Post on 01-Apr-2015
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
Source: RI Pregnancy Risk Assessment Monitoring System, 2005-2007
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
Source: RI Pregnancy Risk Assessment Monitoring System, 2005-2007
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
Source: RI Pregnancy Risk Assessment Monitoring System, 2005-2007
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
Source: RI Pregnancy Risk Assessment Monitoring System, 2005-2007
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
Source: RI Pregnancy Risk Assessment Monitoring System, 2005-2007
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
Source: RI Pregnancy Risk Assessment Monitoring System, 2005-2007
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
Source: RI Pregnancy Risk Assessment Monitoring System, 2005-2007
% 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: Hanna.Kim@health.ri.gov