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

Editorial Note

Despite evidence that maternal vaccination with influenza vaccine protects infants from influenza-like illness during the first 6 months of life,[6] recent national data show that pregnant women have the lowest rates of coverage among all adult populations recommended to receive influenza vaccination.[7] During 2004–2007, influenza vaccination prevalence increased significantly in both states among women with recent live births. The increases in coverage partially could be related to changes in ACIP and ACOG recommendations in 2004, when the recommendation for pregnant women changed from vaccine administration to women who would be in their second or third trimester during influenza season to administration of vaccine any time during pregnancy.[4,5] Also, increased media reporting about vaccination of high-risk populations during the 2004–2005 influenza vaccine shortage might have increased awareness among pregnant women and their providers, perhaps resulting in an increase in influenza vaccination prevalence.[8]

Interventions focusing on providers and pregnant women might address barriers to influenza vaccination experienced by both.[3,9] In July 2006, Rhode Island passed a law* requiring the Rhode Island health department to purchase vaccine and distribute it to physicians who enroll in the Immunize for Life adult immunization program. By enacting specific legislation, Rhode Island increased vaccine availability for health-care providers and perhaps alerted providers and pregnant women about the importance of immunizing pregnant women with influenza vaccine. The Rhode Island experience with vaccine distribution might be a useful example for other states on the effectiveness of working with health-care providers to supply influenza vaccine for pregnant women.

Approximately 25% of women in Georgia cited being in their first trimester as a reason for not getting the influenza vaccine, identifying a need to educate pregnant women about the importance of getting the influenza vaccine, even during the earliest phases of pregnancy. These women and their physicians might not have been aware of current ACIP and ACOG recommendations that women who are pregnant during influenza season should be vaccinated, irrespective of trimester. Providers should be educated about these recommendations, about influenza risks for pregnant women, and about interventions to prevent severe illness in this population.[3–5,9]

The findings in this report are subject to at least three limitations. First, PRAMS data on influenza vaccination were only available from two states, and these findings might not be generalizable to all women with live births in the United States. Second, PRAMS data are self-reported by women 2–4 months postpartum and therefore they might be subject to recall bias. Finally, information on provider recommendations was assessed by maternal report; data from health-care providers regarding their practice related to influenza vaccine might have shown different results.

Because the seasonal influenza vaccine is unlikely to provide protection against pandemic influenza A (H1N1) infection,[10] ACIP recommends that pregnant women receive both vaccine formulations during the 2009–10 influenza season. The trivalent inactivated seasonal influenza vaccine is now available and the influenza A (H1N1) 2009 monovalent vaccine is expected to become available in mid-October.[10]

* Routine childhood and adult immunization vaccines. Title 23, Chapter 23-1, Sect. 23-1-44 (2006). Available at
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