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Children aged 6 months up to their 19th birthday Pregnant women People 50 years of age and older People of any age with certain chronic medical conditions People who live in nursing homes and other long-term care facilities People who live with or care for those at high risk for complications from flu.
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1: Influenza Vaccination Coverage among Pregnant Women:Results from the Pregnancy Risk Assessment Monitoring System (PRAMS), Rhode Island, 2005-2007
3: Background In May 2004, ACIP published new recommendations that all pregnant women or women who will be pregnant during influenza season should be vaccinated.
An inactivated flu vaccine (made from killed influenza virus) is considered safe during any stage of pregnancy.
Pregnant women should not use the nasal-spray flu vaccine, which is made with live, attenuated influenza virus.
4: Background Pregnant women are at increased risk of developing serious complications from the flu.
Flu vaccination during pregnancy has the potential benefit of protecting infants from influenza infection.
Compared with other high risk populations, pregnant women have low rates of flu vaccination.
Nationally, only 13% of pregnant women received a flu shot during the 2006-2007 flu season.
5: Study Objectives
Estimate influenza vaccination coverage levels among pregnant women in RI.
Estimate the proportion of health care providers who recommended/offered flu vaccination to their pregnant patients.
Determine the association between health care provider recommendation/offer and flu vaccine acceptance by pregnant women.
6: What is PRAMS?Pregnancy Risk Assessment Monitoring System
An ongoing, state-specific, population-based surveillance project sponsored by CDC.
Collects self-reported information by mail or telephone on maternal attitudes and experiences before, during, and shortly after delivery of a live infant.
Designed to be representative of women in the state who have delivered during the preceding 2-6 months.
7: Data Collection
In phase 5 (2004-2008) of RI PRAMS survey, two flu immunization questions were added to monitor flu vaccination coverage among pregnant women.
At any time during the most recent pregnancy, did a doctor, nurse, or other health care worker offer you a flu vaccination or tell you to get one?
Did you get a flu vaccination during your most recent pregnancy?
8: Data and Analysis
2005 2007 RI PRAMS data were analyzed
Respondents: 4,165 women (~1,400 / year)
Weighted Response Rate: 73.3%
Statistical Analyses
Univariate analysis
Chi-square tests for bivariate analysis
Multivariate logistic regression
SUDAAN software was used
9: Population Description
10: Population Description
11:
Results
25: Limitations
Self reported information
No separate analyses were performed for pregnant women with chronic health conditions and pregnant women without chronic health conditions
No detailed information on why they did not get a flu shot during pregnancy
26: Conclusions
Flu vaccination coverage rate among pregnant women in RI was higher than national rate.
Less than one third of women in RI had a flu shot during their most recent pregnancy and there was no significant change in flu vaccination rates during 2005-2007.
Less than one half of healthcare providers in RI recommended/offered a flu shot to their pregnant patients and there was little change in the recommendation rates during 2005-2007.
27: Conclusions
The likelihood of getting a flu shot during pregnancy was strongly associated with health care providers recommendation /offer.
Hispanics were more likely to have a flu shot during pregnancy.
All other factors (age, race, education, household income, marital status, pregnancy intendedness, health insurance, parity, WIC status, & pregnancy experience) were not independent predictors of flu vaccination during pregnancy.
28: Public Health Implication
Healthcare / prenatal care providers play an important role in the acceptance of flu vaccine by pregnant women.
RI Immunization program will share these results with healthcare / prenatal care providers to improve flu vaccination coverage among pregnant women.
29: RI Activities / Plans
RI provides thimerosal-free influenza vaccine to OB/GYNs for their pregnant patients.
Focus groups will be conducted (WIC participants, minority women, OB/GYNs, etc) during April 2009 to identify barriers to flu vaccination among pregnant women.
Results of the focus groups will be used to develop educational materials for pregnant women and providers before the 2009/10 flu season.
Continue to monitor flu vaccination coverage among pregnant women using phase 6 of RI PRAMS (2009-2013).
30: THANK YOU!
Contact Information:
Hanna Kim, PhD: Hanna.Kim@health.ri.gov