Running Head: EFFECTIVENESS OF INFLUENZA VACCINATIONS

Effectiveness of Influenza Vaccinations on Pregnant Women and Their Infants

Kimberly Muccio, Ariana Pasqual, Alexa Pasquale

April 25, 2018

NURS 3947: Nursing Research

Dr. Patricia Hoyson & Dr. Mary Shortreed

Running Head: EFFECTIVENESS OF INFLUENZA VACCINATIONS 1

Abstract

The purpose of this research was to determine the effectiveness of the influenza vaccination to

both mother and baby when a mother receives the flu shot during her pregnancy. Most of the

articles explored the correlation between the flu vaccine and its effects on the mother and fetus,

but there was also one study that examined the reasons behind the declination of the influenza

vaccine including reasons like less knowledge about influenza, less perception of mothers’ own

risk of infection, and lack of belief of the safeness and efficacy of the vaccine. This research was

obtained from six sources including qualitative studies, literature reviews, and medical

journals. The studies showed that there is significant evidence concluding that the influenza

vaccination is not only safe for pregnant mothers, but it is encouraged to decrease the risk of the

flu in not only the mother, but also the baby up until six months of age. There was no specific

evidence against the safety of obtaining the influenza vaccine in pregnant women. Overall, the

research done showed that it is favorable for pregnant women the receive the influenza

vaccination to decrease the incidence of the flu and also decrease the incidence of respiratory

illness with fever in mother and baby.

Running Head: EFFECTIVENESS OF INFLUENZA VACCINATIONS 2

Effectiveness of Influenza Vaccinations on Pregnant Women and Their Infants

Influenza vaccinations are among the most controversial adult immunizations. For some

populations, the vaccination is encouraged due to the increased risk of complications that may be

associated with these groups. Pregnant women are an adult population at an increased risk for the

influenza virus and the various complications that may come along with it. Some mothers have

concerns about the effects of the vaccination on their infant during pregnancy and beyond and do

not receive influenza or “flu” vaccinations at all throughout the duration of their pregnancy. In

addition to the concerns of the mother, newborn infants are not able to begin receiving influenza

vaccinations until 6 months of life. The absence of influenza vaccinations in a pregnant mother

leaves the infant without flu protection for the first six months of life. Although this may be a

popular opinion among expectant mothers, receiving the influenza vaccination at any point

during a pregnancy is effective in protecting pregnant women and their infants from contracting

the influenza virus. Nurses are responsible for the education and administration of vaccinations

of patients. Therefore, the following research question was addressed: Is the Influenza

vaccination effective in protecting pregnant women and their infants from contracting the flu?

Literature Review

Introduction

In order to look at the effectiveness of the influenza vaccination among pregnant women

and their infants, data was obtained from Academic Search Complete, OhioLINK, and ProQuest.

Six sources were used to analyze the rates of vaccination in this population as well as the

vaccination effectiveness. Vaccination rates, refusal, and effectiveness will be further discussed.
Running Head: EFFECTIVENESS OF INFLUENZA VACCINATIONS 3

Vaccination Rates

Many expectant mothers are unsure of whether or not the influenza vaccination is

appropriate for them during pregnancy. Many studies have been done to assess the percentage of

pregnant women who were vaccinated against influenza. Two such studies used data from the

Pregnancy Risk Assessment and Monitoring System (PRAMS). PRAMS is a surveying system

used to collect data on maternal behaviors and experiences throughout pregnancy. Experiences

of significance include maternal influenza vaccinations, experiences of the mother before, during

and after pregnancy, live births, and birth weight (Omer, 2011). A research study by Ahluwalia

et al. (2009) assessed the PRAMS in Georgia and Rhode Island from 2004-2007. One hundred to

three hundred women in participating states with recent live births were selected at random to be

included in the research study. In Rhode Island in 2004, 10.4% of women included in the sample

were vaccinated against the flu. The percentage of vaccinated mothers increased to 15.5% by

2006. In Georgia, the percentage of expectant mothers vaccinated against influenza in 2004 was

21.9% and increased to 33.4% by 2007 (Ahluwalia et al., 2009). The research shows that

vaccination rates of women during pregnancy have been trending upward, however, nurses can

improve these statistics further with patient support and education.

Refusal

According to Eppes et al. (2013), less influenza-related knowledge, less perception of

mother’s own risks of infection, and lack of belief in the safety and efficacy of the vaccine are

the primary factors associated with the refusal of the influenza vaccination. The virus causes

very serious complications and results in a drastic increase in doctor’s visits and increased rates

of hospitalization and ICU admission as well (Bernstein, H. H., 2008; Eppes, C., Wu, A., You,

W., Cameron, K. A., Garcia, P., & Grobman, W., 2013). Women who are pregnant have an
Running Head: EFFECTIVENESS OF INFLUENZA VACCINATIONS 4

increased morbidity and mortality rate compared to non-pregnant women. A study was

conducted with a convenience sample of 88 women from inpatient and outpatient clinic settings

including both low-risk and high-risk pregnancies. Women in the study ranged from 18-45 years

of age, and just over half of the women in this study were employed. Sixty nine percent of the

women in the study accepted and received the flu vaccine (Eppes et al., 2013). It was reported

that patients who declined the vaccination were more likely to hold false beliefs about the

immunization including that the vaccine is not effective or safe, whereas patients who accepted

the vaccination were likely to hold more factual knowledge, such as understanding that the

vaccine cannot actually cause someone to contract the flu (Eppes et al., 2013). Also, women

were more likely to receive the flu vaccine if they were cared for in a high-risk clinic. Vaccine

acceptors were shown to have different health beliefs than those who declined the influenza

vaccination. According to Eppes et al. (2013), vaccine acceptors were more likely to believe the

virus could lead to death, more likely to believe the vaccination is safe and effective, and less

likely to believe the vaccine caused birth defects. The vast majority of the women who accepted

the influenza vaccination saw a physician in the year prior to their pregnancy who informed them

about the flu and the benefits of the vaccination (Eppes et al., 2013).

Additionally, across the nation pregnant women are the adult population recommended to

receive the vaccine with the least amount of coverage (Ahluwalia et al., 2009). This reveals that

there is an increased need for coverage of flu vaccines during pregnancy as well as a need to

educate both pregnant women and healthcare providers on the importance of administering

intramuscular, inactivated influenza vaccines during any trimester of pregnancy. It is important

to note that health professionals play a very important role in the health promotion and disease

prevention of their patients and it is also very important that they educate their patients on the
Running Head: EFFECTIVENESS OF INFLUENZA VACCINATIONS 5

benefits of this important vaccination in order to protect pregnant women and their infant up to

six months of age.

Effectiveness

Researchers have been interested in the effectiveness of influenza immunizations on

mother-infant pairs focusing on the infants during the first six months of life. According to

Zaman (2008), a national survey was conducted in the United States which showed that infant

deaths associated with influenza occur most frequently in infants under the age of 6 months. All

studies reviewed compared the rate of illness among vaccinated expectant mothers and their

unvaccinated counterparts. Studies evaluated infants for respiratory illnesses, confirmed

influenza, related hospitalizations, and other complications including prematurity.

Respiratory illness encompasses a broad spectrum of diseases that affects the respiratory

tract and breathing. Respiratory illness with fever is a common complication seen in pregnant

women who are not vaccinated and their infants. One study performed included 340 women and

their infants in which 170 of the mothers received a single dose of the flu vaccine and the other

170 did not. Researchers followed the women for 24 weeks after they gave birth to their

newborns to observe any symptoms of the flu or other issues postpartum. The results of the study

showed that babies born to women who received the flu vaccine were 63% less likely to get the

flu and they also had a lower incidence of respiratory illness as well (Bernstein, 2008). In

another study conducted by Zaman (2008), it was shown that there was a reduction in the rate of

respiratory illness with fever of 29%.

Another study reported that the vaccination directly decreases the prevalence of

confirmed influenza cases among infants. According to Zaman (2008), 159 mothers specifically

received the influenza vaccination and, of these women, six of their infants had at least one case
Running Head: EFFECTIVENESS OF INFLUENZA VACCINATIONS 6

of influenza. This was confirmed by clinic visits where the child was properly swabbed, tested,

and diagnosed with influenza (Zaman, 2008). The vaccination significantly reduced the amount

of confirmed influenza cases in infants whose mothers received the vaccination.

Newborn infants are at an increased risk for developing life-threatening complications

that require hospitalization from the flu virus. Researchers took into account hospitalizations of

infants related to laboratory-confirmed influenza diagnosis. In one study assessing influenza

related hospitalizations, 151 infants were hospitalized; 148 of them born to mothers who were

not immunized against influenza. The influenza vaccine reduced the newborns likelihood of

hospitalization by 81% in their first six months (Shakib, et al., 2016). Similarly, Zaman (2008)

reported a decrease in the amount of infant clinic visits for respiratory illness with fever.

There is also a correlation between influenza vaccination and prematurity. There are a

number of causes of prematurity in infants including illness in the mother prior to the birth of

their child. Omer (2011) conducted a cohort study, which analyzed data from the PRAMS and

reports from the Council of State and Territorial Epidemiologists (CSTE), which assessed the

spread of influenza weekly. During the 28-month-long study period, a total of 578 women

received the vaccination during their pregnancy (Omer, 2011). The vaccination coverage was

very effective and had a positive correlation with the reduction of premature births. The

likelihood of prematurity was reduced by 70% for births during the 8-week widespread influenza

activity among mothers receiving the maternal vaccine (Omer, 2011).

Conclusion

In regard to the effectiveness of influenza vaccinations, research concludes that women

who get the vaccination during pregnancy are not only less likely to become ill themselves, but

their newborns are less likely to contract influenza until 6 months of age as well. There is also
Running Head: EFFECTIVENESS OF INFLUENZA VACCINATIONS 7

less incidence of respiratory illness and premature births in mother-infant pairs that receive the

influenza vaccination than those who are unvaccinated. Since the flu is exceptionally dangerous,

nurses should educate their patients about changes that parents can make to protect themselves

and their newborn child including regularly wiping down toys and surfaces with a disinfectant,

wearing a mask if one is coughing and sneezing, and using disposable tissues. After 6 months, it

is imperative that parents get their children vaccinated to protect themselves from the current

strains of influenza. If mothers and their newborns are getting sick less frequently, there will be

less spread of influenza to the general public.

Running Head: EFFECTIVENESS OF INFLUENZA VACCINATIONS 8

References

Ahluwalia, I. B., Harrison, L., Jamieson, D., & Rasmussen, S. A. (2009). Receipt of Influenza

Vaccine During Pregnancy Among Women With Live Births--Georgia and Rhode Island,

2004-2007. JAMA: Journal Of The American Medical Association, 302(18), 1964-1966.

Bernstein, H. H. (2008). Pregnancy flu shot protects baby. (). Boston: Harvard Health

Publications. Retrieved from Nursing & Allied Health Database

Eppes, C., Wu, A., You, W., Cameron, K. A., Garcia, P., & Grobman, W. (2013). Barriers

to influenza vaccination among pregnant women. Vaccine, 31(27), 2874-2878.

Omer, S. B., Goodman, D., Steinhoff, M. C., Rochat, R., Klugman, K. P., Stoll, B. J., &

Ramakrishnan, U. (2011). Maternal Influenza Immunization and Reduced Likelihood

of Prematurity and Small for Gestational Age Births: A Retrospective Cohort Study.

PLoS Medicine, 8(5), 1-8. doi:10.1371/journal.pmed.1000441

Shakib, J. H., Korgenski, K., Presson, A. P., Xiaoming, S., Varner, M. W., Pavia, A. T., &

Byington, C. I. (2016). Influenza in Infants Born to Women Vaccinated During

Pregnancy. Pediatrics, 137(6), 22. doi:10.1542/peds.2015-2360.

Zaman, K. (2008). Effectiveness of Maternal Influenza Immunization in Mothers and

Infants. New England Journal of Medicine, 359(15), 1555-1564.

doi:10.1056/nejmoa0708630