Influenza and Pregnancy: After 2009 H1N1

Contributed by: Sonja A. Rasmussen, MD, MS, Centers for Disease Control and Prevention, Atlanta, GA

Pregnant women have long been known to be at increased risk for severe illness from influenza.  For this reason, flu shots have been recommended for pregnant women by key professional groups for many years.  However, before the 2009 H1N1 pandemic, vaccination rates among pregnant women were low, the lowest of any of the adult groups for whom influenza vaccination was recommended.

We are now well into the first influenza season following the 2009 H1N1 pandemic.  However, we entered this flu season armed with considerably more knowledge about influenza and pregnant women than we ever had before.  The focus on influenza and pregnancy that occurred during the 2009-2010 flu season led to unprecedented collaborations between CDC and its partners in maternal and child health.  These collaborations resulted in research to better understand influenza during pregnancy.   We now know that pregnant women with influenza who are otherwise healthy can become severely ill and die, even in the 21st century.  We also now know that early treatment can prevent severe illness and death. Pregnant women with 2009 H1N1 who were treated early with antiviral medications were less likely to require admission to an intensive care unit and less likely to die.  And we have more data to show that getting a flu shot during pregnancy can protect infants from influenza for up to 6 months after birth. These babies are at high risk of complications from influenza, but the flu shot is not recommended for them because it doesn’t work well – their immune systems are too immature to respond appropriately.

Equally as important, we know more about what motivates pregnant women to get the flu shot.  Surveys conducted by CDC colleagues have shown that health care providers’ recommendations are powerful:  pregnant women whose health care providers recommended flu vaccination are much more likely to receive flu shots.  Based on this research, messages targeting pregnant women and their health care providers were developed, and these messages were disseminated in new ways – moving beyond the brochure to social media, videos, and posters.  And the great news is that these efforts paid off — recent data suggest that influenza vaccination coverage among pregnant women was higher last year than ever before.  Data from 10 states participating in the Pregnancy Risk Assessment Monitoring System (PRAMS) showed vaccination coverage during the 2009-2010 flu season for pregnant women was 50.7% for seasonal influenza and 46.6% for 2009 H1N1.  This compares to 11.3% of pregnant women receiving the seasonal flu shot during the 2008-2009 season, according to data from the National Health Interview Survey.

But how do we build on this success, now that the media attention has faded?  As professionals who care about the health of mothers and babies, we need to continue to work together to do the research and to develop and disseminate messages that work. I’d like to thank you for your continued partnership – together our efforts are making a difference in the lives of mothers and babies!

My CDC colleagues have developed influenza communications materials that target pregnant women:

  • Posters to promote flu vaccination for clinics and patient rooms:

Print posters yourself:

http://www.cdc.gov/flu/pdf/freeresources/pregnant/preg.pdf (English)

http://www.cdc.gov/flu/pdf/freeresources/pregnant/preg_esp.pdf (Spanish)

http://www.cdc.gov/flu/pdf/freeresources/pregnant/flu_pregnancy_poster_508.pdf (English)

Or order from the warehouse http://wwwn.cdc.gov/pubs/ncird.aspx (scroll down to Flu Materials/Pregnant Women)

  • Patient-friendly educational DVD movie and PSA for your waiting room:

You can preview the movie or send patients to this link: http://www.cdc.gov/CDCTV/ProtectBaby/

Order from the warehouse http://wwwn.cdc.gov/pubs/ncird.aspx (scroll down to Flu Materials/Pregnant Women)

  • Podcasts for pregnant women:

Pregnant Women: Know the Signs and Symptoms of Flu http://www2c.cdc.gov/podcasts/player.asp?f=4062255

Pregnant Women Need a Flu Shot   http://www2c.cdc.gov/podcasts/player.asp?f=4061727

Additional information about flu and pregnancy can be found below:

The findings and conclusions in this report are those of the author and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

2011
02/09
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Healthy People 2020 Launched

Healthy People is a ten year national agenda designed to improve the health and well-being of people living in United States. Today the Department of Health and Human Services launched Healthy People 2020. Healthy People 2020 was put together by professionals in several different areas to reflect how health and health care objectives have changed in the past ten years since the release of Healthy People 2010. Some of the new topics included in this plan are Adolescent Health, Early and Middle Childhood, Lesbian Gay Bisexual and Transgender Health, and Social Determinants of Health.

For a complete list of Health People 2010 topics please visit:

http://www.healthypeople.gov/2020/topicsobjectives2020/default.aspx

Along with the new goals and objectives for the next ten years, the Healthy People 2020 website was also launched. It includes the history of Healthy People, as well as a variety of tools available to understand the nation’s current health status and the ways that Healthy People 2020 will be implemented.

To view the Determinants of Health video please visit:

http://www.healthypeople.gov/2020/about/DOHAbout.aspx

During the launch, it was noted that one of the main objectives of Healthy People 2020 is to ensure health equity for everyone in the U.S. so that each individual can reach the highest attainable quality of health. Doing that will take hard work and commitment from people all around the country.

To follow the progress of Healthy People 2020 or to get involved please visit:

http://www.healthypeople.gov/2020/connect/default.aspx

2010
12/02
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March of Dimes Kicks Off Prematurity Awareness Month

Today is Prematurity Awareness Day! This year the March of Dimes celebrates their 8th annual Prematurity Awareness Month.  And to kick off today, they released the 3rd annual Report Card on Preterm Birth Rates. This report gives the United States an overall grade and compares all 50 states and Puerto Rico’s rankings from last year to this year. Report Cards are based upon many health indicators which include preterm birth (percentage of births before 37 weeks), late preterm birth (percentage of births between 34 and 36 weeks), uninsured women, and women who smoke. The “grades” on each Report Card range from A-F with A being a preterm birth rate of less than or equal to 7.6 percent and an F being a preterm birth rate of greater than or equal to 13.2 percent.

To view the full report please visit:
March of Dimes 2010 Premature Birth Report Card

The U.S. Surgeon General, Dr. Regina Benjamin appeared today alongside March of Dimes President, Dr. Jennifer Howse, at an event in Washington DC. Dr. Benjamin will also appear in a Public Service Announcement which was shown at today’s event.

To view the PSA please visit:
Surgeon General PSA 60sec (View Windows Media Video)
Surgeon General PSA 30sec (View Windows Media Video)

Each year over half a million babies are born preterm and do not make it to their first birthday. Across the country today, March of Dimes volunteers and staff will be holding candlelight vigils to raise awareness and bring attention to the continuing problem of premature birth.

For local events or for more information on how to get involved please visit:
March of Dimes Local Chapters

2010
11/17
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The Knowledge Path MCH Resource Library’s Latest Edition: Infant Mortality and Pregnancy Loss

The Georgetown University Maternal and Child Health Library has just released a new edition of the knowledge path. The knowledge path was made for health professionals, policymakers, researchers, and families as a guide for people to find resources on data analysis, research reports, and program descriptions around one MCH topic. The newest edition of the Knowledge Path is all about Infant Mortality and Pregnancy Loss. In this edition, readers can find resources to intervention strategies, attempts at lowering risk, bereavement support groups, and research on finding out the causes of infant mortality and pregnancy loss. Other sections feature resources on factors that contribute to infant mortality and pregnancy loss like birth defects, injuries, low birthweight and prematurity, and ways to lower the risk of infant mortality and pregnancy loss like preconception care, pregnancy and safe sleep environments.

To view the Knowledge Path online click http://www.mchlibrary.info/KnowledgePaths/kp_infmort.html.

A resource brief for families accompanies the Knowledge Path and is available at http://www.mchlibrary.info/families/frb_infmort.html.

The Maternal and Child Health Library provides access to current, accurate information from a full range of MCH topics. The library offers a variety of electronic resources including the MCH Alert, resource guides, databases, and other materials specifically developed for professionals and families. To view the library online, go to http://mchlibrary.info.

MCH Alert is a weekly electronic newsletter that offers the latest references to research, policy developments, recently released publications, new programs, and initiatives affecting the MCH community. To view and subscribe to MCH Alert, you can visit http://www.mchlibrary.info/alert/index.html.

2010
11/08
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NHSA Holds Congressional Briefing on Infant Mortality

On Thursday, September 23, 2010, the National Healthy Start Association held a briefing on Capitol Hill focused specifically on infant mortality. The event was titled, “Celebrate Day 366: Strategies to Reduce Infant Mortality and Ensure that Every Baby Has a Healthy Start.” Speakers at the event included NHSA Board Chair Lo Berry, NHSA Executive Director Stacy Cunningham, Congressman Steve Cohen, and representatives from the Health Resources and Services Administration and the Office of Minority Health. The second panel of speakers featured representatives from the March of Dimes, National Fatherhood Initiative and Healthy Mothers/Healthy Babies Coalition.

Over forty individuals attended the event, including Congressional staff, officials from federal agencies and representatives from other nonprofits that are committed to improved maternal and child health.  This is the first time that a briefing has been held in the U.S. Capitol specifically to discuss infant mortality and highlight successful strategies to ensure healthy pregnancies and healthy babies. NHSA is committed to playing a leadership role in highlighting the tragedy of infant mortality and educating elected leaders about the need to increase support to disadvantaged mothers, babies and families.

After Congressman Cohen provided opening remarks, Lo Berry provided an overview of Healthy Start and examples of how the Healthy Start program in Tampa, FL has succeeded in improving birth outcomes.  Stacey Cunningham highlighted the work of the National Healthy Start Association and served as moderator during the remainder of the briefing. The event concluded with a personal story offered by the Cooper family of Baltimore Healthy Start.

NHSA wishes to thank all who participated in yesterday’s successful briefing. To paraphrase the Deputy Director of the Office of Minority Health, Mirtha Beadle, the briefing was not the beginning nor end of this important work, but it was an important step in the process of eliminating racial health disparities!

2010
09/24
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NHSA Kicks off National Infant Mortality Awareness Month

Yesterday marked the first day of National Infant Mortality Awareness Month in the U.S. To commemorate the month, the National Healthy Start Association (NHSA) has launched its campaign, Celebrate Day 366…Every Baby Deserves a Chance to promote national awareness around this very critical issue.

Infant mortality refers to the number of infant deaths before the age of one and Celebrate Day 366 is a campaign to increase the public’s awareness about the issue. The campaign is an example of NHSA’s commitment to increasing the number of babies who will live beyond their first birthday. The organization is dedicated to ensuring that the nation’s most vulnerable women and families are receiving high quality services and resources for healthy pregnancies and healthy births. Infant Mortality Awareness Month is a key time to also raise public awareness about the one million babies who die each year because they are born prematurely.

Toward the end of the month, NHSA will host a briefing on Capitol Hill to discuss priorities for action in the public and private sectors that address reducing infant mortality rates and strategies to ensure that every baby has a healthy start. NHSA will inform policymakers, staffers, and the general public about the pressing need for community-based programs to reduce infant mortality, low birth-weight, and racial disparities in perinatal outcomes. Invited to provide remarks at the Congressional Briefing are U.S. Congressman Steve Cohen (D-TN); Deputy Assistant Secretary for Minority Health, Garth Graham, M.D.; Executive Director of Healthy Mothers, Healthy Babies, Judy Meehan; and President of the National Fatherhood Initiative, Roland Warren.

Throughout September, we will use the blog to share information, resources, and activities related to infant mortality and prematurity.You’ll also see a calendar of activities on the NHSA Celebrate Day 366 web page, as well as campaign resources and an updated Toolkit.

Join NHSA this month in its efforts to increase awareness and spread the word about infant mortality. Collectively, we can help save the lives of millions of babies in this country. Help us make sure every baby reaches their first birthday!

2010
09/02
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NHSA White Paper

Today, NHSA released its white paper — Federal Healthy Start Initiative: A National Network for Effective Home Visitation and Family Support Services. This document is in response to the historic legislation, Patient Protection and Affordable Care Act, which is designed to strengthen and approve home visiting programs, improve service coordination for at-risk communities, and identify and provide comprehensive evidence-based home visiting services to families that reside in at-risk communities.  The white paper showcases the strengths and competencies of the federal Healthy Start Initiative, making certain that funders, legislators and other potential supporters know that Healthy Start represent a “shovel ready” network that can offer an array of core services provided through evidence-based and promising home visitation practices.

The recent health reform legislation and the federal Healthy Start Initiative are aligned as both a strategy and response for the delivery of key provisions for addressing the health and health care needs of women and families.  Federal Healthy Start represents a network with 20 years of experience and cultural authenticity to assist in serving underserved and marginalized communities throughout our nation.  The 104 federal Healthy Start sites around the U.S. are well-positioned to play a crucial role in the national effort to build quality, comprehensive, state-wide early childhood systems for pregnant women, parents, caregivers, and children from birth to eight years of age and, ultimately, to improve health outcomes.

You can visit this link to obtain full access to the PDF version of the paper – http://healthystartassoc.org/NHSA_WhitePaper.pdf

2010
08/16
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