WHO’s influenza recommendations aim to protect vulnerable high-risk groups from severe disease. In 2012, WHO published a position paper on influenza vaccine which identified pregnant women as the highest priority group for countries considering initiation or expansion of programmes for seasonal influenza vaccination. Influenza vaccination of pregnant women will protect both the mother and her young infant against influenza as there is no licensed vaccine available for neonates up to 6 months after birth. Giving influenza vaccines to pregnant women is safe and has proven to be efficacious, preventing laboratory-confirmed influenza in 35–70% of mothers and 28–61% of infants under 6 months of age. Maternal influenza vaccination programmes have the potential to augment/reinforce existing vaccination programmes and the maternal and child health infrastructure as well as to establish a delivery platform for future vaccines targeting these high-risk groups. In addition to protecting against yearly influenza outbreaks, a seasonal influenza vaccination programme can support countries’ planning efforts for a potential pandemic by increasing their capacity to produce or procure vaccines, to register and distribute them, to conduct targeted vaccine delivery, and to monitor vaccination coverage and effectiveness.

Vaccination programmes should be based on scientifically sound and cost-effective approaches. It is essential that sufficient human resources and training capacity are present when planning the introduction of a new vaccine. For maternal immunization, a communication strategy should be in place to address potential concerns about the use of the vaccine in pregnant women. As expanded service delivery may put additional stress on health systems, decision-makers should assess the impact of the vaccine’s introduction on the interconnected components of the health system.

This manual has two main parts:
1) decision-making at country level, aimed at policy-makers (section 4), and
2) issues concerning vaccine introduction planning and implementation, aimed at national immunization programme managers and immunization partners.
Annexes at the end of the manual and links throughout provide planning and assessment tools for policy-makers and programme managers.

Main points addressed in the manual: 
1. Background and rationale for implementation of maternal influenza vaccination.
2. Key policy decisions in considering vaccination implementation.
3. Practical guidance for vaccine programme implementers, including: tools for planning the introduction of the vaccine (addressing infrastructure and supply chain management), staff training and communication strategies, and monitoring and evaluation.)