Influenza Vaccination of Pregnant Women In Kaiser Permanente, Northern California

Background: Pregnant women are at increased risk of hospitalizations and death from influenza, and vaccination is recommended for all pregnant women. National vaccination rates for pregnant women have been 13.4%, 24.3% and 11.3% in 2006-07 through 2008-09, and increased to 50.7% in 2009-2010. Rates for pregnant women at Kaiser Permanente have been higher than the national average since 2006-07.  

Setting: Kaiser Permanente, Northern California (KP NCAL) is an integrated health care system that provides comprehensive health care to 3.2 million members at 21 hospital/medical centers and 44 medical offices.  

Population: Women attending prenatal visits during flu season, September through March annually from 2006 to 2010.

Project Description: Free influenza vaccination is provided to pregnant women during their prenatal visit or at mass flu vaccination clinics. Outreach to pregnant women includes a postcard, automated phone reminders and website. In-reach includes posters, tipsheets, reminder on the registration receipt, verbal reminders, etc. A toll-free "flu hotline” provides dates and times for vaccination at a local facility. Flu vaccination during the prenatal visit avoids a missed opportunity as women are not referred elsewhere for vaccination.

Results/Lessons Learned: Offering flu vaccination in the OB setting increases the likelihood that a pregnant woman is vaccinated. Facilities that provided flu shots in the OB dept achieved a higher vaccination rate.  Seasonal flu vaccination rates for women who attended a prenatal visit were:

• 2006-2007: 28%
• 2007-2008: 30%
• 2008-2009: 33%
• 2009-2010: 53%
• 2010: September 1 - November 29: 46%

Once an OB dept has initiated vaccinations and incorporates storing, administering and documenting vaccination, the process is readily adopted and integrated into the workflow. At KP NCAL, rates have increased annually as more OB departments gain experience in providing influenza vaccinations. Hospitalization rates for pregnant women are being analyzed to determine if vaccinated pregnant women were hospitalized less frequently than those not vaccinated.