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About the Authors:
Anna-Leena Lohiniva
* E-mail: anna.leena.lohiniva@hotmail.com
Affiliation: Global Disease Detection Center–Egypt, US Naval Medical Research Unit no. 3, Cairo, Egypt
Amal Barakat
Affiliation: Centre National de réfèrence Grippe–Institut National d'Hygiène–Ministry of Health, Rabat, Morocco
Erica Dueger
Affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America; and Global Disease Detection Center–Egypt, US Naval Medical Research Unit no. 3, Cairo, Egypt
Suzanne Restrepo
Affiliation: Global Disease Detection Center–Egypt, US Naval Medical Research Unit no. 3, Cairo, Egypt
Rajae El Aouad
Affiliation: Centre National de réfèrence Grippe–Institut National d'Hygiène–Ministry of Health, Rabat, Morocco
Introduction
During the A (H1N1) pdm09 pandemic, the World Health Organization (WHO) recommended that pregnant women receive the monovalent A (H1N1) pdm09 vaccine during pregnancy [1] in accordance with studies indicating increased morbidity and mortality among pregnant women associated with the A (H1N1) pdm09 infection [2]–[4]. Furthermore, influenza vaccines are generally safe for both mothers and their fetus [5], [6]. In fact, studies show that infants may receive protection from the virus through the transfer of antibodies from mothers vaccinated with influenza vaccine [7]. However, despite WHO recommendations, uptake of the monovalent A (H1N1) pdm09 vaccine among pregnant women worldwide remained lower than expected during the pandemic response (2009–2010) [8], [9], [10].
In Morocco (population 32 million), the monovalent A (H1N1) pdm09 vaccine was first made available to pregnant women in December 2009 at the Ministry of Health (MoH) facilities with 4,050,000 doses purchased for the target population of healthcare workers and other “high-risk groups” including pregnant women. Concurrently, a pandemic influenza awareness campaign was launched to inform the public about the monovalent A (H1N1) pdm09 vaccine with a key objective to highlight the benefits of vaccination for pregnant women. Despite these campaigns, only 167,870 (41%) of pregnant women were vaccinated.
Studies from other countries among various audiences including pregnant women have identified various barriers to the uptake of the monovalent A (H1N1) pdm09 vaccine including perceived risks and safety concerns [9], [11]–[23]. In addition, studies among pregnant women have identified pregnancy and fetus-specific concerns as barriers to the uptake of the vaccine [11], [12], [17]. Most of the previous studies are based on quantitative approaches, however, qualitative methodologies have provided an important opportunity to understand vaccine-associated perceptions and...