Elsevier

Vaccine

Volume 31, Issue 37, 20 August 2013, Pages 3972-3978
Vaccine

Pregnant women's intention to take up a post-partum pertussis vaccine, and their willingness to take up the vaccine while pregnant: A cross sectional survey

https://doi.org/10.1016/j.vaccine.2013.06.015Get rights and content

Highlights

  • Large survey of pregnant women examining attitudes toward pertussis vaccination.

  • 80% of women would have a pertussis vaccine while pregnant, if recommended.

  • 17% of women already had a pertussis vaccine, 33% plan to have post-partum.

  • Provider recommendation associated with intention to vaccinate post-partum.

  • Safety concerns and information needs are barriers to vaccination during pregnancy.

Abstract

Introduction

Post-partum vaccination of new mothers is currently recommended in Australia to reduce pertussis infection in infants. Internationally, vaccination recommendations now include pregnant women in some countries. Understanding the awareness of pertussis vaccination recommendations among pregnant women, and their willingness to have the vaccine while pregnant is important for informing vaccine program implementation.

Objective

To determine awareness and intentions toward current recommendations for post-partum pertussis vaccination among Australian pregnant women, and their willingness to accept pertussis vaccine during pregnancy, should it be recommended in Australia in the future.

Design

Quantitative self-administered survey, using a non-random stratified sampling plan based on representative proportions by age, parity and region of residence.

Participants and setting

Pregnant women receiving antenatal care through three large, demographically diverse referral hospitals in metropolitan, urban and rural New South Wales, Australia.

Results

The response rate was 815/939 (87%). Most women (80%) reported willingness to have the pertussis vaccine during pregnancy, should it be recommended. Thirty four per cent of women intended to receive a pertussis vaccine post-partum, 17% had received it previously, while 45% had never heard of pertussis vaccine, had not thought about it, or were undecided about having it. Compared with those who had not received a recommendation to have the vaccine post-partum, women who had received a recommendation were 7 times more likely (95% CI 4–14) to report intention to have the vaccine.

Conclusions

Health care provider recommendation is paramount to raising awareness of pertussis vaccination recommendations among pregnant women. Women's willingness to have the vaccine while pregnant is encouraging, and indicates the potential for high pertussis vaccine coverage among pregnant women, should it be recommended in Australia.

Introduction

In recent years high income countries have seen an increase in pertussis incidence and hospitalizations, with the youngest infants bearing the most severe disease burden [1], [2], [3]. In Australia, seven infants aged <3 months died from pertussis between 2009 and 2011and the hospitalization rate for infants <6 months of age was 420.9 per 100,000 for the period January 2009–June 2010 (HE Quinn, National Centre for Immunisation Research & Surveillance, Personal communication, 2012).

Parents are frequently the source of infant pertussis infection [4] and for this reason the current Australian immunisation recommendations include vaccination of parents and other adult house-hold members to protect young infants from infection (cocooning strategy) [5]. Internationally, there is a move toward pertussis immunisation during pregnancy; in 2011 the American Advisory Committee on Immunization Practices (ACIP) recommended that pregnant women receive acellular pertussis vaccine [6], and in 2012, the National Health Service in the United Kingdom also recommended pertussis vaccination during pregnancy [7].

Ideally, awareness of the risk of pertussis to infants and the recommendation for post-partum vaccination of mothers should be raised during pregnancy. It is therefore important to ascertain the level of awareness of current pertussis vaccination recommendations among pregnant women, their intention to receive the vaccine post-partum, and in light of the changing international recommendations, their willingness to accept the vaccine during pregnancy.

This survey forms part of a larger study delivered to pregnant women exploring their attitudes and awareness toward influenza and pertussis vaccines during pregnancy. This paper reports the intention of women receiving public antenatal care in New South Wales, Australia to receive a pertussis vaccine post-partum, and their willingness to receive pertussis vaccine while pregnant, should it be recommended. Currently in Australia pertussis vaccination during pregnancy is not routinely recommended. Barriers and facilitators to vaccine acceptance were also explored.

Section snippets

Study design

The study involved a quantitative self-administered questionnaire administered to a large, demographically diverse sample of pregnant women.

Survey development

A questionnaire was developed based on aspects of the Health Belief and Precaution Adoption Process models of health behavior [8], [9], [10], and face and content validity were measured.

The survey included questions on self-reported intention to take up a post-partum pertussis vaccine, willingness to have the vaccine during pregnancy if it were recommended,

Results

Of the 939 women approached, 815 agreed to participate in the survey (overall response rate 87%). Individual site response rates were 232/298 (78%) for Site B, 335/398 (88%) for Site A and 232/243 (95%) for Site C.

Discussion

To our knowledge, this is the largest study of its kind conducted in Australia to date, and the first to use a translated survey which actively incorporates a demographically diverse sample, thus increasing the study's generalisability to women receiving public antenatal care in New South Wales.

This study has some limitations. Firstly, the women who participated in this study were recruited through public hospital antenatal clinics, with few receiving antenatal care through private obstetric

Acknowledgements

The Authors would like to acknowledge Audrey Raeburn and Patrick Cashman from Hunter New England Area Population Health for their contribution to survey refinement and recruitment; Ms Catherine King of NCIRS for her assistance in literature searching; Dr Richard Bellingham, Kathy Gordon and the Staff and Westmead Hospital Antenatal Clinic, Dr Robert Ogle, Maureen Ryan, Christine Crealy and the staff at Royal Prince Alfred Women and Babies, Mr Brad Hansen, Dr Ken Apen, Robin Skewes, Rose

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