title: Factors Associated with Intention to Receive Influenza and Tetanus, Diphtheria, and Acellular Pertussis (Tdap) Vaccines during Pregnancy: A Focus on Vaccine Hesitancy and Perceptions of Disease Severity and Vaccine Safety.
abstract: BACKGROUND
  Improving influenza and tetanus, diphtheria and acellular pertussis (Tdap) vaccine coverage among pregnant women is needed.
  
  
  OBJECTIVE
  To assess factors associated with intention to receive influenza and/or Tdap vaccinations during pregnancy with a focus on perceptions of influenza and pertussis disease severity and influenza vaccine safety.
  
  
  METHODS
  Participants were 325 pregnant women in Georgia recruited from December 2012 - April 2013 who had not yet received a 2012/2013 influenza vaccine or a Tdap vaccine while pregnant. Women completed a survey assessing influenza vaccination history, likelihood of receiving antenatal influenza and/or Tdap vaccines, and knowledge, attitudes and beliefs about influenza, pertussis, and their associated vaccines.
  
  
  RESULTS
  Seventy-three percent and 81% of women believed influenza and pertussis, respectively, would be serious during pregnancy while 87% and 92% believed influenza and pertussis, respectively, would be serious to their infants. Perception of pertussis severity for their infant was strongly associated with an intention to receive a Tdap vaccine before delivery (p=0.004). Despite perceptions of disease severity for themselves and their infants, only 34% and 44% intended to receive antenatal influenza and Tdap vaccines, respectively. Forty-six percent had low perceptions of safety regarding the influenza vaccine during pregnancy, and compared to women who perceived the influenza vaccine as safe, women who perceived the vaccine as unsafe were less likely to intend to receive antenatal influenza (48% vs. 20%; p < 0.001) or Tdap (53% vs. 33%; p < 0.001) vaccinations.
  
  
  CONCLUSIONS
  Results from this baseline survey suggest that while pregnant women who remain unvaccinated against influenza within the first three months of the putative influenza season may be aware of the risks influenza and pertussis pose to themselves and their infants, many remain reluctant to receive influenza and Tdap vaccines antenatally. To improve vaccine uptake in the obstetric setting, our findings support development of evidence-based vaccine promotion interventions which emphasize vaccine safety during pregnancy and mention disease severity in infancy.
authors: Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.
authors: Allison T
authors: AT
authors: Chamberlain
authors: Department of Medicine, Division of Infectious Disease, Emory University, Atlanta, Georgia, USA.
authors: Katherine
authors: K
authors: Seib
authors: Department of Gynecology and Obstetrics, School of Medicine, Emory University, Atlanta, GA, USA; Department of Obstetrics and Gynecology, University of Kansas Medical Center, Kansas City, KS, USA.
authors: Kevin A
authors: KA
authors: Ault
authors: Department of Medicine, Division of Infectious Disease, Emory University, Atlanta, Georgia, USA; Emory Vaccine Center, Emory University, Atlanta, Georgia, USA.
authors: Walter A
authors: WA
authors: Orenstein
authors: Department of Medicine, Division of Infectious Disease, Emory University, Atlanta, Georgia, USA; Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.
authors: Paula M
authors: PM
authors: Frew
authors: Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.
authors: Fauzia
authors: F
authors: Malik
authors: Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.
authors: Marielysse
authors: M
authors: Cortés
authors: Georgia Obstetrical and Gynecological Society, Suwannee, Georgia, USA.
authors: Pat
authors: P
authors: Cota
authors: Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.
authors: Ellen A S
authors: EA
authors: Whitney
authors: Department of Gynecology and Obstetrics, Emory University, Atlanta, Georgia, USA.
authors: Lisa C
authors: LC
authors: Flowers
authors: Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.
authors: Ruth L
authors: RL
authors: Berkelman
authors: Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA; Emory Vaccine Center, Emory University, Atlanta, Georgia, USA; 6 Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.
authors: Saad B
authors: SB
authors: Omer
keywords: Influenza; maternal vaccination; pertussis; vaccination; vaccine hesitancy