Mapping the delivery of interventions for vaccine-preventable infections in pregnancy in Victoria, Australia
Nafisa Yussf A B * , Nicole Allard
A B , Nicole Romero A , Ann Wilson A , Jack Wallace C , Meg Perrier D , Stacey Rowe E , Rosemary Morey E , Neylan Aykut D and Benjamin Cowie A B F
A WHO Collaborating Centre for Viral Hepatitis, Peter Doherty Institute for Infection and Immunity, Melbourne, Vic. 3000, Australia.
B Department of Infectious Diseases, University of Melbourne, Melbourne, Vic. 3000, Australia.
C Burnet Institute, Melbourne Vic. 3004, Australia.
D LiverWELL, Melbourne, Vic. 3051, Australia.
E Department of Health, Melbourne, Vic. 3000, Australia.
F Royal Melbourne Hospital, Melbourne, Vic. 3000, Australia.
Australian Journal of Primary Health - https://doi.org/10.1071/PY22158
Submitted: 25 July 2022 Accepted: 19 December 2022 Published online: 6 February 2023
© 2023 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of La Trobe University. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)
Abstract
Background: Standard care for pregnant women includes universal screening for hepatitis B, and administration of influenza and pertussis vaccination to women and hepatitis B infant vaccination. This study explored how perinatal services relating to the prevention of these vaccine-preventable diseases are delivered to women and their infants in Victoria, Australia.
Methods: Two online surveys investigated service delivery for the prevention of influenza, pertussis and hepatitis B to identify barriers to optimal care during January–June 2021; (1) The Birthing Hospitals Survey captured facility-level information about service delivery for influenza and pertussis vaccination, and interventions to prevent mother-to-child-transmission of chronic hepatitis B (CHB); and (2) The Healthcare Providers Survey captured individual staff perceptions and knowledge in community and hospital settings.
Results: Thirty-four hospital unit managers (61%) completed The Birthing Hospitals Survey. One-hundred and forty participants completed The Healthcare Providers Survey. Half of the birthing hospitals provided influenza (50%) and pertussis (53%) vaccinations to pregnant women, and 53% provided an infectious diseases service for women with CHB. Barriers to optimal care delivery included reliance on pregnant woman’s self-report to confirm influenza, pertussis vaccination and CHB status, lack of standardised reporting, inadequate workforce training, poor communication between services, and lack of guideline-based clinical care for mothers with CHB and their infants. Three hospitals reported ‘stock out’ of hepatitis B immunoglobulin (HBIG).
Conclusion: Coordinated and standardised system and clinical care improvements are required to provide equitable care for pregnant women and their infants, including training and education for healthcare providers, improving data capture and communication among health services.
Keywords: healthcare providers, healthcare services, hepatitis B, infections in pregnancy, influenza, maternity care, pertussis, vaccine-preventable infections.
References
Amirthalingam G, Andrews N, Campbell H, et al. (2014) Effectiveness of maternal pertussis vaccination in England: an observational study. The Lancet 384, 1521–1528.| Effectiveness of maternal pertussis vaccination in England: an observational study.Crossref | GoogleScholarGoogle Scholar |
Arizona Department of Health Services (2018) ‘Perinatal hepatitis B prevention program manual.’ (Arizona Department of Health Services: Phoenix, AZ, USA) Available at https://azdhs.gov/documents/preparedness/epidemiology-disease-control/immunization/healthcare-professionals/perinatal-hepatitis-b-manual.pdf [Verified 20 December 2020]
Australian Government Department of Health (2018) Third national hepatitis B strategy 2018–2022. (Australian Government Department of Health: Canberra) Available at http://www.health.gov.au/internet/main/publishing.nsf/Content/ohp-bbvs-1/$File/Hep-B-Third-Nat-Strategy-2018-22.pdf
Australian Technical Advisory Group on Immunisation (ATAGI) (2017) ‘The Australian immunisation handbook.’ 10th edn. (Australian Government Department of Health: Canberra, Australia)
Dabrera G, Amirthalingam G, Andrews N, et al. (2015) A case-control study to estimate the effectiveness of maternal pertussis vaccination in protecting newborn infants in England and Wales, 2012–2013. Clinical Infectious Diseases 60, 333–337.
| A case-control study to estimate the effectiveness of maternal pertussis vaccination in protecting newborn infants in England and Wales, 2012–2013.Crossref | GoogleScholarGoogle Scholar |
Deng A (2021) Uptake of perinatal immunoprophylaxis for infants born to women with a record of hepatitis B in Victoria (2009–2017). Presented at the Australasian viral hepatitis conference, Brisbane, Australia.
Giles ML, Garland SM, Sasadeusz JJ, et al. (2004) An audit of obstetricians’ management of women potentially infected with blood-borne viruses. The Medical Journal of Australia 180, 328–332.
| An audit of obstetricians’ management of women potentially infected with blood-borne viruses.Crossref | GoogleScholarGoogle Scholar |
Giles ML, Grace R, Tai A, Michalak K, Walker SP (2013) Prevention of mother-to- child transmission of hepatitis B virus (HBV) during pregnancy and the puerperium: current standards of care. Australian and New Zealand Journal of Obstetrics and Gynaecology 53, 231–235.
| Prevention of mother-to- child transmission of hepatitis B virus (HBV) during pregnancy and the puerperium: current standards of care.Crossref | GoogleScholarGoogle Scholar |
Giles ML, Khai K, Krishnaswamy S, et al. (2021) An evaluation of strategies to achieve greater than 90% coverage of maternal influenza and pertussis vaccines including an economic evaluation. BMC Pregnancy and Childbirth 21, 771
| An evaluation of strategies to achieve greater than 90% coverage of maternal influenza and pertussis vaccines including an economic evaluation.Crossref | GoogleScholarGoogle Scholar |
Hunt RW, Ryan-Atwood TE, Davey M-A, Gaston J, Wallace E, Anil S on behalf of the Maternal and Newborn Clinical Network, INSIGHT Committee (2019) Victorian perinatal services performance indicators 2018–19. Safer Care Victoria, Victorian Government: Melbourne.
Lavanchy D (2004) Hepatitis B virus epidemiology, disease burden, treatment, and current and emerging prevention and control measures. Journal of Viral Hepatitis 11, 97–107.
| Hepatitis B virus epidemiology, disease burden, treatment, and current and emerging prevention and control measures.Crossref | GoogleScholarGoogle Scholar |
MacLachlan JH, Smith C, Towell V, Cowie BC (2020) Viral hepatitis mapping project: national report 2018–19. (Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM): Darlinghurst, NSW, Australia) Available at https://ashm.org.au/programs/Viral-Hepatitis-Mapping-Project/
Markey PG, White HA, Matthews AT, et al. (2017) Prevention of perinatal hepatitis B virus transmission: are we following guidelines? Communicable Diseases Intelligence Quarterly Report 41, E195–E198.
Mertz D, Kim TH, Johnstone J, et al. (2013) Populations at risk for severe or complicated influenza illness: systematic review and meta-analysis. BMJ 347, f5061
| Populations at risk for severe or complicated influenza illness: systematic review and meta-analysis.Crossref | GoogleScholarGoogle Scholar |
Mohammed H, Clarke M, Koehler A, Watson M, Marshall H (2018) Factors associated with uptake of influenza and pertussis vaccines among pregnant women in South Australia. PLoS One 13, e0197867
| Factors associated with uptake of influenza and pertussis vaccines among pregnant women in South Australia.Crossref | GoogleScholarGoogle Scholar |
Navabakhsh B, Mehrabi N, Estakhri A, et al. (2011) Hepatitis B virus infection during pregnancy: transmission and prevention. Middle East Journal of Digestive Diseases 3, 92–102.
New York State Department of Health (2011) ‘Perinatal hepatitis B prevention program manual.’ (New York State Department of Health: Albany, NY, USA) Available at https://www.health.ny.gov/diseases/communicable/hepatitis/hepatitis_b/perinatal/docs/program_manual.pdf [Verified 20 December 2020]
NSW Health (2017) ‘Neonatal hepatitis B prevention and vaccination program.’ (NSW Health: Sydney, NSW, Australia) Available at https://www1.health.nsw.gov.au/pds/ActivePDSDocuments/PD2017_036.pdf [Verified 21 December 2020]
Nunes MC, Madhi SA (2017) Influenza vaccination during pregnancy for prevention of influenza confirmed illness in the infants: a systematic review and meta-analysis. Human Vaccines & Immunotherapeutics 14, 758–766.
| Influenza vaccination during pregnancy for prevention of influenza confirmed illness in the infants: a systematic review and meta-analysis.Crossref | GoogleScholarGoogle Scholar |
Roder C, Chand S, Streat S, Beynon S, Huning E, Dabkowski P, Athan E, Wade AJ (2021) Pregnancy – a key moment for engaging women with hepatitis B in care. Australian and New Zealand Journal of Public Health 45, 299–300.
| Pregnancy – a key moment for engaging women with hepatitis B in care.Crossref | GoogleScholarGoogle Scholar |
Rowe SL, Perrett KP, Morey R, et al. (2019) Influenza and pertussis vaccination of women during pregnancy in Victoria, 2015–2017. The Medical Journal of Australia 210, 454–462.
| Influenza and pertussis vaccination of women during pregnancy in Victoria, 2015–2017.Crossref | GoogleScholarGoogle Scholar |
Rowe SL, Leder K, Perrett KP, Romero N, Nolan TM, Stephens N, Cowie BC, Cheng AC (2021) Maternal vaccination and infant influenza and pertussis. Pediatrics 148, e2021051076
| Maternal vaccination and infant influenza and pertussis.Crossref | GoogleScholarGoogle Scholar |
Shen EX, Lambert SB, Malo JA, et al. (2019) Perinatal immunoprophylaxis in babies born to hepatitis B virus-positive mothers in Queensland Australia: a data linkage study. Vaccine 37, 2884–2888.
| Perinatal immunoprophylaxis in babies born to hepatitis B virus-positive mothers in Queensland Australia: a data linkage study.Crossref | GoogleScholarGoogle Scholar |
Victorian Government (2019) My health, learning and development book (green book). (Better Health Channel) Available at https://www.betterhealth.vic.gov.au/health/healthyliving/victorian-child-health-record [Accessed 16 November 2021]
World Health Organization (2020) ‘Prevention of mother-to-child transmission of hepatitis B virus: guidelines on antiviral prophylaxis in pregnancy.’ (World Health Organization: Geneva)
World Health Organization (2021) Hepatitis B. Available at https://www.who.int/news-room/fact-sheets/detail/hepatitis-b [Accessed 1 August 2021]
World Hepatitis Alliance (2022) Mothers and babies can’t wait – a call for action to end mother-to-child transmission of hepatitis B. (World Hepatitis Alliance: Geneva) Available at https://www.worldhepatitisalliance.org/wp-content/uploads/2022/07/PMTCT-White-Paper-spreads.pdf
Yussf N, Wallace J, Perrier M, Romero N, Cowie B, Allard N (2022) Women with hepatitis B: how mothers with chronic hepatitis B understand and experience the prevention of mother-to-child transmission interventions in Victoria, Australia. Australian Journal of Primary Health 28, 514–521.
| Women with hepatitis B: how mothers with chronic hepatitis B understand and experience the prevention of mother-to-child transmission interventions in Victoria, Australia.Crossref | GoogleScholarGoogle Scholar |
