Obstetricians' Perspectives on the 2009-10 H1N1 Vaccination Effort

Background:  Pregnant women were an important target group for H1N1 vaccination during the 2009-10 influenza season.  The experiences of obstetricians related to H1N1 vaccination may inform future vaccination efforts targeting pregnant women.

Objectives:  To understand the experiences of obstetricians during the 2009-10 H1N1 vaccination campaign.

Methods:  Mailed survey of a national random sample of 4,000 obstetricians, fielded fielded in Summer 2010.

Results:  Response rate was 66%.  Eighty percent reported that H1N1 vaccine was available in their outpatient obstetric clinic.  The vast majority of obstetricians “strongly recommended” H1N1 vaccine for their obstetric patients in the second (86%) and third trimester (86%), but fewer strongly recommended vaccination in the first trimester (71%) or the immediate post-partum period (76%).  With regard to timing of vaccination, only 50% of obstetricians indicated that most first-trimester patients preferred vaccination at that time; 46% felt first-trimester patients preferred to wait until later in pregnancy, and 4% reported that these patients didn’t want to be vaccinated at all.   Just over half of obstetricians prioritized which obstetric patients were offered H1N1 vaccine; prioritization usually involved pregnant women with underlying chronic conditions (94%) and pregnant health care workers (76%).  The most frequently cited “major problems” with H1N1 vaccine were inadequate supply (30%) and lack of thimerosal-free vaccine (12%); only 7% reported major problems with billing or with reporting requirements.  In the event of a future influenza pandemic, 74% of obstetricians said their practice would be “very likely” to provide vaccine, while only 8% said they would be unlikely to provide vaccine.

Conclusions:  Overall, obstetrician involvement in the H1N1 vaccination campaign was successful, and their willingness to participate in influenza vaccine efforts is encouraging.  Public health officials need to address the perceived reluctance of many women to be vaccinated in the first trimester, and the substantial number of obstetricians reluctant to strongly recommend vaccination to this population.