1 o 9
Re is a Española de Quimio e apia Ad ance Access published June 22, 2018
©The Au ho 2018. Published by Sociedad Española de Quimio e apia. This a icle is dis ibu ed unde he e ms o he C ea i e Commons A ibu ion-NonComme cial 4.0
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an essen ial ole in ansmi ing in o ma ion on in luenza
accina ion in p egnan women and has a signi ican impac
on up ake.
Keywo ds: In luenza, P egnancy, Immuniza ion, Vaccine co e age, Vaccina-
ion up ake, Midwi e, Heal h p o essionals.
Vacunación de muje es emba azadas en la
Comunidad Valenciana du an e la empo ada
de g ipe 2014-15: un es udio mul icén ico
RESUMEN
Obje i os. In es iga la cobe u a de la acunación
an ig ipal en ges an es en es Depa amen os de Salud de
la Comunidad Valenciana (España) du an e la empo ada
2014-15, y e alua su acep abilidad, uen es de in o mación y
mo i os de echazo hacia la inmunización con a la g ipe.
Mé odos. Es udio desc ip i o ans e sal mul icén ico
en la campaña acunal 2014-15. La cobe u a acunal se
iden i icó a a és del Regis o Nominal de Vacunas (RVN).
Pos e io men e, se ealiza on 2 encues as ele ónicas a un
mínimo mues al de pué pe as acunadas y no acunadas.
Resul ados. De 1.569 pué pe as, 934 (59,5%) disponen de
in o mación en el RVN; la dis ibución po Depa amen os: 420
(44,9%), 161 (17,2%) y 353 (37,8%) en La Ribe a, To e ieja
y Elx-C e illen espec i amen e. Se ob u o una cobe u a
acunal del 27,9% (n=261). Según la a iable “País de O igen”,
el 77,5% (n=724) es española, con una asa acunal del 26,7%
(n=193), en e al 22,5% (n=210) ex anje a, con el 32,4%
(n=68). La p incipal uen e de in o mación ue la ma ona en
el 83,7% (n=159) de ges an es acunadas y el 44,6% (n=127)
en no acunadas. Los p incipales mo i os de echazo ue on
el desconocimien o (29,5%; n=84) y el no conside a se
imp escindible (25,6%; n=73).
Conclusiones. A pesa de su al a p edisposición a
ABSTRACT
Backg ound. To s udy in luenza accina ion up ake
in p egnan women om h ee Heal h Depa men s in he
Valencian Communi y (Spain) du ing he 2014-15 lu season,
o iden i y deg ee o knowledge, sou ces o in o ma ion and
a i udes owa d immuniza ion agains in luenza.
Me hods. Mul icen e c oss-sec ional desc ip i e s udy
du ing he 2014-15 accina ion campaign. Vaccine co e age
was de e mined using he Nominal Vaccina ion Regis y (NVR).
Subsequen ly, a elephone su ey was ca ied ou on a sample
o accina ed and un accina ed pos pa um women.
Resul s. The NVR had in o ma ion on 934 (59.5%)
ou o 1,569 pos pa um women; dis ibu ion pe Heal h
Depa men s was: 420 (44.9%), 161 (17.2%) and 353 (37.8%)
in La Ribe a, To e ieja and Elx-C e illen espec i ely. Vaccine
up ake was 27.9% (n = 261). Acco ding o he “Coun y o
O igin” a iable, 77.5% (n = 724) o women we e Spanish, wi h
a accina ion a e o 26.7% (n = 193), compa ed o 22.5% (n =
210) who we e non-Spanish, wi h a a e o 32.4% (n = 68). The
main sou ce o in o ma ion was midwi es o 83.7% (n = 159)
o accina ed p egnan women and o 44.6% (n = 127) o
non- accina ed women. The main easons o accine e usal
we e lack o awa eness (29.5%, n = 84) and no conside ing i
necessa y (25.6%, n = 73).
Conclusion. Despi e hei high willingness o be
accina ed a e ecei ing in o ma ion abou he lu accine,
he accina ion co e age in p egnan women s udied is s ill
low and can be imp o ed. Heal h p o essionals need new
in o ma ion s a egies o ex end accine up ake o a la ge
numbe o p egnan women in Spain. Midwi e ad ice plays
Vaccina ion o p egnan women in he Valencian
Communi y du ing he 2014-15 in luenza season: a
mul icen e s udy
1Cá ed a Balmis de Vacunología. Uni e si y o Alican e (Spain)
2Uni e si y Hospi al o Vinalopó, Elche (Spain)
3Uni e si y Hospi al o La Ribe a, Alzi a (Spain)
José Tuells1,2
Noelia Rod íguez-Blanco2
José Luis Du o To ijos1,2
Ra ael Vila-Candel3
And eu Nolasco Bonma i1
Co espondence:
José Tuells
Cá ed a Balmis de Vacunología. Uni e si y o Alican e (Spain)
Campus de San Vicen e Raspeig - Ap.99. E-03080 Alican e (Spain)
Phone: 00 34 965903838
Fax: 00 34 965903964
Email: [email p o ec ed]
O iginal
A icle his o y
Recei ed: 15 Ma ch 2018; Re ision Reques ed: 27 Ap il 2018; Re ision Recei ed: 3 May 2018; Accep ed: 11 May 2018
2 o 9
Vaccina ion o p egnan women in he Valencian Communi y du ing he 2014-15 in luenza season: a
mul icen e s udy
J. Tuells, e al.
sec ional s udy was pe o med among p egnan women
who ga e bi h in he h ee e e al hospi als o he heal h
depa men s unde s udy (LR, TV and EC) be ween Oc obe
20, 2014 and Janua y 31, 2015. These hospi als p o ide heal h
ca e o a o al o 570,000 inhabi an s (250,000 in LR; 170,000
in TV and 150,000 in EC).
Once he o al sample o p egnan women ha ing gi en
bi h du ing he s udy pe iod was ob ained, hei accina ion
up ake was de e mined based on he Nominal Vaccina ion
Regis y (NVR).
The NVR po al was se up by he au onomous go e nmen
and i elec onically s o es in o ma ion on people accina ed
in hospi als, heal h cen es and clinics in he Valencian
Communi y since 1994 [12].
To analyse accina ion co e age and ac o s in luencing
accina ion, he ollowing a iables we e used: heal h
depa men (LR / TV / EC), age (<25 yea s, be ween 25 and 35
yea s,> 35 yea s), coun y o o igin (Spain, O he s), pa i y (1
child, 2 child en, >3 child en) and in luenza accina ion s a us
(yes/no/no da a in NVR) du ing he 2014-15 season.
To iden i y he deg ee o knowledge, sou ces o
in o ma ion and a i udes owa ds he immuniza ion o
p egnan women, a subg oup o 100 p egnan accina ed
women and a subg oup o 100 non- accina ed women we e
selec ed wi hin each depa men . Inclusion in hese wo
subg oups was de e mined andomly om among he s udied
popula ion, in o de o iden i y possible di e ences be ween
hem, wi h a le el o signi icance o <0.05. The subg oup o
accina ed p egnan women did no each he minimum
sample o 100 women in wo heal h depa men s (TV, 49 and
55, EC) due o a lack o eco ds in he NVR o because o i s
low accina ion co e age.
The s udy was conduc ed acco ding o he Decla a ion
o Helsinki and cu en legisla ion and was app o ed by
he Resea ch Commission o he pa icipa ing cen es
a e ob aining au ho iza ion om he Spanish Agency o
Medicinal P oduc s and Medical De ices (“Agencia Española
del Medicamen o y P oduc os Sani a ios”, AEMPS) (numbe
CI2015-20).
Bo h subg oups we e in e iewed by elephone using a
closed ad hoc su ey, a su ey conduc ed by au ho s o he
cu en manusc ip published in simila s udies [14]. Telephone
calls we e made be ween Ma ch and May 2015, esponden s
we e in o med abou con iden iali y, p o ec ed anonymi y, as
well as he igh no o answe ques ions.
We asked accina ed women abou he sou ce o he
in o ma ion o in luenza accine, he heal h p o ide in ol ed
in ecommending he accina ion, and whe he hey would
op o be accina ed again in hei nex p egnancy he
heal h p o ide in ol ed in ecommending he accina ion,
and whe he hey would be accina ed again in hei nex
p egnancy. Fo he g oup o women who did no ecei e
accines, asked i hey had hea d abou he accine and, i
so, which heal hca e p o ide ecommended i , he easons
acuna se después de ecibi in o mación sob e la acuna
con a la g ipe, la cobe u a de acunación en muje es
emba azadas es udiadas es aún baja y puede mejo a se. Son
necesa ias nue as es a egias de o mación e in o mación po
pa e de los p o esionales sani a ios pa a ob ene un mayo
núme o de ges an es acunadas. El consejo de la ma ona es
un ac o esencial en la emisión de la in o mación sob e la
acunación an ig ipal ecibida po las ges an es es udiadas.
Palab as cla es: G ipe, Emba azo, Inmunización, Cobe u a Vacunal, Vacu-
nación, Ma ona, P o esionales Sani a ios.
BACKGROUND
P egnan women p esen a highe numbe and inc eased
se e i y o di e se in ec ions [1, 2], making hem especially
ulne able o in luenza [3-5]. This disease is one o he main
causes o hospi aliza ion du ing any p egnancy imes e , as
well as espi a o y in ec ion in child en aged unde one yea
[6, 7].
The need o p egnan women and newbo ns o
immunological p o ec ion has led he Wo ld Heal h
O ganiza ion (WHO) o ecommend in luenza accina ion
in any imes e o p egnancy [8, 9]. This ecommenda ion is
suppo ed by esul s showing a educ ion in in luenza in 70%
o immunized women [10] demons a ing i s e icacy and
sa e y [11, 4] as well as ex ending i s p o ec ion o in an s o
up o six mon hs o age [8, 9].
Following he ecommenda ions o he WHO, he
Valencian Communi y (Spain) included p egnan women in he
in luenza isk g oup as om 2013 [12]. Spain does no ha e
o icial in luenza accina ion eco ds in p egnan women and
he ew published s udies ha do exis e eal accine co e age
a es below 40% [6, 13, 14]. This igu e con as s wi h da a
epo ed in he Uni ed S a es, whe e up ake in p egnan
women ose o up o 70% ollowing he 2009 in luenza
pandemic [15].
Fea o possible ad e se e ec s was he mos ci ed eason
by p egnan women o a oiding in luenza accina ion [16].
Heal h p o essionals ha e a key ole in p omo ing
immuniza ion in p egnan women. Howe e , i has been ound
ha a signi ican pe cen age o his g oup is unawa e ha
p egnan women a e included in he isk g oup subjec o
accina ion [17].
The pu pose o his s udy is o in es iga e in luenza
accina ion co e age among p egnan women in h ee Heal h
Depa men s o he Valencian Communi y (Spain): La Ribe a
(LR), To e ieja (TV) and Elx-C e illen (EC) du ing he 2014-
15 season, and iden i y hei deg ee o knowledge, sou ces
o in o ma ion and a i udes owa ds immuniza ion agains
in luenza.
METHODS
An obse a ional, mul icen e, desc ip i e and c oss-
3 o 9
Vaccina ion o p egnan women in he Valencian Communi y du ing he 2014-15 in luenza season: a
mul icen e s udy
J. Tuells, e al.
so wa e SPSS e sion 20.0. Quan i a i e and quali a i e
a iables we e exp essed as absolu e equencies, mean and
a ios. Vaccina ion co e age was calcula ed as he pe cen age
o women accina ed wi h espec o he o al numbe o
p egnan women, and hei 95% con idence in e al (CI)
was calcula ed. The Chi-squa e es was used o analyse he
s a is ical signi icance o di e ences in accine co e age
pe cen ages be ween he ca ego ies o a iables. To e alua e
he adjus ed e ec o age, pa i y, coun y o o igin and heal h
depa men a iables on non- accina ion, mul i a ia e logis ic
eg ession models we e cons uc ed, aking non- accina ion
as a esponse a iable and he es as explana o y a iables.
o accine ejec ion, hei knowledge abou he accine and
whe he hey would ha e he accine gi en in hei nex
p egnancy.
The inclusion c i e ia in he s udy consis ed in being
p egnan and ca ed o by he P ima y Heal h Ca e cen es,
as well as being assis ed wi h labou diagnosis in he heal h
depa men s (LR, TV and EC). Women ha ing gi en bi h
in o he hospi als we e excluded, as well as hose wi h
con aindica ions o in luenza accina ion, occu ence o
an ena al dea h o who e used he elephone su ey.
S a is ical analysis was pe o med using he s a is ical
Figu e 1 Flow cha o s udy
P egnan women du ing
lu season 2014-15
La Ribe a n= 577
To e ieja n= 420
Elx-C e illen n= 572
N= 1569
Da a No NVR (La Ribe a) n= 157
Da a No NVR (To e ieja) n= 259
Da a No NVR (Elx-C e illen ) n= 219
S udy sample o pos -pa um women
Vaccina ed Women Su ey
Vaccina ed Women Su ey
NON Vaccina ed Women Su ey
NON Vaccina ed Women Su ey
La Ribe a n= 420
To e ieja n= 161
Elx-C e illen n= 353
N= 934
La Ribe a n= 100
To e ieja n= 49
Elx-C e illen n=55
N= 204
La Ribe a n= 100
To e ieja n= 41
Elx-C e illen n=49
N= 190
La Ribe a n= 100
To e ieja n= 100
Elx-C e illen n= 100
N= 300
La Ribe a n= 100
To e ieja n= 90
Elx-C e illen n= 95
N= 285
Did no answe
0 - 0
8 - 10
6 - 5
4 o 9
Vaccina ion o p egnan women in he Valencian Communi y du ing he 2014-15 in luenza season: a
mul icen e s udy
J. Tuells, e al.
depa men s ood ou because i disposed o no eco ded da a
on 61.7% o pos pa um women ( able 1). The inal sample
unde s udy u ned ou no o be homogeneous ac oss he
di e en heal h depa men s (LR, 420 (44.9%); TV, 161 (17.2%);
and EC, 353 (37.8%)). Vaccina ion co e age was 27.9% (n=261
[CI 95%: 25.0-30.7]), wi h a highe co e age in LR, wi h 37.7%
(n = 157) and TV, wi h 30.4% (n = 49) ( able 2).
RESULTS
A e applying he exclusion c i e ia ( igu e 1), a o al
o 934 pa ien s we e inally selec ed ou o a o al o 1.569
pos pa um pa ien s. A o al o 635 (40.4%) pos pa um
women we e disca ded om he s udy because hey did no
ha e any da a eco ded in he NVR. In his espec , he TV
No NVR in o ma ion NVR in o ma ion
n % n % To al
To al 635 40.5 934 59.5 1,569
Heal h depa men
La Ribe a 157 27.2 420 72.8 577
To e ieja 259 61.7 161 38.3 420
Elx-C e illen 219 38.3 353 61.7 572
Coun y o O igin Spain 374 34.2 724 65.8 1098
No Spain 261 55.4 210 44.5 471
Pa i y
a
1 158 30.7 356 69.3 515
2 224 40.5 329 59.5 553
3 o mo e 253 49.2 248 50.2 286
Age
<25 yea s 73 33.2 147 66.8 220
25-35 yea s 409 40.8 593 59.2 1002
>35 yea s 153 44.1 194 55.9 347
Table 1 P egnan women acco ding o s udy a iables and da a in
he Nominal Vaccina ion Regis y (NVR).
a
To al numbe o p egnancies, including he cu en p egnancy.
n Vaccina ed women % IC95%
To al 934 261 27.9 [25.0-30.7]
Heal h depa men
La Ribe a 420 157 37.4 [33.1-42.3]
To e ieja 161 49 30.4 [23.3-37.5]
Elx-C e illen 353 55 15.6 [11.8-19.4]
Coun y o o igin Spain 724 193 26.7 [23.5-29.9]
No Spain 210 68 32.4 [26.1-38.7]
Pa i y
a
1 357 96 27.8 [22.4-31.6]
2 329 93 28.3 [23.4-33.2]
3 o mo e 248 72 29.0 [23.3-34.6]
Age
<25 yea s 147 38 25.9 [18.8-32.9]
25-35 yea s 593 162 27.3 [23.7-30.8]
>35 yea s 194 61 31.4 [24.8-37.9]
Table 2 In luenza accina ion co e age among p egnan women
du ing he 2014-15 season
a
To al numbe o p egnancies, including he cu en p egnancy.
5 o 9
Vaccina ion o p egnan women in he Valencian Communi y du ing he 2014-15 in luenza season: a
mul icen e s udy
J. Tuells, e al.
TV and EC espec i ely ( able 3).
A o al o 94.7% (n = 180 (95% CI: 91.5-97.8) ecei ed
in o ma ion on he in luenza accine a hei P ima y
Heal h Ca e Cen e, and he LR and EC depa men s s ood
ou wi h 98% (n = 98) and 96 % (N = 47) espec i ely.
Midwi es accoun ed o 83.7% o he o al numbe o heal h
p o essionals in ol ed (n = 159 [95% CI: 78.4-88.9]) and
played a majo ole in ecommending he accine o p egnan
women. The 96.8% o accina ed p egnan women (n = 184
[95% CI: 94.3-99.3]) would ge accina ed again i hey go
p egnan again du ing he seasonal pe iod o he accina ion
campaign ( able 3).
A o al o 285 non- accina ed p egnan women we e
con ac ed o he elephone su ey, wi h a dis ibu ion o
35.1% (N = 100), 31.6% (n = 90), and 33.3% (n = 95), in LR, TV
and EC espec i ely. O hese, 67.7% (n = 193 [95% CI: 26.4-
73.1]) had hea d o in luenza accina ion du ing p egnancy, EC
showing he lowes le el o in o ma ion wi h 45.3% (n = 43)
( able 3). Midwi es, wi h 44.6% (n = 127), we e again he main
sou ce o in o ma ion in all h ee depa men s s udied ( able
3).
The main a gumen s pu o wa d o ejec ing
Spain was he coun y o o igin accoun ing o 77.5%
(n=724) o he sample, p esen ing accina ion co e age o
26.7% (n = 193 [95% CI: 23.5-29.9]). The emaining 22.5%
(n=210) we e non-Spanish, wi h a co e age o 32.4% (n=68
[CI 26.1-38.7]) ( able 2).
Conce ning he pa i y a iable, highe co e age was
obse ed in mul ipa ous p egnan women (> 3 child en), 29.0%
(n = 72 [95% CI: 23.3-32.9]). This esul is in e sely ela ed o
he dis ibu ion o he s udy’s popula ion, since he numbe
o i s pa i y (38.1% (n = 356)) o Second pa ous (35.2% (n =
329)) women p edomina ed.
Women be ween 25 and 35 yea s ep esen ed 63.5% (n
= 593) o he o al, ollowed by 20.7% (n = 194) o p egnan
women> 35 yea s. Vaccina ion co e age in he > 35 yea s
g oup was highes , wi h 31.4% (n = 61 [95% CI: 24.8-37.9]);
his da a had a descending o ien a ion, 27.3% (n=162) and
25.9% (n=38), acco ding o he es ablished age segmen s
( able 2).
Ou o a o al numbe o 190 su eys ca ied ou on
accina ed p egnan women aiming a iden i ying he deg ee
o knowledge, a i udes and sou ces o in o ma ion, 52.6%
(n=100), 21.6% (n=41) and 25.8% (n=49) co esponded o LR,
P egnan women accina ed To al (n=190) % CI (95%) P egnan women no accina ed To al (n=285) % CI (95%)
Ha e you hea d o in luenza accina ion du ing p egnancy?
SI 67.7 [62.3-73.1]
No 32.3 [26.9-37.7]
Whe e did you ecei e in o ma ion?
P ima y Ca e Cen e 94.7 [91.5-97.8] Did no ecei e 31.9 [26.4-37.3]
Media 2.1 [0.1-4.1] Media 8.8 [5.5-12.1]
P i a e consul a ion 2.6 [0.3-4.8] Family/F iends 7.7 [4.6-10.8]
The p egnan woman is a heal h ca e
p o essional
0.5 [0.0-1.5] A wo k 0.7 [0.0-1.6]
Who ecommended he in luenza accine?
Family doc o 7.9 [4.1-11.7] Midwi e 44.6 [38.8-50.4]
Midwi e 83.7 [78.4-88.9] Gynaecologis 0.4 [0.0-1.1]
Heal h ca e p o essional 1.6 [0.0-3.4] P ima y Ca e doc o 2.1 [0.4-3.8]
Gynaecologis 4.2 [1.3-7.0] The p egnan woman is a heal h ca e
p o essional
3.9 [1.6-6.1]
O he 4.2 [1.3-7.0]
I you became p egnan again a he same ime o yea , would you ge
accina ed again?
I you became p egnan again a he same ime o yea , would you ge
accina ed hen?
Yes 96.8 [94.3-99.3] Yes 61.8 [56.1-67.4]
No 3.2 [0.7-5.7] No 31.6 [26.2-36.9]
No su e 6.7 [3.8-9.6]
Table 3 A i udes and in o ma ion sou ces on in luenza accina ion in p egnan women
accina ed and no accina ed du ing he 2014-15 season
6 o 9
Vaccina ion o p egnan women in he Valencian Communi y du ing he 2014-15 in luenza season: a
mul icen e s udy
J. Tuells, e al.
ecommended by he WHO. Vaccina ion co e age o 50% was
ob ained in he popula ion wi h ca diac pa hology, 43% in
heal h p o essionals and 17.4% in p egnan women [18].
Al hough accina ion is an essen ial ecommenda ion
o p e en and comba ma e nal and neona al mo bidi y [1],
accina ion co e age o p egnan women was low, showing
unequal beha iou ac oss he h ee heal h depa men s unde
s udy. The EC depa men , wi h 15.6%, p esen ed he lowes
a es, a igu e simila o he 17.4% ob ained in he sou he n
a ea o Mad id du ing he 2004-05 season [6].
In Eu ope, da a on accine co e age o p egnan women
a e dispa a e. A s udy conduc ed in Ge many du ing he 2012-
13 season u ned ou a co e age o 15.9% [19], ano he in he
UK showed a co e age be ween 14.9% and 21.6% du ing he
2009-10 season [20] and in Belgium a a e o 42.8% o he
2013-14 season [21] was ound. These la e igu es a e simila
o hose in di e en a eas o he Uni ed S a es (41%) du ing
he same season [22].
Al hough hey a e a om accep able, ou esul s e eal
highe co e age a es han hose in o he simila s udies, such
as hose desc ibed in he Ba celona heal h depa men (5%)
du ing he 2007-08 season [13].
The in luenza su eillance p og am de eloped in he
Valencian Communi y shows a p og essi e inc ease in he
numbe o in luenza accine doses adminis e ed o p egnan
women compa ed o p e ious seasons (7.6%; 9.2% and 14.8%
o season 2011-12; 2012-13 and 2013-14 espec i ely) [12,
18, 23].
These epo s do no gi e eal igu es on he o al numbe
o p egnan women, bu hey do p o ide an es ima e, so his
s udy allows upda ing he si ua ion o in luenza immuniza ion
in he g oup o p egnan women in he Valencian Communi y.
Signi ican ly, non-Spanish p egnan women had be e
accina ion co e age han Spanish p egnan women.
Da a ela ing o age and pa i y a iables we e simila
ac oss s udied depa men s, p esen ing a pa e n o highe
accina ion a es in p egnan women who we e elde and
had p e iously been mo he s. This esul coincides wi h ha
e ealed in a ecen sys ema ic e iew o s udies p edominan ly
in Eu ope and Ame ica. This la e e iew concludes ha
olde ages o p egnan women, p e ious expe iences and
ecommenda ions o medical s a we e he mos in luen ial
ac o s in he accep ance o he accine agains seasonal
in luenza [24].
Vaccina ed p egnan women epo ed ecei ing
in o ma ion on he accine a hei heal h cen e and hei
midwi e ecommending i . The bond o us es ablished
be ween midwi es and p egnan women du ing he mon hs o
p egnancy could explain hese esul s [14]. In addi ion, hese
da a coincide wi h a simila s udy conduc ed in London [25],
whe e ecommenda ion by midwi es accoun ed o 76% o
cases. Howe e , a he in e na ional le el, he amily doc o is
ound o be he heal h p o essional ha ing he g ea es impac
in ecommending in luenza accina ion [20, 26]. Almos all
adminis a ion o he accine we e: unawa eness o he
ecommenda ion o in luenza accina ion du ing he
ges a ional pe iod wi h 29.5% (n = 84 [95% CI: 24.2-34.8,
EC da a s anding ou wi h 44.2% (n = 42); and 25,6% (n=73
[IC95%: 15,5-35,6], no conside ing i necessa y as a p e en i e
measu e, especially in he LR depa men wi h a o al o 39%
(n=39) ( able 4).
A o al o 61.8% (n = 176 [95% CI: 56.1-67.4]) o
un accina ed p egnan women in e iewed showed a
p edisposi ion o ge accina ed agains in luenza in he case
o a new p egnancy.
An analysis o he logis ic eg ession model o he
depa men , coun y o o igin, age and pa i y (modelling
he p obabili y o non- accina ion) a iables, showed ha
he e was no s a is ically signi ican ela ionship be ween
in luenza accina ion and he es o he a iables, excep
o he depa men a iable. The EC depa men showed
wo se accina ion co e age han he LR depa men , hese
di e ences being s a is ically signi ican and adjus ed by he
mul i a ia e model.
Di e ences wi h he TV depa men we e no signi ican ,
al hough his may be due o lack o da a on p egnan women
p o iles in he NRV; he la e we e signi ican ly elde han
hose in he RN depa men , wi h a g ea e numbe o child en
and a much highe pe cen age o non-Spanish women.
DISCUSSION
Vaccina ion co e age egis e ed in he Valencian
Communi y du ing he 2014-15 season in he so-called
isk g oups was less han 80% o he immuniza ion a es
P egnan women no accina ed
To al
(n=285)
%
CI (95%)
Could you indica e you eason o e usal?
Unawa eness 29.5 [24.2-34.8]
No necessa y 25.6 [15.5-35.6]
No ecei ing in o ma ion om a heal h wo ke 12.3 [8.5-16.1]
Gi ing bi h soon 8.1 [4.9-11.3]
Fea o ad e se e ec s 8.1 [4.9-11.3]
No e ec i e 6.7 [3.8-9.6]
Ne e ge accina ed 3.9 [1.6-6.1]
Ad ised agains by doc o 2.8 [0.9-4.7]
Ha e a cold 2.1 [0.4-3.7]
Long wai ing lis 1.1 [0.0-2.3]
Table 4 Reason o in luenza accine e usal in
p egnan women no accina ed du ing
he 2014-15 season
7 o 9
Vaccina ion o p egnan women in he Valencian Communi y du ing he 2014-15 in luenza season: a
mul icen e s udy
J. Tuells, e al.
accina ed p egnan women su eyed said ha in he case o a
new p egnancy, hey would ge accina ed again. None heless,
he beha iou o un accina ed p egnan women was une en
acco ding o he depa men , whe e a highe pe cen age o
p egnan women we e loca ed in EC and TV, wi h he in en ion
o no being accina ed again. One s udy iden i ied a g ea e
p edisposi ion o immuniza ion in women who had al eady
been accina ed p io o hei p egnancy du ing o he lu
seasons [27].
Unawa eness ha in luenza accina ion is ecommended
du ing p egnancy is he main eason accine adminis a ion is
ejec ed, hus co obo a ing da a om p e ious s udies. [28].
O he a gumen s agains accina ion we e ha o conside ing
i as non-e ec i e and non-essen ial, which is pa o he
pe cep ion o lack o scien i ic e idence abou he e icacy and
sa e y o he accine [18, 29, 30].
Ne e heless, he sa e y o he in luenza i us accine in
p egnan women has been e alua ed in obse a ional s udies
[31] and o da e, he e is no e idence o an inc ease in ad e se
e ec s such as la e an ena al dea h, misca iage o congeni al
mal o ma ions [32]. No is he e any e idence ha p egnan
women immunized agains in luenza de elop a g ea e
numbe o ad e se e ec s compa ed o hose who a e no
p egnan and a e accina ed [33].
The impo ance o in o ma ion s a egies du ing he
accina ion season highligh s he key ole ha heal h
p o essionals ha e in ansmi ing such in o ma ion [34]
in socio-sani a y con ex s as dispa a e as he Uni ed
Kingdom [35] o Pakis an [36]. Howe e , in o he s udies, he
e ec i eness o hese in e en ions o inc ease accina ion
co e age is pu in o ques ion, and heal h p o essionals in
con ac wi h p egnan women a e ecommended o e balize
he bene i s o he accine o newbo ns [37]. In his line o
esea ch, he majo i y o s udies was si ua ed in No h Ame ica
and was published in 2011, as a consequence o he 2009
in luenza pandemic. F om ha yea onwa ds, a dec ease o
in e es in scien i ic li e a u e can be obse ed on in luenza
accina ion among p egnan women [30].
The ecen inclusion o he dTpa accine as a
ecommenda ion o p egnan women may imp o e
adhe ence o in luenza accina ion. Bo h can be adminis e ed
simul aneously and a e sa e o he mo he and he child [38].
The s udy has some limi a ions since p egnan women
wi hou da a in he RVN ha e been excluded om he s udy.
A g ea e pa icipa ion o he heal h p o essionals in cha ge
o he egis a ion o accines in he RVN would imply a
conside able imp o emen o he accina ion p og am.
Vaccina ion co e age among he s udied popula ion o
p egnan women was low and could be imp o ed. In o de
o each highe co e age a es, new s a egies a e needed o
encou age heal h p o essionals o in o m p egnan women,
minimize excessi e sel -con idence and pe cep ions o he
accine as dispensable. Dissemina ing scien i ic e idence
a ailable on he isks o in luenza and he sa e y o he
in luenza accine as a Public Heal h p e en i e measu e
is essen ial. In Spain, midwi e ad ice is a c ucial ac o in
ansmi ing in o ma ion o p egnan women on he in luenza
accine.
Bo h accina ed and non- accina ed p egnan women
a e highly p edisposed o accep ing immuniza ion agains
in luenza in he case o a new p egnancy, and his ac
ein o ces he impo ance o communica ion s a egies
di ec ed a his g oup.
Finally, in he ligh o he los eco ds obse ed, he NVR
should be used wi h cau ion when de e mining he accina ion
s a us o p egnan women. The du y o p o essionals o eco d
each accina ion should be ein o ced.
CONFLICT OF INTEREST
The au ho s decla e ha hey ha e no con lic s o
in e es
FUNDING
None o decla e
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