Original Article

Influenza Vaccination During Pregnancy: Opinions and Practices of Obstetricians in an Urban Community

Authors: Pingsheng Wu, PHD, Marie R. Griffin, MD, MPH, Airron Richardson, MD, Steven G. Gabbe, MD, Meredith A. Gambrell, BS, Tina V. Hartert, MD, MPH

Abstract

Background: Influenza vaccination is recommended for all women who will be pregnant during the influenza season; however, little is known about the attitudes of physicians regarding vaccination of pregnant women.


Methods: We conducted a survey of all the fellows of the American College of Obstetricians and Gynecologists (ACOG) who live and practice in Nashville, Tennessee, focusing on physician knowledge, practices, and opinions regarding influenza vaccination of pregnant women.


Results: Thirty-seven of 58 (64%) eligible physicians participated. Obstetrician opinion on the earliest influenza vaccine administration for healthy pregnant women was 62% during the second trimester, 32% during the first trimester, and 6% felt that the vaccine should not be given during pregnancy. All physicians responded that pregnant women with an underlying high risk condition should be vaccinated.


Conclusion: Practicing obstetricians differ in their preferences regarding the timing of influenza vaccine administration in pregnant women. Obstetrician and patient opinion and practice should be studied and considered in developing vaccine guidelines and vaccine implementation strategies.


Key Points


* In this urban cohort of obstetricians, 89% of responding obstetricians reported that they routinely recommend influenza vaccination to their pregnant patients. These obstetricians estimated that 70% of pregnant women in their practices received influenza vaccine each year during two influenza seasons (2002-2004).


* Physicians reported their preference for earliest influenza vaccine administration for healthy pregnant women to be the second trimester (62%), the first trimester (32%), or no vaccination at all throughout pregnancy (6%). For high-risk pregnant women, their preference was the second trimester (54%) or the first trimester (46%).


* This study suggests that the preferences of obstetricians regarding timing of influenza vaccination of pregnant women differ from the Advisory Committee on Immunization Practices (ACIP) recommendations. While these preferences may affect vaccine implementation among pregnant women, obstetricians have practical and valid concerns that should also be considered in developing vaccine education and guidelines.


* An understanding of actual practices and opinions of healthcare providers is needed to guide policy and improve vaccination rates.

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References

1. Bridges CB, Fukuda K, Uyeki TM, et al. Prevention and control of influenza: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2002;51:1–31.
 
2. Neuzil KM, Griffin MR, Schaffner W. Influenza vaccine: issues and opportunities. Infect Dis Clin North Am 2001;15:123–141.
 
3. Neuzil KM, Reed GW, Mitchel EF, et al. Impact of influenza on acute cardiopulmonary hospitalizations in pregnant women. Am J Epidemiol 1998;148:1094–1102.
 
4. Sur DK, Wallis DH, O’Connell TX. Vaccinations in pregnancy. Am Fam Physician 2003;68:299–304.
 
5. Silverman NS, Greif A. Influenza vaccination during pregnancy: patients’ and physicians’ attitudes. J Reprod Med 2001;46:989–994.
 
6. Englund JA. Maternal immunization with inactivated influenza vaccine: rationale and experience.Vaccine 2003;21:3460–3464.
 
7. Greenberg M, Jacobziner H, Pakter J, et al. Maternal mortality in the epidemic of Asian influenza, New York City, 1957. Am J Obstet Gynecol 1958;76:897–902.
 
8. Hartert TV, Neuzil KM, Shintani AK, et al. Maternal morbidity and perinatal outcomes among pregnant women with respiratory hospitalizations during influenza season. Am J Obstet Gynecol2003;189:1705–1712.
 
9. Prevention and control of influenza: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 1997;46:1–25.
 
10. Harper SA, Fukuda K, Uyeki TM, et al. Prevention and control of influenza: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2004;53:1–40. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr53e430a1.htm. Accessed July 11, 2006.
 
11. CDC. National Health Interview Survey: 2003. Table: Self-reported influenza vaccination coverage trends 1989–2003 among adults by age group, risk group, race/ethnicity, health-care worker status, and pregnancy status, United States. National Health Interview Survey. Available at:http://www.cdc.gov/flu/professionals/vaccination/pdf/vaccinetrend.pdf. Accessed July 11, 2006.
 
12. Schrag SJ, Arnold KE, Mohle-Boetani JC, et al Prenatal screening for infectious diseases and opportunities for prevention. Obstet Gynecol 2003;102:753–760.
 
13. Influenza vaccination in pregnancy: practices among obstetrician-gynecologists: United States, 2003–04 influenza season MMWR Morb Mortal Wkly Rep 2005;54:1050–1052.
 
14. Munoz FM, Englund JA. Vaccines in pregnancy. Infect Dis Clin North Am 2001;15:253–271.
 
15. Munoz FM, Greisinger AJ, Wehmanen OA, et al. Safety of influenza vaccination during pregnancy.Am J Obstet Gynecol 2005;192:1098–1106.
 
16. Englund JA, Mbawuike IN, Hammill H, et al. Maternal immunization with influenza or tetanus toxoid vaccine for passive antibody protection in young infants. J Infect Dis 1993;168:647–656.
 
17. Chambers K. Asthma education and outcomes for women of childbearing age. Case Manager2003;14:58–61.
 
18. Wilcox AJ, Weinberg CR, O’Connor JF, et al. Incidence of early loss of pregnancy. N Engl J Med1988;319:189–194.
 
19. Simpson JL. Fetal wastage. In: Gabbe SG, Niebyl JR, Simpson JL, eds. Obstetrics: Normal and Problem Pregnancies. New York, Churchill Livingstone, 2002.
 
20. Simpson JL, Mills JL, Holmes LB, et al. Low fetal loss rates after ultrasound-proved viability in early pregnancy. JAMA 1987;258:2555–2557.
 
21. Fitzpatrick M. MMR: risk, choice, chance. Br Med Bull 2004;69:143–153.
 
22. Institute of Medicine. Immunization Safety Review: Vaccines and Autism. Washington, DC, The National Academies Press, 2004.