Morales KF, Menning L, Lambach P. The Faces of Influenza Vaccine Recommendation: A Literature Review of the Determinants and Barriers to Health Providers´ Recommendation of Influenza Vaccine in Pregnancy. Vaccine. 2020;S0264-410X(20)30513-2.
Methods: We undertook a comprehensive global review of literature relating to HPs´ recommendation of seasonal influenza vaccines to pregnant women and the determinants and barriers to recommendation and how this may vary by country and context. We evaluated data from each study including frequency of HP recommendation, vaccine coverage, determinants and barriers to recommendation, and the odds of recommending. We tracked the frequency of determinants and barriers to recommendation in heat maps and organized data by world regions and income classifications.
Results: From 32 studies in 15 countries, we identified 68 determinants or barriers to HPs´ recommendation. Recommendation rates were highest (77%) in the Americas and lowest in South East Asia (18%). A HP´s own influenza vaccine status was a main determinant of recommendation in multiple country contexts and from different provider types. Financial barriers to recommendation were present in higher-income countries and policy-related barriers were highlighted in lower-income countries. HP perceptions of safety, efficacy, and the utility of vaccine were the most frequently cited barriers, relevant in almost every context.
Conclusions: HP recommendation is important to influenza vaccine implementation in pregnant women. A HP´s own status is an important recommendation determinant in multiple contexts. Vaccine program implementation plans should consider the impact of HPs´ knowledge, awareness and vaccine confidence on their own uptake and recommendation practices, as well as on the uptake among pregnant women. Addressing safety and efficacy concerns is relevant in all contexts for HPs and pregnant women.
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