During the Flu Awareness Campaign WHO/Europe highlights the work being undertaken in Lithuania to increase rates of influenza vaccination among pregnant women.
Pregnant women are more prone to severe illness from influenza, and any influenza infection during pregnancy can have a negative impact on the health of the unborn child. Furthermore, vaccination protects both pregnant women and their babies after birth.
The immunization of pregnant women against influenza in Kaunas, Lithuania’s second-largest city, received a significant boost four years ago, when it became a trial project for WHO/Europe’s Tailoring immunization programmes for seasonal influenza (TIP FLU) – a guide for increasing pregnant women’s uptake of seasonal influenza vaccination, which was published in 2017.
The approach was introduced in Kaunas Central, Dainava, Kalniečiai and Šilainiai Polyclinics, where antenatal care is provided by midwives and gynaecologists. Dr Kristina Rudzinskaite is Chief Specialist of the Communicable Diseases Division in Lithuania’s National Public Health Centre and has been central to the implementation of the project, which was supported by WHO/Europe. The project was conducted in close cooperation with the Lithuanian University of Health Sciences in Kaunas, Lithuania.
“In the first year we did this there was a big uptake, in the second year there was a slight decline due to an ongoing debate about trivalent versus quadrivalent vaccines, but in the third year it was back up again. This shows that you have to continuously raise awareness about the issue. The project has been well received. People still remember that two pregnant women in Kaunas died in the influenza pandemic of 2009 and there were many others who experienced complications,” said Dr Rudzinskaite.
While no special interventions or activities took place during the 2020–2021 influenza season due to the COVID-19 pandemic, people involved in the project continued to spread the message via conferences, lectures, television, radio, and social media. The project has had a lasting impact – vaccination levels among pregnant women in Kaunas last year were even higher than in previous years.
Convincing health-care workers
According to Dr Rudzinskaite, the first step was to convince health-care workers themselves. “Before this project, even the doctors were not aware of vaccination for influenza in pregnancy and as a result they were not confident about recommending it,” she explains. The solution to this was a series of lectures open to doctors, nurses and midwives that were delivered in health-care institutions by highly respected doctors in academic positions. There was an opportunity for discussion and any questions were addressed with evidence-based responses. As a result, health-care worker immunization increased by some 30% across the city, along with immunization of pregnant women.
“WHO/Europe was very helpful,” continues Dr Rudzinskaite. “It was great to feel the strong support and it was important when communicating with institutions and health workers. WHO’s convening role was also important in getting everyone together. We would now like to continue receiving WHO support to improve health-care worker immunization in general.”
Also significant was a change in the Ministry of Health that involved adding a checkbox to obstetric records to confirm whether the patient is vaccinated. It was placed on the first page along with a reminder of the reasons for immunization. There were also health promotion efforts supported by WHO with information materials, such as posters and large adverts on trolley buses.
As a medical student, Justina Budemene was especially focused on learning as much as possible about the vaccine and how safe it would be for her baby. “I had some doubts but when I got more information, I was sure that I needed the vaccine. My baby is now one year old and was protected from influenza for six months.” Having had a positive experience, she was also able to reassure others: “My friend was scared she would feel ill after the vaccine. I said, ‘I’m not afraid, just watch me,’ and she saw I was fine.”
“I would like to offer my compliments to my colleagues in Lithuania for their achievements in increasing influenza vaccination uptake among pregnant women. It is critical for pregnant women to get vaccinated against influenza this year, especially in the context of the COVID-19 pandemic in which many health systems are at risk of being overwhelmed,” says Richard Pebody, programme lead of the High-Threat Pathogens team at WHO/Europe.