Paul Van Buynder on the Uptake of Recommended Vaccines in Pregnancy
It is well known that vaccination in pregnancy protects the mother and fetus from infections. Over the years, uptake of the pertussis vaccine has been strong among pregnant women. The same cannot be said for the influenza vaccine, though the infection can be as severe as pertussis.
To shed some light on this subject, Infectious Diseases Consultant spoke with Paul Van Buynder, who is chairman of the Australian Immunisation Coalition and a public health physician at the Gold Coast Health Service. He is also a professor in the School of Medicine at Griffith University in Queensland, Australia.
He will also be speaking about this topic at the 13th Vaccine Congress.1
INFECTIOUS DISEASES CONSULTANT: What do providers need to know about the uptake of recommended vaccines in pregnancy?
Paul Van Buynder: Vaccinations in pregnancy are recommended for the potential benefits of preventing severe pertussis disease in newborns and for preventing the impact of influenza on the pregnant woman, her fetus in utero, and the newborn in the first 6 months of life.
Pertussis is a highly infectious respiratory disease associated with severe disease in very young children. It remains a challenging disease to control. Control of pertussis is problematic because immunity, whether from immunization or infection, wanes over time, resulting in renewed susceptibility to infection, ongoing transmission, and periodic epidemics in the community. Immunity provided by individual early childhood vaccines is limited, and around 3 doses are required before young children are protected. Attempts to protect children through vaccinating families, the “cocoon strategy,” have not been successful.
In pregnant women and in children younger than 6 months who are too young to be vaccinated, influenza disease is also more severe with increased risk of hospitalization in both groups. The World Health Organization Special Advisory Group of Experts looking at the effectiveness of vaccine response and the burden of disease decreed that pregnant women were the highest priority group to be immunized against influenza ahead even of those with chronic diseases and age-based indications.
Many National Immunization Technical Advisory Groups (NITAGs) recommend pregnant women have both vaccines every pregnancy.
However, while many studies, including this Queensland study,2 have seen very promising increases in pertussis vaccine coverage in pregnancy, the same does not apply to influenza vaccine.
Coverage of this recommended vaccine in pregnancy is often well below 50%. The major barriers are a lack of belief in the vaccine itself and a failure of health care providers to recommend vaccine.
ID CON: How does the uptake contribute to vaccine safety and hesitancy?
PVB: Vaccine hesitancy with antenatal influenza is due to a lack of understanding of the risk-benefit equation, with the vaccine seen as ineffective or unsafe and influenza as a benign disease. The opposite is actually true. The effort that produced the good result with pertussis vaccine needs to be replicated with influenza vaccine.
ID CON: What is the key take-home message for health care providers?
PVB: Influenza vaccine in pregnancy is a triple whammy. It is good for the fetus, good for the mother, and good for the newborn. It is also very safe, and even when it doesn't prevent infection, the resultant infection is much milder.
A recommendation from the physician carer is the most important determinant of whether the antenate is vaccinated, and carers need to ensure this is a standard obstetric care activity
- Van Buynder P. Uptake of recommended vaccines in pregnancy. Talk presented at: 13th Vaccine Congress; September 15-18, 2019: Bangkok, Thailand. https://www.elsevier.com/__data/assets/pdf_file/0020/902900/30-July-13th-Vaccine-Congress-Programme-Download_1_.pdf. Accessed August 26, 2019.
- Van Buynder PG, Van Buynder JL, Menton L, Thompson G, Sun J. Antigen specific vaccine hesitancy in pregnancy. Vaccine. 2019;37(21):2814-2820. https://doi.org/10.1016/j.vaccine.2019.04.021.