Flu Season 2020: 4 out of 10 pregnant women didn't get vaccinated last season despite recommendations, says CDC
An estimated four out of 10 pregnant women in the US did not get vaccinated against the flu during the last influenza season, leaving both themselves and their babies more vulnerable to infection as well as potentially serious complications, according to the US Centers for Disease Control and Prevention (CDC). “Despite recommendations and an increase of approximately 12 percentage points in influenza vaccination since the 2017-18 season, maternal vaccination with influenza is suboptimal, and missed opportunities to vaccinate are common,” warns the agency.
Flu is more likely to cause severe illness in pregnant women as compared to women of reproductive age who are not pregnant. The reason could be that changes in the immune system, heart, and lungs during pregnancy make pregnant women (and women up to two weeks postpartum) more prone to severe illness from flu, including illness resulting in hospitalization. The flu may also be harmful to a pregnant woman’s developing baby. A common flu symptom is a fever, which may be associated with neural tube defects and other adverse outcomes for a developing baby.
Vaccination of pregnant women with influenza vaccine can decrease the risk for influenza among pregnant women and their infants. That is why the Advisory Committee on Immunization Practices (ACIP) recommends that all women who are or might be pregnant during the influenza season receive the flu shot, which can be administered at any time during pregnancy. To assess flu vaccination coverage among women pregnant during the 2019-20 flu season, CDC analyzed data from an internet panel survey conducted from April 2-April 14, 2020. A woman was considered to have been vaccinated against influenza if she reported having received 1 dose of flu vaccine (before or during her most recent pregnancy) since July 1, 2019.
The survey was conducted among women aged 18-49 years who reported being pregnant anytime since August 1, 2019, through the date of the survey. Among 1,841 survey respondents who were pregnant anytime during October 2019-January 2020, 61.2% reported receiving the influenza vaccine before or during their pregnancy, which is an increase of 7.5 percentage points compared with 53.7% reported during the 2018-19 season. However, four in 10 did not get the flu vaccine.
Racial and ethnic disparities exist
The overall increase in vaccination was driven by increased vaccination coverage among Black and Hispanic women and those of other races. But despite progress, influenza vaccination coverage was lowest among Black women at 52.7%.
“Increases in influenza vaccination coverage were observed during 2019-20 for Black women (14.7 percentage points, to 52.7%), Hispanic women (9.9 percentage points, to 67.2%), and women of other races (7.9 percentage points, to 69.6%), and did not change for non-Hispanic White (White) women (60.6%). Correspondingly, the difference in influenza vaccination coverage between White and Black women decreased from 19 to 8 percentage points from 2018-19 to 2019-20,” the authors write.
Racial or ethnic disparities in flu vaccination coverage decreased but persisted, even among women who received a provider offer or referral for vaccination. Approximately 70% of Black and White women received a provider offer or referral for influenza vaccination, but Black women were still less likely to be vaccinated than White women. Factors including negative attitudes and beliefs about vaccines, less knowledge about and access to vaccines, and a lack of trust in health care providers and vaccines have been shown to contribute to lower vaccination rates in Black adults, explain researchers.
Approximately 20% of pregnant women reported not receiving a provider recommendation for vaccination. “This circumstance might be partly attributable to differences in perception of a provider recommendation between patients and providers. One study indicated that providers might believe they are giving a recommendation for vaccination, but it might not be remembered by patients,” the research team explains.
The proportion of women who reported receipt of a provider offer or referral for influenza vaccination was higher among Hispanic women (76.9%) than among White (69.5%) and Black (69.1%) women but was similar to that among women of other races (73.7%). Among women with an offer or referral, flu vaccination coverage was lower among Black (66.7%) than among White (75.6%) and Hispanic (79%) women and women of other races (80.7%).
Among women with an offer or referral and 10 or more provider visits, flu vaccination coverage was 64.3% in Black and 80.5% in White women. Influenza vaccination coverage was similar among White (73.6%) and Black (72.7%) women with an offer or referral and a condition (other than pregnancy) that put them at high risk for severe complications from influenza, but among those without high-risk conditions, coverage was lower among Black (62.8%) than among White women (77.4%).
“Vaccination coverage was highest among women who reported receiving a provider offer or referral for vaccination (75.2%). Women who had 10 or more provider visits since July 1, 2019, were more likely to have received the flu vaccine (67.5%) than were those with one to five visits (50.6%),” write authors. The CDC suggests that provider offers or referrals for vaccination, in combination with “conversations culturally and linguistically tailored for patients of all races or ethnicities,” could increase vaccination coverage among pregnant women in all racial or ethnic groups and reduce disparities in coverage.