Influenza immunization: Guidance to inform introduction of influenza vaccine in low and middle-income countries
In 2012, the World Health Organization (WHO) released a position paper on influenza vaccination stating that pregnant women should have the highest priority for seasonal influenza vaccination in countries considering the initiation or expansion of influenza immunization programs. The recommendation that pregnant women be prioritized in immunization programs was based on a review of influenza burden of disease, vaccine safety, and vaccine performance by the WHO Strategic Advisory Group of Experts on Immunization (SAGE).
Despite the WHO recommendation, maternal influenza immunization has not been incorporated into routine immunization programs in many low-resource countries. A 2012 consultation of experts by the Bill & Melinda Gates Foundation (BMGF) identified operational challenges and knowledge gaps hindering implementation of maternal influenza immunization programs.
In response to this consultation, BMGF awarded a grant to WHO and PATH to execute a maternal influenza immunization project in order to address some of the remaining obstacles to implementing seasonal influenza immunization programs for pregnant women and data gaps about potential vaccine impact.
The US Center of Disease Control kindly agreed to provide financial support to the development of economic tools to support decision making on vaccine introduction and to estimate the costs of introducing influenza vaccination in countries.
The following pages will list the guidance documents resulting
from these efforts, addressing uncertainties around routine maternal
influenza immunization decision making and implementation, informing on
how to conduct economic analysis on the burden of influenza and the
introduction of the vaccine, as well as a protocol for conducting a
study to assess and address vaccine hesitancy.
Implementation manual
How to implement influenza vaccination of pregnant women
WHO has developed an introduction manual for national immunization programme managers and policy-makers to support the introduction of influenza immunization of pregnant women.
This document aims to support national decision-making processes that prioritize health interventions, inform operational plans for delivering influenza vaccines to pregnant women, and provide options for service delivery. Suggestions are mindful of local and regional influenza epidemiology, seasonality, availability of vaccines, and include strategies to take these factors into account.
E-learning courseThis online course aims to help policy-makers, national immunization program managers and immunization partners decide, plan and implement maternal influenza vaccination strategies. It will also assist in foreseeing and addressing potential challenges related to decision-making or implementation. |
Principles and considerations for adding a vaccine to a national immunization program:...
The introduction manual for influenza vaccination of pregnant women should be used in conjunction with and complements the following WHO vaccine introduction guidance.
Vaccine perception
Project protocol to assess awareness and acceptance of maternal influenza vaccination in low-resource settings
WHO commissioned the development of a protocol to assess community awareness and acceptance of maternal influenza vaccination and to assess clinicians’ awareness, priority and prescribing practices for influenza vaccination of pregnant women. Aims also included assessing community awareness, hesitancy and confidence with regard to vaccination of pregnant women.
The protocol has been tested in a pilot study to promote maternal influenza vaccination in Pune city. The approach is generic and adaptable for implementation in other settings.
Country studies based on experience in the Pune pilot study and locally appropriate adaptation of the protocol may help country health planners to implement programmes for improving influenza vaccination coverage of pregnant women. The protocol includes an approach and instruments for incorporating findings from qualitative surveys of clinicians’ and community views about AIV in clinicians’ communities of practice.
Such findings should be useful for setting-specific vaccination policy and planning, and to guide clinicians’ practice based on priorities and expectations of women of childbearing age and their spouses. The protocol indicates how the impact of engaging clinicians can be assessed by monitoring and analysing clinic vaccination rates at critical stages of the project by comparing active clinic partners and control clinics without engagement activities.
Countries interested in using this protocol can seek additional information at influenza@who.int
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