Determinants of Influenza Vaccine Hesitancy among Pregnant Women in Europe: A Systematic Review

Abstract Background Pregnant women are at high risk for severe influenza, but 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 provides 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. These included PubMed via MEDLINE, Cochrane Central Register for Controlled Trials, PsycINFO, SAGE Journals, Taylor & Francis and Springer nature, covering the areas of 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 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 stating their anti-vaccine sentiment. Conclusion To overcome influenza vaccine hesitancy among pregnant women, it seems essential to increase the knowledge about influenza and the respective vaccination and to provide information for a valid risk judgment. The development of new information strategies for dialogue between healthcare providers and pregnant women should form part of this strategy.