Potential use of Western Australia's mandatory Midwives Notification System for routinely monitoring antenatal vaccine coverage

Background: Despite the maternal and infant health benefits of antenatal vaccines and availability of government-funded vaccination programs, Australia does not have a national system for routinely monitoring antenatal vaccination coverage. We evaluated the potential use of Western Australia's mandatory Midwives Notification System (MNS) as a tool for routinely monitoring antenatal vaccination coverage. Methods: Two hundred and sixty-eight women who gave birth to a live infant between August and October 2016 participated in a telephone survey of vaccines received in their most recent pregnancy. For women who reported receiving influenza and/or pertussis vaccine and whose vaccination status was documented by their vaccine provider, MNS vaccination data were compared with the vaccine provider's record as the 'gold standard.' For women who reported receiving no vaccines, MNS vaccination data were compared with self-reported information. Results: Influenza and pertussis vaccination status was complete (i.e. documented as either vaccinated or not vaccinated) for 66% and 63% of women, respectively. Sensitivity of MNS influenza vaccination data was 65.7% (95% CI 56.0-74.2%) and specificity was 53.0% (95% CI 42.4-63.4%). Sensitivity of MNS pertussis vaccination data was 62.5% (95% CI 53.3-70.9%) and specificity was 40.4% (95% CI 27.6-54.7%). There was no difference between vaccinated and unvaccinated women in the proportion of MNS records with missing or unknown vaccination information. When considering only MNS records with complete vaccination information, the sensitivity of the MNS influenza vaccination field was 91.8% (95% CI 83.0-96.9%) and the sensitivity of the MNS pertussis vaccination field was 88.0% (95% CI 76.7-95.5%). Conclusion: Due to the high proportion of records with missing or unknown vaccination status, we observed low sensitivity and specificity of antenatal vaccination data in the MNS. However, given we did not observe differential ascertainment by vaccination status, MNS records with complete information may be reliable data source for routinely monitoring antenatal vaccine coverage.

Midwives' knowledge, attitudes and learning needs regarding antenatal vaccination.

OBJECTIVE: To determine the knowledge, attitudes and learning needs of midwives regarding antenatal vaccination. DESIGN AND SETTING: A cross-sectional, paper-based survey of midwives employed at the only public tertiary maternity hospital in the Australian state of Western Australia between November 2015 and July 2016. PARTICIPANTS: 252 midwives providing care in antepartum, intrapartum, and/or postpartum settings. MEASUREMENTS: Self-reported responses to a 41-item survey. FINDINGS: The vast majority of midwives supported influenza and pertussis vaccination for pregnant women, with 90.0% and 71.7% reporting they would recommend pertussis and influenza vaccine, respectively, to a pregnant friend or family member, and almost all stating that midwives should administer vaccines to pregnant patients (94.8%). Seven out of ten midwives (68.1%) responded correctly to all knowledge items regarding vaccines recommended during pregnancy; 52.8% demonstrated correct knowledge regarding vaccine administration despite only 36.6% having attended an education session on antenatal vaccination in the previous two years. Nearly all midwives (97.3%) expressed a need for more education on vaccine administration. The most commonly reported barrier to administering influenza (61.3%) and pertussis (59.0%) vaccination was having staff available with the certification required to administer vaccines. KEY CONCLUSIONS: Midwives view antenatal vaccination as their responsibility and are interested and receptive to education. IMPLICATIONS FOR PRACTICE: There is an unmet need and demand among midwives for professional development that would enable them to recommend and administer vaccines to pregnant women in accordance with national immunisation guidelines and integrate vaccination into routine antenatal care.

Trends in seasonal influenza vaccine uptake during pregnancy in Western Australia: Implications for midwives.

BACKGROUND: Antenatal influenza vaccination is an important public health intervention for preventing serious illness in mothers and newborns, yet uptake remains low. AIM: To evaluate trends in seasonal influenza vaccine coverage and identify determinants for vaccination among pregnant women in Western Australia. METHODS: We conducted an annual telephone survey in a random sample of post-partum women who delivered a baby in Western Australia between 2012 and 2014. Women were asked whether influenza vaccination was recommended and/or received during their most recent pregnancy; women were also asked why or why they were not immunised. FINDINGS: Between 2012 and 2014, influenza vaccine coverage increased from 22.9% to 41.4%. Women who reported receiving the majority of their antenatal care from a private obstetrician were significantly more likely to have influenza vaccination recommended to them than those receiving the majority of their care from a public antenatal hospital or general practitioner (p<0.001). In 2014, the most common reason women reported for accepting influenza vaccination was to protect the baby (92.8%) and the most common reason for being unimmunised was lack of a healthcare provider recommendation (48.5%). DISCUSSION: Antenatal influenza vaccination uptake is increasing, but coverage remains below 50%. A recommendation from the principal care provider is an important predictor of maternal influenza vaccination. CONCLUSION: Antenatal care providers, including midwives, have a key role in providing appropriate information and evidence-based recommendations to pregnant women to ensure they are making informed decisions. Consistent recommendations from antenatal care providers are critical to improving influenza vaccine coverage in pregnant women.

Prevalence and control of trachoma in Australia, 1997-2004.

This study aimed to document the prevalence of active trachoma and trichiasis from 1997 to 2003 and from 1987 to 2004, respectively, and to provide an overview of trachoma control activities in Australia in 2004. Prevalence data were obtained from state, territory and regional population health units and unpublished surveys. Information about trachoma control programs and activities currently implemented in Australia was obtained through structured interviews with staff involved in trachoma control. Active trachoma prevalence in Aboriginal and Torres Strait Islander children, ranging from 0-40 per cent, were reported from the Eastern Goldfields, Midwest-Murchison and Kimberley Population Health Units in Western Australia and the Northern Territory's Centre for Disease Control. Large differences in trachoma prevalence were reported within and between different regions and from different years in the same region. Recent surveys of trichiasis in Kimberley and Central Australian Aboriginal and Torres Strait Islander adults demonstrated a prevalence of 9-12 per cent in inland, desert areas. In contrast with developing countries where active trachoma and trichiasis are more common among adult women than men, Australian surveys have identified equal prevalence in both sexes. Interpretation of trachoma prevalence and inter-regional/state/national comparisons were hampered by lack of a uniform method of data collection and analysis. Trachoma control programs were implemented consistently in some communities, and irregularly and/or in piecemeal fashion in others. Trachoma control programs led by regional population health units working in collaboration with primary health care services were more likely to be consistently implemented over long periods of time. Trachoma is a significant public health issue in some Aboriginal communities within Australia. The Communicable Diseases Network Australia has developed guidelines for the public health management of trachoma which provide recommendations on trachoma screening, control and data collection trachoma for affected states and territories.