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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 21^st 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

• Educational flyer for patients (ready to print in your office): http://www.cdc.gov/flu/pdf/freeresources/pregnant/flushot_pregnant_Factsheet.pdf

Additional information about flu and pregnancy can be found below:

• Vaccine recommendations for the 2010-2011 season http://www.cdc.gov/flu/professionals/acip/

• Antiviral recommendations for pregnant women for the 2010-2011 season http://www.cdc.gov/flu/professionals/antivirals/avrec_ob2011.htm

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.