Gaps in maternal influenza vaccine uptake in Northern Territory: A need for a year-round influenza vaccination campaign.

INTRODUCTION: Maternal influenza vaccination was introduced in 2010 due to the high morbidity and mortality associated with influenza in pregnancy. The aim of this study was to assess the maternal influenza vaccination uptake in Northern Territory public hospitals and identify gaps to improve uptake. METHODS: Birth data from Northern Territory (NT) public hospitals obtained from the Perinatal Register for deliveries in 2016 were merged with vaccination records from the NT immunisation register. RESULTS: There were 3,392 viable pregnancies in NT public hospitals in 2016 with 45.6% vaccination coverage against influenza. There was a statistically significant difference in coverage with 68.5% in Indigenous vs 31.7% in non-Indigenous deliveries (p < 0.001), yielding an odds ratio of 4.67 (95% CI 4.02, 5.42) for maternal influenza vaccination across Indigenous status. Influenza vaccination coverage for preterm births (< 37 weeks) was low especially in non-Indigenous mothers at 27.2% vs 65.05% in Indigenous mothers (p < 0.001). A distinct immunisation administration pattern was noted for 2016 with 58.9% of vaccinations occurring between April and June regardless of Indigenous status and maternal gestational age. This correlated with the annual influenza immunisation campaign by the NT and Commonwealth. CONCLUSION: A year-round maternal influenza vaccination campaign is crucial to avoid missed opportunities and increase vaccination protection for mother and baby. Antenatal influenza vaccination campaign with health care workers education and increasing patient awareness should continue throughout the year.

Current antenatal pertussis vaccination guidelines miss preterm infants: An epidemiological study from the Northern Territory.

IMPORTANCE: Assessing gaps in antenatal pertussis vaccination to increase coverage. INTRODUCTION: Antenatal pertussis vaccination has been proven effective in reducing pertussis disease in infants. Current guidelines recommend maternal pertussis vaccination from 28 weeks gestation. The aim of this study is to determine antenatal pertussis vaccination coverage in the Northern Territory and potential socio-demographic factors affecting uptake, using validated birth and immunisation data. METHODS: Cross-sectional population study including all viable births (from 24 weeks gestation) in Northern Territory public hospitals in 2016. RESULTS: There were 3392 viable delivery episodes in 2016 with 48.9% coverage against maternal pertussis based on current guidelines. Mothers <35 years old were more likely to receive antenatal vaccination (adjusted odds ratio (aOR) = 1.26, CI 1.035-1.52, P = 0.021). Pertussis vaccination coverage for preterm births was low at 0% for extreme, 18.86% for very preterm and 39.8% for moderate preterm births, with an overall coverage of 33.5% for all preterm births. Term births were two times more likely than preterm births to have had mothers receive an antenatal diphtheria toxoid, tetanus toxoid and acellular pertussis vaccine (aOR = 1.957, CI 1.53-2.50, P < 0.001). CONCLUSIONS: A significant proportion (66.5%) of preterm babies are not benefiting from protection against pertussis with the current pertussis vaccination policy from 28 weeks gestation. As timing of birth cannot be predetermined, a review of safety and acceptability of pertussis vaccine administration in the second trimester is needed. Implementation of pertussis vaccination from 20 weeks gestation will provide a wider vaccination period and maximise the protection of all infants including pre-term infants from pertussis.

A Success Story: The Burden of Maternal, Neonatal and Childhood Mortality in Rwanda - Critical Appraisal of Interventions and Recommendations for the Future.

Globally, the burden of maternal, neonatal and childhood mortality is disproportionately shared between the least developed nations and the developed nations. While the global maternal mortality has been almost halved since 1990, 99% of maternal deaths occur in developing regions. This invariably highlights the impact of poverty and, to combat poverty in its different elements, the United Nations (UN) established eight Millennium Development Goals (MDGs), including improving maternal health (MDG 5) and reducing child mortality (MDG 4). Rwanda is one of the few countries that have met both MDGs 4 and 5 ahead of time. In 2015, the UN established 17 Sustainable Development Goals (SDGs), a renewed version of targets to be achieved by 2030, including Good Health and Well-being (SDG 3). SDG 3 aims to achieve a global maternal mortality rate (MMR) of 70 or less by 2030, requiring an annual reduction in MMR by 7.5%. Rwanda is on track to achieving its SDG targets with the support of local government, donors, and international and local agencies. The multipronged approach initiated by the Rwandan government, backed by international organizations, is to be credited for this success. Studying these proven strategies and interventions will allow us to identify gaps, further develop and eventually transfer them to the rest of the world, with suitable contextualization.