Text message reminder to increase influenza vaccination during pregnancy in women booked for pregnancy and birth care at Mercy Hospital for Women: a Pilot study

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Influenza vaccination is recommended during pregnancy to protect 1. pregnant women 2. unborn babies and 3. infants within the first 6 months of life. Because of this “3 for 1” protection, the World Health Organisation prioritises pregnant women as highest among those who should receive influenza vaccination. Influenza vaccine prevents infection complications including critical maternal illness and death, stillbirth, fetal growth restriction, premature birth and serious infection in the first 6 months of life. Babies under the age of 6 months are too young to receive influenza vaccination directly. But babies whose mothers were vaccinated are protected in three ways: 1. antibodies which have crossed the placenta during fetal life stay in babies’ blood for up to 6 months 2. babies get more antibodies in breast milk 3. the baby is “cocooned”, meaning that he or she is unlikely to become infected with influenza from their nearest adult contact, their mother. Despite well studied safety of influenza vaccination during pregnancy, midwives, obstetricians and pregnant women are not well informed about benefits and safety. Previous audits at Mercy Hospital for Women showed that patient information brochures, staff education and reminder stamps in antenatal clinic progress notes increased influenza vaccination from 30% to 40% between 2010 and 2011. By winter 2012, we could not show any further increase, despite hoping that more than 75% of new mothers would have had influenza vaccination before their babies were born. A significant group of pregnant women do not recall influenza vaccination being discussed by obstetric or midwifery staff during pregnancy. This project aims to increase awareness and discussion about influenza vaccination using a text message reminder to women booked to have their baby at Mercy Hospital for Women during the influenza season 2013 (approximately March to October). The text message will read “ Msg from Mercy Hosp: Flu vacc in pregnancy is good for mums & babies. Ask your midwife or dr. about it soon”. Text messages are a familiar sort of appointment reminder used by hairdressers, dentists etc. Audit of new mothers in 2012 found that 80% of women were interested in text, email or web-based reminders or information in additional to written information and talking with their doctor or midwife. Published research on text messages and vaccination in the United States also indicate around 80% uptake and even higher levels of acceptability for pregnant women and families with children. The Mercy Hospital for Women already uses a text message service for the nurse bank. Pregnant women will only be contacted if their privacy consent permits the hospital to contact them. Pregnant women will only be contacted if their mid trimester ultrasound indicates reassuring fetal development. In this way, women who have already suffered a miscarriage will not receive a text message. Women with significant fetal anomalies will not be contacted as part of research. Such women are usually referred to Perinatal Medicine where influenza vaccination is also offered as part of routine care. We plan to assess influenza uptake by auditing new mothers on the postnatal wards in July and/or August 2013. Almost identical audits occurred previously in 2010, 2011 and 2012 using a 5minute interview technique which has previously been well received and been able to gain the views of 95% or more new mothers about why or why not they chose vaccination. No identifying data is collected but summary data is important for quality improvement.

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