Acceptance and uptake of vaccines against tetanus, influenza, pertussis, and COVID-19 among pregnant and postpartum women in low- and middle-income countries: a systematic review and meta-analysis protocol.

doi:10.21203/rs.3.rs-4140735/v1

Download PDF

Research Article

Acceptance and uptake of vaccines against tetanus, influenza, pertussis, and COVID-19 among pregnant and postpartum women in low- and middle-income countries: a systematic review and meta-analysis protocol.

https://doi.org/10.21203/rs.3.rs-4140735/v1

This work is licensed under a CC BY 4.0 License

Journal Publication

published 05 Sep, 2024

Read the published version in Systematic Reviews →

You are reading this latest preprint version

Background

Pregnant women, foetuses, and neonates are particularly vulnerable to vaccine-preventable diseases (VPDs). These VPDs are associated with high morbidity and mortality among expectant mothers and their foetuses and neonates. Vaccination during pregnancy can protect the expectant mother from VPDs to which she may be especially vulnerable while pregnant. In addition, the passive transfer of maternal neutralizing immunoglobulin G (IgG) and secretory immunoglobulin A (IgA) also protects the foetus against congenital infections and may further protect the neonate from infection during the first few months of life. Despite this, coverage of recommended maternal vaccines remains suboptimal globally, especially in resource-constrained settings. Determinants of vaccine acceptance and uptake are frequently understudied in low and middle-income countries (LMICs) and among specific groups such as pregnant and postpartum women. This proposed systematic review will assess the acceptance and uptake of vaccines against tetanus, influenza, pertussis, and COVID-19 vaccines among pregnant and postpartum women in LMICs.

Methods

A Boolean search strategy employing common and medical subject heading (MeSH) terms for tetanus, influenza, pertussis, and COVID-19 vaccines, as well as vaccine acceptance, hesitancy, together with uptake, pregnancy and postpartum, will be used to search electronic databases for relevant literature published between 2009 and 2023. Only studies conducted in LMICs that investigated determinants of acceptance, hesitancy and uptake of tetanus, influenza, pertussis, and COVID-19 vaccines among pregnant and postpartum women will be eligible for inclusion in the review. The quality and the risk of bias of all eligible full-text articles will be assessed using the Joanna Briggs Institute's (JBI) critical appraisal tools.

Discussion

This protocol proposes a systematic review and meta-analysis that aims to assess the uptake of maternal vaccines and to systematically appraise and quantify determinants of the acceptance and uptake of recommended vaccines during pregnancy and postpartum in LMICs. A better understanding of these factors and how they influence maternal vaccine decision-making will enable public health practitioners as well as global and national policymakers to design more effective interventions as we look towards expanding the scope and reach of maternal immunization programs.

maternal immunisation

vaccination in pregnancy

postpartum

vaccine acceptance

vaccine uptake

low-and middle-income countries

Pregnant women, foetuses, and neonates are vulnerable to infectious diseases. This includes those that can be prevented by vaccination and are associated with high morbidity and mortality [1]. The maternal immune system undergoes significant changes during pregnancy to defend the mother and her unborn child against infections while preventing adverse immune reactions to the allogeneic foetus[2]. An essential condition for a healthy pregnancy is the mother’s immune tolerance to the semi-allogeneic foetus [2–5]. The complex adaptive changes required to develop this tolerance increase the likelihood of a severe course of infectious disease, even in immunocompetent pregnant women. The foetus is susceptible to infections during pregnancy or birth [2–5]. Pregnant women often have the same ability as nonpregnant women to develop an immune response to natural illnesses and vaccines. However, as levels of the sex hormones, oestrogen and progesterone rise, the balance of pro-inflammatory and anti-inflammatory responses fluctuates throughout the course of pregnancy. Along with these physiological and hormonal changes, pregnancy results in diminished pulmonary reserve and higher cardiac output, which may also reduce pathogen control and aggravate clinical symptoms [2–5]. Neonates leave the safe intrauterine environment and enter the microbe-filled outer world, where they are exposed to a variety of antigens. Neonatal immune systems are still developing at this critical time, and they differ significantly from adult immune systems in many ways. Therefore, providing broadly passive innate immunity throughout infancy may help create protective immunity while also preventing the negative effects of unchecked inflammation [6–8].

Many studies have indicated that pregnant women are more likely than nonpregnant women to develop severe disease and die from seasonal influenza [7, 9–12]. During the 2009 Influenza A pandemic, pregnant women were 7.2% more likely to be hospitalized than nonpregnant women, and they also had a disproportionately higher risk of mortality [7, 9–12]. A recent prospective cohort research also revealed that pregnant women who were infected with influenza during pregnancy were more likely to have adverse pregnancy outcomes, such as late pregnancy loss and a reduction in their infants’ birthweight when compared to women who were not infected [7, 9–12]. Additionally, acute lower respiratory infection (ALRI) caused by the influenza virus is a leading cause of death in children under the age of five [13, 14]. In 2018, influenza was linked to 15,300 in-hospital deaths in children under the age of five worldwide[13, 14]. More than a third of in-hospital deaths were in children under the age of six months, with the majority (82%) occurring in low-income and lower-middle-income nations (LMICs). When compared to older children in high-income countries (HICs), children under the age of six months had greater rates of influenza-related hospitalization and mortality [13, 14]. Infants can be protected early in infancy if their mothers are vaccinated [13, 14]. Bordetella pertussis is what causes the pertussis infection, also known as whooping cough, a highly contagious disease of the respiratory tract [15–17]. Despite decades of routine childhood vaccination, pertussis remains common globally and is difficult to contain [15–17]. While 60% of pertussis cases occur in adults and adolescents, infants under two months of age who are not yet old enough to receive the vaccine have the greatest incidence of the disease and the highest mortality rates [15–17]. According to the Global Burden of Disease Study's 2013 estimates, 400 per million live births, or over 56,000 deaths each year, were attributable to pertussis in the first year of life [15–17]. In addition to that, pregnant women are at a higher risk of severe disease and death from SARS-CoV-2 infection than nonpregnant women, according to data from several countries. Furthermore, COVID-19 in pregnancy is linked to an increased risk of adverse pregnancy outcomes [18–21].

The World Health Organization (WHO) recommends that pregnant and postnatal women get vaccinated against tetanus influenza and pertussis [22–25]. In most LMICs, vaccination against tetanus during pregnancy has long been recommended. Recently, both pertussis and influenza vaccination programs for pregnant and postpartum women have been recommended in several HICs and LMICs [22–27]. Moreover, given the risks of COVID-19 disease during pregnancy and the growing body of evidence supporting the favourable safety profile of COVID-19 vaccines in pregnant and postpartum women, WHO recommends their use in pregnant and lactating women [28, 29].

The advantages of vaccination during pregnancy for infants were revealed for the first time in 1879 when it was discovered that babies born to mothers who had received the vaccinia virus vaccine during pregnancy were protected from smallpox during the early period of their life [14, 30, 31]. Neonatal vaccination is an alternate method for protecting young infants from infectious diseases. It may however be less likely to be effective in the first weeks of life as the ability of the infant to produce neutralizing antibodies may not yet have matured enough[14, 30, 31]. There are benefits to vaccinating pregnant women. Vaccination at this stage protects the expectant mother from diseases to which she may be especially vulnerable while pregnant and protects the growing foetus against congenital infections and other negative effects of maternal infections. Maternal immunization may be utilized to protect the infant from infection during the first few months of life through the placental transfer of neutralizing immunoglobulin G (IgG) antibodies and/or secretory immunoglobulin A (IgA) antibodies in breast milk [14]. Postpartum vaccination plays a role in protecting mothers from getting sick, and if they are breastfeeding, they will transfer vaccine-specific antibodies to the baby through breast milk. If mothers do not receive recommended vaccines before or during pregnancy, vaccination during postpartum turns out to be critically important[32]. Despite the above, most LMICs do not include maternal vaccination against influenza and pertussis in their routine immunization programs, and coverage of the influenza vaccine, for instance, is still low among pregnant women worldwide, particularly in resource-constrained settings in LMICs [33, 34].

This systematic review study seeks to investigate the prevalence of acceptance and uptake of all recommended vaccines during pregnancy and postpartum in low and middle-income countries (LMICs). Secondly, the study aims to investigate the determinants of acceptance and uptake of these vaccines. Specifically, the systematic review and envisaged meta-analysis aims to assess the acceptance and uptake of vaccines against tetanus, influenza, pertussis, and COVID-19 in pregnant and postpartum women, and systematically appraise and quantify determinants of the acceptance and uptake of these vaccines in these populations.

Vaccine acceptance refers to the number of women vaccinated against any of the recommended vaccines during pregnancy or postpartum. Vaccine acceptance is defined as the individual or group's decision to accept or refuse when presented with an opportunity to vaccinate [35].

Eligibility criteria

Inclusion criteria

Cross-sectional, case-control and cohort studies that assessed the prevalence of acceptance and uptake of tetanus, pertussis, influenza, and COVID-19 vaccines among pregnant and postnatal women in LMICs.

Exclusion criteria

Studies conducted in HICs. Studies conducted on non-pregnant or non-postpartum women. Studies that included vaccines other than tetanus, pertussis, influenza, or COVID-19.

Study design/characteristics

Observational studies including cross-sectional, case-control, and cohort studies that reported the prevalence or incidence of recommended vaccines’ acceptance or uptake among pregnant and postpartum women and explored the factors associated with acceptance and uptake of these vaccines will be considered for inclusion. Alternatively, the studies should include data that can be used to calculate these outcomes. In this review, we will only consider studies conducted in LMICs.

Population

This review will include pregnant and postpartum women in LMICs.

Exposure

Vaccination against tetanus, pertussis, influenza, and Covid-19 during pregnancy or the postpartum period.

Comparators(controls)

Pregnant or postpartum women who didn’t accept to receive or didn’t get vaccinated against tetanus pertussis or influenza or COVID-19.

Outcomes

Primary outcomes

The incidence will be defined as events of acceptance or getting vaccinated against tetanus pertussis or influenza or COVID-19 occurring over the total period participants are at risk. Prevalence will be defined as the proportion of all participants who accepted to get vaccinated or the proportion of participants who were vaccinated against tetanus pertussis or influenza or COVID-19.

Secondary outcomes

Prevalence ratio or odds ratio or incidence ratio for exploring the determinants of acceptance and uptake of vaccination against tetanus pertussis or influenza or Covid-19 among pregnant and postnatal women.

Search strategy methods for the identification of studies

A comprehensive and sensitive search strategy has been developed to identify relevant studies published between the 1st of January 2009 and the 30st of November 2023. Multiple electronic databases will be searched for all the relevant literature namely PubMed, Scopus, Web of Science, EBSCOHost (Academic Premier, Africa Wide information, CINAHL, Health Source Nursing Academic, Medline, APA PsychArticles, and APA PsycInfo), WHOLLIS, WHO database, Google Scholar, and grey literature. We will use both key terms and medical subject heading (MeSH) terms. The search strategy will be tailored for each database. Table 1 shows the search strategy developed and adapted for searches in PubMed.

Table 1

Search strategy in PubMed
Query number	Search term
#1	Pregnant women [MeSH Terms] OR postpartum period [MeSH Terms] OR pregnancy [Title/Abstract] OR postpartum women [Title/Abstract]
#2	Vaccines [MeSH Terms] OR vaccination [Title/Abstract] OR immunization [Title/Abstract]
#3	Influenza, human [MeSH Terms] OR whooping cough [MeSH Terms] OR covid 19 [MeSH Terms] OR tetanus [MeSH Terms] OR influenza [Title/Abstract] OR influenza virus [Title/Abstract] OR pertussis [Title/Abstract] OR covid 19 [Title/Abstract] OR tetanus [Title/Abstract] OR coronavirus [Title/Abstract] OR sars cov2 [Title/Abstract]
#4	#2 AND #3
#5	Afghanistan OR Albania OR Algeria OR American Samoa OR Angola OR Armenia OR Azerbaijan OR Bangladesh OR Belarus OR Belarus OR Belorussia OR Belize OR Benin OR Bhutan OR Bolivia OR Bosnia OR Botswana OR Brazil OR Bulgaria OR Burma OR Burkina Faso OR Burundi OR Cabo Verde OR Cape Verde OR Cambodia OR Cameroon OR Central African Republic OR Chad OR China OR Colombia OR Comoros OR Comoros OR Comoro OR Congo OR Costa Rica OR Côte d'Ivoire OR Cuba OR Djibouti OR Dominica OR Dominican Republic OR Ecuador OR Egypt OR El Salvador OR Equatorial Guinea OR Eritrea OR Ethiopia OR Fiji OR Gabon OR Gambia OR Gaza OR Georgia OR Georgia Republic OR Ghana OR Grenada OR Grenadines OR Guatemala OR Guinea OR Guinea- Bissau OR Guyana OR Haiti OR Herzegovina OR Hercegovina OR Honduras OR India OR Indonesia OR Iran OR Iraq OR Ivory Coast OR Jamaica OR Jordan OR Kazakhstan OR Kenya OR Kiribati OR Democratic People’s Republic of Korea OR Kosovo OR Kyrgyz OR Kirghizia OR Kirghiz OR Kyrgyzstan OR Lao PDR OR Laos OR Lebanon OR Lesotho OR Liberia OR Libya OR Macedonia OR Madagascar OR Malawi OR Malay OR Malaya OR Malaysia OR Maldives OR Mali OR Marshall Islands OR Mauritania OR Mauritius OR Mexico OR Micronesia OR Moldova OR Mongolia OR Montenegro OR Morocco OR Mozambique OR Myanmar OR Namibia OR Nepal OR Nicaragua OR Niger OR Nigeria OR Pakistan OR Palau OR Papua New Guinea OR Paraguay OR Peru OR Philippines OR Principe OR Romania OR Ruanda OR Rwanda OR Samoa OR Sao Tome OR Senegal OR Serbia OR Sierra Leone OR Solomon Islands OR Somalia OR South Africa OR South Sudan OR Sri Lanka OR St Lucia OR St Vincent OR Sudan OR Surinam OR Suriname OR Swaziland OR Syria OR Syrian Arab Republic OR Tajikistan OR Tadzhikistan OR Tajikistan OR Tadzhik OR Tanzania OR Thailand OR Timor OR Togo OR Tonga OR Tunisia OR Turkey OR Turkmen OR Turkmenistan OR Tuvalu OR Uganda OR Ukraine OR Uzbek OR Uzbekistan OR Vanuatu OR Venezuela OR Vietnam OR West Bank OR Yemen OR Zambia OR Zimbabwe
#6	#1 AND #4 AND #5

Data management and study selection

Articles retrieved from databases will be exported to EndNote version 20 citation manager and will then be exported to RAYYAN, a systematic review production tool for title/abstract screening, full-text screening, and data abstraction [36]. After deleting duplications, the first author (IA) will screen the studies using titles and abstracts. In addition, publication date and country, type of vaccines, study setting, study design, methods, and population as well as study outcomes will be evaluated. Then, the first (IA and EAD) and the second authors will independently read the full text of all potentially eligible studies for inclusion in this review to assess their eligibility. Discrepancies in the list of included studies between the two authors will be resolved through discussion and consensus, with the assistance of a third author.

Data collection process

Data will be extracted from text, tables and figures and recorded in a standardized data extraction sheet designed for this review. The following data will be extracted from the included studies in this review:

Study characteristics: publication date, period, design, and aims.
Study population: country, setting, pregnant or postpartum participants.
Type of vaccines: tetanus pertussis or influenza or covid-19.
Prevalence or incidence of acceptance or uptake of tetanus or pertussis influenza or COVID-19.
The number of people vaccinated will form the denominator of the population.
Prevalence ratios, odds ratios, or risk ratios for determinants of acceptance or uptake of tetanus or pertussis influenza or COVID-19.
Factors associated with the acceptance and uptake of each vaccine.

Risk of bias in individual studies

Authors (IA and EAD) will independently assess the risk of bias in the included studies using the Joanna Briggs Institute’s critical appraisal checklists for observational studies for cross-sectional studies, case-control studies, and cohort studies as appropriate[37]. The JBI critical appraisal tool has eleven items to assess cohort studies, ten items to assess case-control studies, and eight items to assess cross-sectional studies [37]. Results of the study risk of bias assessment and data will be extracted into a standard sheet for data synthesis and statistical analysis.

Data synthesis

Data will be analysed, and all the statistical calculations performed using STATA software version 18 (STATA Corporation, College Station, TX, USA). Heterogeneity among the included studies will be assessed by Cochran’s Q χ² statistics and Higgins's (I² statistics) method [38]. The data will be pooled in a meta-analysis using a random effects model to combine the prevalence or incidence estimates. I² statistic estimates of 25%, 50%, and 75% would mean low, medium, and high heterogeneity, respectively [39]. Subgroup analysis will be conducted based on population type pregnant or postpartum women, as well as by type of vaccine. Other variables that will be considered for subgroup analysis are risk of bias assessment and study design.

Forest plots will be used to summarize the pooled estimates allowing the visual examination of publication bias as well. The main characteristics of the included studies including study aim, population studied, types of vaccines, risk of bias, and main outcomes will be presented in tables.

The proposed systematic review will be conducted in line with the Preferred Reporting Items PRISMA for Systematic Reviews and Meta-Analyses guidelines [40]. Findings in our systematic review will be presented using a PRISMA flow diagram to summarize the study selection process including reasons for exclusion, while tables will be used to summarize characteristics and outcomes from the included studies. Results of the quality assessment of studies and level of evidence will be described narratively.

In LMICs, where the burden of vaccine-preventable diseases is highest, maternal vaccination is an effective way to reduce infection in neonates and infants [23, 41–43]. The Maternal Neonatal Tetanus Elimination Program was the first maternal vaccination initiative to be put into action, and it serves as evidence suggesting the feasibility and potential of vaccination during pregnancy to reduce neonatal mortality, particularly in LMICs [23, 41–43]. Neonatal tetanus caused an estimated 787,000 infant fatalities in 1988, according to the WHO, with a global mortality rate of roughly 6.7 deaths per 1000 live births [23, 41–43]. In response, the WHO urged the eradication of maternal and neonatal tetanus and suggested that one of the four elements of the strategy be the routine vaccination of pregnant women with tetanus toxoid [23, 41–43]. As of March 2018, 45 of 59 countries have achieved elimination, with an estimated 96% reduction in tetanus-related neonatal deaths compared with the late 1980s [23, 41–43].

Vaccination during pregnancy and postpartum aims to reduce maternal and neonatal morbidity and mortality caused by infections. In settings where the disease burden is known, the WHO recommends the inactivated influenza, tetanus-toxoid-containing vaccine, and combined tetanus, diphtheria, and acellular pertussis (Tdap) vaccines for pregnant women [2, 3, 44]. Pertussis vaccination was previously limited to childhood. Vaccination during pregnancy and postpartum contains great potential to reduce the global burden of morbidity and mortality among infants, with their unique position to access the infant’s immune system through maternal antibodies' transfer before a childhood vaccine could be effective, especially when maternal vaccines are under development for respiratory syncytial virus (RSV) and group B streptococci, which are estimated to be major causes of neonatal morbidity and mortality worldwide[45–47].

Safe and effective maternal vaccines will only be effective if mothers choose to receive them. Maternal knowledge, attitudes, and beliefs about vaccines are important predictors of vaccine acceptance and uptake, but this issue is frequently understudied in low and middle-income countries and among specific groups such as pregnant and postpartum women [41, 48]. A better understanding of these factors and how they influence maternal decision-making will enable public health practitioners as well as global and national policymakers to design more effective interventions. Addressing determinants of maternal vaccination, such as mothers’ knowledge, attitudes, and beliefs about vaccination during pregnancy and postpartum period, is critical to increasing global vaccination rates and reducing global vaccine-preventable maternal and neonatal morbidity [3, 45, 49].

Protocol registration

This protocol has been published in the PROSPERO International Prospective Register of Systematic Reviews (http://www.crd.york.ac.uk/PROSPERO), registration number CRD42023412893.

VPDs

vaccine-preventable diseases

LMICs

low and middle-income countries

IgG

neutralizing immunoglobulin G

IgA

secretory immunoglobulin A

MeSH

medical subject heading

JBI

Joanna Briggs Institute's

HICs

high-income countries

WHO

World Health Organization

PRISMA

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

Tdap

tetanus, diphtheria, and acellular pertussis

Ethics approval and consent to participate:

Not applicable.

Consent for publication
not applicable.

Competing interests

authors declare no competing interests.

Funding

none

Authors' contributions

IA conceived the study. IA and SN developed the criteria and searched the literature. IA wrote the protocol. EAD, BK, and RM assisted in protocol design. EAD, BK, and RM advised on protocol design and revised the manuscript. All authors read and approved the final manuscript.

Acknowledgements

not applicable.

Availability of data and materials

Not applicable.

Vojtek I, Dieussaert I, Doherty TM, Franck V, Hanssens L, Miller J, et al. Maternal immunization: where are we now and how to move forward? Ann Med. 2018;50(3):193–208.
Sakala IG, Honda-Okubo Y, Fung J, Petrovsky N. Influenza immunization during pregnancy: Benefits for mother and infant. Hum Vaccin Immunother. 2016;12(12):3065–71.
Kourtis AP, Read JS, Jamieson DJ. Pregnancy and Infection. N Engl J Med. 2014;370(23):2211–8.
Global regional. national age-sex specific mortality for 264 causes of death, 1980–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017;390(10100):1151–210.
Neonatal mortality. 2023 [Available from: https://data.unicef.org/topic/child-survival/neonatal-mortality/. Accessed 9 April 2023.
Sanchez-Schmitz G, Levy O. Development of newborn and infant vaccines. Sci Transl Med. 2011;3(90):90ps27.
Etti M, Calvert A, Galiza E, Lim S, Khalil A, Le Doare K, et al. Maternal vaccination: a review of current evidence and recommendations. Am J Obstet Gynecol. 2022;226(4):459–74.
Phadke VK, Omer SB. Maternal vaccination for the prevention of influenza: current status and hopes for the future. Expert Rev Vaccines. 2016;15(10):1255–80.
Dawood FS, Kittikraisak W, Patel A, Rentz Hunt D, Suntarattiwong P, Wesley MG, et al. Incidence of influenza during pregnancy and association with pregnancy and perinatal outcomes in three middle-income countries: a multisite prospective longitudinal cohort study. Lancet Infect Dis. 2021;21(1):97–106.
Mertz D, Lo CK, Lytvyn L, Ortiz JR, Loeb M. Pregnancy as a risk factor for severe influenza infection: an individual participant data meta-analysis. BMC Infect Dis. 2019;19(1):683.
Creanga AA, Johnson TF, Graitcer SB, Hartman LK, Al-Samarrai T, Schwarz AG, et al. Severity of 2009 pandemic influenza A (H1N1) virus infection in pregnant women. Obstet Gynecol. 2010;115(4):717–26.
Siston AM, Rasmussen SA, Honein MA, Fry AM, Seib K, Callaghan WM, et al. Pandemic 2009 influenza A(H1N1) virus illness among pregnant women in the United States. JAMA. 2010;303(15):1517–25.
Wang X, Li Y, O'Brien KL, Madhi SA, Widdowson MA, Byass P, et al. Global burden of respiratory infections associated with seasonal influenza in children under 5 years in 2018: a systematic review and modelling study. Lancet Glob Health. 2020;8(4):e497–e510.
Löwensteyn YN, Nair H, Nunes MC, van Roessel I, Vernooij FS, Willemsen J, et al. Estimated impact of maternal vaccination on global paediatric influenza-related in-hospital mortality: A retrospective case series. EClinicalMedicine. 2021;37:100945.
Kandeil W, van den Ende C, Bunge EM, Jenkins VA, Ceregido MA, Guignard A. A systematic review of the burden of pertussis disease in infants and the effectiveness of maternal immunization against pertussis. Expert Rev Vaccines. 2020;19(7):621–38.
Chow MY, Khandaker G, McIntyre P. Global Childhood Deaths From Pertussis: A Historical Review. Clin Infect Dis. 2016;63(suppl 4):134–s41.
Tan T, Dalby T, Forsyth K, Halperin SA, Heininger U, Hozbor D, et al. Pertussis Across the Globe: Recent Epidemiologic Trends From 2000 to 2013. Pediatr Infect Dis J. 2015;34(9):e222–32.
Vousden N, Bunch K, Morris E, Simpson N, Gale C, O'Brien P, et al. The incidence, characteristics and outcomes of pregnant women hospitalized with symptomatic and asymptomatic SARS-CoV-2 infection in the UK from March to September 2020: A national cohort study using the UK Obstetric Surveillance System (UKOSS). PLoS ONE. 2021;16(5):1–19.
Elsaddig M, Khalil A. Effects of the COVID pandemic on pregnancy outcomes. Best Pract Res Clin Obstet Gynaecol. 2021;73:125–36.
Engjom H, Aabakke AJM, Klungsøyr K, Svanvik T, Äyräs O, Jonasdottir E, et al. COVID-19 in pregnancy-characteristics and outcomes of pregnant women admitted to hospital because of SARS-CoV-2 infection in the Nordic countries. Acta Obstet Gynecol Scand. 2021;100(9):1611–9.
Allotey J, Stallings E, Bonet M, Yap M, Chatterjee S, Kew T, et al. Clinical manifestations, risk factors, and maternal and perinatal outcomes of coronavirus disease 2019 in pregnancy: living systematic review and meta-analysis. BMJ. 2020;370:m3320.
Abu-Raya B, Maertens K, Edwards KM, Omer SB, Englund JA, Flanagan KL et al. Global Perspectives on Immunization During Pregnancy and Priorities for Future Research and Development: An International Consensus Statement. Front Immunol. 2020;11.
Tetanus vaccines. WHO position paper, February 2017 - Recommendations. Vaccine. 2018;36(25):3573–5.
Pertussis vaccines. WHO position paper, August 2015–Recommendations. Vaccine. 2016;34(12):1423–5.
World Health O. Vaccines against influenza WHO position paper — November 2012 = Note de synthèse de l’OMS concernant les vaccins antigrippaux — novembre 2012. Wkly Epidemiol Record = Relevé épidémiologique hebdomadaire. 2012;87(47):461–76.
Thwaites CL, Beeching NJ, Newton CR. Maternal and neonatal tetanus. Lancet. 2015;385(9965):362–70.
Abu Raya B, Edwards KM, Scheifele DW, Halperin SA. Pertussis and influenza immunisation during pregnancy: a landscape review. Lancet Infect Dis. 2017;17(7):e209–e22.
Questions, Answers. COVID-19 vaccines and pregnancy: World Health Organization; [Available from: https://www.who.int/publications/i/item/WHO-2019-nCoV-FAQ-Pregnancy-Vaccines-2022.1. Accessed 22 May 2023.
Frequently asked questions. : COVID-19 vaccines and breastfeeding based on WHO interim recommendations, 12 August 2021: World Health Organization; [Available from: https://www.who.int/publications/i/item/WHO-2019-nCoV-FAQ-Breast_feeding-Vaccines-2021.1. Accessed 22 May 2023.
Kim S, Moon HM, Lee JK, Rhie K, Yoon KW, Choi EH, et al. Changes in trends and impact of testing for influenza in infants with fever < 90 days of age. Pediatr Int. 2017;59(12):1240–5.
Reading R, The Millennium Cohort Study Child Health Group. Factors associated with uptake of measles, mumps, and rubella vaccine (MMR) and use of single antigen vaccines in a contemporary UK cohort: prospective cohort study. Child Care Health Dev. 2008;34(4):545.
Vaccines During and After Pregnancy. : Centers for Disease Control and Prevention; [Available from: https://www.cdc.gov/vaccines/pregnancy/vacc-during-after.html#:~:text=Postpartum%20vaccination%20will%20help%20protect,vaccines%20before%20or%20during%20pregnancy. Accessed 17 May 2023.
Raut S, Apte A, Srinivasan M, Dudeja N, Dayma G, Sinha B, et al. Determinants of maternal influenza vaccination in the context of low- and middle-income countries: A systematic review. PLoS ONE. 2022;17(1):e0262871.
Russell LB, Pentakota SR, Toscano CM, Cosgriff B, Sinha A. What Pertussis Mortality Rates Make Maternal Acellular Pertussis Immunization Cost-Effective in Low- and Middle-Income Countries? A Decision Analysis. Clin Infect Dis. 2016;63(suppl4):227–S35.
Dudley MZ, Privor-Dumm L, Dubé È, MacDonald NE. Words matter: Vaccine hesitancy, vaccine demand, vaccine confidence, herd immunity and mandatory vaccination. Vaccine. 2020;38(4):709–11.
Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan-a web and mobile app for systematic reviews. Syst Rev. 2016;5(1):210.
CRITICAL APPRAISAL TOOLS: the Joanna Briggs Institute. ; [Available from: https://jbi.global/critical-appraisal-tools. Accessed 17 May 2023.
Higgins JPTTJ, Chandler J, Cumpston M, Li T, Page MJ, Welch VA, editors. Cochrane Handbook for Systematic Reviews of Interventions version 6.3 (updated February 2022). Cochrane,2022.
Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21(11):1539–58.
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71.
Krishnaswamy S, Lambach P, Giles ML. Key considerations for successful implementation of maternal immunization programs in low and middle income countries. Hum Vaccines Immunotherapeutics. 2019;15(4):942–50.
Khan R, Vandelaer J, Yakubu A, Raza AA, Zulu F. Maternal and neonatal tetanus elimination: from protecting women and newborns to protecting all. Int J Women's Health. 2015;7:171–80.
Burgess C, Gasse F, Steinglass R, Yakubu A, Raza AA, Johansen K. Eliminating maternal and neonatal tetanus and closing the immunity gap. Lancet. 2017;389(10077):1380–1.
Maertens K, Orije MRP, Van Damme P, Leuridan E. Vaccination during pregnancy: current and possible future recommendations. Eur J Pediatrics. 2020;179(2):235–42.
Larson Williams A, Mitrovich R, Mwananyanda L, Gill C. Maternal vaccine knowledge in low- and middle-income countries—and why it matters. Hum Vaccines Immunotherapeutics. 2019;15(2):283–6.
Chen VL, Avci FY, Kasper DL. A maternal vaccine against group B Streptococcus: past, present, and future. Vaccine. 2013;31(Suppl 4):D13–9.
Heath PT, Culley FJ, Jones CE, Kampmann B, Le Doare K, Nunes MC, et al. Group B streptococcus and respiratory syncytial virus immunisation during pregnancy: a landscape analysis. Lancet Infect Dis. 2017;17(7):e223–e34.
Influenza vaccination coverage. : World Health Organization; [Available from: https://immunizationdata.who.int/pages/coverage/flu.html. Accessed 18 May 2023.
Lambach P, Hombach J, Ortiz JR. A global perspective of maternal influenza immunization. Vaccine. 2015;33(47):6376–9.

PRISMAPchecklistIA.docx

Download PDF

Journal Publication

published 05 Sep, 2024

Read the published version in Systematic Reviews →

Reviewers agreed at journal
17 May, 2024
Reviewers invited by journal
17 May, 2024
Editor assigned by journal
21 Mar, 2024
First submitted to journal
07 Dec, 2023

You are reading this latest preprint version

Acceptance and uptake of vaccines against tetanus, influenza, pertussis, and COVID-19 among pregnant and postpartum women in low- and middle-income countries: a systematic review and meta-analysis protocol.

Status:

Journal Publication

Version 1

Abstract

Background

Methods

Discussion

Introduction

Methods

Eligibility criteria

Inclusion criteria

Exclusion criteria

Study design/characteristics

Population

Exposure

Comparators(controls)

Outcomes

Primary outcomes

Secondary outcomes

Search strategy methods for the identification of studies

Data management and study selection

Data collection process

Risk of bias in individual studies

Data synthesis

Discussion

Protocol registration

Abbreviations

Declarations

Ethics approval and consent to participate:

Consent for publication not applicable.

Competing interests

Funding

Authors' contributions

Acknowledgements

Availability of data and materials

References

Supplementary Files

Status:

Journal Publication

Version 1

Consent for publication
not applicable.