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Effect of Maternal Influenza Vaccination on Influenza Prevention among Newborns in Nigeria

Abstract

Influenza infection is an important public health concern during pregnancy and early infancy, particularly because newborns are vulnerable to respiratory infections and are not eligible for routine influenza vaccination at birth. Influenza infection in newborns and young infants may result in fever, respiratory distress, feeding difficulties, hospitalization, and other complications. Maternal influenza vaccination during pregnancy provides an opportunity to protect both the mother and newborn through the development of maternal antibodies and transfer of antibodies to the fetus before birth. In Nigeria, however, maternal influenza vaccination may be affected by limited awareness, concerns about vaccine safety, inadequate vaccine availability, inconsistent antenatal care attendance, financial and geographical barriers, and limited integration of influenza vaccination into maternal healthcare services. Against this background, this study investigates the effect of maternal influenza vaccination on influenza prevention among newborns in Nigeria. The study will be anchored on the Health Belief Model, Social Ecological Model, and Health Systems Framework. The Health Belief Model explains how pregnant women's perceptions of susceptibility to influenza, perceived severity of influenza infection, perceived benefits of maternal vaccination, perceived barriers, and cues to action may influence vaccination uptake during pregnancy. The Social Ecological Model emphasizes the influence of individual, family, healthcare provider, community, and policy factors on maternal vaccination and newborn health. The Health Systems Framework emphasizes antenatal service delivery, health workforce, vaccine availability, health information, financing, governance, and accessibility as important components of effective maternal immunization programmes. Collectively, these theoretical perspectives provide a suitable framework for explaining how maternal influenza vaccination may influence influenza prevention among newborns in Nigeria. The study will adopt a quantitative analytical cohort or quasi-experimental research design. The study population will comprise pregnant women receiving antenatal care in selected healthcare facilities in Nigeria and their newborns. A multistage sampling technique will be used to select states, local government areas, healthcare facilities, antenatal clinics, pregnant women, and eligible mother-newborn pairs. Maternal influenza vaccination will be assessed using indicators such as receipt of influenza vaccine during pregnancy, gestational age at vaccination, timing of vaccination, vaccination status, antenatal care attendance, and documentation of maternal vaccination. Influenza prevention among newborns will be assessed using indicators such as laboratory-confirmed influenza infection where diagnostic testing is available, suspected influenza illness, influenza-related hospitalization, respiratory complications, healthcare visits for influenza-like illness, and other relevant infant health outcomes during the defined follow-up period. Data will be collected using structured questionnaires, antenatal care records, maternal immunization registers, vaccination cards, delivery records, newborn medical records, hospital admission records, laboratory reports, and relevant disease surveillance records. Descriptive statistics will be used to summarize maternal and newborn characteristics, maternal vaccination coverage, vaccination timing, and influenza-related outcomes. Inferential statistical techniques, including chi-square tests, t-tests, correlation analysis, and logistic or multiple regression analysis where appropriate, will be used to determine the effect of maternal influenza vaccination on influenza prevention among newborns. Where a cohort design is adopted, influenza-related outcomes among newborns whose mothers received influenza vaccination during pregnancy may be compared with outcomes among newborns whose mothers were not vaccinated, with relevant potential confounding factors appropriately controlled. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that maternal influenza vaccination has a significant positive effect on influenza prevention among newborns in Nigeria. Newborns whose mothers received influenza vaccination during pregnancy are expected to have a lower risk of influenza infection and influenza-related complications during the early months of life than newborns whose mothers were not vaccinated. Maternal vaccination is expected to provide passive protection during a period when newborns are particularly vulnerable to respiratory infections and are unable to receive routine influenza vaccination themselves. Maternal immunization may also reduce the likelihood of influenza transmission from infected mothers to their infants. However, inadequate vaccine availability, limited awareness, concerns about vaccination during pregnancy, missed opportunities during antenatal care, late presentation for antenatal services, and poor documentation may reduce programme effectiveness. The study therefore expects improved access to maternal influenza vaccination, timely vaccination during pregnancy, stronger healthcare worker recommendations, and effective maternal immunization education to contribute significantly to influenza prevention among newborns in Nigeria. The study is expected to contribute to the literature on maternal influenza vaccination, influenza prevention, newborn health, maternal immunization, respiratory infections, antenatal care, passive immunity, vaccine-preventable diseases, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Primary Health Care Development Agency, Nigeria Centre for Disease Control and Prevention, state ministries of health, healthcare facilities, maternal and child health programmes, immunization programme managers, obstetricians, midwives, paediatricians, development partners, and policymakers regarding strategies for strengthening maternal influenza vaccination. The study will also provide evidence-based recommendations for integrating influenza vaccination into antenatal care, improving vaccine availability and accessibility, strengthening healthcare worker recommendations, increasing awareness among pregnant women, improving vaccination documentation and monitoring, addressing concerns about maternal vaccination, and strengthening maternal and newborn health programmes for improved influenza prevention across Nigeria.

Keywords: Maternal influenza vaccination, influenza prevention, newborns, maternal immunization, pregnancy, passive immunity, antenatal care, respiratory infections, vaccine-preventable diseases, Nigeria, public health.