Influenza Vaccine Coverage among Pregnant Women in a Public Hospital System during the 2009-2010 Pandemic Influenza Season (original) (raw)
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Monitoring seasonal influenza vaccination coverage among pregnant women in the United States
American Journal of Obstetrics and Gynecology, 2012
This report describes surveillance systems used for assessing influenza vaccination coverage among pregnant women in the United States. Coverage estimates and factors associated with maternal vaccination are reviewed for internet panel surveys of pregnant women and the Pregnancy Risk Assessment Monitoring System (PRAMS); new estimates are reported from the Behavioral Risk Factor Surveillance System (BRFSS) and Internet panel surveys. Influenza vaccination coverage among pregnant women improved from 11% during the 2001-2002 influenza season to approximately 38% measured by BRFSS and 50% measured by Internet panel surveys during the 2010-2011 influenza season. Coverage varied by state, ranging from 26% to 68% among the states participating in PRAMS in 2009-2010. Provider recommendation increased a woman's likelihood of vaccination nearly 6-fold. Despite increases in influenza vaccination coverage among pregnant women, approximately half remain unvaccinated. Continued efforts are needed to ensure pregnant women receive recommendations and offers of vaccination from their health care providers.
Public health reports (Washington, D.C. : 1974)
Vaccination during pregnancy significantly reduces the risk of influenza illness among pregnant women and their infants up to 6 months of age; however, many women do not get vaccinated. We examined disparities in vaccination coverage among women who delivered a live-born infant during the 2009-2010 influenza season, when two separate influenza vaccinations were recommended. Pregnancy Risk Assessment Monitoring System (PRAMS) data from 29 states and New York City, collected during the 2009-2010 influenza season, were used to examine uptake of seasonal (unweighted n=27,153) and pandemic influenza A(H1N1)pdm09 (pH1N1) (n=27,372) vaccination by racially/ethnically diverse women who delivered a live-born infant from September 1, 2009, through May 31, 2010. PRAMS data showed variation in seasonal and pH1N1 influenza vaccination coverage among women with live-born infants by racial/ethnic group. For seasonal influenza vaccination, coverage was 50.5% for non-Hispanic white, 30.2% for non-Hi...
Coverage and determinants of influenza vaccine among pregnant women: a cross-sectional study
BMC Public Health, 2019
Background: Pregnant women are at increased risk of influenza-related complications. The World Health Organisation recommends influenza vaccination to this high-risk population as highest priority. However, achieving high influenza vaccine coverage among pregnant women remains challenging. We conducted a cross-sectional survey to estimate the coverage and determinants of influenza vaccination among pregnant women in Singapore. Methods: Between September and November 2017, pregnant women aged ≥21 years were recruited at two public hospitals in Singapore. Participants completed an anonymous, self-administered online questionnaire assessing participants' influenza vaccination uptake, knowledge of and attitudes towards influenza and the influenza vaccine, vaccination history, willingness to pay for the influenza vaccine, and external cues to vaccination. We estimated vaccine coverage and used multivariable Poisson models to identify factors associated with vaccine uptake. Results: Response rate was 61% (500/814). Only 49 women (9.8, 95% Confidence Interval (CI): 7.3-12.7%) reported receiving the vaccine during their current pregnancy. A few misconceptions were identified among participants, such as the belief that influenza can be treated with antibiotics. The most frequent reason for not being vaccinated was lack of recommendation. Women who were personally advised to get vaccinated against influenza during pregnancy were 7 times more likely to be vaccinated (prevalence ratio (PR) = 7.11; 95% CI: 3.92-12.90). However, only 12% of women were personally advised to get vaccinated. Other factors associated with vaccine uptake were vaccination during a previous pregnancy (PR = 2.51; 95% CI: 1.54-4.11), having insurance to cover the cost of the vaccine (PR = 2.32; 95% CI: 1.43-3.76), and higher vaccine confidence (PR = 1.62; 95% CI: 1.30-2.01). Conclusions: Influenza vaccination uptake among pregnant women in Singapore is low. There is considerable scope for improving vaccination coverage in this high-risk population through vaccination recommendations from healthcare professionals, and public communication targeting common misconceptions about influenza and influenza vaccines.
Policy Considerations for Improving Influenza Vaccination Rates among Pregnant Women
Public Health Nursing, 2014
Background: Influenza exposure during pregnancy can cause severe health problems for both the mother and her offspring, including an increased risk of mortality. Influenza vaccination during all trimesters of pregnancy is safe and effective, and recommended by professional organizations such as the American College of Obstetrics and Gynecology. Despite these recommendations, the U.S. vaccination rates remain low in this high-risk population. Method: A policy analysis based on the five-part method identified by Teitelbaum and Wilensky (2013) addresses factors to consider in identifying the best voluntary policy options to improve the vaccination rates. The authors provide discussion of the background, landscape, and stakeholder interests and the pros and cons of two voluntary policy options to increase vaccination. The policy options include: (a) financial incentives for providers and (b) an education emphasis for providers and staff. Conclusions: The authors conclude that based on considerations of cost, provider preference, and practicality of implementation, a continuing educational intervention is the preferred policy venue to increase vaccination rates.
Influenza and Tdap Vaccination Coverage Among Pregnant Women — United States, April 2018
Morbidity and Mortality Weekly Report, 2018
Abbreviation: N/A = not applicable. * Women pregnant any time during October-January were included in the analysis to assess influenza vaccination coverage for the 2017-18 season. Women who received an influenza vaccination since July 1, 2017, before or during their pregnancy were considered vaccinated. † Women pregnant any time since August 1, 2017, and had a live birth were included in the analysis to assess Tdap coverage. Women who received a Tdap vaccination during their recent pregnancy were considered vaccinated. § ≥5 percentage-point difference compared with reference group. ¶ Reference group for comparison within subgroups. ** Race/ethnicity was self-reported. Women identified as Hispanic might be of any race. Women categorized as white, black, or other race were identified as non-Hispanic. The "other" race category included Asians, American Indians or Alaska Natives, Native Hawaiians or other Pacific Islanders, and women who selected "other" or multiple races. † † Women considered to have any public insurance selected at least one of the following when asked what kind of medical insurance they had: Medicaid, Medicare, Indian Health Service, state sponsored medical plan, or other government plan. Women considered to have private/military insurance selected private medical insurance and/or military medical insurance and did not select any type of public insurance. § § Estimates not reported because sample size was <30. ¶ ¶ Women who were employed for wages and self-employed were categorized as working; those who were out of work, homemakers, students, retired, or unable to work were categorized as not working. *** Poverty status was defined based on the reported number of people and children living in the household and annual household income, according to the U.S. Census poverty thresholds (https://www.census.gov/data/tables/time-series/demo/income-poverty/historical-poverty-thresholds.html). † † † Conditions associated with increased risk for serious medical complication from influenza, including chronic asthma, a lung condition other than asthma, a heart condition, diabetes, a kidney condition, a liver condition, obesity, or a weakened immune system caused by a chronic illness or by medicines taken for a chronic illness. Women who were missing information were not included in the analysis for high-risk conditions (n = 233). § § § Excluded women who did not report having a provider visit since July 2017 (n = 30) for the influenza vaccination coverage analysis; no women were excluded for the Tdap vaccination coverage analysis.
Factors Associated with Antenatal Influenza Vaccination in a Medically Underserved Population
Infectious Diseases in Obstetrics and Gynecology
Influenza infection in pregnant women is associated with increased risk of morbidity and mortality. Despite recommendations for all women to receive the seasonal influenza vaccine during pregnancy, vaccination rates among pregnant women in the U.S. have remained around 50%. The objective of this study was to evaluate clinical and demographic factors associated with antenatal influenza vaccination in a medically underserved population of women. We conducted a retrospective cohort study at Grady Memorial Hospital, a large safety-net hospital in Atlanta, Georgia, from July 1, 2016, to June 30, 2018. Demographic and clinical characteristics were abstracted from the electronic medical record. The Kotelchuck index was used to assess prenatal care adequacy. Relative risks and 95% confidence intervals for associations between receipt of influenza vaccine and prenatal care adequacy, demographic characteristics, and clinical characteristics were calculated using multivariable log-binominal mo...
2009 H1N1 vaccination by pregnant women during the 2009-10 H1N1 influenza pandemic
American Journal of Obstetrics and Gynecology, 2012
OBJECTIVE: Pregnant women were identified at greater risk and given priority for 2009 H1N1 vaccination during the 2009 through 2010 H1N1 pandemic. We identified factors associated with acceptance or refusal of 2009 H1N1 vaccination during pregnancy. STUDY DESIGN: We conducted an in-person survey of postpartum women on the labor and delivery service from June 17 through Aug. 13, 2010, at 4 New York hospitals. RESULTS: Of 1325 survey respondents, 34.2% received 2009 H1N1 vaccination during pregnancy. A provider recommendation was most strongly associated with vaccine acceptance (odds ratio [OR], 19.4; 95% confidence interval [CI], 12.7-31.1). Also more likely to take vaccine were women indicating the vaccine was safe for the fetus (OR, 12.4; 95% CI,.0) and those who previously took seasonal flu vaccination (OR, 7.9; 95% CI, 5.8 -10.7). Race, education, income, and age were less important in accepting vaccine.
Journal of Women's Health, 2011
Since 2004, the American College of Obstetricians and Gynecologists (ACOG) and the Advisory Committee on Immunization Practices (ACIP) have recommended that pregnant women receive the seasonal influenza vaccine, regardless of pregnancy trimester, because of their increased risk for severe complications from influenza. However, the uptake of the influenza vaccine by pregnant women has been low. During the 2009-2010 influenza season, pregnant women were identified as a priority population to receive the influenza A (H1N1) 2009 (2009 H1N1) monovalent vaccine in addition to the seasonal influenza vaccine. In this issue, we highlight information from the 10 states that collected data using the survey administered by the Pregnancy Risk Assessment and Monitoring System (PRAMS) about seasonal vaccine coverage among women with recent live births and reasons for those who chose not to get vaccinated. The combined estimates from PRAMS of influenza vaccination coverage for the from 10 states were 50.7% for seasonal and 46.6% for 2009 H1N1 vaccine among women with recent live births. Among women who did not get vaccinated, reasons varied from worries about the safety of the vaccines for self and baby to not normally getting the vaccination. Further evaluation is needed on ways to increase influenza vaccination among pregnant women, effectively communicate the risk of influenza illness during pregnancy, and address women's concerns about influenza vaccination safety during pregnancy.
Influenza and Tdap Vaccination Coverage Among Pregnant Women — United States, April 2020
Morbidity and Mortality Weekly Report, 2020
Vaccination of pregnant women with influenza vaccine and tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap) can decrease the risk for influenza and pertussis among pregnant women and their infants. The Advisory Committee on Immunization Practices (ACIP) recommends that all women who are or might be pregnant during the influenza season receive influenza vaccine, which can be administered at any time during pregnancy (1). ACIP also recommends that women receive Tdap during each pregnancy, preferably during the early part of gestational weeks 27-36 (2,3). Despite these recommendations, vaccination coverage among pregnant women has been found to be suboptimal with racial/ethnic disparities persisting (4-6). To assess influenza and Tdap vaccination coverage among women pregnant during the 2019-20 influenza season, CDC analyzed data from an Internet panel survey conducted during April 2020. Among 1,841 survey respondents who were pregnant anytime during October 2019-January 2020, 61.2% reported receiving influenza vaccine before or during their pregnancy, an increase of 7.5 percentage points compared with the rate during the 2018-19 season. Among 463 respondents who had a live birth by their survey date, 56.6% reported receiving Tdap during pregnancy, similar to the 2018-19 season (4). Vaccination coverage was highest among women who reported receiving a provider offer or referral for vaccination (influenza = 75.2%; Tdap = 72.7%). Compared with the 2018-19 season, increases in influenza vaccination coverage were observed during the 2019-20 season for non-Hispanic Black (Black) women (14.7 percentage points, to 52.7%), Hispanic women (9.9 percentage points, to 67.2%), and women of other non-Hispanic (other) races (7.9 percentage points, to 69.6%), and did not change for non-Hispanic White (White) women (60.6%). As in the 2018-19 season, Hispanic and Black women had the lowest Tdap vaccination coverage (35.8% and 38.8%, respectively), compared with White women (65.5%) and women of other races (54.0%); in addition, a decrease in Tdap vaccination coverage was observed among Hispanic women in 2019-20 compared with the previous season. Racial/ethnic disparities in influenza vaccination coverage decreased but persisted, even among women who received a provider offer or referral for vaccination. Consistent provider offers or referrals, in combination with conversations culturally and linguistically tailored for patients of all races/ethnicities, could increase vaccination coverage among pregnant women in all racial/ethnic groups and reduce disparities in coverage. An Internet panel* survey was conducted to assess end-ofseason influenza and Tdap vaccination coverage estimates among women pregnant during the 2019-20 influenza season; the methods have been previously described (5). The survey was conducted during April 2-April 14, 2020, among women aged 18-49 years who reported being pregnant anytime since August 1, 2019, through the date of the survey. Among 18,314 women who were screened, 2,515 were eligible, and of these, 2,268 completed the survey (cooperation rate † = 90.2%). Data were weighted to reflect the age, race/ethnicity, and geographic distribution of the total U.S. population of pregnant women (5). Analysis of influenza vaccination coverage was limited to 1,841 women pregnant anytime during October 2019-January 2020. A woman was considered to have been vaccinated against influenza if she reported having received 1 dose of influenza vaccine (before or during her most recent pregnancy) since July 1, 2019. To accommodate the optimal timing for Tdap vaccination during 27-36 weeks' gestation, analysis of Tdap coverage was limited to women pregnant anytime since August 1, 2019, who had a live birth by their survey date. A woman was considered to have received Tdap if she reported receiving 1 dose of Tdap vaccine during her most recent pregnancy. Among 532 women with a recent live birth, 69 (12.9%) were excluded because they did not know whether they had ever received Tdap (10.3%) or whether they received it during their pregnancy (2.6%), leaving a final analytic sample of 463. The proportion of pregnant women who received both recommended maternal vaccines (i.e., full vaccination) was assessed among 462 women (one respondent reported Tdap but not influenza vaccination status). A difference was noted as an increase or decrease when a percentage-point difference * Pregnant women were recruited from a large, pre-existing, opt-in Internet panel of the general population, a panel operated by Dynata (https://www.dynata.com). † An opt-in Internet panel survey is a nonprobability sampling survey. The denominator for a response rate calculation cannot be determined because no sampling frame with a selection probability is involved at the recruitment stage. Instead, the survey cooperation rate (the percentage interviewed among all eligible persons contacted) is provided.