Am J Perinatol
DOI: 10.1055/a-2505-5434
Review Article

Pneumonia Vaccines: Indications for Use and Current Safety Data in Pregnancy

1   Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, South Carolina
,
Hayley Berry
2   Department of Infectious Diseases, Medical University of South Carolina, Charleston, South Carolina
,
Gweneth B. Lazenby
1   Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, South Carolina
› Institutsangaben

Funding None.

Abstract

Streptococcus pneumoniae is a leading cause of pneumonia, meningitis, and invasive pneumococcal disease among adults in the United States, with higher rates of disease occurring among individuals with chronic medical and immunocompromising conditions. Pregnant individuals, especially those with comorbid conditions, are also at increased risk of infection due to S. pneumoniae due to physiological and immunologic changes in pregnancy. Vaccination against pneumococcus is recommended for adults living with HIV aged 19 to 49, congenital or acquired immunodeficiency, asplenia, chronic renal failure, sickle cell disease, alcohol abuse, cerebrospinal fluid leaks, congestive heart failure and cardiomyopathies, chronic lung disease, chronic liver disease, and diabetes mellitus. During pregnancy, the American College of Obstetricians and Gynecologists (ACOG) recommends vaccination against S. pneumoniae for individuals meeting the criteria for immunization outside of pregnancy. Pneumococcal vaccine uptake has been low. There are no data available for vaccine uptake in pregnancy, but we suspect it is lower than nonpregnant populations. Low uptake of immunization rates in pregnancy is likely multifactorial and includes general vaccine hesitancy among pregnant individuals, cost, access to care, and supply shortages. While data in support of pneumococcal vaccines during pregnancy are limited, sufficient evidence exists to support the safety and efficacy of vaccination in the antepartum period. Pregnancy provides an opportunity to continuously engage individuals in care, allowing obstetricians and gynecologists to establish rapport, work to reduce vaccine hesitancy, and to provide pneumococcal immunization to those who are eligible. Medical indications for pneumococcal vaccination will increasingly apply to pregnant persons as the population acquires comorbidities and there is a need for improved education among obstetricians on the topic of antenatal pneumococcal vaccination.

Key Points

  • Pregnant persons are at risk of S. pneumoniae.

  • Adult pneumococcal vaccine uptake has been low.

  • Obstetricians and gynecologists can benefit from education on pneumococcal vaccines.

  • Encourage pneumococcal vaccines for eligible pregnant people.



Publikationsverlauf

Eingereicht: 01. Oktober 2024

Angenommen: 18. Dezember 2024

Accepted Manuscript online:
19. Dezember 2024

Artikel online veröffentlicht:
09. Januar 2025

© 2025. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 
  • References

  • 1 Ryan KJ. Streptococci and Enterococci. Sherris & Ryan's Medical Microbiology, 8th ed. New York, NY: McGraw-Hill Education; 2022: 24-32
  • 2 Goldblatt D, O'Brien KL. Pneumococcal infections. In: Loscalzo J, Fauci A, Kasper D. et al., eds. Harrison's Principles of Internal Medicine, 21e. New York, NY: McGraw-Hill Education; 2022
  • 3 Centers for Disease Control and Prevention. Pneumococcal disease: clinical features. Accessed April 18, 2024 at: https://www.cdc.gov/pneumococcal/clinicians/clinical-features.html
  • 4 Kruckow KL, Zhao K, Bowdish DME, Orihuela CJ. Acute organ injury and long-term sequelae of severe pneumococcal infections. Pneumonia 2023; 15 (01) 5
  • 5 Tang P, Wang J, Song Y. Characteristics and pregnancy outcomes of patients with severe pneumonia complicating pregnancy: a retrospective study of 12 cases and a literature review. BMC Pregnancy Childbirth 2018; 18 (01) 434
  • 6 van Aalst M, Lötsch F, Spijker R. et al. Incidence of invasive pneumococcal disease in immunocompromised patients: a systematic review and meta-analysis. Travel Med Infect Dis 2018; 24: 89-100
  • 7 Garcia Garrido HM, Mak AMR, Wit FWNM. et al. Incidence and risk factors for invasive pneumococcal disease and community-acquired pneumonia in human immunodeficiency virus-infected individuals in a high-income setting. Clin Infect Dis 2020; 71 (01) 41-50
  • 8 Søgaard OS, Reekie J, Ristola M. et al. Severe bacterial non-AIDS infections in HIV-positive persons: incidence rates and risk factors. J Infect 2013; 66 (05) 439-446
  • 9 Centers for Disease Control and Prevention. Hepatitis C surveillance 2021. Accessed May 6, 2024 at: https://www.cdc.gov/hepatitis/statistics/2021surveillance/hepatitis-c.htm#:~:text=Chronic%20Hepatitis%20C%20in%202021&text=Hepatitis%20C%2Dassociated%20deaths%20during,4.13%20deaths%20per%20100%2C000%20people
  • 10 Gibney KB, MacLachlan J, Coutts R, Higgins N, Strachan J. Incidence of invasive pneumococcal disease higher among people notified with markers of hepatitis C virus infection: population-based surveillance in Victoria, Australia, 2001-2017. Clin Infect Dis 2021; 72 (09) e319-e325
  • 11 Marrie TJ, Tyrrell GJ, Majumdar SR, Eurich DT. Concurrent infection with hepatitis C virus and Streptococcus pneumoniae . Emerg Infect Dis 2017; 23 (07) 1118-1123
  • 12 Ely DMGE. Trends and characteristics in maternal hepatitis C virus infection rates during pregnancy. United States 2016–2021. Natl Vital Stat Rep 2023;72(03):
  • 13 Airola C, Andaloro S, Gasbarrini A, Ponziani FR. Vaccine responses in patients with liver cirrhosis: from the immune system to the gut microbiota. Vaccines (Basel) 2024; 12 (04) 349
  • 14 Shea KM, Edelsberg J, Weycker D, Farkouh RA, Strutton DR, Pelton SI. Rates of pneumococcal disease in adults with chronic medical conditions. Open Forum Infect Dis 2014; 1 (01) ofu024
  • 15 Halasa NB, Shankar SM, Talbot TR. et al. Incidence of invasive pneumococcal disease among individuals with sickle cell disease before and after the introduction of the pneumococcal conjugate vaccine. Clin Infect Dis 2007; 44 (11) 1428-1433
  • 16 Wiyeh AB, Abdullahi LH, Wonkam A, Wiysonge CS, Kaba M. Effects of vaccines in patients with sickle cell disease: a systematic review protocol. BMJ Open 2018; 8 (03) e021140
  • 17 Robinson TM, Lanzkron SM. Standard definitions of pneumococcal immunity may not accurately predict protection in adults with sickle cell disease. Blood 2019; 134: 1014
  • 18 Musher DM, Anderson R, Feldman C. The remarkable history of pneumococcal vaccination: an ongoing challenge. Pneumonia 2022; 14 (01) 5
  • 19 Shirley M. 20–valent pneumococcal conjugate vaccine: pediatric first approval. Paediatr Drugs 2023; 25 (05) 613-619
  • 20 American Academy of Pediatrics. Types of pneumococcal vaccines. Accessed April 30, 2024 at: https://www.aap.org/en/patient-care/immunizations/pneumococcal-vaccines/more-about-the-pneumococcal-vaccines/
  • 21 Kobayashi M, Leidner AJ, Gierke R. et al. Use of 21-valent pneumococcal conjugate vaccine among U.S. adults: recommendations of the advisory committee on immunization practices - United States, 2024. MMWR Morb Mortal Wkly Rep 2024; 73 (36) 793-798
  • 22 Pletz MW, Maus U, Krug N, Welte T, Lode H. Pneumococcal vaccines: mechanism of action, impact on epidemiology and adaption of the species. Int J Antimicrob Agents 2008; 32 (03) 199-206
  • 23 Thompson A, Lamberth E, Severs J. et al. Phase 1 trial of a 20-valent pneumococcal conjugate vaccine in healthy adults. Vaccine 2019; 37 (42) 6201-6207
  • 24 Hurley D, Griffin C, Young Jr M. et al. Safety, tolerability, and immunogenicity of a 20-valent pneumococcal conjugate vaccine (PCV20) in adults 60 to 64 years of age. Clin Infect Dis 2021; 73 (07) e1489-e1497
  • 25 Klein NP, Peyrani P, Yacisin K. et al. A phase 3, randomized, double-blind study to evaluate the immunogenicity and safety of 3 lots of 20-valent pneumococcal conjugate vaccine in pneumococcal vaccine-naive adults 18 through 49 years of age. Vaccine 2021; 39 (38) 5428-5435
  • 26 Fitz-Patrick D, Young Jr M, Scott DA. et al. A randomized phase 1 study of the safety and immunogenicity of 2 novel pneumococcal conjugate vaccines in healthy Japanese adults in the United States. Hum Vaccin Immunother 2021; 17 (07) 2249-2256
  • 27 Essink B, Sabharwal C, Cannon K. et al. Pivotal phase 3 randomized clinical trial of the safety, tolerability, and immunogenicity of 20-valent pneumococcal conjugate vaccine in adults aged ≥18 years. Clin Infect Dis 2022; 75 (03) 390-398
  • 28 Centers for Disease Control and Prevention. Pneumococcal Vaccines. Accessed April 30, 2024 at: https://www.cdc.gov/vaccines/vpd/pneumo/hcp/about-vaccine.html#:~:text=PCV13%20in%20Adults&text=46%25%20efficacy%20against%20vaccine%2Dtype,efficacy%20against%20vaccine%2Dtype%20IPD
  • 29 Suzuki M, Dhoubhadel BG, Ishifuji T. et al; Adult Pneumonia Study Group-Japan (APSG-J). Serotype-specific effectiveness of 23-valent pneumococcal polysaccharide vaccine against pneumococcal pneumonia in adults aged 65 years or older: a multicentre, prospective, test-negative design study. Lancet Infect Dis 2017; 17 (03) 313-321
  • 30 Kim JH, Chun BC, Song JY. et al. Direct effectiveness of pneumococcal polysaccharide vaccine against invasive pneumococcal disease and non-bacteremic pneumococcal pneumonia in elderly population in the era of pneumococcal conjugate vaccine: a case-control study. Vaccine 2019; 37 (21) 2797-2804
  • 31 Lawrence H, Pick H, Baskaran V. et al. Effectiveness of the 23-valent pneumococcal polysaccharide vaccine against vaccine serotype pneumococcal pneumonia in adults: a case-control test-negative design study. PLoS Med 2020; 17 (10) e1003326
  • 32 Moberley S, Holden J, Tatham D. et al. Vaccines for preventing pneumococcal infection in adults. The Cochrane Collaboration, ed. Cochrane Database Syst Rev. Chichester (UK): John Wiley & Sons, Ltd; 2008
  • 33 Centers for Disease Control and Prevention. Pneumococcal vaccination: summary of who and when to vaccinate. Accessed October 31, 2024 at: https://www.cdc.gov/vaccines/vpd/pneumo/hcp/who-when-to-vaccinate.html
  • 34 Ault KRL. ACOG practice advisory: maternal immunization. Obstet Gynecol 2022; 131 (06) e214-e217
  • 35 Kobayashi M, Pilishvili T, Farrar JL. et al. Pneumococcal vaccine for adults aged ≥19 years: recommendations of the advisory committee on immunization practices, United States, 2023. MMWR Recomm Rep 2023; 72 (3, No. RR-3): 1-39
  • 36 Centers for Disease Control and Prevention. Guidelines for vaccinating pregnant women. Accessed April 25, 2024 at: https://www.cdc.gov/vaccines/pregnancy/hcp-toolkit/guidelines.html#ppsv23
  • 37 Federal Drug Administration. Prevnar-20 package insert Available: https://www.fda.gov/media/149987/download?attachment
  • 38 Lehmann D, Pomat WS, Combs B, Dyke T, Alpers MP. Maternal immunization with pneumococcal polysaccharide vaccine in the highlands of Papua New Guinea. Vaccine 2002; 20 (13-14): 1837-1845
  • 39 Riley ID, Douglas RM. An epidemiologic approach to pneumococcal disease. Rev Infect Dis 1981; 3 (02) 233-245
  • 40 Mussi-Pinhata MM, Ward S, Laimon L. et al. Effect of maternal immunization with 10-valent pneumococcus conjugate vaccine (PCV-10), 23-valent pneumococcus polysaccharide vaccine, or placebo on the immunogenicity of PCV-10 in human immunodeficiency virus-exposed uninfected infants: a randomized clinical trial. Clin Infect Dis 2022; 75 (06) 996-1005
  • 41 Makris MC, Polyzos KA, Mavros MN, Athanasiou S, Rafailidis PI, Falagas ME. Safety of hepatitis B, pneumococcal polysaccharide and meningococcal polysaccharide vaccines in pregnancy: a systematic review. Drug Saf 2012; 35 (01) 1-14
  • 42 Munoz FM, Englund JA, Cheesman CC. et al. Maternal immunization with pneumococcal polysaccharide vaccine in the third trimester of gestation. Vaccine 2001; 20 (5-6): 826-837
  • 43 O'Dempsey TJ, McArdle T, Ceesay SJ. et al. Immunization with a pneumococcal capsular polysaccharide vaccine during pregnancy. Vaccine 1996; 14 (10) 963-970
  • 44 Almeida VdeC, Mussi-Pinhata MM, De Souza CB. et al. Immunogenicity of 23-valent pneumococcal polysaccharide vaccine in HIV-infected pregnant women and kinetics of passively acquired antibodies in young infants. Vaccine 2009; 27 (29) 3856-3861
  • 45 Duarte G, Muresan P, Ward S. et al. Immunogenicity of conjugated and polysaccharide pneumococcal vaccines administered during pregnancy or postpartum to women with HIV. J Infect Dis 2022; 225 (06) 1021-1031
  • 46 Weinberg A, Muresan P, Laimon L. et al; NICHD P1091 study team. Safety, immunogenicity, and transplacental antibody transport of conjugated and polysaccharide pneumococcal vaccines administered to pregnant women with HIV: a multicentre randomised controlled trial. Lancet HIV 2021; 8 (07) e408-e419
  • 47 Daly KA, Scott Giebink G, Lindgren BR. et al. Maternal immunization with pneumococcal 9-valent conjugate vaccine and early infant otitis media. Vaccine 2014; 32 (51) 6948-6955
  • 48 See KC. Pneumococcal vaccination in adults: a narrative review of considerations for individualized decision-making. Vaccines (Basel) 2023; 11 (05) 908
  • 49 Centers for Disease Control and Prevention. Administering pneumococcal vaccines. Accessed May 21, 2024 at: https://www.cdc.gov/vaccines/vpd/pneumo/hcp/administering-vaccine.html#administration
  • 50 Diseases NCfIaR. Timing and spacing of immunobiologics. Accessed July 29, 2024 at: https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/timing.html
  • 51 Riekkinen M, Pakkanen SH, Hutse V. et al. Coadministered pneumococcal conjugate vaccine decreases immune response to hepatitis A vaccine: a randomized controlled trial. Clin Microbiol Infect 2023; 29 (12) 1553-1560
  • 52 Tashani M, Alfelali M, Barasheed O. et al. Effect of Tdap when administered before, with or after the 13-valent pneumococcal conjugate vaccine (coadministered with the quadrivalent meningococcal conjugate vaccine) in adults: a randomised controlled trial. Vaccine 2016; 34 (48) 5929-5937
  • 53 Song JY, Cheong HJ, Noh JY. et al. Immunogenicity and safety of a tetanus-diphtheria vaccine and a 13-valent pneumococcal conjugate vaccine after concomitant vaccination in ≥ 50-year-old adults. BMC Infect Dis 2018; 18 (01) 628
  • 54 Bilgin GM, Lokuge K, Glass K. Modelling the impact of maternal pneumococcal vaccination on infant pneumococcal disease in low-income settings. Vaccine 2022; 40 (31) 4128-4134
  • 55 Committee Opinion No. 718. Update on immunization and pregnancy: tetanus, diphtheria, and pertussis vaccination. Obstet Gynecol 2017; 130: e153-e157
  • 56 Nunes MC, Madhi SA. Prevention of influenza-related illness in young infants by maternal vaccination during pregnancy. F1000 Res 2018; 7: 122
  • 57 Fleming-Dutra KEJJ, Jones JM, Roper LE. et al. Use of the Pfizer respiratory syncytial virus vaccine during pregnancy for the prevention of respiratory syncytial virus-associated lower respiratory tract disease in infants: recommendations of the Advisory Committee on Immunization Practices - United States, 2023. MMWR Morb Mortal Wkly Rep 2023; 72 (41) 1115-1122
  • 58 Chaithongwongwatthana S, Yamasmit W, Limpongsanurak S, Lumbiganon P, Tolosa JE. Pneumococcal vaccination during pregnancy for preventing infant infection. Cochrane Database Syst Rev 2015; 1 (01) CD004903
  • 59 Voysey M, Pollard AJ, Sadarangani M, Fanshawe TR. Prevalence and decay of maternal pneumococcal and meningococcal antibodies: a meta-analysis of type-specific decay rates. Vaccine 2017; 35 (43) 5850-5857
  • 60 de Bruin O, Phijffer E, Ahmadizar F. et al. Are maternal vaccines effective and safe for mothers and infants? A systematic review and meta-analysis of randomised controlled trials. BMJ Glob Health 2023; 8 (10) e012376
  • 61 Lehmann D, Pomat WS, Riley ID, Alpers MP. Studies of maternal immunisation with pneumococcal polysaccharide vaccine in Papua New Guinea. Vaccine 2003; 21 (24) 3446-3450
  • 62 Finn A, Zhang Q, Seymour L, Fasching C, Pettitt E, Janoff EN. Induction of functional secretory IgA responses in breast milk, by pneumococcal capsular polysaccharides. J Infect Dis 2002; 186 (10) 1422-1429
  • 63 Obaro SK, Deubzer HE, Newman VO, Adegbola RA, Greenwood BM, Henderson DC. Serotype-specific pneumococcal antibodies in breast milk of Gambian women immunized with a pneumococcal polysaccharide vaccine during pregnancy. Pediatr Infect Dis J 2004; 23 (11) 1023-1029
  • 64 Teshale EH, Hanson D, Flannery B. et al. Effectiveness of 23-valent polysaccharide pneumococcal vaccine on pneumonia in HIV-infected adults in the United States, 1998–2003. Vaccine 2008; 26 (46) 5830-5834
  • 65 Peñaranda M, Falco V, Payeras A. et al. Effectiveness of polysaccharide pneumococcal vaccine in HIV-infected patients: a case-control study. Clin Infect Dis 2007; 45 (07) e82-e87
  • 66 Community Acquired Pneumonia. Accessed April 30, 2024 at: https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-opportunistic-infections/community-acquired
  • 67 Platt HL, Cardona JF, Haranaka M. et al. A phase 3 trial of safety, tolerability, and immunogenicity of V114, 15-valent pneumococcal conjugate vaccine, compared with 13-valent pneumococcal conjugate vaccine in adults 50 years of age and older (PNEU-AGE). Vaccine 2022; 40 (01) 162-172
  • 68 Wilck M, Cornely OA, Cordonnier C. et al; V114-022 (PNEU-STEM) Study Group. A phase 3, randomized, double-blind, comparator-controlled study to evaluate safety, tolerability, and immunogenicity of V114, a 15-valent pneumococcal conjugate vaccine, in allogeneic hematopoietic cell transplant recipients (PNEU-STEM). Clin Infect Dis 2023; 77 (08) 1102-1110
  • 69 Mohapi L, Pinedo Y, Osiyemi O. et al; V114-018 (PNEU-WAY) Study Group. Safety and immunogenicity of V114, a 15-valent pneumococcal conjugate vaccine, in adults living with HIV. AIDS 2022; 36 (03) 373-382
  • 70 Kishino H, Sawata M, Igarashi R. et al. Safety and immunogenicity of V114, a 15-valent pneumococcal conjugate vaccine, compared with 13-valent pneumococcal conjugate vaccine in Japanese adults aged ≥65 years: subgroup analysis of a randomized phase III trial (PNEU-AGE). Jpn J Infect Dis 2022; 75 (06) 575-582
  • 71 Song JY, Chang CJ, Andrews C. et al; V114-016 (PNEU-PATH) study group. Safety, tolerability, and immunogenicity of V114, a 15-valent pneumococcal conjugate vaccine, followed by sequential PPSV23 vaccination in healthy adults aged ≥50 years: a randomized phase III trial (PNEU-PATH). Vaccine 2021; 39 (43) 6422-6436
  • 72 French N, Gordon SB, Mwalukomo T. et al. A trial of a 7-valent pneumococcal conjugate vaccine in HIV-infected adults. N Engl J Med 2010; 362 (09) 812-822
  • 73 Sabharwal C, Sundaraiyer V, Peng Y. et al. Immunogenicity of a 20-valent pneumococcal conjugate vaccine in adults 18 to 64 years old with medical conditions and other factors that increase risk of pneumococcal disease. Hum Vaccin Immunother 2022; 18 (06) 2126253
  • 74 McCashland TM, Preheim LC, Gentry MJ. Pneumococcal vaccine response in cirrhosis and liver transplantation. J Infect Dis 2000; 181 (02) 757-760
  • 75 Doing A, Griffin D, Jacobson JA, Amber IJ, Gilbert E. B-cell function in chronic heart failure: antibody response to pneumococcal vaccine. J Card Fail 2001; 7 (04) 318-321
  • 76 Jaiswal V, Ang SP, Lnu K. et al. Effect of pneumococcal vaccine on mortality and cardiovascular outcomes: a systematic review and meta-analysis. J Clin Med 2022; 11 (13) 3799
  • 77 Marques Antunes M, Duarte GS, Brito D. et al. Pneumococcal vaccination in adults at very high risk or with established cardiovascular disease: systematic review and meta-analysis. Eur Heart J Qual Care Clin Outcomes 2021; 7 (01) 97-106
  • 78 Breukels MA, Zandvoort A, van Den Dobbelsteen GP. et al. Pneumococcal conjugate vaccines overcome splenic dependency of antibody response to pneumococcal polysaccharides. Infect Immun 2001; 69 (12) 7583-7587
  • 79 Hosea SW, Burch CG, Brown EJ, Berg RA, Frank MM. Impaired immune response of splenectomised patients to polyvalent pneumococcal vaccine. Lancet 1981; 1 (8224) 804-807
  • 80 Melica G, Bartolucci P, Audureau E. et al. Immunological efficacy of pneumococcal vaccination including the 13-valent pneumococcal conjugate vaccine in adult patients with sickle cell disease: results of the randomized DREVAC controlled trial. Clin Infect Dis 2023; 76 (11) 1949-1958
  • 81 Meerveld-Eggink A, de Weerdt O, van Velzen-Blad H, Biesma DH, Rijkers GT. Response to conjugate pneumococcal and Haemophilus influenzae type b vaccines in asplenic patients. Vaccine 2011; 29 (04) 675-680
  • 82 Vietri J, Harnett J, Emir B, Chilson E. Uptake of 13-valent pneumococcal conjugate vaccine among US adults aged 19 to 64 years with immunocompromising conditions. Hum Vaccin Immunother 2020; 16 (01) 161-168
  • 83 Mei-Chuan Hung AS, Lu P-J, Carla L. et al. Vaccination coverage among adults in the United States, National Health Interview Survey 2021. Accessed April 18, 2024 at: https://www.cdc.gov/vaccines/imz-managers/coverage/adultvaxview/pubs-resources/vaccination-coverage-adults-2021.html#print
  • 84 Liu J, Johnson KD, Shoener Dunham L. Pneumococcal vaccination coverage among US adults enrolled in Medicaid and newly diagnosed with underlying medical conditions. Expert Rev Vaccines 2023; 22 (01) 596-607
  • 85 Ostropolets A, Shoener Dunham L, Johnson KD, Liu J. Pneumococcal vaccination coverage among adults newly diagnosed with underlying medical conditions and regional variation in the U.S. Vaccine 2022; 40 (33) 4856-4863
  • 86 Calhoun KKK, Razzaghi H, Garacci E, Lindley M, Black C. Association of vaccine hesitancy with maternal influenza and Tdap vaccination coverage- United States, 2019–20 to 2022–23. Center for Disease Control and Prevention; 2023
  • 87 Spires B, Brewton A, Maples JM, Ehrlich SF, Fortner KB. Vaccine hesitancy in women's health. Obstet Gynecol Clin North Am 2023; 50 (02) 401-419
  • 88 Frawley JE, McKenzie K, Sinclair L, Cummins A, Wardle J, Hall H. Midwives' knowledge, attitudes and confidence in discussing maternal and childhood immunisation with parents: a national study. Vaccine 2020; 38 (02) 366-371
  • 89 Leddy MA, Anderson BL, Power ML, Gall S, Gonik B, Schulkin J. Changes in and current status of obstetrician-gynecologists' knowledge, attitudes, and practice regarding immunization. Obstet Gynecol Surv 2009; 64 (12) 823-829
  • 90 Chamberlain AT, Seib K, Ault KA. et al. Improving influenza and Tdap vaccination during pregnancy: a cluster-randomized trial of a multi-component antenatal vaccine promotion package in late influenza season. Vaccine 2015; 33 (30) 3571-3579
  • 91 Ding H, Black CL, Ball S. et al. Influenza vaccination coverage among pregnant women - United States, 2016-17 influenza season. MMWR Morb Mortal Wkly Rep 2017; 66 (38) 1016-1022
  • 92 O'Leary ST, Riley LE, Lindley MC. et al. Obstetrician-gynecologists' strategies to address vaccine refusal among pregnant women. Obstet Gynecol 2019; 133 (01) 40-47
  • 93 Goggins ER, Williams R, Kim TG. et al. Assessing influenza vaccination behaviors among medically underserved obstetric patients. J Womens Health (Larchmt) 2021; 30 (01) 52-60
  • 94 Roussos-Ross D, Prieto A, Goodin A, Watson AK, Bright MA. Increased Tdap and influenza vaccination acquisition among patients participating in group prenatal care. J Prim Prev 2020; 41 (05) 413-420
  • 95 Centers for Disease Control and Prevention. CDC vaccine price list. Accessed July 16, 2024 at: https://www.cdc.gov/vaccines/programs/vfc/awardees/vaccine-management/price-list/index.html
  • 96 Rand CM, Olson-Chen C. Maternal vaccination and vaccine hesitancy. Pediatr Clin North Am 2023; 70 (02) 259-269
  • 97 Armstrong K, Putt M, Halbert CH. et al. Prior experiences of racial discrimination and racial differences in health care system distrust. Med Care 2013; 51 (02) 144-150
  • 98 Dudley MZ, Limaye RJ, Salmon DA. et al. Racial/ethnic disparities in maternal vaccine knowledge, attitudes, and intentions. Public Health Rep 2021; 136 (06) 699-709
  • 99 Callahan AG, Coleman-Cowger VH, Schulkin J, Power ML. Racial disparities in influenza immunization during pregnancy in the United States: a narrative review of the evidence for disparities and potential interventions. Vaccine 2021; 39 (35) 4938-4948
  • 100 Centers for Disease Control and Prevention. COVID-19 response VTF. CDC's state of vaccine confidence insights report; 2023
  • 101 Robinson R, Nguyen E, Wright M. et al. Factors contributing to vaccine hesitancy and reduced vaccine confidence in rural underserved populations. Humanit Soc Sci Commun 2022; 9 (01) 416
  • 102 Cox E, Sanchez M, Baxter C. et al. COVID-19 vaccine hesitancy among English-speaking pregnant women living in rural western United States. Vaccines (Basel) 2023; 11 (06) 1108
  • 103 Gierke R. Current epidemiology of pneumococcal disease among adults, United States. In: Centers for Disease Control and Prevention, ed. February 2024, ACIP Meeting 2024