Influenza vaccination in pregnant women in Iceland 2010–2020 and the burden of influenza in pregnant women and their infants.

• Flu vaccine uptake in pregnant women was in 6.2–37.5 % in the flu seasons 2010–2020. • Flu vaccinations are protective for pregnant women in the season of vaccination. • Maternal flu vaccinations protect infants in the season of vaccination. Influenza vaccinations are recommended in pregnancy to protect both the pregnant woman and the unborn baby. The aim of this study was to assess the influenza vaccine uptake among pregnant women in Iceland in ten influenza seasons and to estimate the influenza disease burden on pregnant women and their infants. This was a retrospective, descriptive study on influenza vaccine uptake among pregnant women and the burden of influenza and influenza-like illness (ILI) among pregnant women and their infants in ten influenza seasons. All women attending a 20-week ultrasound at Landspitali University Hospital in Reykjavik in August-April each influenza season 2010–2020 were included in the study. Data on influenza vaccinations and influenza/ILI diagnoses was collected from central national databases. The influenza vaccine uptake increased from 6.2 % in 2011–2012 to 37.5 % in 2019–2020. The incidence rate of influenza/ILI among pregnant women ranged from 5.5 to 22.1/1000 person-years. The estimated vaccine effectiveness in the ten influenza seasons was 34–100 %. The incidence rate of influenza/ILI among infants < 12 months of age was 0–13.4/1000 person-years. Influenza vaccinations in pregnancy are protective against influenza/ILI in pregnant women (IRR 0.36, 95 % CI 0.22–0.58), infants in the season of vaccination (IRR 0.40, 95 % CI 0.17–0.97) and probably for infants < 6 months of age (IRR 0.51, 95 % CI 0.22–1.21). Influenza vaccine coverage in pregnancy is suboptimal. Influenza vaccinations in pregnancy provide significant protection against influenza/ILI for pregnant women and infants in the season of vaccination. Initiatives to improve maternal vaccination coverage are needed. [ABSTRACT FROM AUTHOR]