title: Surveillance of antenatal influenza vaccination: validity of current systems and recommendations for improvement.
abstract: BACKGROUND
  Although influenza vaccination is recommended during pregnancy as standard of care, limited surveillance data are available for monitoring uptake. Our aim was to evaluate the validity of existing surveillance in Western Australia for measuring antenatal influenza immunisations.
  
  
  METHODS
  The self-reported vaccination status of 563 women who delivered between April and October 2013 was compared against three passive data collection sources: a state-wide antenatal influenza vaccination database maintained by the Department of Health, a public maternity hospital database, and a private health service database. Sensitivity, specificity, and positive and negative predictive values were calculated for each system using self-report as the "gold standard."
  
  
  RESULTS
  The state-wide antenatal vaccination database detected 45.7 % (95 % CI: 40.1-51.4 %) of influenza vaccinations, the public maternity hospital database detected 66.7 % (95 % CI: 55.1-76.9 %), and the private health service database detected 29.1 % (95 % CI: 20.5-39.4 %). Specificity exceeded 90 % and positive predictive values exceeded 80 % for each system. Sensitivity was lowest for women whose antenatal care was provided by a private obstetrician.
  
  
  CONCLUSIONS
  Existing resources for surveillance of antenatal influenza vaccinations detect 29-67 % of vaccinations. Considering the importance of influenza immunisation as a public health intervention, particularly in pregnant women, improvements to routine monitoring of influenza vaccination is warranted.
authors.affiliation: School of Pathology and Laboratory Medicine, University of Western Australia, Crawley, Western Australia, Australia. Annette.Regan@health.wa.gov.au.|Western Australia Department of Health, Communicable Disease Control Directorate, Shenton Park, WA, 6008, Australia. Annette.Regan@health.wa.gov.au.
authors.forename: Annette K
authors.initials: AK
authors.lastname: Regan
authors.affiliation: Western Australia Department of Health, Communicable Disease Control Directorate, Shenton Park, WA, 6008, Australia. Donna.Mak@health.wa.gov.au.
authors.forename: Donna B
authors.initials: DB
authors.lastname: Mak
authors.affiliation: Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Subiaco, Western Australia, Australia. Hannah.Moore@telethonkids.org.au.
authors.forename: Hannah C
authors.initials: HC
authors.lastname: Moore
authors.affiliation: Western Australia Department of Health, Communicable Disease Control Directorate, Shenton Park, WA, 6008, Australia. Lauren.Tracey@health.wa.gov.au.
authors.forename: Lauren
authors.initials: L
authors.lastname: Tracey
authors.affiliation: Joondalup Health Campus, Joondalup, Western Australia, Australia. SakerR@ramsayhealth.com.au.
authors.forename: Richard
authors.initials: R
authors.lastname: Saker
authors.affiliation: Infection Control, King Edward Memorial Hospital, Subiaco, Western Australia, Australia. Catherine.Jones@health.wa.gov.au.
authors.forename: Catherine
authors.initials: C
authors.lastname: Jones
authors.affiliation: School of Pathology and Laboratory Medicine, University of Western Australia, Crawley, Western Australia, Australia. Paul.Effler@health.wa.gov.au.|Western Australia Department of Health, Communicable Disease Control Directorate, Shenton Park, WA, 6008, Australia. Paul.Effler@health.wa.gov.au.
authors.forename: Paul V
authors.initials: PV
authors.lastname: Effler
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007252:Influenza Vaccines / Q000008:administration & dosage*; D007251:Influenza, Human / Q000453:epidemiology / Q000517:prevention & control*; D011159:Population Surveillance; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000517:prevention & control*; D011295:Prenatal Care / Q000706:statistics & numerical data; D014611:Vaccination / Q000706:statistics & numerical data*; D014904:Western Australia / Q000453:epidemiology
chemical_list: D007252:Influenza Vaccines