Are Pregnant Women in Nebraska Getting Vaccinated?

Maternal Child Health Topics in Nebraska Figure 1: Percent of women who received Are Women Getting the Influenza/Flu Vaccine? Figure 1.the Percent flu shot ofin thewomen 12 months who received prior to a the flu shot in the 12 months prior to a recent live birth Vaccines help protect an unborn baby and are safe to recent live birth administer during pregnancy. 100 90 75.5 The inactivated influenza vaccination can be 80 70.9 70.6 73.4 70.8 administered at any time during pregnancy. Flu season 70 begins in early fall and lasts into January or later. 60 50 Women who are or will be pregnant during influenza 40 1 season should receive the vaccine. 30 20 Obstetricians and gynecologists are encouraged to stock 10 and administer the influenza vaccine to their pregnant 0 patients in their offices and should get the vaccine 2014 2015 2016 2017 2018 themselves every season.2 Source: Nebraska PRAMS, 2014-2018

Vaccination rates are increasing in Nebraska. Between 2014 and 2018 flu shot receipt increased by 5%. About 800 more pregnant women received the vaccine each year compared to five years earlier. In 2018, 70.8% of women got a flu shot before or during their most recent pregnancy.

Disparities in Influenza Vaccination Overall, 16.2% fewer women reported receiving Figure 2.Figure Percent 2. Percent of women of women who were who wereoffered offered a flu a flu a flu shot than being offered a flu shot. shot andshot percent and percent of women of women who receivedwho received a flu a flushot shot in the 12 months, among women with a recent birth in the 12 months, among women with a recent birth Women in poverty report being offered and

Total 73.2 receiving the flu shot less often than women 89.4 above 194% of the federal poverty level. Under 194% of FPL 1 69.5 85.4

1 Status 81.9 All women should be advised to get a flu shot Poverty Over 194% of FPL 94.3 during or before pregnancy. 30 and Older 75.2 91.1

20 to 29 70.6 Age 88.2 Concerns About Getting a Flu Shot 19 and Younger 80.6 84.6 ● “I don’t normally get a seasonal flu shot.” - 75%

Hispanic 75 86.6 ● “I was worried about side effects of the

Asian/Pacific Islander 78.6 seasonal flu shot for me.” -46% 87.5 ● “I was worried that the seasonal flu shot might Native American 65.5 90.7 Race harm my baby.” - 44% Black 66.4 88.9 ● “My doctor didn’t mention anything about a White 73.4 seasonal flu shot during my pregnancy.” - 90.2 31% 50 55 60 65 70 75 80 85 90 95 100 ● Other reason - 28% Flu shot received Flu shot offered/advised Source: Nebraska PRAMS, 2009-2010 Source: Nebraska PRAMS, 2017-2018 1. Poverty status is indicated by 194% of the federal poverty level as this is the threshold for qualifying for Medicaid during pregnancy/ delivery in Nebraska. Are Pregnant Women in Nebraska Getting Vaccinated?

Maternal Child Health Topics in Nebraska

Are Women Getting the Whooping Cough Vaccine? All pregnant women should receive a tetanus toxoid, reduced diphtheria toxoid and acellular pertussis (Tdap) vaccine during each pregnancy, as early in the 27–36 weeks-of-gestation window as possible.3 Obstetrician–gynecologists and other obstetric care providers play a critical role in ensuring that pregnant women receive recommended vaccines. When vaccines are recommended and made available directly from a woman’s obstetrician or other obstetric care provider, the odds of vaccine acceptance and receipt during pregnancy are 5-fold to 50-fold higher.4 Routinely assess pregnant patients’ vaccination status and, based on this assessment, recommend and (when possible) administer needed vaccines to pregnant patients. Other vaccines may be recommended during pregnancy depending on a patient’s age, prior immunizations, comorbidities, or disease risk factors.

Disparities in Tdap Vaccination Coverage Women with lower receipt of the Tdap Figure 3. Percent of women who received a Tdap vaccine during pregnancy may need Figure 3. Percent of women who received a Tdap vaccination, among women with a recent birth additional outreach, education, and service vaccination, among women with a recent birth to encourage essential vaccination. Overall 86.8

1 Under 194% of FPL 84.4

1 Status Pregnancy and Vaccinations: Poverty Over 194% of FPL 91.1 https://www.cdc.gov/vaccines/pregnancy/ 30 and older 86.3 hcp-toolkit/index.html

20 to 29 87.3 Age Resources for Patient Education: 19 and younger 86.7 https://www.cdc.gov/vaccines/pregnancy/ hcp-toolkit/resources-patient-education. Hispanic 84.9 html Asian/Pacific Islander 82.8 Nebraska Pregnancy Risk Assessment Native American 85.3 is an

Race Monitoring System (PRAMS)

Black 86 ongoing population-based surveillance system of maternal behavior and White 87.5 experiences before, during, and shortly 50 55 60 65 70 75 80 85 90 95 100 after pregnancy. The data presented

in this publication are based on 6,521 Source: Nebraska PRAMS, 2017-2018 completed surveys representing Nebraska References: mothers who gave birth to live infants 1. CDC. General recommendations on immunization: recommendations of the Advisory between 2014-2018. PRAMS data are Committee on Immunization Practices (ACIP). MMWR 2011; 60 (No. 2): 26. 2. Influenza vaccination during pregnancy. ACOG Committee Opinion No. 732. American self-reported. College of Obstetricians and Gynecologists. Obstet Gynecol 2018;131:e109–14. 3. Maternal immunization. ACOG Committee Opinion No. 741. American College of For more information, visit www.dhhs.ne.gov/ Obstetricians and Gynecologists. Obstet Gynecol 2018;131:e214–7. PRAMS 4. Ahluwalia IB, Jamieson DJ, Rasmussen SA, D’Angelo D, Goodman D, Kim H. Correlates of seasonal influenza vaccine coverage among pregnant women in Georgia and Rhode Island. Obstet Gynecol 2010;116:949–55. PH-OTH-36 1/2020