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

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.

Dlugacz Y ，Fleischer A ，Carney MT ，Copperman N ，Ahmed I ，Ross Z ，Buchman T ，Fried AM ，Cabello C ，De Geronimo M ，Sweetapple C ，Besthoff CM ，Silverman RA ... -  《-》

Acceptance of 2009 H1N1 influenza vaccine among pregnant women in Delaware.

Due to disproportionately high mortality from 2009 H1N1 influenza, pregnant women were given highest priority for H1N1 vaccination. We surveyed postpartum women to determine vaccine uptake and reasons for lack of vaccination. We performed a cross-sectional survey of postpartum women delivering at our institution from February 1 to April 15, 2010. The 12-question survey ascertained maternal characteristics and vaccination concerns. Among 307 postpartum women, 191 (62%) had received H1N1 vaccination and 98 (32%) had declined. Factors associated with H1N1 vaccination included older age (relative risk [RR] 1.3, 95% confidence interval [CI] 1.1 to 1.5 for age ≥35 years compared with 20 to 34 years), at least college education (RR 1.5, 95% CI 1.3 to 1.8), prior influenza vaccination (RR 1.6, 95% CI 1.3 to 2.0), provider recommendation (RR 3.9, 95% CI 2.1 to 7.4), vaccination of family members (RR 1.6, 95% CI 1.3 to 1.9), and receipt of seasonal influenza vaccination (RR 2.2, 95% CI 1.7 to 2.9). Non-Hispanic black women were less likely to have been vaccinated (RR 0.6, 95% CI 0.5 to 0.8) than non-Hispanic white women. Safety concerns were cited by the majority (66%) of nonvaccinated women. H1N1 vaccine uptake among pregnant women was substantially higher than reported influenza vaccination rates during previous seasons. Safety concerns were the major barrier to vaccination.

Drees M ，Johnson O ，Wong E ，Stewart A ，Ferisin S ，Silverman PR ，Ehrenthal DB ... -  《-》

Uptake of influenza vaccine in pregnant women during the 2009 H1N1 influenza pandemic.

The goals of this study were to define the uptake of H1N1 and seasonal influenza vaccination during pregnancy among women delivering during the 2009 H1N1 pandemic and explore barriers to vaccination. All postpartum women at the Massachusetts General Hospital from January 2010 through March 2010 were invited to complete an anonymous questionnaire about demographics, vaccination status, and attitudes about vaccination during pregnancy. Among 370 participants (53% response rate), 81% accepted both the H1N1 and seasonal influenza vaccines during pregnancy. Patients who declined one or both vaccines cited concerns over safety as a major deterrent. Of the 36% of participants who reported having flu-like symptoms during this pregnancy only 8.6% took oseltamivir. While a high vaccination rate was identified in this study, further education is needed to reassure patients regarding vaccine safety. Education for providers and patients emphasizing the benefits of early treatment of pregnant women with flu-like symptoms should be a priority.

Goldfarb I ，Panda B ，Wylie B ，Riley L ... -  《-》

Influenza vaccination coverage among pregnant women--National 2009 H1N1 Flu Survey (NHFS).

We sought to describe vaccination with influenza A (H1N1) 2009 monovalent (2009 H1N1) and trivalent seasonal (seasonal) vaccines among pregnant women during the 2009 through 2010 influenza season. A national H1N1 flu survey was conducted April through June 2010. The 2009 H1N1 and seasonal vaccination coverage estimates were 45.7% and 32.1%, respectively, among pregnant women aged 18-49 years. Receipt of a health care provider's recommendation for vaccination, perceived effectiveness of influenza vaccinations, and perceived high chance of influenza infection were independently associated with higher 2009 H1N1 and seasonal vaccination coverage. Pregnancy during October 2009 through January 2010 was independently associated with higher 2009 H1N1 vaccination coverage. The 2009 H1N1 vaccination level among pregnant women was higher than the seasonal vaccination level during the 2009 through 2010 season; it was also higher than vaccination among nonpregnant women with and without high-risk conditions. Health care providers and public health messaging played important roles in influencing vaccination behavior.

Ding H ，Santibanez TA ，Jamieson DJ ，Weinbaum CM ，Euler GL ，Grohskopf LA ，Lu PJ ，Singleton JA ... -  《-》

Predictors of H1N1 vaccination in pregnancy.

The purpose of this review was to determine factors that influence a pregnant woman's acceptance of the H1N1 vaccine with the use of the Health Belief Model (HBM). A self-administered questionnaire based on the HBM was used in a cross-sectional study of postpartum women during the 2009 H1N1 epidemic. Overall, 212 postpartum women were approached and agreed to participate; of these women, 25.5% had received an H1N1 vaccination. Perceived barriers to vaccination (P = .001) and perceived severity of infection (P = .018) were independent predictors of vaccination. The total predictive utility of the full model that incorporated HBM dimensions, age, race, care provider, and education level was moderate (area under the curve, -0.86). The addressing of perceived barriers (such as fear of side-effects), an explanation of the safety of the vaccine for the fetus, and the stressing of complications that are associated with H1N1 infection in pregnancy may increase the rate of vaccination.

Fridman D ，Steinberg E ，Azhar E ，Weedon J ，Wilson TE ，Minkoff H ... -  《-》