title: Influenza Vaccination During Pregnancy: Influenza Seasons 2002-2012, Vaccine Safety Datalink.
abstract: BACKGROUND
  Pregnant women are at risk for influenza-related complications and have been recommended for vaccination by the Advisory Committee on Immunization Practices (ACIP) since 1990. Annual rates of influenza coverage of pregnant women have been consistently low. The Vaccine Safety Datalink was used to assess influenza vaccine coverage over 10 consecutive years (2002-2012); assess patterns related to changes in ACIP recommendations; identify predictors of vaccination; and compare the results with those published by national U.S. surveys.
  
  
  METHODS
  Retrospective cohort study of 721,898 pregnancies conducted in 2014. Coverage rates were assessed for all pregnancies and for live births only. Multivariate regression analysis identified predictors associated with vaccination.
  
  
  RESULTS
  Coverage increased from 8.8% to 50.9% in 2002-2012. Seasonal coverage rates increased slowly following the 2004 ACIP influenza vaccine recommendation (to remove the first trimester restriction), but spiked significantly during the 2009 H1N1 influenza pandemic. Significant predictors of vaccination during pregnancy included older age; vaccination in a previous season; high-risk conditions in addition to pregnancy; pregnancy during either the 2004-2005 or 2009-2010 seasons; entering the influenza season after the first trimester of pregnancy; and a pregnancy with longer overlap with the influenza season (p<0.001 for each).
  
  
  CONCLUSIONS
  Influenza vaccination coverage among pregnant women increased between the 2002-2003 and 2011-2012 seasons, although it was still below the developmental Healthy People 2020 goal of 80%. The 2004 ACIP language change positively impacted first-trimester vaccination uptake. Vaccine Safety Datalink data estimates were consistent with U.S. estimates.
authors.affiliation: Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon. Electronic address: holly.c.groom@kpchr.org.
authors.forename: Holly C
authors.initials: HC
authors.lastname: Groom
authors.affiliation: Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon.
authors.forename: Michelle L
authors.initials: ML
authors.lastname: Henninger
authors.affiliation: Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon.
authors.forename: Ning
authors.initials: N
authors.lastname: Smith
authors.affiliation: Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon.
authors.forename: Padma
authors.initials: P
authors.lastname: Koppolu
authors.affiliation: Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California.
authors.forename: T Craig
authors.initials: TC
authors.lastname: Cheetham
authors.affiliation: Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado; Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Aurora, Colorado.
authors.forename: Jason M
authors.initials: JM
authors.lastname: Glanz
authors.affiliation: Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado; Ambulatory Care Services, Denver Health, Denver, Colorado.
authors.forename: Simon J
authors.initials: SJ
authors.lastname: Hambidge
authors.affiliation: Group Health Research Institute, Seattle, Washington.
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Jackson
authors.affiliation: HealthPartners Institute for Education and Research, Minneapolis, Minnesota.
authors.forename: Elyse O
authors.initials: EO
authors.lastname: Kharbanda
authors.affiliation: Kaiser Permanente Vaccine Study Center, Oakland, California.
authors.forename: Nicola P
authors.initials: NP
authors.lastname: Klein
authors.affiliation: Immunization Safety Office, CDC, Atlanta, Georgia.
authors.forename: Natalie L
authors.initials: NL
authors.lastname: McCarthy
authors.affiliation: HealthPartners Institute for Education and Research, Minneapolis, Minnesota.
authors.forename: James D
authors.initials: JD
authors.lastname: Nordin
authors.affiliation: Immunization Safety Office, CDC, Atlanta, Georgia.
authors.forename: Eric S
authors.initials: ES
authors.lastname: Weintraub
authors.affiliation: Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon.
authors.forename: Allison L
authors.initials: AL
authors.lastname: Naleway
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007252:Influenza Vaccines / Q000008:administration & dosage*; D007251:Influenza, Human / Q000517:prevention & control*; D015999:Multivariate Analysis; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000517:prevention & control* / Q000821:virology; D012044:Regression Analysis; D012189:Retrospective Studies; D012621:Seasons; D014481:United States; D014611:Vaccination / Q000379:methods* / Q000639:trends
chemical_list: D007252:Influenza Vaccines