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Interventions to increase vaccination against COVID-19, influenza and pertussis during pregnancy: a systematic review
Mohammad S Razai1, Rania Mansour1, Lucy Goldsmith1
1Population Health Research Institute, St George's University of London, London, UK.
Insights
Vaccine uptake during pregnancy remains low for COVID-19, influenza, and pertussis. Interventions showed a small effect on influenza vaccination, highlighting the need for provider training and mobile health technologies.
Area of Science:
- Obstetrics and Gynecology
- Public Health
- Infectious Diseases
Background:
- Pregnant individuals and their newborns face elevated risks from COVID-19, influenza, and pertussis.
- Despite proven safety and efficacy, vaccination rates during pregnancy are suboptimal.
- Addressing these risks is critical for maternal and infant well-being.
Approach:
- A systematic review and meta-analysis (January 2012-December 2022) evaluated interventions to boost vaccination rates for COVID-19, influenza, and pertussis in pregnant individuals.
- Searched nine databases and grey literature, extracting data from 39 studies (168,262 participants) across nine countries.
- Employed random-effects models for meta-analyses and assessed heterogeneity using I2 statistics.
Key Points:
- Interventions modestly increased influenza vaccine uptake (risk ratio = 1.07).
- No clear benefit was observed for pertussis vaccine interventions (risk ratio = 0.98).
- No relevant randomized controlled trials were identified for COVID-19 vaccines during pregnancy.
- Effective strategies included patient-level recommendations, provider education, and policy-level changes like financial incentives and electronic health record integration.
Conclusions:
- Interventions demonstrated a small but significant effect on increasing influenza vaccination rates during pregnancy.
- Enhanced training for healthcare providers on vaccine promotion, potentially using mobile health technologies, is essential.
- Further research is needed to identify effective strategies for increasing COVID-19 and pertussis vaccination in pregnant populations.
Background:
Pregnant women and their babies face significant risks from three vaccine-preventable diseases: COVID-19, influenza and pertussis. However, despite these vaccines' proven safety and effectiveness, uptake during pregnancy remains low.
Methods:
We conducted a systematic review (PROSPERO CRD42023399488; January 2012-December 2022 following PRISMA guidelines) of interventions to increase COVID-19/influenza/pertussis vaccination in pregnancy. We searched nine databases, including grey literature. Two independent investigators extracted data; discrepancies were resolved by consensus. Meta-analyses were conducted using random-effects models to estimate pooled effect sizes. Heterogeneity was assessed using the I2 statistics.
Results:
From 2681 articles, we identified 39 relevant studies (n = 168 262 participants) across nine countries. Fifteen studies (39%) were randomized controlled trials (RCTs); the remainder were observational cohort, quality-improvement or cross-sectional studies. The quality of 18% (7/39) was strong. Pooled results of interventions to increase influenza vaccine uptake (18 effect estimates from 12 RCTs) showed the interventions were effective but had a small effect (risk ratio = 1.07, 95% CI 1.03, 1.13). However, pooled results of interventions to increase pertussis vaccine uptake (10 effect estimates from six RCTs) showed no clear benefit (risk ratio = 0.98, 95% CI 0.94, 1.03). There were no relevant RCTs for COVID-19. Interventions addressed the 'three Ps': patient-, provider- and policy-level strategies. At the patient level, clear recommendations from healthcare professionals backed by text reminders/written information were strongly associated with increased vaccine uptake, especially tailored face-to-face interventions, which addressed women's concerns, dispelled myths and highlighted benefits. Provider-level interventions included educating healthcare professionals about vaccines' safety and effectiveness and reminders to offer vaccinations routinely. Policy-level interventions included financial incentives, mandatory vaccination data fields in electronic health records and ensuring easy availability of vaccinations.
Conclusions:
Interventions had a small effect on increasing influenza vaccination. Training healthcare providers to promote vaccinations during pregnancy is crucial and could be enhanced by utilizing mobile health technologies.
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