2009 H1N1 vaccination by pregnant women during the 2009-10 H1N1 influenza pandemic

Krasnoff Quality Management Institute, North Shore-LIJ Health System, Hempstead, NY, USA.
American journal of obstetrics and gynecology (Impact Factor: 4.7). 12/2011; 206(4):339.e1-8. DOI: 10.1016/j.ajog.2011.12.027
Source: PubMed


Pregnant women were identified at greater risk and given priority for 2009 H1N1 vaccination during the 2009 through 2010 H1N1 pandemic. We identified factors associated with acceptance or refusal of 2009 H1N1 vaccination during pregnancy.
We conducted an in-person survey of postpartum women on the labor and delivery service from June 17 through Aug. 13, 2010, at 4 New York hospitals.
Of 1325 survey respondents, 34.2% received 2009 H1N1 vaccination during pregnancy. A provider recommendation was most strongly associated with vaccine acceptance (odds ratio [OR], 19.4; 95% confidence interval [CI], 12.7-31.1). Also more likely to take vaccine were women indicating the vaccine was safe for the fetus (OR, 12.4; 95% CI, 8.3-19.0) and those who previously took seasonal flu vaccination (OR, 7.9; 95% CI, 5.8-10.7). Race, education, income, and age were less important in accepting vaccine.
Greater emphasis on vaccine safety and provider recommendation is needed to increase the number of women vaccinated during pregnancy.

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Available from: Carolyn Sweetapple, Nov 20, 2014
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    • "Nonphysician prenatal office staff can also be influential, with only two thirds of respondents in one study stating that they would recommend the seasonal influenza vaccine.70 Many studies have documented that women are more likely to actually get vaccinated if it is strongly recommended by their prenatal care provider or health team.67,68,71 In one survey study, pregnant women who were offered the vaccine by their doctor were five-times as likely to be vaccinated as those not offered vaccination.67 "
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    ABSTRACT: Influenza poses unique risks to pregnant women, who are particularly susceptible to morbidity and mortality. Historically, pregnant women have been overrepresented among patients with severe illness and complications from influenza, and have been more likely to require hospitalization and intensive care unit admission. An increased risk of adverse outcomes is also present for fetuses/neonates born to women affected by influenza during pregnancy. These risks to mothers and babies have been observed during both nonpandemic and pandemic influenza seasons. During the H1N1 influenza pandemic of 2009-2010, pregnant women were more likely to be hospitalized or admitted to intensive care units, and were at higher risk of death compared to nonpregnant adults. Vaccination remains the most effective intervention to prevent severe illness, and antiviral medications are an important adjunct to ameliorate disease when it occurs. Unfortunately, despite national guidelines recommending universal vaccination for women who are pregnant during influenza season, actual vaccination rates do not achieve desired targets among pregnant women. Pregnant women are also sometimes reluctant to use antiviral medications during pregnancy. Some of the barriers to use of vaccines and medications during pregnancy are a lack of knowledge of recommendations and of safety data. By improving knowledge and understanding of influenza and vaccination recommendations, vaccine acceptance rates among pregnant women can be improved. Currently, the appropriate use of vaccination and antiviral medications is the best line of defense against influenza and its sequelae among pregnant women, and strategies to increase acceptance are crucial. This article will review the importance of influenza in pregnancy, and discuss vaccination and antiviral medications for pregnant women.
    International Journal of Women's Health 07/2014; 6(1):681-689. DOI:10.2147/IJWH.S47235
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    ABSTRACT: Please cite this paper as: Källén B, Olausson P. Vaccination against H1N1 influenza with Pandemrix® during pregnancy and delivery outcome: a Swedish register study. BJOG 2012;119:1583–1590. Objective To describe a large study on pregnancy outcome after vaccination against H1N1 during the 2009/10 pandemic. Design A cohort study of women vaccinated with Pandemrix® during pregnancy. Setting The Swedish Medical Birth Register was used for the analysis. Information on vaccination and pregnancy week when vaccination was made was obtained from antenatal care documents. Population All women who gave birth during 2009 and 2010 in Sweden. Methods Characteristics of the vaccinated women and their delivery outcome were compared with two groups of women: women without a known vaccination who gave birth in 2009/10 after 1 October 2009, and women who gave birth during 2009 before 1 October. Adjustment was made for year of delivery, maternal age, parity, smoking habits and body mass index. Outcome measures Stillbirth, congenital malformations, preterm birth, low birthweight, small for gestational age. Results A total of 18 612 vaccinated women having 18 844 infants were studied. The risk for stillbirth, preterm birth and low birthweight was lower than in the comparison groups whereas the risk for small for gestational age and a congenital malformation (after vaccination during the first trimester) did not differ from the comparison groups. No clear-cut explanation to the ‘protective’ effect of vaccination was found. Conclusions Vaccination during pregnancy with Pandemrix® appeared to have no ill effects on the pregnancy. On the contrary, the rate of preterm birth and low birthweight was lower than expected, which agrees with some previous results.
    BJOG An International Journal of Obstetrics & Gynaecology 08/2012; 119(13). DOI:10.1111/j.1471-0528.2012.03470.x · 3.45 Impact Factor
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    ABSTRACT: The 2009-2010 A/H1N1 pandemic provided a unique setting to study the safety of MF59-adjuvanted vaccination in pregnancy. This was an observational cohort study of the safety of an MF59-adjuvanted A/H1N1 vaccine (Focetria) conducted among 4508 pregnant women (2295 vaccinated vs 2213 unvaccinated), with 3 month follow-up of neonates. No maternal deaths or abortions occurred among the vaccinated women. No differences between the vaccinated and unvaccinated cohorts were observed for gestational diabetes, preeclampsia, stillbirth, low birthweight, neonatal deaths, or congenital malformations. The risk of premature birth was significantly decreased among the vaccinated women (adjusted proportional hazard, 0.69; 95% confidence interval, 0.51-0.92). No differences were observed in rates of congenital malformations after vaccination in the first (2.1%), second (2.7%), or third (2.1%) trimesters. There was no evidence of a safety risk for MF59-adjuvanted A/H1N1 vaccination in pregnant women; protection was observed against premature birth.
    American journal of obstetrics and gynecology 09/2012; 207(3):177.e1-8. DOI:10.1016/j.ajog.2012.07.007 · 4.70 Impact Factor
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