1887
  1. Home
  2. Eurosurveillance
  3. Volume 31, Issue 7, 19/Feb/2026
  4. Article
Research Open Access
Like 0
Download

Abstract

BACKGROUND

Pregnant women and their newborns are at increased risk of severe outcomes from influenza and COVID-19 infections; maternal vaccination is recommended. However, no routine surveillance of maternal vaccine coverage exists in Norway.

AIM

To provide insights into vaccination coverage and timing during pregnancy.

METHODS

This population-based registry study included women who gave birth in Norway during 1 October 2023–30 September 2024. Data on influenza and COVID-19 vaccinations administered during 1 October 2023–10 May 2024 were obtained from the national immunisation registry and linked to birth data from the Medical Birth Registry Norway. Cumulative coverage included vaccines administered during pregnancy, with sub-analyses focusing on second and third trimester vaccinations, month of delivery and maternal age.

RESULTS

Overall influenza vaccination coverage was 29.9% (15,915/53,161), with 22.3% (11,856/53,161) vaccinated in the second or third trimester. Coverage increased from 16.4% (7,287/44,454) in October to 26.4% (12,982/49,170) in November and plateaued thereafter. Coverage peaked among women delivering in February (50.8%; 2,159/4,248) and declined afterwards. COVID-19 vaccination coverage was 12.1% (6,423/53,161) with 10.1% (5,349/53,161) in the second or third trimester, following a similar pattern to influenza. Overall, 11.4% received both vaccines. The lowest uptake (< 19%) was among women aged 25 years or younger.

CONCLUSION

Coverage of maternal influenza and COVID-19 vaccinations for 2023/24 remained low, with missed opportunities to reach pregnant women beyond November 2023. Overall, the coverage was lowest among women aged 25 years or younger. Strengthened efforts are needed to increase vaccination coverage among pregnant women and reduce gaps in protection.

© Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.
Loading

Article metrics loading...

/content/10.2807/1560-7917.ES.2026.31.7.2500504
2026-02-19
2026-03-15
/content/10.2807/1560-7917.ES.2026.31.7.2500504
Loading
Loading full text...

Full text loading...

/deliver/fulltext/eurosurveillance/31/7/eurosurv-31-7-4.html?itemId=/content/10.2807/1560-7917.ES.2026.31.7.2500504&mimeType=html&fmt=ahah

References

  1. Blanchard-Rohner G, Eberhardt C. Review of maternal immunisation during pregnancy: focus on pertussis and influenza. Swiss Med Wkly. 2017;147(4344):w14526.  https://doi.org/10.4414/smw.2017.14526  PMID: 29120017 
  2. Santilli V, Sgrulletti M, Costagliola G, Beni A, Mastrototaro MF, Montin D, et al. Maternal Immunization: Current Evidence, Progress, and Challenges. Vaccines (Basel). 2025;13(5):450.  https://doi.org/10.3390/vaccines13050450  PMID: 40432062 
  3. Wang R, Yan W, Du M, Tao L, Liu J. The effect of influenza virus infection on pregnancy outcomes: A systematic review and meta-analysis of cohort studies. Int J Infect Dis. 2021;105:567-78.  https://doi.org/10.1016/j.ijid.2021.02.095  PMID: 33647509 
  4. Xu K, Sun W, Yang S, Liu T, Hou N. The impact of COVID-19 infections on pregnancy outcomes in women. BMC Pregnancy Childbirth. 2024;24(1):562.  https://doi.org/10.1186/s12884-024-06767-7  PMID: 39210282 
  5. Goldshtein I, Nevo D, Steinberg DM, Rotem RS, Gorfine M, Chodick G, et al. Association between BNT162b2 vaccination and incidence of SARS-CoV-2 infection in pregnant women. JAMA. 2021;326(8):728-35.  https://doi.org/10.1001/jama.2021.11035  PMID: 34251417 
  6. Mølgaard-Nielsen D, Fischer TK, Krause TG, Hviid A. Effectiveness of maternal immunization with trivalent inactivated influenza vaccine in pregnant women and their infants. J Intern Med. 2019;286(4):469-80.  https://doi.org/10.1111/joim.12947  PMID: 31259452 
  7. Mazagatos C, Godoy P, Muñoz Almagro C, Pozo F, Larrauri A, et al. Effectiveness of influenza vaccination during pregnancy to prevent severe infection in children under 6 months of age, Spain, 2017-2019. Vaccine. 2020;38(52):8405-10.  https://doi.org/10.1016/j.vaccine.2020.07.014  PMID: 32741669 
  8. European Centre for Disease Prevention and Control (ECDC). Survey report on national seasonal influenza vaccination recommendations and coverage rates in EU/EEA countries. Stockholm: ECDC; 2024. Available from: https://www.ecdc.europa.eu/en/publications-data/survey-report-national-seasonal-influenza-vaccination-recommendations
  9. European Centre for Disease Prevention and Control (ECDC). COVID-19 vaccination coverage in the EU/EEA during the 2023-24 season campaigns. Stockholm: ECDC; 2024. Available from: https://www.ecdc.europa.eu/en/publications-data/covid-19-vaccination-coverage-eueea-during-2024-25-season-campaigns
  10. Norwegian Institute of Public Health (NIPH). Vaccination of pregnant and breastfeeding women - handbook for healthcare professionals. Oslo: NIPH; 2024. Available from: https://www.fhi.no/va/vaksinasjonshandboka/vaksinasjon-i-ulike-livsfaser/vaksinasjon-av-gravide-og-ammende/?term=#vaksiner-som-anbefales-i-svangerskapet.
  11. Norwegian Institute of Public Health (NIPH). Vaccination of pregnant and breastfeeding women - handbook for healthcare professionals. Oslo: NIPH; 2024. Available from: https://www.fhi.no/va/vaksinasjonshandboka/vaksinasjon-i-ulike-livsfaser/vaksinasjon-av-gravide-og-ammende/?term=
  12. Hansen BT, Dahl J, Greve-Isdahl M, Winje BA, Rydland KM, Campbell S, et al. Low and inequitable influenza and COVID-19 vaccination coverage among pregnant women in Norway: Nationwide population-based cohort study. Vaccine. 2025;61:127386.  https://doi.org/10.1016/j.vaccine.2025.127386  PMID: 40517499 
  13. Irgens LM. The Medical Birth Registry of Norway. Epidemiological research and surveillance throughout 30 years. Acta Obstet Gynecol Scand. 2000;79(6):435-9.  https://doi.org/10.1034/j.1600-0412.2000.079006435.x  PMID: 10857866 
  14. Trogstad L, Ung G, Hagerup-Jenssen M, Cappelen I, Haugen IL, Feiring B. The Norwegian immunisation register--SYSVAK. Euro Surveill. 2012;17(16):20147.  https://doi.org/10.2807/ese.17.16.20147-en  PMID: 22551462 
  15. Centers for Disease Control and Prevention (CDC). Epidemiology and Prevention of Vaccine-Preventable Diseases. Atlanta: CDC; 2024. Available from: https://www.cdc.gov/pinkbook/hcp/table-of-contents/chapter-12-influenza.html
  16. Norwegian Health Directorate. Information about prenatal diagnostics for health personnel in prenatal care in the municipal health and care services: Norwegian Health Directorate; 2024. Available from: https://www.helsedirektoratet.no/lov-og-forskrift/bioteknologi/fosterdiagnostikk/informasjon-om-fosterdiagnostikk-til-helsepersonell-i-svangerskapsomsorgen-i-den-kommunale-helse-og-omsorgstjenesten/tidlig-ultralyd-svangerskapsuke-uke-11-0--13-6-
  17. White RA, Zhang C, CSIDS. csmaps: preformatted maps of Norway that don’t need geolibraries. CSIDS. [Accessed: 27 Jan 2026]. Available from: https://github.com/csids/csmaps
  18. Norwegian Institute of Public Health (NIPH). Influenza Virological and Epidemiological 2023-2024 season report. Oslo: NIPH; 2024. Available from: https://www.fhi.no/publ/2024/influensasesongen-2023-2024
  19. World Health Organization (WHO). Reducing Missed Opportunities for Vaccination (MOV). Geneva: WHO; 2025. Available from: https://www.who.int/teams/immunization-vaccines-and-biologicals/essential-programme-on-immunization/implementation/reducing-missed-opportunities-for-vaccination
  20. Zhong Z, Haltalli M, Holder B, Rice T, Donaldson B, O’Driscoll M, et al. The impact of timing of maternal influenza immunization on infant antibody levels at birth. Clin Exp Immunol. 2019;195(2):139-52.  https://doi.org/10.1111/cei.13234  PMID: 30422307 
  21. De Weerdt L, Herzog SA, Van Damme P, Maertens K. Timing of pertussis vaccination during pregnancy: Evidence and implementation - A systematic review. Vaccine. 2024;42(21):126152.  https://doi.org/10.1016/j.vaccine.2024.07.053  PMID: 39088988 
  22. De Brabandere L, Hendrickx G, Poels K, Daelemans W, Van Damme P, Maertens K. Influence of the COVID-19 pandemic and social media on the behaviour of pregnant and lactating women towards vaccination: a scoping review. BMJ Open. 2023;13(2):e066367.  https://doi.org/10.1136/bmjopen-2022-066367  PMID: 36764726 
  23. Cuningham W, Geard N, Fielding JE, Braat S, Madhi SA, Nunes MC, et al. Optimal timing of influenza vaccine during pregnancy: A systematic review and meta-analysis. Influenza Other Respir Viruses. 2019;13(5):438-52.  https://doi.org/10.1111/irv.12649  PMID: 31165580 
  24. Örtqvist AK, Dahlqwist E, Magnus MC, Ljung R, Jonsson J, Aronsson B, et al. COVID-19 vaccination in pregnant women in Sweden and Norway. Vaccine. 2022;40(33):4686-92.  https://doi.org/10.1016/j.vaccine.2022.06.083  PMID: 35842337 
  25. Kuptarak A, Phupong V. Knowledge, attitude, and acceptance of COVID-19 vaccine in pregnant women. Ther Adv Vaccines Immunother. 2024;12:25151355241278832.  https://doi.org/10.1177/25151355241278832  PMID: 39345730 
  26. Norwegian Institute of Public Health (NIPH). Interim Influenza Virological and Epidemiological season report prepared for the WHO Consultation on the Composition of Influenza Virus Vaccines for the Northern Hemisphere 2025/2026. Oslo: NIPH; 2025. Available from: https://www.fhi.no/en/publ/2025/interim-influenza-virological-and-epidemiological-season-report-prepared-for-the-who-20252026
  27. Hansen BT, Kristoffersen AB, Stecher M. Vaccination readiness among adults in Norway: A cross-sectional survey using the 7C model. Vaccine. 2025;56:127169.  https://doi.org/10.1016/j.vaccine.2025.127169  PMID: 40288085 
  28. Rotevatn TA, Høy-Petersen N, Hussaini L, Håberg SE, Magnus MC, Morken NH, et al. Utilization of antenatal care among immigrant women in Norway: a nationwide register-based cohort study. BMC Pregnancy Childbirth. 2025;25(1):417.  https://doi.org/10.1186/s12884-025-07519-x  PMID: 40211185 
  29. Klüwer B, Rydland KM, Mamelund SE, Gleditsch RN. Drivers and barriers of seasonal influenza vaccination 2015/16 & 2019/20 to 2022/23 - a survey on why most Norwegians don’t get the flu vaccine. BMC Public Health. 2024;24(1):2687.  https://doi.org/10.1186/s12889-024-20157-w  PMID: 39358784 
  30. Klüwer B, Margrethe Rydland K, Nybru Gleditsch R, Mamelund SE, Laake I. Social and demographic patterns of influenza vaccination coverage in Norway, influenza seasons 2014/15 to 2020/21. Vaccine. 2023;41(6):1239-46.  https://doi.org/10.1016/j.vaccine.2023.01.013  PMID: 36639272 
  31. White ND, Grimm H. Vaccine equity: lessons learned from the COVID-19 pandemic. Am J Lifestyle Med. 2022;16(4):443-6.  https://doi.org/10.1177/15598276221090451  PMID: 35855781 
  32. Alessandrini V, Anselem O, Girault A, Mandelbrot L, Luton D, Launay O, et al. Does the availability of influenza vaccine at prenatal care visits and of immediate vaccination improve vaccination coverage of pregnant women? PLoS One. 2019;14(8):e0220705.  https://doi.org/10.1371/journal.pone.0220705  PMID: 31369626 
  33. Norwegian Institute of Public Health. Vaccination during pregnancy 2024/2025: Norwegian Institute of Public Health; 2025. https://www.fhi.no/en/publ/2025/Vaccination-during-pregnancy-24-25/.
  34. Razai MS, Mansour R, Ravindran P, Freeman S, Mason-Apps C, Morris J, et al. Facilitators and barriers to vaccination uptake in pregnancy: A qualitative systematic review. PLoS One. 2024;19(4):e0298407.  https://doi.org/10.1371/journal.pone.0298407  PMID: 38640190 
  35. Skirbekk H, Magelssen M, Conradsen S. Trust in healthcare before and during the COVID-19 pandemic. BMC Public Health. 2023;23(1):863.  https://doi.org/10.1186/s12889-023-15716-6  PMID: 37170208 
  36. Norwegian Institute of Public Health (NIPH). The Childhood Immunization Programme 2023. Oslo: NIPH; 2024. Available from: https://www.fhi.no/en/publ/2024/The-Childhood-Immunization-Programme-2023
  37. Allington D, McAndrew S, Moxham-Hall VL, Duffy B. Media usage predicts intention to be vaccinated against SARS-CoV-2 in the US and the UK. Vaccine. 2021;39(18):2595-603.  https://doi.org/10.1016/j.vaccine.2021.02.054  PMID: 33810905 
  38. Smith SE, Sivertsen N, Lines L, De Bellis A. Decision making in vaccine hesitant parents and pregnant women - An integrative review. Int J Nurs Stud Adv. 2022;4:100062.  https://doi.org/10.1016/j.ijnsa.2022.100062  PMID: 38745627 
  39. Bernard C, Drouin J, Le Vu S, Botton J, Semenzato L, Bertrand M, et al. COVID-19 vaccination rates among pregnant women in France: A nationwide cohort study. Vaccine. 2025;53:127070.  https://doi.org/10.1016/j.vaccine.2025.127070  PMID: 40186994 
  40. McRae JE, McHugh L, King C, Beard FH, Blyth CC, Danchin MH, et al. Influenza and pertussis vaccine coverage in pregnancy in Australia, 2016-2021. Med J Aust. 2023;218(11):528-41.  https://doi.org/10.5694/mja2.51989  PMID: 37248802 
  41. Jurga J, Mierzwa G, Kuciel JA, Kołak M, Jaworowski A, Huras H. Maternal vaccination in pregnancy: an assessment of influenza, pertussis, and covid-19 vaccination rates in Cracow, Poland. Med Sci Monit. 2024;30:e943304.  https://doi.org/10.12659/MSM.943304  PMID: 38525559 
  42. Corbeau M, Mulliez A, Chenaf C, Eschalier B, Lesens O, Vorilhon P. Trends of influenza vaccination coverage in pregnant women: a ten-year analysis from a French healthcare database. Sci Rep. 2022;12(1):7153.  https://doi.org/10.1038/s41598-022-11308-3  PMID: 35505069 
  43. Morris SE, O’Halloran A, Sundaresan D, Dawood FS, Ellington S, Grohskopf LA, et al. Heterogeneity in seasonal influenza vaccination opportunity and disease risk during pregnancy and in infants <6 months. Vaccine. 2025;68:127887.  https://doi.org/10.1016/j.vaccine.2025.127887  PMID: 41176967 
Missed opportunities for maternal immunisation against influenza and COVID-19, Norway, October 2023 to May 2024: a population-based registry study
<p class="citation"> <span>Citation style for this article:</span> <span class="meta-value authors"> <a href="/search?value1=Melanie+Stecher&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Stecher Melanie</a>, <a href="/search?value1=Margrethe+Greve-Isdahl&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Greve-Isdahl Margrethe</a>, <a href="/search?value1=Jesper+Dahl&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Dahl Jesper</a>, <a href="/search?value1=Evy+Dvergsdal&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Dvergsdal Evy</a>, <a href="/search?value1=Suzanne+Campbell&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Campbell Suzanne</a>, <a href="/search?value1=Frederik+Sk%C3%A5r&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Skår Frederik</a>, <a href="/search?value1=Svein+Rune+Andersen&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Andersen Svein Rune</a>, <a href="/search?value1=Kjersti+Margrethe+Rydland&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Rydland Kjersti Margrethe</a>, <a href="/search?value1=Inger+Johanne+Bakken&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Bakken Inger Johanne</a>, <a href="/search?value1=Hilde+Marie+Engjom&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Engjom Hilde Marie</a>, <a href="/search?value1=Hinta+Meijerink&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Meijerink Hinta</a></span>. Missed opportunities for maternal immunisation against influenza and COVID-19, Norway, October 2023 to May 2024: a population-based registry study. <a href="/content/ecdc">Euro Surveill.</a> 2026;31(7):pii=2500504. <a href="https://doi.org/10.2807/1560-7917.ES.2026.31.7.2500504" title="doi link" target="_blank">https://doi.org/10.2807/1560-7917.ES.2026.31.7.2500504</a> <span class="ES_Article_citation"> <span class="generated">Received</span>: 10 Jul 2025;&nbsp;&nbsp; <span class="generated">Accepted</span>: 23 Oct 2025 </span> </p>
/content/10.2807/1560-7917.ES.2026.31.7.2500504
/content/10.2807/1560-7917.ES.2026.31.7.2500504
Loading

Data & Media loading...

Supplementary data

Submit comment
Close
Comment moderation successfully completed
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error