Efficacy of a Web-Based Intervention to Increase Uptake of Maternal Vaccines: An RCT

doi:10.1016/j.amepre.2019.05.018

American Journal of Preventive Medicine

Volume 57, Issue 4, October 2019, Pages e125-e133

https://doi.org/10.1016/j.amepre.2019.05.018 Get rights and content

Introduction

Tetanus, diphtheria, and acellular pertussis (Tdap) and influenza vaccines are recommended for pregnant women in each pregnancy, yet uptake is suboptimal. This study tested the efficacy of an online vaccine resource in increasing uptake of Tdap and influenza vaccines among pregnant women.

Study design

RCT.

Setting/participants

This study was conducted among women in the third trimester of pregnancy in an integrated healthcare system in Colorado in September 2013–July 2016, with data analysis in 2017–2018.

Intervention

Women were randomly assigned to 1 of 3 arms: website with vaccine information and interactive social media components, website with vaccine information only, or usual care. Participants in the website with vaccine information and interactive social media components and website with vaccine information only arms had access to the same base vaccine content. The website with vaccine information and interactive social media components also included a blog, discussion forum, and “Ask a Question” portal.

Main outcome measures

Tdap and influenza vaccination. These outcomes were analyzed separately.

Results

For influenza (n=289), women in both the website with vaccine information and interactive social media components (OR=2.19, 95% CI=1.06, 4.53) and website with vaccine information only (OR=2.20, 95% CI=1.03, 4.69) arms had higher vaccine uptake than the usual care arm. The proportions of women receiving the influenza vaccine were 57%, 55%, and 36% in the website with vaccine information and interactive social media components, website with vaccine information only, and usual care arms, respectively. For Tdap (n=173), there were no significant differences in vaccine uptake between study arms. The proportions of women receiving Tdap were 71%, 69%, and 68% in the website with vaccine information and interactive social media components, website with vaccine information only, and usual care arms, respectively.

Conclusions

Web-based vaccination information sent to pregnant women can positively influence maternal influenza vaccine uptake. Because of potential scalability, the impact of robust vaccination information websites should be studied in other settings.

Trial registration

This study is registered at www.clinicaltrials.gov NCT01873040.

Section snippets

INTRODUCTION

Pregnant women are at increased risk for severe disease from influenza,1, 2, 3, 4, 5 and newborns are at high risk of morbidity and mortality from both influenza6, 7, 8 and pertussis.9, 10 For these reasons, influenza and tetanus, diphtheria, and acellular pertussis (Tdap) vaccination have been recommended routinely for all pregnant women since 2004 and 2011, respectively.11, 12 Substantial evidence exists on both the effectiveness13, 14, 15, 16, 17, 18, 19, 20 and safety21, 22, 23, 24, 25, 26,

METHODS

Between September 2013 and July 2016, a single-center RCT of vaccine information and social media interventions designed to reduce undervaccination among infants was conducted. Participants were individually randomized to 1 of 3 groups: website with vaccine information and interactive social media components (vaccine social media [VSM]), website with vaccine information only (vaccine information [VI]), or usual care only (UC).

As part of that study, maternal vaccination concerns were also

RESULTS

There were 1,093 members enrolled in the overall study and randomized (Figure 1). In the overall study population, of 1,093 enrolled pregnant women, 94% received the Tdap vaccine and 74% received the influenza vaccine. Of the 952 women enrolled into the overall study at least 2 weeks before their estimated due date who were followed through the birth of their children, 82% had received Tdap before enrollment, resulting in a total of 173 who met criteria for the Tdap analysis (i.e., unvaccinated

DISCUSSION

In this study, women receiving a web-based intervention designed to address concerns about vaccines were more likely to receive the influenza vaccine than women receiving UC, although the addition of social media components did not appear to impact uptake beyond provision of the web-based information. These results suggest that web-based vaccine information sent to pregnant women can have a positive impact on maternal vaccine uptake.

There have been relatively few intervention trials to address

CONCLUSIONS

Web-based interventions, with and without social media components, designed to increase uptake of childhood vaccines by focusing on women during pregnancy showed higher uptake of influenza vaccine in pregnant women receiving the intervention, which is notable as very few interventions have been shown to be effective at addressing vaccine hesitancy in any population, including pregnant women. These results suggest there is potential for such interventions to increase uptake of maternal vaccines.

ACKNOWLEDGMENTS

This study was supported by a research grant from the Agency for Health care Research and Quality (R01HS021492).

Portions of this paper were presented at IDWeek 2017, San Diego, CA, October 2017.

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Agency for Health care Research and Quality.

STO'L conceptualized and designed the study, contributed to the website design and moderation, and drafted the initial and final

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Research ArticleEfficacy of a Web-Based Intervention to Increase Uptake of Maternal Vaccines: An RCT

Introduction

Study design

Setting/participants

Intervention

Main outcome measures

Results

Conclusions

Trial registration

Section snippets

INTRODUCTION

METHODS

RESULTS

DISCUSSION

CONCLUSIONS

ACKNOWLEDGMENTS

J Adolesc Health

Am J Obstet Gynecol

Am J Obstet Gynecol

Lancet

Am J Obstet Gynecol

Vaccine

Vaccine

Vaccine

Vaccine

Vaccine

Inf Sci

Vaccine

Vaccine

Vaccine

Vaccine

Am J Obstet Gynecol

Vaccine

Severity of 2009 pandemic influenza A (H1N1) virus infection in pregnant women

Obstet Gynecol

Severe 2009 H1N1 influenza in pregnant and postpartum women in California

N Engl J Med

Impact of influenza on acute cardiopulmonary hospitalizations in pregnant women

Am J Epidemiol

Epidemiology, complications, and cost of hospitalization in children with laboratory-confirmed influenza infection

Pediatrics

Influenza and the rates of hospitalization for respiratory disease among infants and young children

N Engl J Med

Impact of type A influenza on children: a retrospective study

Am J Public Health

Pertussis hospitalizations among infants in the United States, 1993 to 2004

Pediatrics

Increase in deaths from pertussis among young infants in the United States in the 1990s

Pediatr Infect Dis J

Updated recommendations for use of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap) in pregnant women–Advisory Committee on Immunization Practices (ACIP), 2012

MMWR Morb Mortal Wkly Rep

Prevention and control of influenza: recommendations of the Advisory Committee on Immunization Practices (ACIP)

MMWR Recomm Rep

Effectiveness of seasonal influenza vaccination during pregnancy in preventing influenza infection in infants, England, 2013/14

Euro Surveill

Maternal influenza vaccination and effect on influenza virus infection in young infants

Arch Pediatr Adolesc Med

Effectiveness of maternal influenza immunization in mothers and infants

N Engl J Med

Influenza vaccine given to pregnant women reduces hospitalization due to influenza in their infants

Clin Infect Dis

Effectiveness of prenatal Tdap vaccination on pertussis severity in infants

Clin Infect Dis

Effectiveness of prenatal versus postpartum Tdap vaccination in preventing infant pertussis

Clin Infect Dis

Maternal safety of trivalent inactivated influenza vaccine in pregnant women

Obstet Gynecol

Evaluation of the association of maternal pertussis vaccination with obstetric events and birth outcomes

JAMA

Maternal and infant outcomes among women vaccinated against pertussis during pregnancy

Hum Vaccin Immunother

Research Article
Efficacy of a Web-Based Intervention to Increase Uptake of Maternal Vaccines: An RCT