scholarly journals Influenza Vaccination During Pregnancy And Influencing Factors In Korea: A Multicenter Questionnaires Study of Pregnant Women and Obstetrics and Gynecology Doctors.

2020 ◽  
Author(s):  
Byung Soo Kang ◽  
San Ha Lee ◽  
Woo Jeng Kim ◽  
Jeong Ha Wie ◽  
In Yang Park ◽  
...  
Keyword(s):  
Influenza Vaccine ◽  
Influenza Vaccination ◽  
Pregnant Women ◽  
Influencing Factors ◽  
Multivariate Logistic Regression Analysis ◽  
Public Health Care ◽  
Vaccination Program ◽  
Obstetrics And Gynecology ◽  
The Government ◽  
Maternal Influenza

Abstract BackgroundOur objective was to investigate: (1) the proportion of influenza vaccination, attitudes, and barriers among pregnant women, (2) the proportion of obstetrics and gynecology (OBGYN) doctors who routinely recommend influenza vaccination in pregnant women, and (3) the influencing factors in Korea, during the flu season of 2019-2020, following the introduction of free influenza vaccination program for pregnant women.MethodsTwo separate anonymized questionnaires were developed for pregnant or postpartum women and physicians, and distributed to public or private healthcare centers and clinics, in South Korea. The proportions of women who received influenza vaccination during pregnancy and OBGYN doctors who routinely recommend influenza vaccine for pregnant women were analyzed. Independent influencing factors of influenza vaccination and OBGYN doctors’ routine recommendation for pregnant women were analyzed using multivariate logistic regression analysis, respectively.Result The self-reported proportion of influenza vaccination during pregnancy among 522 women was 63.2%. Independent factors influencing maternal influenza vaccination were ‘(ever) received information about influenza vaccination during pregnancy’, ‘information obtained from OBGYN doctors’, and ‘2nd/3rd trimester or postpartum period’ (OR 8.988, 95% CI 4.21–19.188, p < 0.001, OR 2.611, 95% CI 1.705-3.998, p < 0.001 and OR 3.082, 95% CI 1.508–6.297, p < 0.001, respectively).In 372 OBGYN doctors, the proportion of doctors with the routine recommendation of influenza vaccine for pregnant women was 76.9%. Independent factors affecting the routine recommendation were: 1) affiliation with private hospital or clinic (OR 4.508, 95% CI 2.225–9.133, p<0.001); 2) awareness of guidelines (OR 3.153, 95% CI 1.118–8.894, p=0.03); (3) awareness of 2019 National free influenza vaccination program for pregnant women (OR 4.955, 95%CI 2.377–10.329, p<0.001). For a future recommendation of influenza vaccine for pregnant women, the guidelines proposed by the government or public health care [108 (46%)] and academic committees [59 (25%)] were most commonly chosen by OBGYN doctors.Conclusion This study demonstrated that providing information about maternal influenza vaccination and the recommendation by OBGYN doctors are crucial for increasing the vaccination coverage in pregnant women.

scholarly journals Influenza vaccination during pregnancy and influencing factors in Korea: A multicenter questionnaire study of pregnant women and obstetrics and gynecology doctors

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Byung Soo Kang ◽  
San Ha Lee ◽  
Woo Jeng Kim ◽  
Jeong Ha Wie ◽  
In Yang Park ◽  
...  
Keyword(s):  
Influenza Vaccination ◽  
Pregnant Women ◽  
Influencing Factors ◽  
World Health ◽  
Obstetrics And Gynecology ◽  
Health Authorities ◽  
The Government ◽  
Vaccine Information ◽  
Health Organization ◽  
Maternal Influenza

Abstract Background Although the World Health Organization and health authorities in most countries recommend that pregnant women receive inactivated influenza virus vaccines, coverage remains low. This study aimed to investigate (1) the proportion of pregnant women who received an influenza vaccination and influencing factors and (2) the proportion of obstetrics and gynecology (OBGYN) doctors who routinely recommend influenza vaccination to pregnant women and influencing factors. Methods Two separate, anonymized questionnaires were developed for physicians and pregnant and postpartum women and were distributed to multicenters and clinics in South Korea. The proportions of women who received influenza vaccination during pregnancy and OBGYN doctors who routinely recommend the influenza vaccine to pregnant women were analyzed. Independent influencing factors for both maternal influenza vaccination and OBGYN doctors’ routine recommendations to pregnant women were analyzed using log-binomial regression analysis. Results The proportion of self-reported influenza vaccination during pregnancy among 522 women was 63.2%. Pregnancy-related independent factors influencing maternal influenza vaccination were “(ever) received information about influenza vaccination during pregnancy” (OR 8.9, 95% CI 4.17–19.01), “received vaccine information about from OBGYN doctors” (OR 11.44, 95% CI 5.46–24.00), “information obtained from other sources” (OR 4.38, 95% CI 2.01–9.55), and “second/third trimester” (OR 2.41, 95% CI 1.21–4.82).. Among 372 OBGYN doctors, 76.9% routinely recommended vaccination for pregnant women. Independent factors effecting routine recommendation were “working at a private clinic or hospital” (OR 5.33, 95% CI 2.44–11.65), “awareness of KCDC guidelines” (OR 3.11, 95% CI 1.11–8.73), and “awareness of the 2019 national free influenza vaccination program for pregnant women” (OR 4.88, 95% CI 2.34–10.17). OBGYN doctors most commonly chose ‘guidelines proposed by the government or public health (108, 46%) and academic committees (59, 25%), as a factor which expect to affect the future recommendation Conclusion This study showed that providing information about maternal influenza vaccination, especially by OBGYN doctors, is crucial for increasing vaccination coverage in pregnant women. Closer cooperation between the government and OBGYN academic societies to educate OBGYN doctors might enhance routine recommendations.

scholarly journals Do Turkish Gynecologists and Obstetricians recommend pregnant women the influenza vaccine?

2020 ◽  
Vol 2 (1) ◽  
pp. 16-23
Author(s):  
Irem Akdemir Kalkan ◽  
Ayşe Nur Usturalı Mut ◽  
Gule Cinar ◽  
Fatih Keskin ◽  
Kemal Osman Memikoglu ◽  
...  
Keyword(s):  
Influenza Vaccine ◽  
Influenza Vaccination ◽  
Pregnant Women ◽  
Social Insurance ◽  
Viral Infections ◽  
Multivariate Logistic Regression Analysis ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Vaccination Rates ◽  
Immunization Rates

Objective: Influenza is a systemic infectious disease. It is recommended that all pregnant women receive the influenza vaccine because the mortality of the disease is high during pregnancy. However, the rates of influenza vaccination in pregnant women are low. This study aims to estimate the rate at which Turkish gynecologists and obstetricians (GOs) recommend the influenza vaccine to their pregnant patients.. Materials and Methods: This study was designed as a cross-sectional survey. The sample size was calculated to be 364 based on 95% confidence interval and 5% margin of error. The data were collected through a questionnaire consisting of 17 questions, which was distributed through social media. The final study group included in the research consisted of 384 GOs. Results:The mean age of the GOs that participated in the study was 39.7 years (SD = 10.2). 43.5% of the GOs reported that they recommended the influenza vaccine to pregnant women who had consulted with them, while 62.8% reported that at least 50% of the pregnant women they had recommended the vaccine rejected it. According to multivariate logistic regression analysis, three factors increased the rate of GOs’ not to recommend influenza vaccination: the GOs’ age, not receiving influenza vaccination themselves, and not knowing the social insurance reimbursement for the vaccine. Conclusion: Vaccination of pregnant women is necessary because of the increased mortality risk of influenza during pregnancy. Even though GOs are not in charge of vaccinating their patients during their routine pregnancy follow-up, they can contribute to vaccination rates by recommending the vaccine. Physicians’ application of scientific knowledge and transferring it to their patients can contribute to increased adult immunization rates. Conclusion: Influenza, Influenza Vaccine, Pregnancy, Vaccination, Viral Infections

scholarly journals 2738. Influenza Vaccination During Pregnancy Among Mothers of Infants with Acute Respiratory Illness, United States, 2016–2018

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S963-S964
Author(s):  
Constance E Ogokeh ◽  
Manish Patel ◽  
Joana Y Lively ◽  
Mary A Staat ◽  
Geoffrey A Weinberg ◽  
...  
Keyword(s):  
Influenza Vaccine ◽  
Influenza Vaccination ◽  
Pregnant Women ◽  
Influenza Season ◽  
Respiratory Illness ◽  
Vaccine Safety ◽  
Acute Respiratory Illness ◽  
Surveillance Network ◽  
Vaccination History ◽  
Maternal Influenza

Abstract Background Influenza vaccination has been shown to reduce influenza risk in pregnant women and their infants who are not yet age-eligible for vaccine. Ascertainment of vaccination history is important for vaccine safety and effectiveness evaluations. Our goals were to (a) determine coverage, location, and timing of maternal influenza vaccination and (b) compare a subset of self-reported influenza vaccinations with documented vaccine records. Methods We enrolled children < 18 years. with acute respiratory illness in 7 pediatric hospitals and emergency departments in the New Vaccine Surveillance Network from December 1, 2016 to October 31, 2018. We interviewed all mothers of enrolled infants < 1 year, and obtained mother’s influenza vaccine information while pregnant. As an option, sites obtained maternal influenza vaccine records from reported sources (e.g., registries, provider records, pharmacies). Results Among 5,458 mothers, 2,944 (54%) self-reported receiving influenza vaccine during pregnancy (57% in 2016–2017; 51% in 2017–2018), varying from 49% to 74% by site. Among self-reported vaccinees, 17%, 36%, and 47% received vaccine during their first, second, and third trimester, respectively. Most women (76%) were vaccinated at their OB/GYN or midwife office, 7% at their primary care provider, 7% at their workplace, and 5% at a retail pharmacy. Among 1,338 infants < 6 months. during early influenza season (i.e., born from June to August) and thus ineligible for vaccination, only 46% of mothers reported receiving vaccine during pregnancy (42% reported not receiving it, 12% were unsure). Of 2,242 women for whom vaccine verification was attempted, 1,491 (67%) self-reported receiving influenza vaccine during pregnancy; of those, documentation of vaccine receipt was found for 901 (60%). Conclusion Influenza vaccination coverage among pregnant women was suboptimal, potentially increasing the risk of influenza in unvaccinated pregnant women. Infants born to unvaccinated women, particularly those born from June to August, may also be at higher risk since they are not age-eligible to receive vaccine before influenza season. The optimal approach to ascertainment of maternal vaccination history with accuracy and completeness merits further investigation. Disclosures All authors: No reported disclosures.

scholarly journals Influenza and Tetanus, Diphtheria, and Acellular Pertussis Vaccination During Pregnancy, Pregnancy Risk Assessment Monitoring System, 2019

2022 ◽  
Author(s):  
Titilope Oduyebo ◽  
Katie Kortsmit ◽  
Regina Simeone ◽  
Katherine Kahn ◽  
Hilda Razzaghi ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Influenza Vaccine ◽  
Influenza Vaccination ◽  
Pregnant Women ◽  
Healthcare Provider ◽  
Monitoring System ◽  
Rhode Island ◽  
Pregnancy Risk ◽  
Maternal Characteristics ◽  
Maternal Influenza

Abstract Background Influenza and tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccines is recommended for pregnant women to protect themselves and their infants from adverse health outcomes. Objectives To estimate the prevalence of maternal influenza and Tdap vaccination and determine factors associated with receipt of these vaccines. Methods We analyzed 2019 data from the Pregnancy Risk Assessment Monitoring System, from 43 jurisdictions. We estimated the overall prevalence of women reporting receipt of a healthcare provider offer or recommendation for influenza vaccine (n=44,528), and influenza vaccine during the 12 months before delivery (n=44,213). We also estimated Tdap vaccine receipt during pregnancy from the 21 jurisdictions (n=22,972). Maternal influenza and Tdap vaccination were examined by selected maternal characteristics and by jurisdiction. Results Overall, 86.4% of women reported being offered or recommended an influenza vaccination, and 60.8% of women reported receiving an influenza vaccination in the 12 months prior to their delivery, ranging from 36.0% in Puerto Rico to 82.1% in Rhode Island. Tdap receipt during pregnancy was 73.7%, ranging from 52.2% in Mississippi to 85.1% in Vermont. Prevalence of influenza vaccination was lower among women aged 18–24 years (52.2%), who are non-Hispanic black (44.5%), with a high school diploma or less education (51.3%), with no prenatal insurance (43.2%), having no (42.0%) prenatal care, with ≥3 previous live births (49.3%) and not offered or recommended the influenza vaccine by a healthcare provider (20.0%). Tdap vaccination also varied by all characteristics examined and was lower among similar groups of women observed to have lower influenza vaccination uptake. Conclusion In 2019, influenza and Tdap vaccination were suboptimal among women with a recent live birth. It is important that U.S. jurisdictions provide equitable access to these vaccines during pregnancy. These results may also inform efforts for vaccination for other infectious diseases among pregnant women.

scholarly journals Determinants of influenza vaccine hesitancy among pregnant women in Europe: a systematic review

2021 ◽  
Vol 26 (1) ◽  
Author(s):  
Gbadebo Collins Adeyanju ◽  
Elena Engel ◽  
Laura Koch ◽  
Tabea Ranzinger ◽  
Imtiaz Bin Mohammed Shahid ◽  
...  
Keyword(s):  
Systematic Review ◽  
Influenza Vaccine ◽  
Influenza Vaccination ◽  
Pregnant Women ◽  
Healthcare Providers ◽  
Primary Objective ◽  
World Health ◽  
Vaccine Hesitancy ◽  
Cochrane Central Register ◽  
Adequate Knowledge

Abstract Background Pregnant women are at high risk for severe influenza. However, maternal influenza vaccination uptake in most World Health Organization (WHO) European Region countries remains low, despite the presence of widespread national recommendations. An influenza vaccination reduces influenza-associated morbidity and mortality in pregnancy, as well as providing newborns with protection in their first months. Potential determinants of vaccine hesitancy need to be identified to develop strategies that can increase vaccine acceptance and uptake among pregnant women. The primary objective of the systematic review is to identify the individual determinants of influenza vaccine hesitancy among pregnant women in Europe, and how to overcome the hesitancy. Methods Databases were searched for peer-reviewed qualitative and quantitative studies published between 2009 and 2019 inclusive. Databases included PubMed via MEDLINE, Cochrane Central Register for Controlled Trials, PsycINFO, SAGE Journals, Taylor and Francis and Springer nature. These covered themes including psychology, medicine, and public health. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) approach, 11 studies were eligible and analyzed for significant determinants of influenza vaccine hesitancy among pregnant women in Europe. Results The most commonly reported factors were psychological aspects, for example concerns about safety and risks to mother and child, or general low risk perception of becoming ill from influenza. Doubts about the effectiveness of the vaccine and a lack of knowledge about this topic were further factors. There was also influence of contextual factors, such as healthcare workers not providing adequate knowledge about the influenza vaccine or the pregnant lady stating their antivaccine sentiment. Conclusion Health promotion that specifically increases knowledge among pregnant women about influenza and vaccination is important, supporting a valid risk judgment by the pregnant lady. The development of new information strategies for dialogue between healthcare providers and pregnant women should form part of this strategy.

scholarly journals Estimating Vaccine Effectiveness Against Hospitalized Influenza During Pregnancy: Multicountry Protocol for a Retrospective Cohort Study (Preprint)

2018 ◽  
Author(s):  
Allison L Naleway ◽  
Sarah Ball ◽  
Jeffrey C Kwong ◽  
Brandy E Wyant ◽  
Mark A Katz ◽  
...  
Keyword(s):  
Influenza Virus ◽  
Virus Infection ◽  
Influenza Vaccine ◽  
Influenza Vaccination ◽  
Pregnant Women ◽  
Retrospective Cohort ◽  
Clinical Course ◽  
Influenza Virus Infection ◽  
The United States ◽  
Vaccine Effectiveness

BACKGROUND Although pregnant women are believed to have elevated risks of severe influenza infection and are targeted for influenza vaccination, no study to date has examined influenza vaccine effectiveness (IVE) against laboratory-confirmed influenza-associated hospitalizations during pregnancy, primarily because this outcome poses many methodological challenges. OBJECTIVE The Pregnancy Influenza Vaccine Effectiveness Network (PREVENT) was formed in 2016 as an international collaboration with the Centers for Disease Control and Prevention; Abt Associates; and study sites in Australia, Canada, Israel, and the United States. The primary goal of this collaboration is to estimate IVE in preventing acute respiratory or febrile illness (ARFI) hospitalizations associated with laboratory-confirmed influenza virus infection during pregnancy. Secondary aims include (1) describing the incidence, clinical course, and severity of influenza-associated ARFI hospitalization during pregnancy; (2) comparing the characteristics of ARFI-hospitalized pregnant women who were tested for influenza with those who were not tested; (3) describing influenza vaccination coverage in pregnant women; and (4) comparing birth outcomes among women with laboratory-confirmed influenza-associated hospitalization versus other noninfluenza ARFI hospitalizations. METHODS For an initial assessment of IVE, sites identified a retrospective cohort of pregnant women aged from 18 to 50 years whose pregnancies overlapped with local influenza seasons from 2010 to 2016. Pregnancies were defined as those that ended in a live birth or stillbirth of at least 20 weeks gestation. The analytic sample for the primary IVE analysis was restricted to pregnant women who were hospitalized for ARFI during site-specific influenza seasons and clinically tested for influenza virus infection using real-time reverse transcription polymerase chain reaction. RESULTS We identified approximately 2 million women whose pregnancies overlapped with influenza seasons; 550,344 had at least one hospitalization during this time. After restricting to women who were hospitalized for ARFI and tested for influenza, the IVE analytic sample included 1005 women. CONCLUSIONS In addition to addressing the primary question about the effectiveness of influenza vaccination, PREVENT data will address other important knowledge gaps including understanding the incidence, clinical course, and severity of influenza-related hospitalizations during pregnancy. The data infrastructure and international partnerships created for these analyses may be useful and informative for future influenza studies. INTERNATIONAL REGISTERED REPOR DERR1-10.2196/11333

scholarly journals An Internet-Based Survey of Influenza Vaccination Coverage in Healthcare Workers in China, 2018/2019 Season

Vaccines ◽  
2019 ◽  
Vol 8 (1) ◽  
pp. 6 ◽  
Author(s):  
Haitao Liu ◽  
Yayun Tan ◽  
Muli Zhang ◽  
Zhibin Peng ◽  
Jiandong Zheng ◽  
...  
Keyword(s):  
Influenza Vaccine ◽  
Influenza Vaccination ◽  
Vaccination Coverage ◽  
Healthcare Workers ◽  
Online Survey ◽  
Vaccine Coverage ◽  
National Level ◽  
Influence Factors ◽  
Multivariate Logistic Regression Analysis ◽  
Vaccine Uptake

Influenza vaccination coverage was low among healthcare workers (HCWs) in China. In October 2018, the National Health Commission of China began to require all hospitals to provide free influenza vaccination for HCWs to increase vaccine uptake, and no study on vaccine coverage among HCWs at the national level after the announcement of new policy. This evaluation aims to investigate self-reported influenza vaccination coverage among HCWs and factors that may affect vaccine receipt during the 2018/2019 influenza season. We delivered an opt-in internet panel survey among registered HCWs of DXY forum (the biggest online forum for HCWs in China). The survey was self-administered using a standard questionnaire to collect information on demographics, occupational characteristics, policy implementation, influenza vaccination and influence factors. We conducted multivariate logistic regression analysis to assess factors associated with receipt of influenza vaccine. The response rate of this online survey was 3.6%. The seasonal influenza vaccine coverage reported among HCWs surveyed during the 2018/2019 season was 11.6% (472/4078). Only 19.0% (774/4078) of HCWs surveyed reported free policy in their workplace. Combing free policy and workplace requirement proved to be effective to improve influenza vaccination coverage in HCWs (PR = 6.90, 95% CI: 6.03–7.65). The influenza vaccination coverage among surveyed HCWs in China was low during the 2018/2019 season. To increase future vaccination uptake, we recommend a multi-faceted strategy that include free policy, workplace requirement and promotion, on-site vaccination, and monitoring.

scholarly journals Identification of Two Novel Candidate Genetic Variants Associated With the Responsiveness to Influenza Vaccination

2021 ◽  
Vol 12 ◽  
Author(s):  
Simin Wen ◽  
Hejiang Wei ◽  
Qijun Liao ◽  
Mao Li ◽  
Shuyi Zhong ◽  
...  
Keyword(s):  
Influenza Vaccine ◽  
Influenza Vaccination ◽  
Genetic Variants ◽  
Lower Risk ◽  
Chinese Population ◽  
Multivariate Logistic Regression Analysis ◽  
Serological Response ◽  
Effective Prevention ◽  
The Difference ◽  
Group 2

BackgroundAnnual vaccination is the most effective prevention of influenza infection. Up to now, a series of studies have demonstrated the role of genetic variants in regulating the antibody response to influenza vaccine. However, among the Chinese population, the relationship between genetic factors and the responsiveness to influenza vaccination has not been clarified through genome-wide association study (GWAS).MethodA total of 1,968 healthy volunteers of Chinese descent were recruited and 1,582 of them were available for the subsequent two-stage analysis. In the discovery stage, according to our inclusion criteria, 123 of 1,582 subjects were selected as group 1 and received whole-genome sequencing to identify potential variants and genes. In the verification stage, 29 candidate variants identified by GWAS were selected for further validation in 481 subjects in group 2. Besides, we also analyzed nine variants from previously published reports in our study.ResultsMultivariate logistic regression analysis showed that compared with the TT genotype of ZBTB46 rs2281929, the TC + CC genotype was associated with a lower risk of low responsiveness to influenza vaccination adjusted for gender and age (Group 2: P = 7.75E-05, OR = 0.466, 95%CI = 0.319–0.680; Combined group: P = 1.18E-06, OR = 0.423, 95%CI = 0.299–0.599). In the combined group, IQGAP2 rs2455230 GC + CC genotype was correlated with a lower risk of low responsiveness to influenza vaccination compared with the GG genotype (P = 8.90E-04, OR = 0.535, 95%CI = 0.370–0.774), but the difference was not statistically significant in group 2 (P = 0.008). The antibody fold rises of subjects with ZBTB46 rs2281929 TT genotype against H1N1, H3N2,and B were all significantly lower than that of subjects with TC + CC genotype (P &lt; 0.001). Compared with IQGAP2 rs2455230 GC + CC carriers, GG carriers had lower antibody fold rises to H1N1 (P = 0.001) and B (P = 0.032). The GG genotype of rs2455230 tended to be correlated with lower antibody fold rises (P = 0.096) against H3N2, but the difference was not statistically significant. No correlation was found between nine SNPs from previously published reports and the serological response to influenza vaccine in our study.ConclusionOur study identified two novel candidate missense variants, ZBTB46 rs2281929 and IQGAP2 rs2455230, were associated with the immune response to influenza vaccination among the Chinese population. Identifying these variants will provide more evidence for future research and improve the individualized influenza vaccination program.

scholarly journals Knowledge, attitudes and practices on influenza vaccine during pregnancy in Quito, Ecuador

2020 ◽  
Author(s):  
Carlos E. Erazo ◽  
Carlos V. Erazo ◽  
Mario J. Grijalva ◽  
Ana L. Moncayo
Keyword(s):  
Health Care ◽  
Influenza Vaccine ◽  
Antenatal Care ◽  
Influenza Vaccination ◽  
Pregnant Women ◽  
Health Care Providers ◽  
Care Providers ◽  
Factors Associated ◽  
Attitudes And Practices ◽  
Knowledge Attitudes And Practices

Abstract Background: Vaccination is the most effective way to prevent infection and severe outcomes caused by influenza viruses in pregnant women and their children. In Ecuador, the coverage of seasonal influenza vaccination in pregnant women is low. The aim of this study was to assess the knowledge, attitudes and practices of pregnant women toward influenza vaccination in Quito-Ecuador.Methods: A cross-sectional study enrolled 842 women who delivered at three main public gynecological-obstetric units of the Metropolitan District of Quito. A questionnaire regarding demographics, antenatal care, risk conditions and knowledge, attitudes and practices related to influenza vaccination was administered. We examined factors associated with vaccination using log-binomial regression models.Results: A low vaccination rate (36.6%) against influenza was observed among pregnant women. The factors associated with vaccination included the recommendations from health providers (adjusted PR: 15.84; CI 95% 9.62-26.10), belief in the safety of the influenza vaccine (adjusted PR: 1.53; CI 95% 1.03-2.37) and antenatal care (adjusted PR: 1.21; CI 95% 1.01-1.47). The most common reasons for not vaccinating included the lack of recommendation from health care providers (73.9%) and lack of access to vaccine (9.0%).Conclusions: Health educational programs aimed to pregnant women and antenatal care providers have the most potential to increase influenza vaccination rates. Further studies are needed to understand the barriers of health care providers regarding influenza vaccination in Ecuador.

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