Maternal Influenza Review Program: Identifying Barriers to Maternal Immunization

Pregnant women are at increased risk of severe illness and hospitalization resulting from influenza infection. American College of Obstetricians and Gynecologists (ACOG) and the Advisory Committee on Immunization Practices (ACIP) recommends influenza vaccination for women who will be pregnant during the influenza season, regardless of trimester. Despite this recommendation, many pregnant women remain unvaccinated and are hospitalized each year with influenza or complications from influenza. In 2013, 52% of pregnant women received a flu vaccine.

To facilitate development of strategies to reduce hospitalizations and increase influenza vaccination rates in pregnant women, ACOG conducted a four state pilot project modeled after the Fetal Infant Mortality Review (FIMR) Program focused on improving the system of care for pregnant women with influenza. The FIMR methodology is an evidence-based process that employs an in-depth look at potentially preventable events such as system failures, lack of resources, or lack of education that result in an adverse outcome, in this case pregnant women hospitalized with influenza during the 2012-13 flu season. These reviews were conducted by a coalition of health care stakeholders coordinated by the State Departments of Health in each of the four pilot locations. Each state identified several barriers to maternal influenza immunization and influenza infection treatment that may have resulted in hospitalization. Based on findings from the review of cases by the four states, ACOG has compiled recommended strategies to improve immunization rates of pregnant women. Additional work will be funded to implement many of the recommendations for system change from each state.