Myra Tucker, BSN, MPH Denise D’Angelo, MPH Cheryl Prince, MPH, PhD

1. H1N1 and Seasonal Influenza Surveillance among American Indian Mothers using Pregnancy Risk Assessment and Monitoring System (PRAMS) data Myra Tucker, BSN, MPH Denise D’Angelo, MPH Cheryl Prince, MPH, PhD NCCDPHP/Division of Reproductive Health June 20, 2012

2. Project Goal Use PRAMS data to assess the H1N1 and seasonal influenza experience of American Indian (AI) women.

3. Objectives • Fund AI PRAMS influenza programs in 4 States • Support state PRAMS AI coordinators • Establish PRAMS Tribal Oversight Committees • Implement measures to improve AI response rates • Analyze PRAMS AI influenza data by state and share with tribal health leaders within each state

4. Persons at higher risk of influenza complications * • Persons 50 years and older • Women who will be pregnant during influenza season • Persons with chronic diseases, immunosuppression • Residents of nursing homes and other long-term care facilities • Children < 4 years of age (infants < 6 months cannot be vaccinated) • Children on long-term aspirin therapy • American Indians and Alaska Natives (AI/AN) * from the Advisory Committee on Immunization Practices (ACIP)

5. Influenza mortality among AI/AN The 2009 H1N1 pandemic influenza mortality rate among American Indians and Alaska Natives(AI/AN) was 4 times higher than the rate for all other racial/ethnic groups combined.

6. Pregnancy Risk Assessment and Monitoring System (PRAMS) • Population-based surveillance system • Women who have recently had a live birth • Provides state-specific estimates on key maternal and child health indicators • Only such system that solicits data from AI mothers • Response rates among AI women are low

7. Tribal Supplement to 2011 PRAMS Cooperative Agreement • May 2011 Award • 3 grantees: New Mexico, Oregon, Washington • Average funding: $50,000/year • Epidemiologist to work with states

8. WA ME VT MN OR NY MI CT NYC NE NJ OH IL UT WV MD CO NC NM OK AR SC MS AL GA LA TX AK FL HI PRAMS Participation, 2011 NH MA WI WY RI IA PA DE VA MO TN Ongoing New Tribal Flu

9. Methods Adapt South Dakota Tribal PRAMS model

10. Methods • Assign state PRAMS AI coordinator • Establish PRAMS tribal oversight committee • Identify and implement activities to increase response rates among AI women • Compare response rates and seasonal influenza findings for 2012/2013 PRAMS to 2009/2010 • Report H1N1 and Seasonal Influenza Surveillance findings

11. Activities and Accomplishments • May 2011, Oregon, New Mexico, and Washington were funded for a two year project to improve PRAMS surveillance among AI women • Wyoming is participating without supplemental funding. Note: The 2009 baseline PRAMS response rates for AI women in these 4 states ranged from 42%-64%.

12. Activities and Accomplishments • CDC epidemiologist consultant/project coordinator • Examining seasonal and 2009 H1N1 influenza vaccination during pregnancy among AI women • Preparing state-specific briefs about influenza vaccination • Conducting site visits to participating states • Each state has secured a dedicated AI PRAMS project coordinator and has begun tribal engagement  

13. New Mexico WIC Program Partnership

14. Oregon • Department of Human Services Tribal Quarterly meeting • Northwest Portland Indian Health Board Partnership

15. Washington Partnership with the American Indian Health Commission for Washington State

16. Wyoming

17. Next Steps • Establish PRAMS tribal oversight committee • Identify and implement activities to increase response rates among AI women • Compare response rates and seasonal influenza findings for 2012/2013 PRAMS to 2009/2010 • Report findings

18. Closing Comment

19. Thank You