Flu Shot Reminders for Pregnant Women Should Be Diverse and Repeated

All pregnant women, plus those planning to become pregnant during the influenza season, should receive an inactivated influenza vaccine, according to the American College of Obstetricians and Gynecologists and the CDC’s Advisory Committee on Immunization Practices.

An online survey by the CDC in 2013-2014 found that only 49.4% of pregnant women received an influenza vaccination. The most common reason given for refusing vaccination was safety concerns.

Influenza vaccination uptake is poorer among pregnant black patients than pregnant white patients, even though black patients experience higher rates of influenza-related morbidity, mortality, and hospitalizations. Unfortunately, reducing cost and access barriers hasn’t affected racial and ethnic disparities.

Now, an article published ahead-of-print in Human Vaccines & Immunotherapeutics indicates that one-time educational interventions ineffectively induce influenza vaccination in patients with low or no vaccination history.

The researchers recruited pregnant black women aged 18 to 50 years for a prospective, randomized, controlled trial conducted from January to April 2013. The study randomized the women to 3 arms that delivered different messages: affective messaging, cognitive messaging, or comparison condition (standard of care).

No single method of vaccination education can impact deeply held vaccine beliefs. Less than 13% of participants were vaccinated, and less than 39% reported that they would be vaccinated during a future pregnancy.

Settings that didn’t provide routine vaccines exaggerated the low vaccine uptake. Practices that regularly experienced resistance to vaccination were also less inclined to stock adequate supplies of vaccines.

The message from this study is something all health care practitioners need to know and heed: providers need to normalize maternal immunization through repeated, diverse communication. Patients respect their OB/GYNs’ opinions, and these providers may be best positioned to provide vaccines.

Bottom line: repeated, targeted, persuasive messaging is necessary to increase influenza vaccination in pregnant women who decline immunizations.