Trends and Facilitators/Barriers to Seasonal Influenza Vaccination Among Pregnant Women In Rhode Island: Findings From the Pregnancy Risk Assessment Monitoring System (PRAMS)

Background: Pregnant women are at increased risk of influenza related complications. Despite CDC’s recommendation that pregnant women should get vaccinated during flu season, coverage levels had remained low. During 2009-10 flu season, influenza vaccination among pregnant women (both seasonal and H1N1) was a high priority initiative, both nationally and in RI.

Objectives: 1) to assess the trends of seasonal influenza vaccination coverage among RI pregnant women, and 2) to identify barriers and facilitators of vaccination during pregnancy.

Methods: We analyzed the 2004-2010 RI PRAMS data. RI PRAMS survey has collected data on seasonal influenza vaccination from a sample of recent mothers since 2004. Respondents were asked if they received flu vaccination during their most recent pregnancy and if the flu vaccine was recommended /offered by their Health Care Provider (HCP). In addition, during 09-10 flu season, the PRAMS survey collected data on barriers to flu vaccination during pregnancy. SUDAAN software was used for statistical analyses.

Results: The rate of seasonal influenza vaccination among pregnant women increased significantly from 22% in 2004 to 66% in 09-10 flu season (p< .0001). The rate of HCP’s recommendation for vaccination also increased significantly from 33% to 86% (p< .0001). The most dramatic increases in both rates occurred during 09-10 season. A concern about vaccine safety for their babies (33%) and for themselves (29%) was a common barrier to vaccination during pregnancy. A HCP’s recommendation for vaccination was a key facilitator; 73% of pregnant women were vaccinated with a HCP’s recommendation, compared to only 23% without a recommendation (p< .0001).

Conclusions: Although the influenza vaccination rate among pregnant women increased dramatically during 09-10 flu season, a substantial number of pregnant women are still concerned about vaccine safety. HCP should educate pregnant women about the safety and benefits of influenza vaccination during pregnancy and recommend/offer vaccination.