title: Factors associated with a successful expansion of influenza vaccination among pregnant women in Nicaragua.
abstract: BACKGROUND
  Pregnant women are at risk of severe influenza disease and are a priority group for influenza vaccination programs. Nicaragua expanded recommendations to include influenza vaccination to all pregnant women in the municipality of Managua in 2013.
  
  
  METHODS
  We carried out a survey among 1,807 pregnant women who delivered at public hospitals in the municipality of Managua to evaluate the uptake of influenza vaccination and factors associated with vaccination.
  
  
  RESULTS
  We observed a high (71%) uptake of influenza vaccination among this population, with no differences observed by age, education or parity of the women. Having four antenatal visits and five or more visits were associated with receipt of influenza vaccination (AORs: 2.58; 95% CI: 1.15, 5.81, and 2.37; 95% CI: 1.12, 5.0, respectively). Also, receipt of influenza vaccination recommendation from a health care provider was positively associated with receipt of influenza vaccination (AOR: 14.22; 95% CI: 10.45, 19.33).
  
  
  CONCLUSIONS
  The successful expansion of influenza vaccination among pregnant women in the municipality of Managua may be due to ready access to free medical care and health care providers' recommendation for vaccination at health care clinics that received influenza vaccine.
authors.affiliation: Epidemic Intelligence Service Program, Centers for Disease Control and Prevention, Atlanta, GA, USA; Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA. Electronic address: wus3@cdc.gov.
authors.forename: Carmen S
authors.initials: CS
authors.lastname: Arriola
authors.affiliation: Pan American Health Organization, Managua, Nicaragua.
authors.forename: Nancy
authors.initials: N
authors.lastname: Vasconez
authors.affiliation: Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Thompson
authors.affiliation: Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Sara
authors.initials: S
authors.lastname: Mirza
authors.affiliation: Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Ann C
authors.initials: AC
authors.lastname: Moen
authors.affiliation: Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Bresee
authors.affiliation: Pan American Health Organization, Managua, Nicaragua.
authors.forename: Ivy
authors.initials: I
authors.lastname: Talavera
authors.affiliation: Pan American Health Organization, Washington, DC, USA.
authors.forename: Alba María
authors.initials: AM
authors.lastname: Ropero
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006779:Hospitals, Public; D006801:Humans; D017589:Immunization Programs; D007252:Influenza Vaccines / Q000627:therapeutic use*; D007251:Influenza, Human / Q000517:prevention & control*; D009527:Nicaragua; D011247:Pregnancy; D037841:Pregnant People; D011295:Prenatal Care; D014611:Vaccination / Q000706:statistics & numerical data*; D055815:Young Adult
chemical_list: D007252:Influenza Vaccines
keywords: Acceptability; Influenza vaccination; Pregnant women