The Influence of Effective Counseling on Flu Vaccinations among Women Before Delivery

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1 The Influence of Effective Counseling on Flu Vaccinations among Women Before Delivery Leticia Hernandez, PhD, MS Angel Watson, MPH, RHIA CityMatCH Leadership and Epidemiology Conference September 2016 To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts.

2 Background During pregnancy, it is harder for a woman s immune system to fight infections 1 Influenza during pregnancy increases the risk of maternal morbidity or mortality 1 In Florida, during the period , 121 pregnant women were admitted to the hospital with a diagnosis of influenza (HDD ) 2

3 Background Continued During there were eight pregnancy related deaths due to influenza (PAMR ) Flu vaccinations are key to preventing severe cases of the flu that can harm pregnant women or their babies 2 Flu vaccination for pregnant women reduces newborn s influenza risk during the first six months of life 2 3

4 4 Background Continued

5 Study Question Among women who experienced a live birth, what is the association between flu vaccination counseling and getting a flu shot during the 12 months before the delivery? 4

6 Data Source and Methods Merged Florida Pregnancy Risk Assessment Monitoring System (PRAMS) and birth certificate data PRAMS: Population-based mail surveillance system With telephone follow-up of non-responders Samples stratified by birthweight and race Study Design: Cross-sectional study Selection Criteria: Answered the PRAMS survey 5

7 Methods Continued PRAMS Questions: Flu recommendation During the 12 months before the delivery of your new baby, did a doctor, nurse, or other health care worker offer you a flu shot or tell you to get one? Flu vaccination During the 12 months before the delivery of your new baby, did you get a flu shot? 6

8 Methods Continued Analysis Poisson Regression was used to determine the association between preconception or prenatal counseling and getting a flu shot STATA SE, V.14 7

9 Results Florida PRAMS , Counts (%) Population Unweighted Weighted Number of Surveys 2, ,638 Women Included in the Analysis Women Recommended the Flu Shot Women that Got a Flu Shot 2, ,461 1, , (26.9%) 111,001 8

10 50 Results: Percentages Percentage of Women who Got a Flu Shot By Demographic Characteristics, FL Percent (95% CI) NH- White NH- Black Hispanic NH- Other Less than or more HS or less More than HS Married Not Married 9

11 Results: Percentages Percentage of Women who Got a Flu Shot By Maternal Characteristics, FL Percent (95% CI) Less than 44,000 44,000 or more Intended Not intended Medicaid Non-Medicaid 10

12 Results: Crude (CPR) and Adjusted Prevalence Ratio (APR) Got a Flu Shot During the 12 Months Before the Delivery CPR (95% CI) APR* (95% CI) Flu Shot Recommendation 8.54 ( )* 8.77 ( )* Adjusted for race/ethnicity, pregnancy intention, and payer source before the pregnancy. * p<

13 Results: Crude (CPR) and Adjusted Prevalence Ratio (APR) Other Factors Got a Flu Shot During the 12 Months Before the Delivery CPR (95% CI) APR* (95% CI) Non-Hispanic Black 0.61 ( )* 0.72 ( )* Pregnancy Intention (Yes) 1.47 ( )* 1.23 ( )* Adjusted for race/ethnicity, pregnancy intention, and insurance before the pregnancy. * p<

14 Results Stratum-specific Adjusted* Prevalence Ratios (APR) for the Association of Flu Recommendation and on Medicaid before Pregnancy Non-Medicaid (APR=10.7; 95% CI: ) Medicaid (APR=4.6; 95% CI: ) Medicaid 13 Adjusted for race/ethnicity, pregnancy intention, and payer source before the pregnancy. * p<0.05

15 Conclusions Women who reported receiving flu vaccination counseling during 12 months before delivery were more likely to get a flu shot While all insurance levels benefited from flu vaccination counseling, the greatest benefit was observed for women not on Medicaid 14

16 Conclusions Continued The relationship was strongest for women whose pregnancy was intended Being non-hispanic Black was associated with a lower probability of getting a flu vaccination 15

17 Limitations Self-reported data: reporting the flu vaccination may not be accurate Potential recall bias: responding in an interval of 6 to 12 months Results may not be generalizable to all women 16

18 Public Health Implications Offering or talking about the flu vaccination provides a pathway to increase flu shot application among pregnant women in Florida 17

19 References 1. Centers for Disease Control and Prevention. Influenza Vaccination in Pregnancy: Practices Among Obstetrician- Gynecologists United States, Influenza Season. MMWR. 2005;54(41): Available from: 2. Centers for Disease Control and Prevention. Flu Vaccine Safety and Pregnancy. Available from 18

20 Thank You! Contact information: 19