Receipt of Influenza Vaccine during Pregnancy among Women with Live Births — Georgia and Rhode Island, 2004–2007

IB Ahluwalia, PhD; L Harrison, MPH; D Jamieson, MD; SA Rasmussen, MD


Morbidity and Mortality Weekly Report. 2009;58(35):972-975. 

In This Article

Abstract and Introduction


Pregnant women are at increased risk for complications from influenza.[1–3] Since 2004, the Advisory Committee on Immunization Practices (ACIP) and American College of Obstetricians and Gynecologists (ACOG) Committee on Obstetric Practice have recommended that all pregnant women be vaccinated with the trivalent inactivated vaccine during any trimester of pregnancy.[4,5] To assess the percentage of women who were vaccinated during pregnancy among women with recent live births, CDC analyzed data from the Pregnancy Risk Assessment and Monitoring System (PRAMS) from Georgia and Rhode Island, the two states that collected this information on the PRAMS survey. This report summarizes the results, which showed that in Georgia, the prevalence of influenza vaccination during the woman's most recent pregnancy increased from 10.4% in 2004 to 15.5% in 2006. In Rhode Island, vaccination prevalence increased from 21.9% in 2004 to 33.4% in 2007. During 2006 in Georgia, the most common reasons for not receiving vaccination were, "I don't normally get the flu vaccination" (69.4%), and "my physician did not mention anything about a flu vaccine during my pregnancy" (44.5%). Increased efforts are needed to assess vaccine coverage during pregnancy and to educate providers and pregnant women about ACIP and ACOG recommendations on providing intramuscular, inactivated influenza vaccine during any trimester of pregnancy.

PRAMS is a population-based surveillance system that collects data on a wide range of maternal behaviors and experiences before, during, and after pregnancy. PRAMS surveys currently are administered by 37 states, New York City, and one tribal-state partnership in South Dakota. Each month, participating states or entities use birth certificate data to select a stratified random sample of 100–300 women with recent live births. A questionnaire is mailed to the women 2–6 months after delivery. The participating entities use a standard questionnaire, to which they can add questions. From 2004 to 2007, Georgia and Rhode Island included questions about influenza vaccination on their surveys. Responses from Georgia for 3 years (2004–2006; N = 5,231) and Rhode Island for 4 years (2004–2007; N = 5,499) were analyzed. Variables included receipt of influenza vaccination in women during pregnancy, demographics, and health-care service use indicators. Response rates for the years of data examined for Georgia were 70.0% for 2004, 70.2% for 2005, and 70.8% for 2006; rates for Rhode Island were 75.5% for 2004, 75.1% for 2005, 72.5% for 2006, and 72.1% for 2007.

Women whose influenza vaccination status was missing (229 for Georgia and 163 for Rhode Island) were excluded. PRAMS data were weighted to take into account complex survey design, nonresponse, and noncoverage for each state. Data were analyzed to estimate influenza vaccination prevalence and 95% confidence intervals. Chi-square tests were used to determine statistical significance and statistical software were used to account for the complex sampling strategy.

Surveys conducted by both states inquired about influenza vaccination coverage by asking the question, "Did you get a flu vaccination during your most recent pregnancy?" The Georgia survey included a follow-up question for women who reported not being vaccinated to assess their reasons. The question included was, "What were your reasons for not getting a flu vaccination during your most recent pregnancy?" A list of reasons with a choice of yes/no response included items on receipt of provider advice, perceptions of vaccine safety, and timing of pregnancy. The Rhode Island survey included a question on provider advice, "At any time during your pregnancy, did a doctor, nurse, or other health-care worker offer you a flu vaccination or tell you to get one?"

In both states, most of the increase in influenza vaccination coverage was observed from 2004 to 2005 (Figure); in Georgia, coverage increased 62.5%, from 10.4% to 16.9%, and in Rhode Island, coverage increased 37.4%, from 21.9% to 30.1%. Vaccination prevalence remained mostly stable during 2005–2006, but with a further 10.0% increase observed in Rhode Island from 2006 to 2007. Prevalence of influenza vaccination during pregnancy in the two states varied by state and demographically (Table 1).

Figure 1.

Influenza vaccination coverage during most recent pregnancy among women with recent live births* — Pregnancy Risk Assessment and Monitoring System, Georgia and Rhode Island, 2004–2007
* Based on response to the question, "Did you get a flu vaccination during your most recent pregnancy?"
2007 data for Georgia were not available. Percentages are weighted.
§ 95% confidence interval.

In Rhode Island, the prevalence of women who reported receiving advice about influenza vaccine or an offer of vaccination increased from 33.0% during 2004 to 47.7% during 2007 (p < 0.001). In 2007, among respondents who reported receiving vaccination advice from a health-care provider, the prevalence of those who also were vaccinated was 65.7%. In 2007, Rhode Island data showed that among women who did not report receiving advice from their health-care provider about influenza vaccine, only 4.6% reported receiving influenza vaccination.

In Georgia, previous vaccination history, provider advice, perceptions of safety, and timing of pregnancy were among the reasons unvaccinated women cited for not getting the influenza vaccine (Table 2). The top reasons cited were "I don't normally get the flu vaccination" (69.4%) and "my physician did not mention anything about a flu vaccine during my pregnancy" (44.5%); 28.1% were worried about the safety of the influenza vaccine for their infant and 27.1% were worried about the safety for themselves.


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