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Novel pandemic A (H1N1) influenza vaccination among pregnant women: motivators and barriers

Presented, in part, at a scientific and technical meeting at the Centers for Disease Control and Prevention in Atlanta, GA, by Dr SteelFisher on May 19, 2010, in a presentation entitled “Pregnant Women, Mothers of Infants, and the H1N1 Outbreak.” A similar set of selected findings were presented at a meeting entitled “Pandemic Influenza Revisited: Special Considerations for Pregnant Women and Newborn” put forth by the Centers for Disease Control and Prevention and the Association of Maternal and Child Health Programs. The slides were presented by Dr Mitchell in Atlanta, GA, on Aug. 12, 2010, and entitled “Maternal Health Communication During the 2009 H1N1 Response.”
https://doi.org/10.1016/j.ajog.2011.02.036Get rights and content

We sought to examine motivators and barriers related to monovalent 2009 influenza A (H1N1) vaccination among pregnant women. We conducted a national poll of pregnant women using a random online sample (237) and opt-in supplement (277). In all, 42% of pregnant women reported getting the vaccine. Vaccination was positively associated with attitudinal factors including believing the vaccine is very safe or benefits the baby, and with provider recommendations. Women in racial/ethnic minority groups, women with less education, and women <35 years were less likely to get the vaccine and had differing views and experiences. Despite H1N1 vaccination rates that are higher than past seasonal influenza rates, barriers like safety concerns may persist in a pandemic. Messaging from providers that encourages women to believe the vaccine is very safe and benefits their baby may be compelling. Messaging and outreach during future pandemics may require customization to increase vaccination among high-risk groups.

Section snippets

Materials and methods

Pregnant women comprise a very small percentage of the population, estimated in some studies as approximately 1%.1, 25, 26, 27 (The Centers for Disease Control and Prevention reports statistics on births rather than pregnancies due to the difficulties in capturing data on all pregnancies that may not result in births. Based on estimates from 2007, there were 4,316,233 live births in the United States, with a fertility rate of 69.5 live births per 1000 women and girls aged 15-44 years.) To get a

Vaccination

Approximately 4 in 10 pregnant women (42%) reported that they had received the H1N1 vaccine, and another 8% said they expected to get it by the end of March 2010 (Table 1). Half of pregnant women said they either did not intend to get the H1N1 vaccine for themselves (37%) or were not sure about getting the H1N1 vaccine by the end of March 2010 (13%) (Table 1).

Awareness of vaccine recommendation

Most pregnant women heard either “a lot” (41%) or “some” (45%) about the H1N1 vaccine (Table 1), and most (82%) knew that the public

Comment

More pregnant women received the H1N1 vaccine this year than have received seasonal influenza vaccine in past years. The overall estimate of 42% in this poll is consistent with H1N1 vaccination rates seen in other studies of pregnant women (38%,29 44%,30 and 46.6%31). This suggests pregnant women's reactions to the pandemic influenza were different than their reactions to seasonal influenza, and they were more motivated to get the vaccine. Nonetheless, a majority of pregnant women did not get

Acknowledgments

We are grateful for the assistance of several people who facilitated the development of this manuscript, including: Juliette Kendrick, MD, FACFP; William Pollard, PhD; Capt Kitty McFarlane, CMN, MPH; and Patricia Mersereau, RN, MN, CPNP, at the Centers for Disease Control and Prevention; as well as Johanna Mailhot, MSc, at the Harvard Opinion Research Program at the Harvard School of Public Health.

References (35)

  • J.W. Harris

    Influenza occurring in pregnant women: a statistical study of thirteen hundred and fifty cases

    JAMA

    (1919)
  • A.L. Naleway et al.

    Delivering influenza vaccine to pregnant women

    Epidemiol Rev

    (2006)
  • C.B. Bridges et al.

    Prevention and control of influenza: recommendations of the Advisory Committee on Immunization Practices (ACIP)

    MMWR Morb Mortal Wkly Rep

    (2001)
  • Use of influenza A (H1N1) 2009 monovalent vaccine: recommendations of the Advisory Committee on Immunization Practices (ACIP), 2009

    MMWR Morb Mortal Wkly Rep

    (2009)
  • A.E. Fiore et al.

    Prevention and control of influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP), 2010

    MMWR Recomm Rep

    (2010)
  • Mitchell EW. Maternal communication during the 2009 H1N1 response. Presented at: Pandemic influenza revisited: special...
  • Self-reported influenza vaccination coverage trends 1989-2003 among adults by age group, risk group, race/ethnicity, health-care worker status, and pregnancy status, United States, National Health Interview Survey (NHIS) [Table]

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    Reprints not available from the authors.

    Conflict of Interest: none.

    The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

    The poll was funded under a cooperative agreement with the Centers for Disease Control and Prevention and the National Public Health Information Coalition.

    Publication of this article was supported by the Centers for Disease Control and Prevention and the Association of Maternal and Child Health Programs.

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