Learning Objectives for this Presentation:
Recognize the need to develop strategies to improve influenza vaccination in pregnant women
Understand a model program to increase influenza vaccine coverage in pregnant women

Background:
ACIP recommends that pregnant women receive inactivated influenza vaccine. U.S. coverage is only 12.8% in this vulnerable population.

Setting:
Kelsey-Seybold Clinic (KSC) provides primary and specialized care in the Houston area. Influenza vaccine coverage of pregnant women at KSC averaged 3.5% per year during 1998-2002. We describe strategies adopted to improve influenza immunization coverage in pregnant women in a large health care organization.

Population:
Women receiving prenatal care at KSC obstetric-gynecology (OB-GYN).

Project Description:
A retrospective electronic database search of four consecutive influenza seasons (2003/04 to 2006/07) was performed to estimate influenza immunization rates in pregnant women after implementation of three main strategies: 1) adoption of standing orders for influenza vaccine administration in OB and general medicine practices, 2) annual employee influenza immunization campaign through broadcast emails and notices with information on immunization in pregnancy, and 3) assessment of immunization rates in pregnant women for individual OB providers, followed by encouragement and behavior modeling by the department Chair, with updates on influenza vaccine in pregnancy to staff during quarterly meetings.

Results/Lessons Learned:
Influenza vaccine coverage rates increased from 3.5% to 21.1%) in 2003/04, 30.6% in 2004/05, 32% in 2005/06, and 40.5% in 2006/07. The number of prenatal care visits was the most important predictor for receipt of influenza vaccine, while insurance plans that cover pregnancy as a bundled service were a potential barrier for vaccination. Concurrently, employee influenza vaccine coverage increased from 36% in 2003/04, to 51% in 2004/05, 56% in 2005/06, and 62% in 2006/07. Influenza vaccination rates in pregnant women can be improved substantially with standing orders for immunization and promotion through vaccine advocates and active educational activities focusing on encouraging influenza immunization in patients and health care providers. .