The rise in pertussis incidence among infants in Guizhou, China underscores the need for maternal acellular pertussis vaccine (aP) immunization, a key strategy in protecting infants from severe health consequences. However, the willingness of pregnant women in Guizhou to receive this vaccine is not well-understood. This study aimed to explore pregnant women’s intentions toward maternal pertussis vaccination in Guizhou and identify the associated factors. A questionnaire based on the health belief model, was administered in an exploratory cross-sectional study from January to February 2022. Data from 564 participants were collected and analyzed. The chi-square test, Mann-Whitney U test, and Poisson regression were used to identify potential factors associated with vaccination intentions. Participants’ median age was 27 y (interquartile range (IQR): 24–31), and the median number of children per participant was one. The study found that only 36.0% of the participants intended to receive the aP vaccine while 64.0% were uncertain or negative in this regard. Significant factors associated with intentions to vaccinate included perceived barriers and cues for action and perceived benefits. The major barriers for low vaccination intentions were safety concerns for both the fetus and the mother, and family members’ negative attitudes. Free vaccines, perceiving preventive benefits, observing other pregnant women getting vaccinated, and healthcare provider recommendations may facilitate vaccination intentions. Multiple immune strategies should be developed or optimized to cope with the resurgence of pertussis.

Background: Our study sought to characterize the knowledge and willingness levels regarding vaccinations against pertussis and seasonal influenza (influenza) among pregnant women in Guizhou province, China, which have previously been unclear. Methods: In total, 11 hospitals that carried out obstetrics and antenatal examination services were randomly included in the target organizations, and 564 questionnaires completed by the pregnant women were collected and analyzed in Guizhou province. The questionnaires contained questions addressing awareness and knowledge of pertussis and influenza, willingness to be vaccinated at different life stages, and the basic statuses of subjects. A two-paired McNemar test was used to compare the knowledge levels on pertussis and influenza. A Friedman test was used to compare the willingness to be vaccinated at different life stages. To explore the factors influencing knowledge levels, a chi-square test and binary logistic regression were used with stepwise backward regression. Results: In total, 11.9 percent of the pregnant women had received influenza vaccines in the year prior to their pregnancy in Guizhou province. The pregnant women had poorer knowledge of pertussis than of influenza. Given a vaccine was available, the willingness of pregnant women to partake in the following vaccination-related actions could be ranked, from highest to lowest: free vaccination of babies, recommend vaccination to family members, postpartum vaccination, vaccination of babies at mothers’ expense, and vaccination during pregnancy. Knowledge levels played different roles in the women’s willingness to receive vaccinations at different life stages. Common knowledge of pertussis and influenza played a limited role in the willingness to receive maternal vaccinations. Among the pregnant women, the factors influencing the low levels of pertussis knowledge were occupation as nonmedical-institution staff, lower educational level, pregnancy stage past the first trimester, and not bearing children; for influenza, the factors were occupation as nonmedical-institution staff, lower educational level, denial of pregnancy-induced disease, and lower monthly household income per capita. Conclusions: Pregnant women have poorer levels of knowledge on pertussis than influenza, whereas there was no significant difference in their willingness to be vaccinated against these conditions. Health education on pertussis should be strengthened and we called for vaccines given at birth.

Objective: to assess Chinese children’s guardians’ intentions and attitudes toward accepting a pertussis cocooning vaccination and its determinants. Methods: a self-administered questionnaire was designed based on a theoretical framework that originated mainly from the reasoned action approach. Associations between questionnaire variables and outcomes were assessed using univariate and multivariate analyses with odds ratios (OR), regression coefficients (β), and their 95% confidence intervals (CIs). Results: among 762 eligible participants, most (80.71%) reported a positive intention to accept a pertussis cocooning vaccination. The guardians’ positive intention was related to the children’s pertussis vaccination experience (OR = 2.483, 95% CI: 1.340–4.600). Guardians who had a positive attitude towards pertussis vaccination (OR = 1.554, 95% CI: 1.053–2.296), higher subjective norms (OR = 1.960, 95% CI: 1.371–2.802) and better perceived behavioral control (OR = 7.482, 95% CI: 4.829–11.591) stated a higher intention to receive a pertussis cocooning vaccination. The mean attitude score was 3.88 ± 0.863. Greater risk perception about pertussis (β = 0.390, 95% CI: 0.298–0.483), stronger obligation from moral norms (β = 0.355, 95% CI: 0.279–0.430), and good knowledge (β = 0.108, 95% CI: 0.070–0.146) were significantly related to positive attitude toward pertussis cocooning vaccination among guardians. Conclusions: Chinese children’s guardians held positive intentions and attitudes toward accepting a pertussis cocooning vaccination. The current findings described the determinants of such intention and attitude and provided knowledge based on improving guardians’ intentions for policymakers if cocooning vaccinations or related immunization strategies are implemented in China in the future.

Despite global recommendations, maternal influenza vaccination coverage in China remains critically low. This hospital-based cross-sectional study (January-February 2022) applied the Health Belief Model (HBM) to examine determinants among 564 pregnant women in Guizhou Province. Mann-Whitney U tests and modified Poisson regression were employed to compare inter-group distributions and estimate prevalence ratios (PRs). Analysis revealed only 11.9% (67 of 564) of respondents received pre-pregnancy vaccination, and 36.7% (207 of 564) intended to be vaccinated during pregnancy. Key HBM-based predictors of vaccination intention included: (i) perceived barriers, primarily fetal/maternal safety concerns and familial opposition; (ii) cues to action and perceived benefits; and (iii) perceived susceptibility and severity. PRs and 95% CIs across quantiles indicated statistical significance in influenza vaccination intention by levels of perceived barriers (contrast = -0.34; 95% CI: -0.51, -0.17; P_trend < 0.001), cues to action, and perceived benefits (contrast = 0.34; 95% CI: 0.13, 0.55; P_trend = 0.002). These context-specific determinants provide the basis for our intervention strategies and measures. Integrated interventions, such as prenatal counseling, mobile health education, financial incentives, peer networks, and reminders, may enhance maternal influenza vaccination coverage, warranting broader implementation.