Pregnant women are at greater risk for serious complications from influenza than women who are not pregnant. The Advisory Committee on Immunization Practices (ACIP) has recommended seasonal influenza vaccination in pregnant women since 1990, however, annual rates of influenza coverage in pregnant women have remained consistently low. We used the Vaccine Safety Datalink (VSD) to assess coverage over 10 consecutive seasons (2002–12), assess patterns related to changes in ACIP recommendations, identify predictors of vaccination, and compare the results with those published by other U.S. agencies.
Vaccine coverage rates assessed for a retrospective cohort s of 721,898 pregnancies. Multivariate regression analysis identified predictors associated with vaccination.
Seasonal influenza vaccine coverage increased from 8.8% to 50.9% over the 10-year study period. Coverage rates increased slowly following the 2004 ACIP influenza vaccine recommendation (to remove the first-trimester restriction), but spiked significantly during the 2009 H1N1 influenza pandemic. There was a 71% increase in first trimester uptake between 2004 and 2012. Significant predictors of vaccination during pregnancy included older maternal age, prior influenza vaccination, being at high risk for serious complications from influenza, pregnancy during either the 2004-05 or 2009-10 seasons, entering the flu season after the first trimester of pregnancy, and a pregnancy with longer overlap with the influenza season (p<0.001 for each).
Influenza vaccination coverage among pregnant women increased significantly between the 2002–03 and 2011–12 seasons, but still remains below the developmental Healthy People 2020 goal of 80%. The ACIP language change in 2004 positively influenced uptake of vaccination during the first trimester of pregnancy. Estimates generated using VSD data were consistent with other U.S. estimates and add potential to enhance existing surveillance systems and to explore patterns of uptake among large cohorts of pregnant women. Combining use of electronic medical data and national survey data can help identify subgroups of pregnant women who may respond to additional outreach.
N. Smith, None
P. Koppolu, None
C. Cheetham, None
J. Glanz, None
S. Hambidge, None
L. A. Jackson, None
E. Kharbanda, None
N. P. Klein, GSK: Grant Investigator , Research grant
Sanofi Pasteur: Grant Investigator , Research grant
Pfizer: Grant Investigator , Research grant
Merck: Grant Investigator , Research grant
Novartis: Grant Investigator , Research grant
Nuron Biotech: Grant Investigator , Research grant
Protein Science: Grant Investigator , Research grant and Research support
MedImmune: Grant Investigator , Research grant
N. Mccarthy, Sanofi Pasteur: Investigator , Research support
GlaxoSmithKline: Investigator , Research support
Novartis: Investigator , Research support
MedImmune: Investigator , Research support
Merck & Co: Investigator , Research support
Protein Science: Investigator , Research support
Pfizer: Investigator , Research support
J. Nordin, None
E. Weintraub, None
A. Naleway, GlaxoSmithKline: Investigator , Research support