Pregnant Women

Pregnant women were at high risk for developing complications from 2009 H1N1 and were disproportionately represented among hospital and intensive care unit cases and mortality related to 2009 H1N1. They were also one of the ACIP target groups, yet vaccine uptake in this group varied across the nation. Pregnant women and their physicians had many questions and concerns about vaccine safety during pregnancy. “Even with all the information out there about how it was so important and it was safe during pregnancy, and how it was made in the same fashion as a seasonal vaccine, some of the private practitioners had a lot of issues getting their pregnant women to take it,” said Sheffield of the Maternal–Fetal Medicine Fellowship at the University of Texas. Complicating matters, many OB/GYNs referred patients to their primary-care physicians because they do not routinely give seasonal flu vaccinations, but primary-care physicians referred women back to the OB/GYNs because they were unsure about vaccinating pregnant women.

Public health authorities, medical associations, and the OB/GYN provider community should work together, participants said, to improve vaccination rates for pregnant women by ensuring that influenza vaccine is routinely recommended for pregnant women and “institutionalizing” access to vaccine where obstetrical care is provided. Three concrete suggestions were made: (1) Use electronic standing orders (“opt out”) and automatic “best practice” alerts in electronic medical records for pregnant women; (2) educate healthcare providers about the safety and importance of vaccinating pregnant women so that they are more likely to encourage their patients to be vaccinated; and (3) increase the number of OB/GYNs who provide seasonal influenza vaccine to their patients and make vaccination a regular part of their practice.

To increase vaccine uptake in its pregnant population, the University of Texas Southwestern Medical Center developed a best practice alert within its electronic medical record system. Each time a healthcare provider opened the patient’s chart, he or she received an alert asking, “Have you offered H1N1 vaccine?” The provider was required to answer yes or no. If no was checked, the provider had to enter an explanation. This questioning enabled the organization to track the percentage of patients vaccinated and the reasons why vaccinations did not occur. The same system was used for the seasonal influenza vaccine. A benefit of the best practice alert was increased awareness among healthcare providers. Kim Boggess, assistant professor of obstetrics and gynecology at the



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