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\nInfluenza (flu) can cause severe illness among pregnant women and result in preterm labor and increased risk for hospitalization and death (1).
\nInfants younger than 6 months are at high risk of severe complications from the flu, but they are too young to be vaccinated (1, 5).
\nVaccination coverage among pregnant women increased in 2009-10, but has been relatively stable since that time.
\nCDC analyzed data from an Internet panel survey conducted October 30-November 13, 2013, among women who were pregnant any time since August 2013. The results of this survey provide information for use in vaccination campaigns during National Influenza Vaccination Week (December 8-14, 2013). This report provides early flu season (early November) estimates of vaccine uptake by pregnant women. Final 2013-14 flu season coverage estimates for pregnant women will become available after the end of the flu season.
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\nRespondents who were vaccinated at the time of the survey were asked to report their main reason for receiving a flu shot.
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\nUnvaccinated respondents who reported that they did not intend to be vaccinated\u2020\u2020 were asked to report their main reason for not receiving a flu shot.
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\nOverall, early 2013-14 season estimates of flu vaccination coverage before or during pregnancy among women pregnant anytime during August through the time of the survey were similar to 2012-13 early season estimates. Flu vaccination coverage was highest among women who reported that their doctor or other medical professional recommended the flu vaccine and offered to administer the vaccine during the same visit (64.6%). Coverage estimates were substantially lower among women who reported receiving only a recommendation without an offer of vaccine or not receiving a recommendation at all. Concern about safety of the developing baby and perceived efficacy of the flu vaccine were the most common reasons for not receiving a flu vaccination (reported by 13.4% and 13.6% of unvaccinated respondents). Continued efforts are needed to improve flu vaccination coverage among pregnant women, including:
\nIncrease the proportion of pregnant women who receive a recommendation and offer for flu vaccination from their doctor or other medical professional:
\nContinue to vaccinate pregnant women throughout the flu season:
\nInform pregnant women about flu and the safety and efficacy of the flu vaccine:
\nThe November Internet panel survey of pregnant women is designed to provide timely estimates of national flu vaccination coverage and to assess the effectiveness of current vaccination efforts. The follow-up survey in April 2014 will provide end-of-season flu vaccination coverage estimates.
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\nCDC conducted an Internet panel survey from October 30-November 13, 2013, to provide early season estimates of flu vaccination coverage and information on knowledge, attitudes, and behaviors related to flu vaccination among pregnant women. Women 18\u201349 years who were pregnant at any time since August 1, 2013, were recruited from SurveySpot, a general population Internet panel. SurveySpot is the same recruitment mechanism that was used in the November 2012 survey. Eligible respondents were either pregnant at the time of the survey or had recently been pregnant. Of 2,185 panel members who were eligible and started the survey, 2,109 (96.5%) completed the online survey. The sample was weighted to reflect the age group, racial/ethnic, and geographic distribution of the total U.S. population of pregnant women during 1995-2008 (13\u201314).
\nSurvey respondents were asked if they had a flu vaccination since July 1, 2013, and if yes, in which month and whether it was before, during, or after pregnancy. Pregnancy status questions included whether respondents were currently pregnant or pregnant at any time since August 1, 2013, and if so, what were the actual months of pregnancy. Respondents were asked their beginning and end (or expected delivery) date of the pregnancy. Women who reported receiving vaccination since July 1, 2013, and who were vaccinated before or during pregnancy were counted as vaccinated. This differs slightly from the methodology used in previous Internet panel surveys (15\u201316). In surveys conducted prior to the 2012-13 flu season, the vaccination period was measured from August 1 until the time of survey. Beginning with the November 2012 survey, the vaccination period was extended by one month to July 1 until the time of survey. Additionally, published estimates prior to the April 2013 survey include vaccinations received before, during, or after pregnancy, while estimates in this report exclude vaccinations received after pregnancy. For comparison, estimates from prior seasons were recalculated using the same definition as in this report (i.e., women who were vaccinated before or during pregnancy), and thus may differ from previously published estimates.
\nAll respondents were asked if their doctor or other medical professional had recommended or offered the flu vaccine, and if yes, had offered them flu vaccination during the same office visit. They were also asked about their attitudes toward and beliefs about flu and flu vaccination.
\nWeighted analyses were conducted using SAS v9.2 survey procedures. Because the opt-in Internet panel sample was based on those who initially self-selected for participation in the panel rather than a random probability sample, statistical measures such as calculation of confidence intervals and tests of differences cannot be performed (17). A difference of five percentage points was considered a notable difference.
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\nThese results are preliminary and should be interpreted with caution. The follow-up Internet panel survey in April 2014 will assess flu vaccination coverage at the end of the flu season. State-specific estimates of flu vaccination coverage for the 2013-14 season will be provided later from the Pregnancy Risk Assessment Monitoring System (PRAMS). National coverage estimates from the Behavioral Risk Factor Surveillance System (BRFSS) and National Health Interview Survey (NHIS) will be provided later for comparison to the Internet panel survey estimates.
\nThe findings in the report are subject to several limitations.
\nDespite these limitations, Internet panel surveys are a useful surveillance tool for timely early season and postseason evaluation of flu vaccination coverage and knowledge, attitude, practice, and barrier data.
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\nAUTHORS: Helen Ding, MD, MSPH, Carla L. Black, PhD, Stacie M, Greby, DVM, MPH, Peng-Jun Lu, MD, PhD, Katherine E. Kahn, MPH, Walter W. Williams, MD, MPH, James A. Singleton, PhD, Erin D. Kennedy, DVM, MPH, Carolyn B. Bridges, MD; Immunization Services Division, NCIRD; Denise Jamieson, MD, MPH; Division of Reproductive Health, NCCDPHP; Sarah Ball, DrPH, David Izrael, MS; Abt Associates Inc.
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\n* Vaccinated before or during pregnancy as of early November based on women who provided a response to vaccination status questions and who were pregnant any time during August-November 2010 for 2010-11 flu season (n=1,496), August-November 2011 for 2011-12 flu season (n=2,047), August-November 2012 for 2012-13 flu season (n=1,796), and August-November 2013 for 2013-14 flu season (n=2,096). Beginning in the 2012-13 season, women vaccinated since July 1 were counted as vaccinated. In prior seasons, only women vaccinated since August 1 were counted as vaccinated.
\n\u2020 Vaccinated before or during pregnancy as of mid-April based on women who provided a response to vaccination status questions and who were pregnant anytime during October 2010-January 2011 for 2010-11 flu season (n=1,457), October 2011-January 2012 for 2011-12 flu season (n=1,660), and October 2012-January 2013 for 2012-13 flu season (n=1,702). Beginning in the 2012-13 season, women vaccinated since July 1 were counted as vaccinated. In prior seasons, women vaccinated since August 1 were counted as vaccinated.
\n\u00a7 These estimates include women who may have been vaccinated after their pregnancy ended. The PRAMS estimate includes pregnant women from 21 states and is not a national estimate.
\n\u00b6 These estimates differ from published estimates from the 2010-11 and 2011-12 Internet panel surveys because they do not count vaccinations reported after pregnancy had ended, whereas published estimates did count women who were vaccinated before, during, or after pregnancy as vaccinated. Additionally, the 2010-11 and 2011-12 estimates counted vaccinations from August-April of each flu season. The 2012-13 season estimate counted vaccinations from July-April.
\n** Currently have conditions other than pregnancy associated with increased risk for serious medical complications from flu, including chronic asthma, a lung condition other than asthma, a heart condition, diabetes, a kidney condition, a liver condition, a weakened immune system caused by a chronic illness or by medicines taken for a chronic illness, or obesity.
\n\u2020\u2020 Includes unvaccinated respondents who reported that they probably or definitely do not intend to be vaccinated before the end of the flu season.
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