Influenza Vaccination Coverage among Pregnant Women: Results from the Pregnancy Risk Assessment...

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

• 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

Who Should Get Flu Vaccination?

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.

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.

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.

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.

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?

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

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%)

Population Description

Insurance: Public (40%) Private (56%) Other (4%)

Parity: 1st birth (44%) 2nd or later (56%)

Pregnancy Intendedness: Unintended (37%) Intended (63%)

WIC Status: WIC participants (44%) Non-WIC participants (56%)

Pregnancy Experience Happy time (78%)Hard time (22%)

All of these characteristics were examined with respect to flu vaccination during pregnancy using bivariate and multivariate analyses

Results

30.1 33.4 31.330.4

0

20

40

60

80

100

2005 2006 2007 2005-2007Average

Per

cen

t% 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

16.1

33.325.025.9

0

20

40

60

80

100

2005 2006 2007 2005-2007Average

Per

cen

t% 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

30.133.4

16.1

25.9

33.330.4

0

10

20

30

40

50

2005 2006 2007

Perc

en

t

Pregnant Women+

Non-Pregnant Women aged 18-44++

% 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

46.6 47.7 46.645.5

0

20

40

60

80

100

2005 2006 2007 2005-2007Average

Per

cen

t% of Women Who were Offered a Flu Shot by Health Care Provider during Pregnancy Rhode Island, 2005-2007

P < 0.6358


62.9

4.1

0

20

40

60

80

100

Offered/Recommended Not Offered/Recommended

Per

cen

t% of Women Who Had a Flu Shot during Pregnancy by Provider Recommendation Rhode Island, 2005-2007

P < 0.0001


37.5

29.7

0

10

20

30

40

50

Hispanic Non-Hispanic

Per

cen

t% of Women Who Had a Flu Shot during Pregnancy by Ethnicity Rhode Island, 2005-2007

P < 0.001


32.3

26.1

34.0

0

10

20

30

40

50

< 12 years 12 years > 12 years

Per

cen

t% of Women Who Had a Flu Shot during Pregnancy by Education Rhode Island, 2005-2007

P < 0.001


33.7

27.7

0

10

20

30

40

50

Married Unmarried

Per

cen

t% of Women Who Had a Flu Shot during Pregnancy by Marital Status Rhode Island, 2005-2007

P < 0.001


32.728.8

24.0

34.7

0

10

20

30

40

50

< $10,000 $10,000 -$24,999

$25,000 -$49,999

>= $50,000

Per

cen

t% of Women Who Had a Flu Shot during Pregnancy by Household Income Rhode Island, 2005-2007

P < 0.001


33.128.4

0

10

20

30

40

50

Intended Pregnancy Unintended Pregnancy

Per

cen

t% of Women Who Had a Flu Shot during Pregnancy by Pregnancy Intendedness Rhode Island, 2005-2007

P < 0.01


% 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

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

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

AOR (95% CI)

Recommended/offered

Not Recommended/offered

48.98 (34.64-69.26)***

reference

Hispanic

Non-Hispanic

1.51 (1.10-2.08)*

reference

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

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.

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.

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.

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).

THANK YOU!

Contact Information:

Hanna Kim, PhD: [email protected]

Influenza Vaccination Coverage among Pregnant Women: Results from the Pregnancy Risk Assessment...

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