Influenza Vaccination Coverage Among Pregnant Women — 2011–12 Influenza Season, United States | WPN World People News

Pregnant women and their newborns are at elevated risk for influenza-associated hospitalization and death (1). The Advisory Committee on Immunization Practices (ACIP) and the American College of Obstetricians and Gynecologists (ACOG) have recommended influenza vaccination for all women who are or will be pregnant during the influenza season, regardless of trimester (1,2). To estimate influenza vaccination coverage among pregnant women for the 2011–12 influenza season, CDC analyzed data from an Internet panel survey (3) conducted April 3–17, 2012, among women pregnant at any time during the 4-month period October 2011–January 2012. Among 1,660 survey respondents, 47.0% reported they had received influenza vaccination; 9.9% were vaccinated before pregnancy, 36.5% during pregnancy, and <1.0% after pregnancy. Overall, 43.7% of women reported receipt of both a health-care provider recommendation and offer of influenza vaccination; these women had higher vaccination coverage (73.6%) than women who received only a recommendation but no offer of vaccination (47.9%) and women who received neither a recommendation nor an offer (11.1%). Continued efforts are needed to encourage providers of medical care to routinely recommend and offer influenza vaccination to women who are pregnant or who might become pregnant.

To provide timely end-of-season estimates of influenza vaccination coverage and information on knowledge, attitudes, and behaviors related to influenza vaccination among women pregnant during the 2011–12 influenza season, CDC conducted an Internet panel survey during April 3–17, 2012 that was similar to a survey conducted in April 2011 (3). Women aged 18–49 years who were pregnant at any time since August 2011 were recruited from a SurveySpot panel operated by Survey Sampling International.* Of 7,485 women who visited the Internet survey site during the study period, 2,223 were determined to be eligible for the survey based on the timing of their pregnancies; of those, 2,096 (94%) completed the online survey. Data were weighted to reflect the age group, racial/ethnic, and geographic distribution of the total U.S. population of pregnant women during 1995–2005.† The same questions used to determine pregnancy status in the April 2011 survey (3) were used in this survey. In addition, women pregnant since August 2011 but no longer pregnant at the time of their response were asked to provide the start and end months of pregnancy. For this analysis, the study population was limited to 1,660 women reporting pregnancy any time during the usual peak influenza vaccination period of October 2011–January 2012.

Survey respondents were asked questions about their knowledge and attitudes regarding influenza and influenza vaccination; their vaccination status before, during, and after pregnancy; their physician's practices regarding influenza vaccination, place of vaccination, and reasons for not receiving influenza vaccination. Weighted analyses were conducted. Because opt-in Internet panels are not random samples, statistical measures such as compilation of confidence intervals and tests of differences cannot be performed.§

Of the 1,660 women pregnant at any time during October 2011–January 2012, 47.0% reported influenza vaccination since August 1, 2011: 9.9% were vaccinated before pregnancy; 36.5% during pregnancy; and 0.6% after pregnancy. By trimester of pregnancy, the percentages vaccinated were similar (10.1%, 12.6%, and 11.8% during the 1st, 2nd, and 3rd trimester, respectively). Women aged 18–24 years had lower vaccination coverage (42.3%) than women aged 25–49 years (49.4%). Non-Hispanic black women had lower vaccination coverage (39.8%) than Hispanic women (48.8%), non-Hispanic white women (47.9%), and other non-Hispanic women (53.7%). Vaccination coverage estimates varied by U.S. Census regions from 43.9% in the south to 49.7% in the northeast. Women with education beyond a college degree had higher coverage (61.3%) than those with a college degree (49.4%) or less than a college degree (42.8%). Women with private or military medical insurance had higher vaccination coverage (50.2%) than those without medical insurance (36.9%).

Of women in the April 2012 survey, 39.8% reported having received influenza vaccination for the 2010–11 influenza season. Among these women, vaccination coverage for the 2011–12 season was 86.5%, compared with 20.7% for those who did not receive vaccination for the 2010–11 season.

Among women who received a health-care provider recommendation to be vaccinated, 81.6% were offered vaccination during a provider visit. Among women who received both a health-care provider recommendation and offer for influenza vaccination, 73.6% received influenza vaccination, which was substantially higher than for women whose health-care provider recommended but did not offer vaccination (47.9%) and for women who did not receive either a provider recommendation or offer (11.1%).

Among the 87.7% of women participants who indicated that they had visited a provider since August 2011, 62.9% received a provider recommendation for influenza vaccination. Within each of the categories, the subgroups with lower percentages reporting receipt of a provider recommendation were non-Hispanic black (54.1%), having no medical insurance (46.4%), underweight before pregnancy (55.0%), not vaccinated for the previous season (48.6%), and visited a provider because of pregnancy five times or fewer (52.3%). The subgroups with a higher percentage receiving a provider recommendation were women with more than a college degree (71.9%), women who were vaccinated for the previous season (83.7%), and those with more than 10 pregnancy-related provider visits (76.0%).

Most women who received influenza vaccination received it at their obstetrician's or midwife's office (41.4%), at a non-obstetrician health-care provider's office (20.7%), or a hospital, clinic or health center (17.5%). Other locations for vaccination included pharmacy/drug or grocery store (8.0%); health department (4.1%); and workplace, school, or others (8.3%).

Among unvaccinated women who received a health-care provider recommendation and offer of vaccination, when the main reason for nonvaccination was asked, the top three most common answers were 1) concern that the vaccination would cause influenza (25.6%); 2) concern about the safety risk to the baby (13.1%); and 3) not believing the vaccination was effective (12.5%). Among women reporting no provider offer for influenza vaccination, the same three answers for not being vaccinated were most frequently cited.

Source: U.S. Centers for Disease Control and Prevention