Madison Clarke
Vaccination during pregnancy is an increasingly adopted strategy worldwide, with many European countries implementing vaccination policies specifically for pregnant women. However, there is a lack of consistency in the recommendations across Europe, with significant differences in the number of vaccines, vaccination indications, and regulatory frameworks. While there is no mandatory vaccination policy for pregnant women in Europe, it is recommended that they receive vaccinations to protect themselves and their newborns until they can receive their own vaccinations.
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What You'll Learn
Influenza vaccines
Vaccination during pregnancy is an increasingly adopted strategy worldwide, including in Europe, to protect the mother and her offspring. Many European countries implement vaccination policies specifically designed for pregnant women, but there is a lack of homogeneity among programs.
As of March 2021, 37 out of 42 European countries have national vaccination programs for pregnant women, with a median of 2 vaccinations. Five countries have no vaccination recommendations for pregnant women.
Inactivated influenza vaccines are used in all countries. Recent recommendations state that women can and should be immunised during pregnancy with any licensed, recommended, and age-appropriate quadrivalent inactivated or recombinant influenza vaccine, but not with live-attenuated influenza vaccines. Influenza vaccines can be safely administered at any time during pregnancy, and vaccination is also considered safe during the third trimester.
In Denmark, Germany, Malta, and Norway, influenza vaccination is recommended in the second and third trimesters, and in the first trimester for high-risk conditions. In Sweden, vaccination is recommended from gestational week 16, while in the Netherlands, it is only recommended for high-risk pregnancies. Austria, Portugal, and Russia recommend vaccination in the second or third trimester, and also in the first trimester during epidemic seasons. All other European countries recommend influenza vaccination for all pregnant women, regardless of the trimester.
Twenty-seven out of 38 countries recommend influenza vaccination between the first and third trimesters. These countries include Albania, Belarus, Croatia, Cyprus, the Czech Republic, Estonia, Finland, France, Greece, Hungary, Iceland, Ireland, Italy, Latvia, Liechtenstein, Lithuania, Luxembourg, Monaco, Poland, Romania, Serbia, Slovenia, Spain, Switzerland, Ukraine, and the United Kingdom.
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Vaccination timing
Vaccination during pregnancy is an increasingly adopted strategy worldwide, with 37 out of 42 European countries implementing vaccination policies specifically designed for pregnant women. However, there is a lack of homogeneity in these vaccination programs, with differences in the number of vaccines, vaccination indications, and schemes.
In terms of timing, the World Health Organization (WHO) and the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) recommend maternal immunization to prevent influenza, diphtheria, pertussis, tetanus, and COVID-19. The Tdap vaccine, which includes tetanus, diphtheria, and acellular pertussis antigens, is routinely recommended during pregnancy.
For influenza vaccination, there are variations in the recommended timing across European countries. Denmark, Germany, Malta, and Norway recommend influenza vaccination in the second and third trimesters, while vaccination in the first trimester is advised for high-risk conditions. Sweden recommends vaccination starting from gestational week 16, while the Netherlands only suggests it for high-risk pregnancies, regardless of the trimester. Austria, Portugal, and Russia recommend vaccination in the second or third trimester, but also include the first trimester during epidemic seasons. Most other European countries recommend influenza vaccination for all pregnant women, regardless of the trimester.
Pertussis vaccination is also advised during pregnancy in numerous European countries, but with variations in timing and conditions. For example, in Croatia, pregnant women in the second or third trimester can apply for vaccination through health insurance, even without an official policy.
Overall, vaccination timing during pregnancy in European countries can vary depending on the specific vaccine and the recommendations of each country's health authorities. It is important for pregnant individuals to consult with their doctors and stay informed about the national recommendations on vaccination during pregnancy.
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Maternal and infant health
Vaccination during pregnancy is an increasingly adopted strategy worldwide, including in Europe, to protect maternal and infant health. Vaccination can safeguard both parents and their babies before, during, and after pregnancy. It is important to note that a person's immune system is slightly weakened during pregnancy, making them more susceptible to infections and potential complications.
As of March 2021, 37 out of 42 European countries have implemented national vaccination programs specifically for pregnant women. However, there is significant heterogeneity among these programs, with varying numbers of vaccines, vaccination indications, and regulatory frameworks. The World Health Organization (WHO) considers pregnant women a high-risk group for influenza and recommends prioritising them for influenza vaccination. As a result, most European countries recommend influenza vaccination during pregnancy, with some specifying the second and third trimesters as the ideal time.
In addition to influenza, other commonly recommended vaccinations for pregnant women in Europe include pertussis, tetanus, diphtheria, and COVID-19. These vaccines have been demonstrated to be safe, immunogenic, and effective. Vaccination during pregnancy can protect the mother from several infections and prevent vertical transmission to the newborn. Furthermore, passive antibody transfer can offer protection to the infant in their first months of life until they can receive their own vaccinations.
Despite the availability of vaccination programs, vaccine hesitancy remains a challenge in Europe, with factors such as limited information, poor health literacy, and misinformation contributing to reluctance among patients and medical staff. Establishing cohesive and harmonized pregnancy vaccination strategies across European countries could help optimise maternal and infant health outcomes.
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Country-specific recommendations
As of March 2021, 37 out of 42 European countries have implemented vaccination policies specifically for pregnant women. However, there is a lack of uniformity in the vaccination recommendations across Europe. The World Health Organization (WHO) considers pregnant women a high-risk group and recommends prioritizing them for influenza vaccination.
Austria, Denmark, Germany, Malta, Norway, and Russia recommend influenza vaccination during the second and third trimesters. They extend this recommendation to the first trimester for pregnant women with high-risk conditions or during epidemic seasons.
Sweden suggests vaccination starting from gestational week 16.
The Netherlands only advises vaccination for high-risk pregnancy conditions, regardless of the trimester.
Albania, Belarus, Croatia, Cyprus, the Czech Republic, Estonia, Finland, France, Greece, Hungary, Iceland, Ireland, Italy, Latvia, Liechtenstein, Lithuania, Luxembourg, Monaco, Poland, Romania, Serbia, Slovenia, Spain, Switzerland, Ukraine, and the United Kingdom recommend influenza vaccination between the first and third trimesters.
Portugal recommends vaccination during the second or third trimester.
Influenza and pertussis vaccinations are recommended by almost all countries exclusively for pregnant women, regardless of high-risk conditions. However, there are differences in the timing of these vaccinations.
Hepatitis B vaccination is advised during pregnancy in 12 countries, while tetanus and pneumococcal disease vaccinations are recommended in 10 countries each.
Meningococcal disease vaccination is suggested in 10 countries, while rabies and tick-borne encephalitis are recommended mainly for pregnant women at high risk of exposure or severe illness.
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Vaccine hesitancy
Vaccination during pregnancy is an increasingly adopted strategy worldwide, with many European countries implementing vaccination policies specifically designed for pregnant women. However, vaccine hesitancy among pregnant women in Europe poses a significant challenge to public health. High rates of hesitancy or reluctance can lead to a complete refusal of immunization, impacting the health of both the mother and the fetus. Acceptance rates of vaccination during pregnancy vary widely across Europe, and vaccine hesitancy can be attributed to several factors.
Firstly, a lack of proper information or limited patient information can contribute to hesitancy. This includes poor health literacy, insufficient training of medical staff, and a lack of medical recommendations for vaccination. Erroneous perceptions of the risks associated with the infectious disease, including its severity and potential complications, can also play a role. Additionally, fear of needles, distrust in the medical system and vaccinations, and the influence of misinformation or disinformation from the media, relatives, or friends, can all contribute to vaccine hesitancy. Other factors include the lack of vaccine availability and the associated costs.
To address vaccine hesitancy, it is crucial to establish cohesive and harmonized pregnancy vaccination strategies across European countries. A transparent and adaptable European framework that identifies a core set of priority recommended vaccines, while allowing for country-specific additions based on epidemiological circumstances, could help promote optimal maternal and fetal health outcomes. Systematic monitoring would facilitate timely adjustments to the recommended vaccines, ensuring responsiveness to evolving conditions.
Furthermore, addressing misinformation and disinformation through targeted medical and communication strategies is essential. Providing accurate and accessible information about the safety and effectiveness of vaccination during pregnancy and the benefits it confers can help increase vaccine acceptance and uptake among pregnant women in Europe.
In summary, vaccine hesitancy during pregnancy is a complex issue that requires a multifaceted approach. By addressing information gaps, improving health literacy, building trust, and ensuring vaccine accessibility, European countries can work towards optimizing maternal and fetal health through vaccination programs specifically tailored to the needs of pregnant women.
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Frequently asked questions
Yes, there are several vaccines recommended during pregnancy in European countries. The most common recommendation is for the influenza vaccine, with 36 out of 42 European countries recommending it during pregnancy.
Yes, in addition to the influenza vaccine, there are several other vaccines that may be recommended during pregnancy in European countries, including:
- Pertussis (whooping cough)
- Tetanus
- Diphtheria
- COVID-19
- Hepatitis B
- Pneumococcal disease
- Meningococcal disease
- Rabies
- Tick-borne encephalitis
- Hepatitis A
- Poliomyelitis
- Haemophilus influenzae
- Human papillomavirus
Vaccinating a pregnant person not only protects them from potentially severe diseases and complications during their pregnancy but also helps extend that protection to their newborn after birth. This is because the antibodies generated in response to the vaccine cross the placenta to the unborn baby, offering protection until they are old enough to receive their own vaccinations.
Yes, as of 2021, five European countries do not have any specific vaccination recommendations for pregnant women.
