Conocimiento, actitudes y prácticas de mujeres gestantes respecto a la vacunación

Introducción: La vacunación durante el embarazo ha demostrado ser una medida segura y efectiva que protege a la mujer gestante y al feto contra enfermedades inmunoprevenibles. Objetivo: Determinar los conocimientos, actitudes y prácticas de mujeres gestantes respecto a la vacunación en el marco de la pandemia por el virus SARS-CoV-2. Materiales y Métodos: Estudio observacional de corte transversal realizado en Instituciones Prestadoras de Servicios de Salud Públicas de los 19 municipios de Casanare, Colombia, entre enero y marzo de 2022. Los datos se recolectaron mediante un instrumento de medición documentado que incluyó 22 ítems agrupados en cuatro secciones: datos sociodemográficos, conocimiento, actitudes y prácticas sobre vacunación. Resultados: La media de puntuación de conocimientos fue 5,9 (DE 1,9) de un máximo de 10. El 93,7% cree que la vacunación es realmente necesaria durante el embarazo. Los factores asociados al nivel adecuado de conocimiento incluyeron el grupo de edad entre 26-30 años (OR: 2,27; IC 95%: 1,21-4,25; p = 0,011), estar en el tercer trimestre de embarazo (OR: 2,37; IC 95%: 1,12-5,01; p = 0,024) y contar con un nivel educativo básico, medio o superior (OR: 10,45; IC 95%: 2,37-46,03; p = 0,002). Conclusión: Es esencial fortalecer las estrategias de información, educación y comunicación, para promover la vacunación segura durante el embarazo.

Background: Vaccination during pregnancy has proven to be a safe and effective measure that protects pregnant woman and the fetus against immuno-preventable diseases. Aim: To determine the knowledge, attitudes and practices of pregnant women regarding vaccination in the context of the SARS-CoV-2 pandemic. Methods: A cross-sectional observational study was conducted at public health care institutions in the 19 municipalities of Casanare, Colombia, from January to March 2022. Data were collected using a documented measurement instrument that included 22 items grouped into four sections: sociodemographic data, knowledge, attitudes and practices about vaccination. Results: The mean knowledge score was 5.9 (SD: 1.9) of a maximun of 10; 93.7% believed that vaccination was really necessary during pregnancy. Factors associated with adequate level of knowledge included age group 26-30 years (OR: 2.27; 95% CI: 1.21-4.25; p = 0.011), being in the third trimester of pregnancy (OR: 2.37; 95% CI: 1.12-5.01; p = 0.024) and having basic, intermediate or higher education (OR: 10.45; 95% CI: 2.37-46.03; p = 0.002). Conclusions: It is essential to strengthen information, education and communication strategies to promote safe vaccination during pregnancy.

Effects of booster vaccination with tetanus toxoid, reduced diphtheria and acellular pertussis combined vaccine (Tdap) after vaccination of rats with DTacP-sIPV or DTacP-IPV/Hib / 中华微生物学和免疫学杂志

Objective:To evaluate the effects of a booster immunization with a candidate tetanus toxoid, reduced diphtheria toxoid and acellular pertussis combined vaccine (Tdap) in a rat model after primary vaccination with diphtheria, tetanus, acellular pertussis and Sabin strain inactivated poliovirus combined vaccine (DTacP-sIPV) or diphtheria, tetanus, acellular pertussis, inactivated poliovirus and haemophilus type b combined vaccine (DTacP-IPV/Hib) for further preclinical study.Methods:Wistar rats were randomly divided into three groups and respectively immunized with a self-developed DTacP-sIPV, a marketed DTacP-IPV/Hib and normal saline at 0, 1, and 2 months of age. Serum levels of antibody against each component in each group were detected before immunization and after each dose. A booster dose of the candidate Tdap was given 10 months after primary immunization. Serum levels of antibody against each component in each group were detected before, 1 month and 6 months after the booster immunization.Results:One month after three doses of primary immunization, the geometric mean titers (GMT, Log2) of antibodies against diphtheria toxoid (DT), tetanus toxoid (TT), pertussis toxin (PT), filamentous hemagglutinin (FHA) and pertactin (PRN) in the DTacP-sIPV group were 17.41, 18.34, 18.11, 19.93 and 13.91, respectively, and the seroconversion rates of these components all reached 100%. Ten months after primary immunization, the GMTs of antibodies against DT, TT, PT, FHA and PRN decreased to 15.17, 14.26, 13.60, 14.51 and 10.39, respectively, and the seroconversion rates remained above 89%. One month after booster immunization, the GMTs of antibodies against DT, TT, PT and FHA in the DTacP-sIPV and DTacP-IPV/Hib groups were 16.49/17.26, 16.80/17.63, 16.70/17.74 and 18.48/19.26, respectively, and the seroconversion rates of these components all reached 100% with no significant difference between the two groups ( P>0.05). The GMTs of anti-PRN antibody in the DTacP-sIPV and DTacP-IPV/Hib groups were 13.07 and 11.00, and the seroconversion rates were 100% and 88%, which were higher in the DTacP-sIPV group than in the DTacP-IPV/Hib group ( P<0.05). Six months after booster immunization, the GMTs of antibodies against DT, TT, PT, FHA and PRN in the DTacP-sIPV and DTacP-IPV/Hib groups decreased to 15.74/14.87, 15.07/15.14, 14.84/15.73, 16.62/16.37 and 11.44/9.96, respectively, and the seroconversion rates remained above 88%. Conclusions:Booster vaccination with the candidate Tdap vaccine induces humoral immune response following primary immunization with DTacP-sIPV or DTacP-IPV/Hib in the Wistar rat model, while the antibody titer decreases with time.

Vacunación de la embarazada / Maternal immunization

Las vacunas han sido una de las herramientas más útiles para lograr disminuir la mortalidad infantil. Sin embargo, los beneficios de las vacunas para menores de un año son dispares, debido a que son muy pequeños para ser vacunados. Otro grupo vulnerable son las embarazadas, quienes presentan mayor morbimortalidad por enfermedades como la influenza. La inmunización materna puede proteger a la madre contra las infecciones prevenibles por vacuna y al recién nacido mediante el traspaso de anticuerpos específicos al feto. No hay evidencia de resultados adversos en el embarazo o el feto/recién nacido por la vacunación de mujeres gestantes con vacuna inactivada contra virus, bacterias o toxoides. Por lo tanto, el embarazo no debe impedir que las mujeres reciban las vacunas que están médicamente indicadas. En Chile, se recomienda la vacunación de las mujeres gestantes, antes o durante la temporada de influenza. A fines de 2017 se implementó la vacunación con dTpa de las embarazadas con más de 28 semanas de gestación, con el objetivo de proteger al recién nacido contra el coqueluche y sus complicaciones. En el presente artículo, se hace una revisión de la literatura disponible sobre la vacunación de las embarazadas, principalmente enfocado en inmunización contra la influenza, el coqueluche y los beneficios en sus hijos.

Vaccines have been one of the most useful tools to reduce infant mortality. However, the benefits of vaccines for children under one year are disparate, because they are too small to be vaccinated. Another vulnerable group are pregnant women, who have a higher morbidity and mortality due to diseases such as influenza. Maternal immunization can protect the mother against vaccine-preventable infections and the newborn by transferring specific antibodies to the fetus. There is no evidence of adverse outcomes in pregnancy or the fetus / newborn by vaccination of pregnant women with inactivated vaccine against viruses, bacteria or toxoids. Therefore, pregnancy should not prevent women from receiving vaccines that are medically indicated. In Chile, vaccination is recommended for pregnant women, before or during the influenza season. In addition to the end of 2017, vaccination with Tdap of pregnant women with more than 28 weeks of gestation was implemented, with the aim of protecting the newly born against pertussis and its complications. In this article, we review the available literature on the vaccination of pregnant women, mainly focused on immunization against influenza, pertussis and benefits in their children.

A 6-year Prospective, Observational, Multi-Center Post-Marketing Surveillance of the Safety of Tetanus Toxoid, Reduced Diphtheria Toxoid, and Acellular Pertussis (Tdap) Vaccine in Korea

BACKGROUND: Incidence of whooping cough is increasing in Korea. Since 2011, occurrence among adolescents and adults has risen putting vulnerable neonates at risk. National immunization guidelines now include Tdap (tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis) vaccination during pregnancy and as a cocooning strategy (i.e., vaccinating adults and adolescents in contact with neonates). This study assessed post-marketing Tdap (Boostrix®, GSK, Belgium) vaccine safety in subjects ≥ 10 years. METHODS: This open, non-comparative multi-center study was conducted over six years at 10 hospitals in Korea. Subjects received Tdap in normal clinical practice according to local prescribing information. All adverse events (AEs) were recorded, classified as expected or unexpected, and severity and relationship to Tdap were assessed. RESULTS: The analysis included 672 Korean subjects (mean age, 44 years; range, 11–81), 451 were women and 211 were pregnant. Ninety subjects experienced 124 AEs (incidence 13.39%) of which six were serious AEs (SAEs) assessed as not related to vaccination, and 51 were non-SAEs related to vaccination (mostly administration site reactions). Overall 65/124 AEs were unexpected; the most common were 14 constipation, 5 dyspepsia, 4 common cold and 4 premature labor cases. One case of common cold was assessed as possibly related to vaccination. Pregnancy outcome was ‘live infant, no apparent congenital anomaly’ in 195 subjects (92.42%) or ‘lost to follow-up’ in 16 subjects. CONCLUSION: Tdap administration to Korean subjects ≥ 10 years, including pregnant women, for the prevention of diphtheria, tetanus and pertussis was shown to have a well-tolerated safety profile. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01929291

Preventing Pertussis in the Early Infant: Development and Results of a Prenatal Vaccination Program.

Introduction: Cases of Pertussis increase every year with special morbidity and mortality in early infants. The objective was to evaluate results of a program of vaccination of pregnant women launched in our center in 2013. Methods: This is an observational retrospective study. We reviewed all cases of Pertussis disease in our center (2011-2015) and compared clinical data between two groups of age: Early infants (<3 months of age) and Other Groups (>3 months). We also compared perinatal events in vaccinated versus non vaccinated pregnant women. Results: During the period 2011-2015, 63 cases (9 in Early Infants; 54 Other Groups) were treated. All cases in Early Infants required hospitalization (100% vs. 3,70%; p<0,05) with more days of hospitalization (10,2 days vs. 0,36 days; p<0,05) and need of oxygen (66,67% vs.3,70%; p<0,05). No differences were seen in response to Azithromycin (87,5% vs. 97,91%; p>0.05) nor in incidence in close relatives (44,44% vs. 27,45%; p>0,05). No differences were observed in Perinatal events in vaccinated vs. non vaccinated in terms of duration of pregnancy (279 days vs. 278 days; p>0,05), weight at birth (3290gr vs. 3220gr; p>0,05), admission at NICU (1,58% vs.1,87%; p>0,05) and Apgar test score <7 at 5 minutes (0,27% vs. 0%; p>0,05). Proportion in early infants affected lowered from 40% in 2011 to 3,85% in 2015. Conclusions: Maternal immunization with Tdap vaccine seems to be a good strategy to reduce incidence of pertussis in the offspring. Additional measures such as vaccinating relatives should be considered.

Perceptions of Tetanus-diphteria-acellular pertussis (Tdap) Vaccination among Korean Women of Childbearing Age / 감염과화학요법

BACKGROUND: The number of cases of pertussis reported has increased gradually in the last decade. Pertussis vaccination is the most effective strategy for the prevention of infection. Despite the fact that young infants are at the highest risk for pertussis, the rate of tetanus-diphtheria-acellular pertussis (Tdap) vaccination is presumed to be very low among women of childbearing age in Korea. The purpose of this study was to investigate the perceptions of women of childbearing age regarding Tdap vaccination in Korea. MATERIALS AND METHODS: Women of childbearing age, who visited the Department of Obstetrics and Gynecology at 3 University hospitals in the Seoul and Gyeonggi-do provinces of Korea, were surveyed. Individual questionnaires were administered from April to May 2012. Demographic data, Tdap vaccination history, general knowledge about pertussis, and information on factors associated with decision on vaccination were collected. RESULTS: Of the 500 reproductive-age women enrolled, only 4 (0.8%) had received the Tdap. The most common reason for non-vaccination was the lack of awareness of pertussis and information about the Tdap. Totally, 171 (34.2%) responded that they would receive a Tdap vaccination in the future. By multivariate analysis, general confidence in the effectiveness of the vaccine (odds ratio [OR] = 1.88, 95% confidence interval [CI] 1.17 to 3.01) was indicated as an important factor for deciding whether to receive the Tdap vaccine (P < 0.01). CONCLUSIONS: The coverage of Tdap vaccination of women of childbearing age, including pregnant women, is very low because of the lack of awareness of pertussis and the Tdap. Education of women of childbearing age about pertussis is very important to increase Tdap vaccination rates among these women, particularly during the perinatal period.

Recommendation for the use of newly introduced Tdap vaccine in Korea / 소아과

Pertussis is an acute respiratory infection characterized by paroxysmal cough and inspiratory whoop for over 2 weeks. The incidence of pertussis has decreased markedly after the introduction of DTwP/DTaP vaccine, but the incidence of pertussis has increased steadily among young infant and among adolescents and adults in many countries. Td vaccine was used in this age group but the increase in pertussis has lead to the development of a Tdap vaccine. The Tdap vaccine is a Td vaccine with a pertussis vaccine added and is thought to decrease the incidence and transmission of pertussis in the respective age group. In Korea, two products are approved by the KOREA FOOD & DRUG ADMINISTRATION, which are ADACEL(TM) (Sanofi-Pasteur, Totonto, Ontario, Canada) and BOOSTRIX(R) (GlaxoSmithKline Biologicals, Rixensart, Belgium) for those aged between 11-64. This report summarizes the recommendations approved by the Committee on Infectious Diseases, the Korean Pediatric Society.