Pandemic influenza prevention for minority pregnant women

1. Pandemic influenza prevention for minority pregnant women LeShonda Wallace, PhD Student Walden University PUBH 8165 -1 Instructor: Dr. Robert Marino Fall, 2011

2. Objectives • After this presentation, you will be able to • Describe potential affects from influenza infection for pregnant women • Identify risk factors for minority pregnant women to influenza morbidity and mortality • Identify challenges to prevention of influenza among minority pregnant women • Identify safe vaccine and treatment options of influenza for pregnant women • Implement prevention and early treatment strategies to reduce minority pregnant women morbidity and mortality associated with influenza

3. Target audience • Physicians • Public health agencies • Obstetricians

4. Introduction • H1N1 (swine flu) is a virus that spreads from person to person by transmission of droplets from sneezing, coughing and contact with contaminated surfaces. • Risks for high disease severity include chronic illness, immune compromise & pregnant women. Although pregnant women are not more likely to get the flu than others, they may suffer from a greater severity of the illness. • Minority pregnant women tend to be effected by the disease prevalence at a disproportionately higher rate than others. The best protection against swine flu and disease severity is prevention. • Prevention includes vaccination, hand washing, treatment with antivirals within 48 hours of diagnoses and protection against exposure. Antiviral treatment is safe for pregnant women. Alberta Health Services, 2009

5. Significance • Pregnancy changes the immune, cardiovascular and respiratory systems and this creates health risk vulnerability for expectant mothers • Pregnant women comprise 1% of the US population but made up 5% of the deaths for H1N1 in 2009 • In delayed treatment, there is a higher acuity of illness (ICU admission 57%) or death (80%) • Increased death risk associated with third trimester illness (64%) • Adverse pregnancy outcomes Rasmussen, Jamieson & Bresse, 2008 Sistonet al, 2010

6. Triple jeopardy: Influenza, Pregnant and Minority • Minority pregnant women comprised more than half of reported influenza illnesses in 2009 • Chronic illness • Diabetes • Asthma • Anemia • HTN • Obesity Centers for Disease Control and Prevention, 2010 Dodds et al, 2007 Siston, et al, 2010 Umar, 2010

7. Challenges for prevention • Behavioral • Psychosocial • Environment

8. Behavioral challenges • Black women are less likely to get vaccinated (when they do consider, access may be an issue) • Discrimination by healthcare providers • General practitioners' ambivalence • Social distancing noncompliance during illness Quinn, Kumar, Freimuth, Musa, Casteneda-Angarita & Kidwell, 2011

9. Psychosocial challenges • Mistrust • Misconception CDC, 2010 Jones, Ingram, Craig & Schaffner, 2004

10. Environmental challenges • Caregivers • Metropolitan areas • Doctor visits Nandor, Ferenc, Erzsebet, & Andrew, 2006 Quinn et al, 2011

11. Prevention • Primary • Vaccinate: inactivated influenza vaccine • Infection control: hand washing, covering coughs/sneezes, isolation(separate waiting areas, face masks) • Education: vaccine safety, tailor the message • Secondary • Diagnose and treat early • Safe Antivirals: zanamivirand oseltamivir Morbidity and Mortality Weekly Report, 2010 Rasmussen, Jamieson & Bresse, 2008

12. Questions and Answers

13. References Alberta Health Services. (2009). Pandemic preparedness what is H1N1? Alberta RN, 65(8), 20-21. Available through the Walden library CINAHL database. Dodds, L., McNeill, S., Fell, D., Allen, V., Coombs, A., Scott, J. & Macdonald, N. (2007). Impact of influenza exposure on rates of hospital admissions and physician visits because of respiratory illness among pregnant women. Canadian Medical Association, 176 (4), 463-468. Available through the Walden library CINAHL database. Jones, T., Ingram, A., Craig, A. & Schaffner, W. (2004). Determinants of influence vaccination, 2003-2004: shortages, fallacies and disparities. Clinical Infectious disease, 2004 (39), 1824-1828. Available through the Walden library CINAHL database. Morbidity and Mortality Weekly Report. (2010). Seasonal influenza and 2009 H1N1 influenza vaccine coverage among pregnant women – 10 states, 2009-10 influenza season. MMWR 59 (47), 1541-1545. Available through the Walden library CINAHL database. Mouzoon, M., Munoz, F., Greisinger, A., Brehm, B., Wehmanen, O., Smith, F., Markee, J., & Glezen, P. (2010). Improving influenza immunization in pregnant women and healthcare workers. American Journal of Managed Care, 16 (3), 209-216. Available through the Walden library CINAHL database. Nandor, A., Ferenc, B., Erzsebet, P., & Andrew, C. (2006). Pregnancy complications and delivery outcomes of pregnant women with influenza. Journal of Maternal-Fetal Medicine and Neonatal Medicine, 19 (3), 135-140. Available through the Walden library CINAHL database. Pratt, R. (2009). Pandemic influenza: The primary care challenge. Vaccination, 19 (9), 16-21. Available through the Walden library CINAHL database. Quinn, S., Kumar, S., Freimuth, V., Musa, D., Casteneda-Angarita, N. & Kidwell, K. (2011). Racial disparities in exposure, susceptibility, and access to health care in the US H1N1 influenza pandemic. American Journal of Public Health, 101 (2), 285-293. Available through the Walden library CINAHL database. Rasmussen, S., Jamieson, D., & Bresee, J. (2008). Pandemic influenza and pregnant women. Emerging infectious diseases, 14(1), 95-100. Available through the Walden library CINAHL database. Siston, A., Rasmussen, S., Honein, M., Fry, A., Seib, K., Callaghan, W., Louie, J., Doyle, T., Crockett, M., Lynfield, R., Moore, Z., Wiedeman, C., Anand, M., Tabony, L., Nielsen, C., Waller, K., Page, S., Thompson, J., Avery, Ca., & Springs, C. (2010). Pandemic 2009 influenza (H1N1) virus illness among pregnant women in the United States. Journal of the American Medical Association, 303 (15), 1517-1525. Available through the Walden library CINAHL database. Umar, K. (2010). Diabetes during pregnancy: women of color at increased risk.Closing the Gap, Sept-October, 16-18. Available through the Walden library CINAHL database.

14. Sources for further reading • Berlin, M., Schwartz, S., Propert, K., & Ubel, P. (2011). Barriers to influenza immunization in a low-income urban population. American Journal of Preventive Medicine, 20(1), pg 21-25. Retrieved from http://www.sciencedirect.com/science/article/pii/S0749379700002634. • Centers for Disease Control and Prevention. (2011). ACIP Recommendations. Retrieved from http://www.cdc.gov/vaccines/pubs/ACIP-list.htm#flu. • Centers for Disease Control and Prevention. (2011). Pregnancy and influenza vaccine safety. Retrieved from http://www.cdc.gov/vaccinesafety/Concerns/pregnancy_influenza.html. • Morbidity and Mortality Weekly Report. (2011). Influenza vaccine coverage among pregnant women: United States 2010-11 influenza season. Morbidity & Mortality Weekly Report, 60(32), pg 1078-1082. Retrieved from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6032a2.htm. • Rodriguez-Rieiro, C., Esteban-Vasallo, M., Domingues-Berjon, M., Astray-Mochales, J., Iniesta-Fornies, D., Barranco-Ordonez, D., Cameno-Heras, M. & Jimenez-Garcia, R. (2011). Coverage and predictors of vaccination against 2009 pandemic H1N1 influenza in Madrid, Spain. Vaccine, 29, 1332-1338.