Depending on the local context, countries may wish to apply various approaches for vaccinating pregnant women. The decision should be based on epidemiology and seasonality of the disease, choice of optimal immunization strategies to reach the target population, financial resources, existing infrastructure and workforce, and availability of the vaccine. Responsibilities will need to be clearly defined on the basis of local contexts to ensure that health-care workers are aware of who is vaccinating and who should refer women for vaccination.
One or several of the following delivery strategies should be chosen, depending on the degree of desired coverage, optimal use of available resources, and potential disruption of established services:
- vaccination campaigns;
- routine vaccine delivery incorporated into antenatal care, primary care, HIV care, at preconception or family planning visits, and/or at well or sick child visits to health-care facilities;
- vaccine delivery through outreach.
To reinforce vaccination efforts, delivery approaches can be co-delivered with other health interventions to pregnant women (e.g. TT/dT/Tdap vaccination, iron, folic acid, health education) and, where possible, to their children (e.g. vitamin A, deworming, growth monitoring) to reduce costs to the health-care system . Strategies including co-delivery with other interventions need to be assessed with regard to their ability to reach a critical number of pregnant women during the projected delivery times for influenza vaccination.