Pandemic influenza prevention for minority pregnant women Le

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

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

Target audience Physicians Public health agencies Obstetricians

Introduction H 1 N 1 (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

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 H 1 N 1 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 Siston et al, 2010

Triple jeopardy: Influenza, Pregnant and 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

Challenges for prevention Behavioral Psychosocial Environment

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

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

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

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: zanamivir and oseltamivir Morbidity and Mortality Weekly Report, 2010 Rasmussen, Jamieson & Bresse, 2008

Questions and Answers

References Alberta Health Services. (2009). Pandemic preparedness what is H 1 N 1? Alberta RN, 65(8), 20 -21. Available through the Walden library CINAHL database. Dodds, L. , Mc. Neill, 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 H 1 N 1 influenza vaccine coverage among pregnant women – 10 states, -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 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 H 1 N 1 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 (H 1 N 1) 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. 2009 of

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/S 0749379700002634. 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/mm 6032 a 2. 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 H 1 N 1 influenza in Madrid, Spain. Vaccine, 29, 1332 -1338.