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Influenza Vaccination Coverage among Pregnant Women: Results from the Pregnancy Risk Assessment Monitoring System (PRAMS

Influenza Vaccination Coverage among Pregnant Women: Results from the Pregnancy Risk Assessment Monitoring System (PRAMS), Rhode Island, 2005-2007. Hanna Kim, PhD, Virginia Paine, RN, MPH, and Rachel Cain, BA Rhode Island Department of Health. Who Should Get Flu Vaccination?.

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Influenza Vaccination Coverage among Pregnant Women: Results from the Pregnancy Risk Assessment Monitoring System (PRAMS

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  1. Influenza Vaccination Coverage among Pregnant Women:Results from the Pregnancy Risk Assessment Monitoring System (PRAMS), Rhode Island, 2005-2007 Hanna Kim, PhD, Virginia Paine, RN, MPH, and Rachel Cain, BA Rhode Island Department of Health

  2. Who Should Get Flu Vaccination? • 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

  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 Age : < 20 yrs (9%) 20-29 yrs (47%) >= 30 yrs (44%) Mean: 28.4 yrs Ethnicity: Hispanic (24%) Non-Hispanic (76%) Race: White (84%) Black (10%) Other (6%) Education: < 12 yrs (17%) 12 yrs (29%) > 12 yrs (54%) Income: < $10K (18%) $10K - < $25K (20%) $25K - < $50K (20%) >= $50K (42%) Marital Status: Married (60%) Unmarried (40%)

  10. Population Description Pregnancy Intendedness: Unintended (37%) Intended (63%) WIC Status: WIC participants (44%) Non-WIC participants (56%) Pregnancy Experience Happy time (78%) Hard time (22%) Insurance: Public (40%) Private (56%) Other (4%) Parity: 1st birth (44%) 2nd or later (56%) All of these characteristics were examined with respect to flu vaccination during pregnancy using bivariate and multivariate analyses

  11. Results

  12. % of Women Who Had a Flu Shot during Pregnancy Rhode Island, 2005-2007 P < 0.2454 Source: RI Pregnancy Risk Assessment Monitoring System, 2005-2007

  13. % of Women Who Had a Flu Shot among Non-Pregnant Women aged 18-44 years Rhode Island, 2005-2007 P <0.0001 Source: RI Behavioral Risk Factor Surveillance System, 2005-2007

  14. % of Women Who Had a Flu Shot Pregnant Women vs. Non-Pregnant Women Rhode Island, 2005-2007 + Data are from the RI Pregnancy Risk Assessment Monitoring System (PRAMS), 2005-2007 ++ Data are from the RI Behavioral Risk Factor Surveillance System (BRFSS), 2005-2007

  15. % of Women Who were Offered a Flu Shot by Health Care Provider during Pregnancy Rhode Island, 2005-2007 P < 0.6358 Source: RI Pregnancy Risk Assessment Monitoring System, 2005-2007

  16. % of Women Who Had a Flu Shot during Pregnancy by Provider Recommendation Rhode Island, 2005-2007 P < 0.0001 Source: RI Pregnancy Risk Assessment Monitoring System, 2005-2007

  17. % of Women Who Had a Flu Shot during Pregnancyby Ethnicity Rhode Island, 2005-2007 P < 0.001 Source: RI Pregnancy Risk Assessment Monitoring System, 2005-2007

  18. % of Women Who Had a Flu Shot during Pregnancyby Education Rhode Island, 2005-2007 P < 0.001 Source: RI Pregnancy Risk Assessment Monitoring System, 2005-2007

  19. % of Women Who Had a Flu Shot during Pregnancyby Marital Status Rhode Island, 2005-2007 P < 0.001 Source: RI Pregnancy Risk Assessment Monitoring System, 2005-2007

  20. % of Women Who Had a Flu Shot during Pregnancyby Household Income Rhode Island, 2005-2007 P < 0.001 Source: RI Pregnancy Risk Assessment Monitoring System, 2005-2007

  21. % of Women Who Had a Flu Shot during Pregnancyby Pregnancy Intendedness Rhode Island, 2005-2007 P < 0.01 Source: RI Pregnancy Risk Assessment Monitoring System, 2005-2007

  22. % of Women Who Had a Flu Shot during Pregnancy Rhode Island, 2005-2007 Maternal age, Race, Health insurance, Parity, WIC status, and Pregnancy experience were not significantly associated with flu vaccination during pregnancy

  23. Multivariate Logistic Regression Model • Outcome Variable: • - Having had flu vaccination during pregnancy • Potential Predictors: • - Healthcare provider recommendation/offer • - Ethnicity • - Education level • - Marital status • - Household income • - Pregnancy Intendedness

  24. Multivariate Logistic Regression Rhode Island, 2005-2007 • Factors associated with flu vaccination during pregnancy • *p<0.05 ***p<0.0001 • Controlling for maternal education, marital status, household income, and pregnancy intendedness

  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 provider’s 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/GYN’s 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

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