Correlates of Seasonal Influenza Vaccine Uptake by Women During Pregnancy: Evidence From the Pregnancy Risk Assessment Monitoring System (PRAMS)

Background: Pregnant women have the lowest rates of seasonal influenza vaccine coverage among all adult priority groups and little is known about the characteristics of pregnant or post-partum women who receive or choose not to receive vaccination. 

Objectives: This study examined correlates of receiving seasonal influenza vaccine during pregnancy, among women with recent live-births participating in the Pregnancy Risk Assessment Monitoring System (PRAMS) in two states.

Methods: PRAMS data from 2006 and 2007 were analyzed from Georgia (n= 2692) and Rhode Island (n=2732) to examine correlates of seasonal flu-vaccine during pregnancy.   We used SUDAAN software to account for PRAMS survey design, non-response, and non-coverage.  Multi-variable logistic regression analyses were used to examine the correlates of vaccine uptake.

Results: The 2006-2007 seasonal influenza immunization prevalence for Georgia was 18.4% (95%CI 15.9-21.1) and 31.9% (95%CI: 29.8-34.0) for Rhode Island. In Georgia, parity was significantly associated with receipt of seasonal influenza vaccine in that women with ≥2 children were less likely to report having received it (Adjusted Odds Ratio or AOR=0.60; 95%CI: 0.40-0.89) than primiparas.  In Rhode Island, provider advice/offer (AOR=56.62; 95% CI: 37.43-85.63), and tobacco use during pregnancy (AOR=0.52; 95%CI: 0.34-0.80) were associated with receipt of influenza vaccination.  There was a significant association between receipt of the seasonal influenza vaccine during pregnancy and breastfeeding in Rhode Island (AOR=1.38; 95%CI: 1.05-1.80).

Conclusions: In Rhode Island, provider advice and tobacco use were associated with receipt of seasonal influenza vaccine while in Georgia parity was associated with receipt of seasonal vaccine.  Breastfeeding women were more likely to report having received seasonal influenza vaccine during pregnancy in Rhode Island.  Findings can be used to develop targeted interventions to increase vaccine uptake by pregnant and breastfeeding women in Georgia and Rhode Island.