2009 H1N1 Vaccination by Pregnant Women During the 2009–10 H1N1 Influenza Pandemic

Abstract

Pregnant women infected with the 2009 H1N1 virus are at high risk for hospitalization and intensive care unit admission as well as mortality. It is strongly recommended that they be vaccinated against this virus. Despite widespread public health efforts to publicize the risk of infection in unvaccinated pregnant women, less than 50% of pregnant women were vaccinated during the 2009 H1N1 pandemic. Although there is clear evidence of the safety of influenza vaccination to the mother and fetus, some pregnant women believe that it is unsafe, and this perception seems to be a primary reason for their lack of acceptance of vaccination. Another reason for low acceptance may be the failure of many obstetrical practices to offer influenza vaccination. The primary aim of this survey was to investigate the factors responsible for acceptance or refusal by pregnant women of 2009 H1N1 vaccination. A secondary aim was to assess the role of sociodemographic factors in accepting vaccination. Data were obtained through an in-person survey of postpartum women on the labor and delivery service at 4 New York hospitals in the summer of 2010. A total of 1325 women completed the survey. More than 90% of the respondents recognized that the virus could cause hospitalization or death. However, only 34% reported that they received 2009 H1N1 vaccination during pregnancy. The most important factor associated with vaccine acceptance was recommendation by a clinical provider; the odds ratio (OR) was 19.4, with a 95% confidence interval (CI) of 12.7 to 31.1. Other important factors increasing the likelihood of accepting the vaccine were a belief that the vaccine was safe (OR, 12.4; 95% CI, 8.3–19.0) and previous seasonal vaccination (OR, 7.9; 95% CI, 5.8–10.7). Sociodemographic factors of race, education, age, and income were less important in acceptance of vaccination. These findings demonstrate that greater emphasis on public health efforts that promote vaccine safety and provider recommendation are needed to increase vaccination during pregnancy.