University Hospital of Parma, from July to September 2021. An anonymous questionnaire was administered to pregnant women on a voluntary basis. The questionnaire comprised 31 questions and provided socio-demographic characteristics and information on determinants of maternal dTaP vaccination.

Results: A total of 100 pregnant women were enrolled in the study, of whom 72% had been vaccinated against pertussis, with dTaP vaccine. Eighty-six per cent of the participants stated that they had received adequate information from health professionals, with a statistically significant association between this determinant and vaccination adherence. The main reasons for adherence were the health of their child (91.6%) and the attention to the recommended vaccinations (34.7%). Among the reasons for non-adherence, were the difficulty in making an appointment at the vaccination centre (39.2%) and not considering the vaccination necessary (25%). Citizenship, educational level, number of children and knowledge of vaccination were not statistically significant.

Conclusions: The results of the study highlight a satisfactory adherence to vaccination and a good knowledge of the safety of the vaccine during pregnancy. However, a higher level of adherence could be achieved by implementing educational interventions on vaccination during checkups and antenatal classes, as well as by including the dTaP vaccination as part of routine antenatal care.

References

Ebell MH, Marchello C, Callahan M. Clinical Diagnosis of Bordetella Pertussis Infection: A Systematic Review. J Am Board Fam Med. 2017;30(3):308-319. doi: 10.3122/jabfm.2017.03.160330.

Shojaei J, Saffar M, Hashemi A, Ghorbani G, Rezai M, Shahmohammadi S. Clinical and laboratory features of pertussis in hospitalized infants with confirmed versus probable pertussis cases. Ann Med Health Sci Res. 2014;4(6):910-4. doi: 10.4103/2141-9248.144911.

Vittucci AC, Spuri Vennarucci V, Grandin A, et al. Pertussis in infants: an underestimated disease. BMC Infect Dis. 2016;16(1):414. doi: 10.1186/s12879-016-1710-0.

Istituto Superiore di Sanità. Pertosse aspetti epidemiologici - Epicentro. Available at: https://www.epicentro.iss.it.

Nieves DJ, Heininger U. Bordetella pertussis. Microbiol Spectr. 2016;4(3). doi: 10.1128/microbiolspec.EI10-0008-2015.

ECDC. Increase of pertussis cases in the EU/EEA. Available at: https://www.ecdc.europa.eu/sites/default/files/documents/Increase%20in%20pertussis%20cases%20in%20the%20EU-EEA%20-%20May%202024%20FINAL.pdf.

Wilkinson K, Righolt CH, Elliott LJ, Fanella S, Mahmud SM. Pertussis vaccine effectiveness and duration of protection - A systematic review and meta-analysis. Vaccine. 2021;39(23):3120-3130. doi: 10.1016/j.vaccine.2021.04.032.

Vygen-Bonnet S, Hellenbrand W, Garbe E, et al. Safety and effectiveness of acellular pertussis vaccination during pregnancy: a systematic review. BMC Infect Dis. 2020;20(1):136. doi: 10.1186/s12879-020-4824-3.

Merdrignac L, Acosta L, Habington A, et al. Effectiveness of pertussis vaccination in pregnancy to prevent hospitalisation in infants aged <2 months and effectiveness of both primary vaccination and mother's vaccination in pregnancy in infants aged 2-11 months. Vaccine. 2022;40(44):6374-6382. doi: 10.1016/j.vaccine.2022.09.054.

Abu-Raya B, Forsyth K, Halperin SA, et al. Vaccination in Pregnancy against Pertussis: A Consensus Statement on Behalf of the Global Pertussis Initiative. Vaccines (Basel). 2022;10(12):1990. doi: 10.3390/vaccines10121990.

Vermillion MS, Klein SL. Pregnancy and infection: using disease pathogenesis to inform vaccine strategy. NPJ Vaccines. 2018;3:6. doi: 10.1038/s41541-017-0042-4.

Mazzilli S, Tavoschi L, Lopalco PL. Tdap vaccination during pregnancy to protect newborns from pertussis infection. Ann Ig. 2018;30(4):346-363. doi: 10.7416/ai.2018.2226.

Piano Nazionale della Prevenzione Vacconale 2017-2019. Available at: https://www.salute.gov.it/imgs/C_17_pubblicazioni_2571_allegato.pdf.

Vilca LM, Cesari E, Tura AM, et al. Barriers and facilitators regarding influenza and pertussis maternal vaccination uptake: A multi-centre survey of pregnant women in Italy. Eur J Obstet Gynecol Reprod Biol. 2020;247:10-15. doi: 10.1016/j.ejogrb.2020.02.007.

Poeta M, Moracas C, Albano C, et al. Pertussis outbreak in neonates and young infants across Italy, January to May 2024: implications for vaccination strategies. Euro Surveill. 2024;29(23):pii=2400301. doi: 10.2807/1560-7917.ES.2024.29.23.2400301.

Montuori P, Gentile I, Fiorilla C, et al. Understanding Factors Contributing to Vaccine Hesitancy in a Large Metropolitan Area. Vaccines (Basel). 2023;11(10):1558. doi: 10.3390/vaccines11101558.

Signorelli C, Priori M, Odone A, et al. [New challenges in vaccination policies: the role of General Practitioners]. Acta Biomed. 2020;91(3-S):135-140. doi: 10.23750/abm.v91i3-S.9452.

Riccò M, Vezzosi L, Gualerzi G, et al. Knowledge, attitudes and practices (KAP) towards vaccinations in the school settings: an explorative survey. J Prev Med Hyg. 2017;58(4):E266-E278. doi: 10.15167/2421-4248/jpmh2017.58.4.673.

Paulik E, Molnár R, Zsiros V, et al. A védőoltásokkal kapcsolatos ismeretek és attitűdök orvostanhallgatók körében a COVID–19-pandémia alatt [Knowledge and attitudes about vaccinations among medical students during the COVID-19 pandemic]. Orv Hetil. 2023;164(21):803-810. doi: 10.1556/650.2023.32774.

Piano Nazionale della Prevenzione Vacconale 2023-2025. Available at: https://www.trovanorme.salute.gov.it/norme/dettaglioAtto?id=95963&completo=true.

Moschese V, De Angelis L, Capogna MV, et al. Vaccine hesitancy and knowledge regarding maternal immunization among reproductive age women in central Italy: a cross sectional study. Front Glob Womens Health. 2023;4:1237064. doi: 10.3389/fgwh.2023.1237064.

Bianchi FP, Stefanizzi P, Lattanzio S, et al. Attitude for vaccination prophylaxis among pregnant women: a cross-sectional study. Hum Vaccin Immunother. 2022;18(1):2031698. doi: 10.1080/21645515.2022.2031698.

Chamberlain AT, Seib K, Ault KA, et al. Factors Associated with Intention to Receive Influenza and Tetanus, Diphtheria, and Acellular Pertussis (Tdap) Vaccines during Pregnancy: A Focus on Vaccine Hesitancy and Perceptions of Disease Severity and Vaccine Safety. PLoS Curr. 2015;7:ecurrents.outbreaks.d37b61bceebae5a7a06d40a301cfa819. doi: 10.1371/currents.outbreaks.d37b61bceebae5a7a06d40a301cfa819.

Donaldson B, Jain P, Holder BS, et al. What determines uptake of pertussis vaccine in pregnancy? A cross sectional survey in an ethnically diverse population of pregnant women in London. Vaccine. 2015;33(43):5822-5828. doi: 10.1016/j.vaccine.2015.08.093.

Healy CM, Rench MA, Montesinos DP, et al. Knowledge and attitudes of pregnant women and their providers towards recommendations for immunization during pregnancy. Vaccine. 2015;33(41):5445-5451. doi: 10.1016/j.vaccine.2015.08.028.

Cappozzo F, Dal Zotto A, Scollo M, et al. dTap vaccination uptake during pregnancy: Pregnant women-focused and health professionals-focused predictors in the Veneto Region (Italy). Vaccine. 2021;39(47):6913-6919. doi: 10.1016/j.vaccine.2021.10.012.

Maisa A, Milligan S, Quinn A, et al. Vaccination against pertussis and influenza in pregnancy: a qualitative study of barriers and facilitators. Public Health. 2018;162:111-117. doi: 10.1016/j.puhe.2018.05.025.

Krishnaswamy S, Cheng AC, Wallace EM, et al. Understanding the barriers to uptake of antenatal vaccination by women from culturally and linguistically diverse backgrounds: A cross-sectional study. Hum Vaccin Immunother. 2018;14(7):1591-1598. doi: 10.1080/21645515.2018.1445455.

Mak DB, Regan AK, Vo DT, et al. Antenatal influenza and pertussis vaccination in Western Australia: a cross-sectional survey of vaccine uptake and influencing factors. BMC Pregnancy Childbirth. 2018;18(1):416. doi: 10.1186/s12884-018-2051-3.

Strassberg ER, Power M, Schulkin J, et al. Patient attitudes toward influenza and tetanus, diphtheria and acellular pertussis vaccination in pregnancy. Vaccine. 2018;36(30):4548-4554. doi: 10.1016/j.vaccine.2018.05.121.

Qiu X, Bailey H, Thorne C. Barriers and Facilitators Associated With Vaccine Acceptance and Uptake Among Pregnant Women in High Income Countries: A Mini-Review. Front Immunol. 2021;12:626717. doi: 10.3389/fimmu.2021.626717.

Mohammed H, Clarke M, Koehler A, et al. Factors associated with uptake of influenza and pertussis vaccines among pregnant women in South Australia. PLoS One. 2018;13(6):e0197867. doi: 10.1371/journal.pone.0197867.

Winslade CG, Heffernan CM, Atchison CJ. Experiences and perspectives of mothers of the pertussis vaccination programme in London. Public Health. 2017;146:10-14. doi: 10.1016/j.puhe.2016.12.018.