title: Influenza vaccination during pregnancy and factors for lacking compliance with current CDC guidelines.
abstract: BACKGROUND
  The Center for Disease Control and Prevention (CDC) and the American College of Obstetricians and Gynecologists (ACOG) recommend influenza vaccination for all pregnant women during the influenza season. However, the actual rate of vaccination is substantially below the target levels. Given the recent emergence of novel influenza strains, there is an important need to address knowledge gaps in women and their healthcare providers to improve vaccination coverage for pregnant women during inter-pandemic and pandemic periods. This study attempted to identify potentially remediable attitudinal factors among women and their physicians that may present barriers to influenza vaccination and then assess the impact of interventions to increase the influenza vaccination rate in pregnant women.
  
  
  METHODS
  This prospective study initially analyzed patient and physician knowledge regarding the influenza vaccine in pregnancy and then examined the impact of several interventions aimed to increase immunization rates implemented over the following year. Influenza vaccination rates were assessed before and after the interventions.
  
  
  RESULTS
  Five hundred twenty patients were enrolled in the study during the influenza season 2007/2008. Only 19% of those patients reported receiving the influenza vaccination and only 28% recalled that the vaccine was offered. Following this, in the summer and fall of 2008, we performed a physician education program and distributed posters advertising the influenza vaccine to all offices offering prenatal care in our area in order to increase patient awareness of the need for the vaccine. In the following influenza season, we again reassessed the vaccination rate and patient's knowledge and awareness of the vaccine in 480 postpartum women. Influenza vaccination rates increased from 19% to 31%. After the intervention, 51% of patients recalled that the vaccine was offered to them during the pregnancy as opposed to only 28% the year prior.
  
  
  CONCLUSIONS
  Understanding the specific barriers to vaccination that our population faced was helpful in designing the interventions to improve knowledge and acceptance of influenza vaccination in pregnancy, which led to an increased vaccination rates in women.
authors.affiliation: Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA. alexander.panda@yale.edu
authors.forename: Britta
authors.initials: B
authors.lastname: Panda
authors.forename: Robert
authors.initials: R
authors.lastname: Stiller
authors.forename: Alexander
authors.initials: A
authors.lastname: Panda
mesh_terms: D000328:Adult; D002487:Centers for Disease Control and Prevention, U.S. / Q000331:legislation & jurisprudence*; D003144:Communication Barriers; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D017408:Guidelines as Topic; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007252:Influenza Vaccines / Q000627:therapeutic use; D007251:Influenza, Human / Q000517:prevention & control*; D058873:Pandemics; D010349:Patient Compliance / Q000706:statistics & numerical data; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000209:etiology / Q000517:prevention & control*; D012307:Risk Factors; D014481:United States; D014611:Vaccination / Q000009:adverse effects / Q000523:psychology; D055815:Young Adult
chemical_list: D007252:Influenza Vaccines