American Journal of Preventive Medicine
April 2016 Volume 50, Issue 4, p427-552, e91-e122
http://www.ajpmonline.org/current

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Research Articles
Influenza Vaccination During Pregnancy: Influenza Seasons 2002–2012, Vaccine Safety Datalink
Holly C. Groom, Michelle L. Henninger, Ning Smith, Padma Koppolu, T. Craig Cheetham, Jason M. Glanz, Simon J. Hambidge, Lisa A. Jackson, Elyse O. Kharbanda, Nicola P. Klein, Natalie L. McCarthy, James D. Nordin, Eric S. Weintraub, Allison L. Naleway
p480–488
Published online: October 30 2015
Abstract
Introduction
Pregnant women are at risk for influenza-related complications and have been recommended for vaccination by the Advisory Committee on Immunization Practices (ACIP) since 1990. Annual rates of influenza coverage of pregnant women have been consistently low. The Vaccine Safety Datalink was used to assess influenza vaccine coverage over 10 consecutive years (2002–2012); assess patterns related to changes in ACIP recommendations; identify predictors of vaccination; and compare the results with those published by national U.S. surveys.
Methods
Retrospective cohort study of 721,898 pregnancies conducted in 2014. Coverage rates were assessed for all pregnancies and for live births only. Multivariate regression analysis identified predictors associated with vaccination.
Results
Coverage increased from 8.8% to 50.9% in 2002–2012. Seasonal coverage rates increased slowly following the 2004 ACIP influenza vaccine recommendation (to remove the first trimester restriction), but spiked significantly during the 2009 H1N1 influenza pandemic. Significant predictors of vaccination during pregnancy included older age; vaccination in a previous season; high-risk conditions in addition to pregnancy; pregnancy during either the 2004–2005 or 2009–2010 seasons; entering the influenza season after the first trimester of pregnancy; and a pregnancy with longer overlap with the influenza season (p Conclusions
Influenza vaccination coverage among pregnant women increased between the 2002–2003 and 2011–2012 seasons, although it was still below the developmental Healthy People 2020 goal of 80%. The 2004 ACIP language change positively impacted first-trimester vaccination uptake. Vaccine Safety Datalink data estimates were consistent with U.S. estimates.

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Current Issues
Understanding Vaccine Refusal: Why We Need Social Media Now
Mark Dredze, David A. Broniatowski, Michael C. Smith, Karen M. Hilyard
p550–552
Published online: December 2 2015
Preview
The recent Disneyland measles outbreak brought national attention to a growing problem: vaccine refusal—herd immunity is no longer a reality in many communities. Only 70% of children aged 19–35 months are up-to-date on immunizations,1 and in some communities, more than a quarter of school-age children have exemptions on file (www.doh.wa.gov/Portals/1/Documents/Pubs/348-247-SY2014-15-ImmunizationMaps.pdf). Although they vary across the ideological spectrum, vaccine refusers tend to be well educated, white, and more affluent than people who typically experience health disparities.