Factors Influencing H1N1 Vaccine Administration Among Prenatal Medicaid Providers in Los Angeles County

Background: The CDC recommends routine and priority vaccinations of pregnant women, yet current immunization rates do not meet national goals. As obstetric providers take on more primary care duties, perinatal infection prevention becomes an important responsibility of women's health providers.

Objectives: To assess current immunization practices, including plans to administer the H1N1 vaccine, and variables predictive of vaccination among prenatal Medi-Cal providers in Los Angeles County.

Methods: In August 2009, a ten-item electronic survey on demographics, immunizations offered, and perceived barriers to vaccination was sent to 381 Comprehensive Perinatal Service Program obstetric providers in Los Angeles County. Responses were collected over a 10-day period. Analyses were done using chi-square tests with a one-tailed level of significance of p<0.05.

Results: Eleven percent of physicians completed the survey (43/381). Twenty-four physicians were obstetricians/gynecologist (56%) and nineteen were general practitioners (44%). Twenty-one percent (9/43) did not provide any immunizations, and the rest offered at least one vaccine. General practitioners were significantly more likely to provide vaccines than obstetricians/gynecologist (χ2=12.26, p<0.05). The provision of other vaccines was positively associated with plans to administer the H1N1 vaccine (χ2=6.62, p<0.05). Thirty-four providers (79%) were aware of current H1N1 influenza immunization guidelines, and of physicians that offer vaccines, those aware of current recommendations were significantly more likely to plan to administer the H1N1 influenza vaccine (χ2=4.63, p<0.05). The most common barriers against vaccination cited involved costs, but barriers due to costs were not significantly associated with plans to administer H1N1.

Conclusions: Prenatal providers can serve an important role to reduce vaccine-preventable disease, including H1N1 influenza. Physician knowledge of H1N1 vaccination guidelines and prior experience with vaccine administration were predictive of plans to administer the H1N1 vaccine, indicating that provider education on vaccinations is likely to increase vaccination rates among high-risk pregnant women.