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Thursday, 1 September 2011

[CDC, Office of Women's Health, Health Matters for Women] Liquid-based Cytology Test Use by Office-based Physicians: United States, 2006?2007

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Source: http://www2c.cdc.gov/podcasts/download.asp?af=h&f=8123212

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Erectile Dysfunction And Inability To Orgasm

Main Category: Erectile Dysfunction / Premature Ejaculation
Also Included In: Sexual Health / STDs;��Men's health;��Urology / Nephrology
Article Date: 25 Aug 2011 - 0:00 PDT

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For men with erectile dysfunction (ED), 65 percent are unable to have an orgasm and 58 percent have problems with ejaculation, according to new research led by physician-scientists at NewYork-Presbyterian Hospital/Weill Cornell Medical Center.

The study followed 12,130 men with mild to severe ED and is the largest-ever analysis of orgasmic and ejaculatory dysfunction. Results are published in the British Journal of Urology International.

Approximately 30 million American men, or half of all men aged 40 to 70, have trouble achieving or sustaining an erection. "While medications like Viagra or Cialis have been successful in helping many of these men, our research suggests there are other common sexual issues that remain largely unaddressed," says Dr. Darius Paduch, the study's lead author; male sexual medicine specialist at NewYork-Presbyterian Hospital/Weill Cornell Medical Center; and assistant professor of urology and reproductive medicine at Weill Cornell Medical College.

"We must expand the definition of quality of life when it comes to sexual performance," Dr. Paduch adds. "For the last few decades, we have focused on penile rigidity, with erection as a synonym of normal sexual function. However, many patients say that problems with ejaculation -- like decreased force or volume or decreased sensation of orgasm -- are just as critical.

"Despite the frequency of these issues, non-erectile sexual dysfunction is underreported and undertreated due to social stigma and misunderstandings about the physiology of male sexual response and orgasmic dysfunction in particular. For decades it was believed that only women had problems with orgasm; our study shows that orgasmic dysfunction could be as prevalent among men as it is among women."

While severity of dysfunctional ejaculation and orgasm correlated with ED severity, says Dr. Paduch, these issues were still surprisingly common in men with very mild ED: Orgasm dysfunction was reported by 26 percent in this group, and ejaculation dysfunction by 18 percent. "This suggests that non-erectile sexual dysfunction is a regular occurrence even in men without ED."

The study reported factors associated with increased risk of ejaculatory and orgasmic dysfunction which includes commonly prescribed antidepressant medications. Ejaculatory and orgasmic dysfunction can be caused by low testosterone and minor brain injury such as that sustained by motor vehicle accident victims, football players suffering from concussion, or by soldiers with combat-related blast head injuries.

The most common ejaculatory dysfunction is premature ejaculation, but the condition also describes delayed ejaculation, inability to ejaculate, painful ejaculation, retrograde ejaculation, as well as a reduced volume of ejaculate or diminished force of ejaculation. Orgasm dysfunction is defined as absence of an orgasm.

In the current study, Dr. Paduch and Alexander Bolyakov, a research associate at Weill Cornell Medical College, in collaboration with a research team from Eli Lilly and Company, analyzed questionnaires from 28 clinical trials of men with mild to moderate erectile dysfunction from a diverse, international cohort of patients enrolled in clinical trials for tadalafil (Cialis).

The study was supported by an educational grant from Eli Lilly and Company. Dr. Paduch and Bolyakov are paid investigators and/or consultants/advisers/speakers for the study sponsor. Additional co-authors included Dr. Anthony Beardsworth and Steven D. Watts -- both from Eli Lilly.

Going forward, Dr. Paduch and Bolyakov will use uniquely specialized equipment available in their lab at Weill Cornell to measure biological and subjective changes that occur in men during orgasm and ejaculation. They will look at whether testosterone-replacement therapy can help men who suffer from non-erectile sexual dysfunction.

"Sexual satisfaction is known to be linked to the likelihood of orgasm, which in turn affects emotional intimacy and relationship satisfaction. The high prevalence of both orgasmic and ejaculatory dysfunction warrants further clinical and translational research into new treatments to improve sexual health and overall quality of life for hundreds of thousands of affected men and their loved ones," says Dr. Paduch.

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Source: http://www.medicalnewstoday.com/releases/233270.php

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You've Lost Weight, But Can You Keep It Off?

The Associated Press reports that a study published earlier this year in the New England Journal on a small European study can help you learn how to best keep off lost pounds.

If you've ever been on a weight loss diet, then you probably have experienced the difficulty of? keeping off lost pounds. Maintaining weight loss is often an incredible roller coaster ride with your scale going up and down.

So what does it take to keep off lost pounds?

The researchers, in this study,? looked at 773 overweight and obese adults who had families. The participants were from eight countries in Europe. Each of the 773 adults lost an average of 24 pounds after spending two months on a low fat diet prior to participating in the study. The families of the participants were included because researchers believed it would help the overweight and obese family members stick to their assigned weight loss maintenance diets.

One of five different weight loss maintenance diets was assigned to each study participant. Each of four different diets were a combination of high or low amounts of protein and carbs. A fifth diet was used as a control diet. This diet was a combination of moderate protein with no restriction on carbs.

Study participants received counseling, recipes, and cooking tips. There were no restrictions on the amount of food eaten on any of the five diets. Participants were instructed to keep food diaries, and gave periodic blood and urine samples for laboratory evaluation.

After six months on the weight loss maintenance diets, only one group was able to not only keep the lost weight off, but lose additional pounds. This group was the one that was assigned a high protein, low carb diet.

The weight loss maintenance group assigned a low protein, high carb diet regained a significant amount of weight at almost 4 pounds.

The high protein, low carb group also had far fewer dropouts than all of the other diet groups who had significant numbers of dropouts. The researchers believe the difficulty with dropouts was caused by problems keeping families motivated.

While this study is promising and offers more hope to yo-yo dieters who find it not so hard to lose the weight, but often impossible to maintain weight loss. However, more studies with larger groups is necessary before any firm conclusions can be reached.

Have you been able to maintain weight loss long term? How have you done it?

10 Steps For Healthy And Permanent Weight Loss

Source: http://womenshealth.about.com/b/2011/08/26/keeping-off-lost-pounds.htm

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Gene Mutation Found in Uterine Fibroids

Discovery May Lead to Targeted Therapies for These Common, Benign Tumors

By Matt McMillen
WebMD Health News

Reviewed by Laura J. Martin, MD

Latest Womens Health News

Aug. 25, 2011 -- Mutations in a single gene MED12 occur in about 70% of uterine fibroids, Finnish researchers find.

"This is a giant step toward understanding why fibroids arise -- but toward design of targeted therapies it is a very early step," study leader Lauri A. Aaltonen, MD, PhD, of the University of Helsinki, says in a news release. "Let's hope that this journey has begun."

Fibroids, also known as leiomyomas, are noncancerous growths of the uterus. As many as 60% of women develop fibroids by age 45.

In about half of all cases, fibroids cause problems. This may be because of their size, their location in the uterus, or the number of fibroids. Symptoms can include abnormal vaginal bleeding, painful menstruation, abdominal pain, and pain during sex. They can also lead to infertility. Fibroids are the most common reason for hysterectomy -- surgical removal of the uterus.

Previous research has linked several genetic changes to fibroids. But these occur only in a minority of cases, so Aaltonen's team searched for much more common genetic alterations.

They examined 18 fibroids collected from 17 patients. Using a technique called exome sequencing, they compared all protein-coding genes in the fibroids to those of normal tissue. Ten of those 18 fibroids displayed a mutation.

When the researchers examined an additional 207 fibroids from 80 patients, their analysis confirmed the "striking frequency" of the genetic mutations of MED12. Based on their findings, they conclude that such mutations likely play a key role in the development of fibroids.

Their findings appear in today's online issue of the journal Science.

SOURCES: M�kinen, N. Science, published online Aug. 25, 2011.News release, University of Helsinki.American Congress of Obstetricians and Gynecologists: "Uterine Fibroids." �2011 WebMD, LLC. All Rights Reserved.

Source: http://www.medicinenet.com/guide.asp?s=rss&a=148688&k=Womens_Health_General

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Women gain weight after marriage, men after divorce

Dmitry Tumin of Ohio State University, who led the study, said: ?Clearly, the effect of marital transitions on weight changes differs by gender.

?Divorces for men and, to some extent, marriages for women promote weight gains that may be large enough to pose a health risk.?

The impact was greatest on older people because a marriage or divorce comes as a greater shock later in life, he added.

The study, to be presented at the annual meeting of the American Sociological Association in Las Vegas today [AUG 22], says it is not clear why men?s and women?s waistlines respond differently to marriage and divorce.

But Prof Zhenchao Qian, one of the researchers, said: ?Married women often have a larger role around the house than men do, and they may have less time to exercise and stay fit than similar unmarried women.

?On the other hand, studies show that married men get a health benefit from marriage, and they lose that benefit once they get divorced, which may lead to their weight gain.?

Source: http://telegraph.feedsportal.com/c/32726/f/568409/s/178fa808/l/0L0Stelegraph0O0Chealth0Cwomen0Ishealth0C87116140CWomen0Egain0Eweight0Eafter0Emarriage0Emen0Eafter0Edivorce0Bhtml/story01.htm

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High blood pressure to be tested 'at home'

?Patients thought to have high blood pressure should have the diagnosis confirmed at home,? reported BBC News. Many newspapers covered the introduction of a new, more accurate way of diagnosing people with hypertension (high blood pressure).

The Daily Telegraph said that current diagnostic methods result in millions of people being misdiagnosed every year. The newspaper said that ?about a quarter of people become anxious while they have their blood pressure taken in the surgery, meaning they potentially give a misleading reading?.

The news stories are�of new guidance from the National Institute for Clinical Excellence (NICE), which recommends that new technology is used to confirm a diagnosis of high blood pressure.

The technology, known as Ambulatory Blood Pressure Monitoring (ABPM) automatically measures a person?s blood pressure throughout the course of a day. It has been evaluated as more accurate and better value-for-money compared to clinic-based measurements or home-based measurements for which the person must remember to measure their own blood pressure.

NICE has produced guidance for people with high blood pressure and their carers. People currently taking treatment for high blood pressure should consult their GP before making any changes to their treatment plan.

�

What are the news stories based on?

These news stories are based on updated NICE guidelines on the diagnosis and treatment of high blood pressure. The guidelines not only suggest the introduction of ABPM but also make several other recommendations for the diagnosis and treatment of blood pressure, details of which can be found within�the guidelines themselves.

The guidance was put together using evidence from many studies, including data from a cost effectiveness study published this week in The Lancet, which assessed the value-for-money of three types of confirmatory diagnostic tests: clinic-based, home-based and ambulatory blood pressure monitoring. This study found that not only did ABPM result in cost savings, but also provided better value for money in terms of health outcomes.

�

What is the new technique for measuring blood pressure?

NICE recommends the introduction of a system called ambulatory blood pressure monitoring (ABPM). This involves a device that is given to patients who have been given an initial high blood pressure reading at the clinic. The patient then wears the device for the following 24 hours, during which it� monitors their blood pressure in non-clinical settings, such as at home.

People who find ABPM too uncomfortable or inconvenient may be offered home blood pressure monitoring instead, which involves a different device.

�

Why is the new technique being introduced?

ABPM aims to provide a more accurate measurement of a person?s blood pressure, as it takes measurements throughout the day in normal settings. It is thought that many people (up to a quarter) who are diagnosed with high blood pressure in a clinical setting do not actually meet the definition of hypertension. Instead, the high reading is the result of the temporary stress of visiting the doctor (called ?white coat? hypertension). By confirming the diagnosis of high blood pressure with ABPM, the idea is that only those who truly need treatment will be offered it.�

�

What does the monitoring device involve?

Following an initial high blood pressure reading at the clinic, a person with suspected hypertension will be given the ABPM device to take away with them. The device will involve an arm cuff that is fitted to the person?s arm and attached to a monitoring device worn at the waist. The doctor or nurse will make sure the device is fitted to your arm correctly. The device automatically takes BP measurements every 30 minutes, for 24 hours. An average of at least 14 of these measurements taken during normal waking hours is then used to provide a general measurement of a person?s blood pressure.

The home blood pressure monitoring device is similar to the one that the doctor or nurse uses to take blood pressure at the surgery. Using this technique, two measurements are taken a day, once in the morning and once in the evening. Your GP will make sure that the device fits your arm correctly, and they will instruct you on how to use the device.

�

How is high blood pressure currently diagnosed?

Currently, high blood pressure is diagnosed in a clinical setting, such as a doctor?s surgery. After an initial high blood pressure reading, patients have their BP taken again at two subsequent doctor visits. If these readings are also high, the person is diagnosed with high blood pressure.

It is thought that about a quarter of these diagnoses are inaccurate, and the result of ?the white coat effect?. This effect is seen when people who do not exhibit high blood pressure in their daily lives have high readings due to the stress of visiting the GP (see box below).

Evidence shows that confirming clinical BP measurements with ABPM improves the accuracy of the diagnosis.

�

What are the benefits of the new method?

The authors of the cost effectiveness study say that benefits of the use of ABPM in the diagnosis of high blood pressure include quicker and more accurate diagnosis, fewer patients taking unnecessary medication, improved health outcomes and health-related quality of life, and reduced prescription drug costs for both individuals and the NHS.

The NICE Cost Report says that in addition to reductions in money spent on drugs, additional resources, such as physician time, will be saved, as fewer appointments will be required for diagnosis and treatment.

In addition to quicker diagnosis and avoidance of unnecessary medication and side effects, the use of ABPM is predicted to lead to financial savings. The cost effectiveness study and the NICE guideline development group predicted that the costs of changing the way that blood pressure is diagnosed would be returned in a few years.

Much of the estimated cost savings are the result of avoiding unnecessary drug treatments due to the improved accuracy of ABPM. The NICE Cost Report, which accompanies the new guideline, estimates the total national cost for England to be �5.1m per year. By the fifth year of full implementation, they estimate annual savings of �10.5m. These are estimates based on the best available data, and are not considered to be conclusive.

Additionally, these savings are based on the current proportion of people in the country with suspected high blood pressure. If that proportion continues to increase, due to the ageing population and lifestyle factors, the total cost of diagnosing and treating hypertension will increase as well. The Cost Report takes care to point out that this would occur if current diagnostic practices were to continue, and that use of ABPM should still result in cost savings over clinic-based blood pressure monitoring.

�

Who will be given the new type of BP monitoring?

The guidelines recommend that people who have blood pressure readings of 140/90 mmHg or higher should be offered ABPM in order to confirm the diagnosis. If ABPM does not confirm the diagnosis, the guidelines suggest that the person?s blood pressure is checked again at least every five years. People should have their blood pressure checked more often if their ABPM indicates that their blood pressure is close to the 140/90 mmHg threshold.

�

When will the new monitoring start?

It is up to individual surgeries to decide when they introduce the NICE guideline. Sufficient supplies of the monitoring devices will need to be ordered, and GP surgeries will need to ensure that adequate training is completed before offering the monitoring to their patients.

NICE provides support information for GPs to help them implement the guideline. Newspapers suggest that this may take up to a year to implement nationwide, and that individual patients currently being treated for high blood pressure will be offered ABPM during their regular check-up.

�

Where can I get more information?

Additional information of this new guideline can be found in the NICE guidance written for patients and carers.

In addition, people currently receiving treatment for high blood pressure who think that the reading may have been inaccurate should consult their GP before making any changes to their treatment plan.

More information on the management and treatment of high blood pressure can be found in the Health A-Z.

Links To The Headlines

Blood pressure guidelines revised in England and Wales.�BBC News, August 24 2011

Go home for your blood pressure test to avoid 'waiting room nerves', patients told.�Daily Mail, August 24 2011

Blood pressure test changes expected to cut misdiagnoses.�The Guardian, August 24 2011

Blood pressure testers not fit for purpose.�The Independent, August 24 2011

Home checks for high blood pressure.�The Daily Telegraph, August 24 2011

Home blood pressure tests 'might give better results'.�BBC News, August 24 2011

Links To Science

Lovibond K, Jowett S, Barton P et al.�Cost-effectiveness of options for the diagnosis of high blood pressure in primary care: a modelling study. The Lancet 2011, Early Online Publication, August 24

Hypertension: management of hypertension in adults in primary care.�NICE 2011

Source: http://www.nhs.uk/news/2011/08August/Pages/high-blood-pressure-test-home.aspx

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[CDC, Office of Women's Health, Health Matters for Women] Influenza Vaccination Coverage Among Pregnant Women-United States, 2010-11 Influenza Season

Women are at increased risk for morbidity and mortality from influenza during pregnancy (1). Vaccinating pregnant women for influenza can protect both the women and their infants, especially infants aged <6 months who are not old enough to receive influenza vaccination (2--4). Since 2004, the Advisory Committee on Immunization Practices and the American College of Obstetricians and Gynecologists have recommended inactivated influenza vaccine for all women who are pregnant during influenza season, regardless of trimester (1,5). Before 2009, estimated influenza vaccination coverage among pregnant women had been consistently low (approximately 15%) (1,5). However, vaccination levels increased substantially in response to the 2009 influenza A (H1N1) pandemic to nearly 50% (6--7). To estimate influenza vaccination coverage among pregnant women for the 2010--11 season, CDC analyzed data from an Internet panel survey conducted in April 2011 among women who were pregnant any time during October 2010--January 2011. Among 1,457 survey respondents, 49% reported that they had received influenza vaccination: 12% were vaccinated before pregnancy, 32% during pregnancy, and 5% after pregnancy. Women offered influenza vaccination by a health-care provider (62%) were more likely to be vaccinated (71%) than other women (14%) and were more likely to have positive attitudes about vaccine effectiveness and safety. These results indicate that the higher vaccination level achieved the previous season (2009--10) was sustained and emphasize the critical role of health-care providers in promoting influenza vaccination. Continued efforts are needed to encourage health-care providers to strongly recommend and offer influenza vaccination to pregnant patients to protect both the mothers and their infants.

CDC conducted an Internet panel survey during April 4--25, 2011, to provide end-of-season estimates of influenza vaccination coverage and information on knowledge, attitudes, and behaviors related to influenza vaccination among pregnant women. Women aged 18--49 years who were pregnant at any time since August 1, 2010, were recruited from the SurveySpot panel operated by Survey Sampling International.* Of all panel members contacted in April 2011, a total of 2,126 were determined to be eligible for the survey, and 1,937 (91%) completed the online survey. The sample was weighted to reflect the age and race/ethnicity distribution based on census region estimates from the U.S. population of pregnant women (8). To be consistent with a previous study (6), the study population was limited to 1,457 women reporting pregnancy at any time during the peak influenza vaccination period (October 2010--January 2011).

Survey respondents were asked if they had an influenza vaccination since August 1, 2010, and if yes, in which month and whether it was before, during, or after pregnancy. Pregnancy status questions included whether respondents were currently pregnant or pregnant at any time since August 1, 2010, and if so, what were the actual months of pregnancy. Respondents who were pregnant at the time of the survey were asked their expected delivery date. All respondents were asked if their doctor or other health professional had offered them influenza vaccination during an office visit and their attitudes toward influenza and influenza vaccination. Weighted analyses were conducted using statistical software. Confidence intervals were calculated, and chi-square tests were used to assess statistical significance of differences in vaccination coverage levels between subgroups.

Of the 1,457 women pregnant at any time during October 2010--January 2011, 49% reported influenza vaccination for the 2010--11 season: 12% were vaccinated before pregnancy, 32% during pregnancy, and 5% after pregnancy. Vaccination after pregnancy was more prevalent for women delivering early in the vaccination period, and vaccination before pregnancy was more prevalent among women who were in earlier stages of pregnancy later in the vaccination period (Figure). Younger women (aged 18--24 years) were less likely to be vaccinated than older women (aged 25--49 years) (44% versus 52%) (Table 1). College graduates were more likely to be vaccinated than those with less education. Women with health insurance coverage also were more likely to report influenza vaccination compared with those who were not insured.

Overall, 62% of women reported that they were offered influenza vaccination by their health-care providers; among those offered vaccination, 71% received influenza vaccination, substantially higher than the 14% vaccination level among women whose health-care providers did not offer vaccination (Table 1). Forty-five percent of women reported influenza vaccination in a previous influenza season, and these women were four times as likely to report 2010--11 vaccination as women without previous vaccination (84% versus 21%).

Compared with women whose health-care provider did not offer vaccination, women who received a health-care provider offer were more likely to have positive attitudes about the effectiveness of influenza vaccination (82% versus 54%), safety of influenza vaccination for pregnant women (78% versus 53%), and safety of vaccination for their infants (75% versus 47%) (Table 2). In addition, women who received a health-care provider offer consistently had higher vaccination levels than those who did not receive a health-care provider offer, regardless of their perceptions of vaccination safety or effectiveness expressed in April 2011. Moreover, women with a negative attitude toward vaccination who had received a health-care provider offer of vaccination were more likely to be vaccinated than women who had a positive attitude without a health-care provider offer.

The top five "main" reasons for not receiving influenza vaccination were "I am concerned about possible safety risks to my baby if I got vaccinated" (20%), "I am concerned that the vaccination would give me the flu" (17%), "I don't think the vaccination is effective in preventing flu" (14%), "I am concerned about possible safety risk to myself if I got vaccinated" (11%), and either "I don't think I would get very sick if I got the flu" or "I think if I get the flu, I will just get some medication to treat it" (14%).

The majority of women who were vaccinated during pregnancy received vaccination at their obstetrician/gynecologist or midwife's office (61%), followed by another doctor's office or another medical-related place (22%), a pharmacy or grocery store (8%), health department (5%), and their workplace or school (5%). Among women vaccinated either before or after pregnancy, 18% were vaccinated in an obstetrician/gynecologist or midwife's office, and 61% in another doctor's office or another medical-related place.

Reported by

Deborah K Walker, EdD, Sarah Ball, ScD, Robert Black, MPH, David Izrael, MS, Abt Associates, Inc., Atlanta, Georgia. Helen Ding, MD, Gary L. Euler, DrPH, James A. Singleton, MS, Carolyn B. Bridges, MD, Immunization Svc Div, Lisa A. Grohskopf, MD, Influenza Div, National Center for Immunization and Respiratory Diseases; Denise J. Jamieson, MD, Div of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC. Corresponding contributor: Helen Ding, hding@cdc.gov, 404-639-8513.

Editorial Note

Results from this survey indicate that the record high influenza vaccination levels among pregnant women reported for the previous influenza season (2009--10) were sustained during the 2010--11 season. During 2009--10, pregnant women were included in the initial target groups to receive the inactivated 2009 H1N1 pandemic vaccine, and CDC worked closely with key partners, especially the American College of Obstetricians and Gynecologists, to increase awareness that pregnant women were at increased risk for severe illness from influenza and were recommended for influenza vaccination to protect themselves and their infants (9). However, vaccination levels are still below the Healthy People 2020 target of 80% influenza vaccination coverage for pregnant women.?

This study found that women who received a health-care provider offer were more likely to believe influenza vaccination was effective, protective, and safe for themselves and their infants, and were nearly five times more likely to report receipt of vaccination compared with those who visited a doctor but did not receive an offer of vaccination. Pregnant women who had previously received influenza vaccination were four times more likely to receive influenza vaccination compared with those without a prior history of influenza vaccination. Because influenza vaccination is now recommended for all persons aged ?6 months (1), further implementation of the universal vaccination recommendation among women of childbearing age might help to increase the likelihood of influenza vaccination before and during pregnancy.

Pregnant women who receive regular prenatal care have many more opportunities for a health-care provider offer of influenza vaccination than nonpregnant women. However, nearly four out of 10 women in this survey did not receive an offer of vaccination even though they visited a health-care provider at least one time. Barriers to providing influenza vaccination in health-care providers' offices identified by previous studies include lack of infrastructure for vaccine storage, lack of training for nurses to administer vaccines, and concern about safety and related lawsuits for vaccinating first trimester women (10). Another finding of this study was that women still reported safety risk to their infant as the most common main reason for refusing influenza vaccination, even though influenza vaccination during pregnancy can protect women and their infants (2--4). This study also indicated that a substantial proportion of women who delivered early in the influenza season received their vaccination after delivery. Vaccination of members of households with an infant aged <6 months is important for minimizing influenza risk for the upcoming influenza season.

The findings in this report are subject to at least two limitations. First, selection bias might remain after weighting adjustments, given the exclusion of women with no Internet access and the self-selection processes for entry into the panel and participation in the survey. However, influenza vaccination coverage estimated from this study, restricted to women who were pregnant at any time during December 2010 (48%), was similar to the coverage estimates based on December 2010 Behavioral Risk Factor Surveillance System (BRFSS) interviews of women who were pregnant at that time (51%) (CDC, unpublished data, 2011). BRFSS is a telephone survey and also might be subject to selection bias because of exclusion of households without landline telephone service. Pregnant women account for only 1% of the general population, and conducting a random-digit--dialing survey or a mail survey large enough to obtain an adequate sample size would be costly and time-consuming. The similar estimate from BRFSS provides more evidence to support the use of Internet panels as useful surveillance data sources for timely midseason and postseason evaluation of influenza vaccination among pregnant women. Second, the survey was self-administered, and because pregnancy and vaccination status were not validated by medical record review, all responses are subject to recall and reporting error.

This study found that the higher vaccination level achieved during the 2009--10 influenza season (the fall wave of 2009 H1N1 virus activity) among pregnant women was repeated the following season, and identified key elements highly associated with pregnant women's acceptance of influenza vaccination, such as the health-care provider offer of vaccination and past receipt of influenza vaccination. Continued efforts are needed to encourage health-care providers to strongly recommend and offer influenza vaccination to their pregnant patients. Additional efforts are needed to remove barriers for health-care providers to administer influenza vaccination as part of routine practice. Messages to pregnant women from health-care providers and others should emphasize the safety and effectiveness of maternal influenza vaccination to maximize protection of pregnant patients and their infants.

Acknowledgments

John Boyle, PhD, Chuck Shuttles, Abt SRBI, Inc., Washington, DC. Peng-jun Lu, MD, Leah N Bryan, MPH, Immunization Svc Div, National Center for Immunization and Respiratory Diseases, CDC.

References

CDC. Prevention and control of influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP), 2010. MMWR 2010;59(No. RR-8).
Eick AA, Uyeki TM, Klimov A, et al. Maternal influenza vaccination and effect on influenza virus infection in young infants. Arch Pediatr Adolesc Med 2011;165:104--11.
Zaman K, Roy E, Arifeen SE, et al. Effectiveness of maternal influenza immunization in mothers and infants. N Engl J Med 2008;359:1555--64.
Poehling KA, Szilagyi PG, Staat MA, et al., Impact of maternal immunization on influenza hospitalizations in infants. Am J Obstet Gynecol 2011;204(6 Suppl 1):S141--8.
American College of Obstetricians and Gynecologists Committee on Obstetric Practice. Influenza vaccination and treatment during pregnancy. Obstet Gynecol 2004;104(5 pt 1):1125--6.
Ding H, Santibanez TA, Jamieson DJ, et al. Influenza vaccination coverage among pregnant women---National 2009 H1N1 Flu Survey (NHFS). Am J Obstet Gynecol 2011;204(6 Suppl 1):S96--106.
CDC. Seasonal influenza and 2009 H1N1 influenza vaccination coverage among pregnant women---10 states, 2009--10 influenza season. MMWR 2010;59:1541--5.
CDC. Estimated pregnancy rates for the United States, 1990--2005: an update. Natl Vital Stat Rep 2009;58(4).
Rasmussen SA, Kissin DM, Yeung LF, et al; Pandemic Influenza and Pregnancy Working Group. Preparing for influenza after 2009 H1N1: special considerations for pregnant women and newborns. Am J Obstet Gynecol 2011;204(6 Suppl 1):S13--20.
Naleway AL, Smith WJ, Mullooly JP. Delivering influenza vaccine to pregnant women. Epidemiol Rev 2006;28:47--53.

What is already known on this topic?

Pregnant women are recommended by the American College of Obstetricians and Gynecologists and the Advisory Committee on Immunization Practices to receive influenza vaccination regardless of trimester. Vaccination coverage among pregnant women was approximately 50% for the 2009--10 season, much higher than coverage reported for previous influenza seasons. Health-care provider recommendation is strongly associated with vaccination among pregnant women.

What is added by this report?

Approximately 49% of pregnant women in an Internet panel survey were vaccinated for influenza for the 2010--11 influenza season; 32% were vaccinated during pregnancy, and 17% before pregnancy or after delivery. Among the 62% of pregnant women who received a health-care provider offer for influenza vaccination, nearly three quarters were vaccinated, which was five times the coverage among those who didn't receive a health-care provider offer.

What are the implications for public health practice?

Continued efforts are needed to 1) encourage health-care providers to strongly recommend and offer inactivated influenza vaccination to their pregnant patients and 2) remove barriers for health-care providers to administer influenza vaccination as part of routine practice. Messages to pregnant women from health-care providers and others should emphasize the safety and effectiveness of maternal influenza vaccination to maximize protection of pregnant patients and their infants.

FIGURE. Percentage of women aged 18--49 years pregnant at any time during October 2010--January 2011 (N = 1,457) who received influenza vaccination before, during, or after pregnancy for the 2010--11 influenza season, by month of delivery or expected month of delivery --- United States, Internet panel survey, April 2011

Alternate Text: The figure above shows the percentage of women aged 18-49 years pregnant at any time during October 2010-January 2011 (N = 1,457) who received influenza vaccination before, during, or after pregnancy for the 2010-11 influenza season, by month of delivery or expected month of delivery, in the United States, based on results of an Internet panel survey conducted in April 2011. Vaccination after pregnancy was more prevalent for women delivering early in the vaccination period, and vaccination before pregnancy was more prevalent among women who were in earlier stages of pregnancy later in the vaccination period.

Characteristic	Sample			Vaccination coverage*
Characteristic	No.	%?	(95% CI�)	%	(95% CI)
Overall	1,457	---	---	49.0	(�2.8)
Age group (yrs)
18--24	504	34.5	(�2.6)	43.6	(�4.6)
?25	953	65.5	(�2.6)	51.8	(�3.5)
Race/Ethnicity
Hispanic	195	21.7	(�2.7)	53.2	(�7.3)
White, non-Hispanic	977	56.3	(�2.9)	46.5	(�3.3)
Black, non-Hispanic	200	16.5	(�2.1)	47.1	(�7.2)
Other	84	5.5	(�1.2)	63.8	(�10.9)
Education
<College graduation	890	63.3	(�2.7)	43.4	(�3.6)
College graduate	441	30.2	(�2.6)	54.9	(�5.1)
>College graduation	93	6.5	(�1.4)	66.9	(�10.7)
Marital status
Married	567	40.9	(�2.8)	53.6	(�3.6)
Not married	890	59.1	(�2.7)	42.3	(�4.4)
Working status�
Working	830	56.6	(�2.8)	54.6	(�4.2)
Not working	625	43.4	(�2.7)	44.6	(�3.7)
Health insurance coverage (at interview)
Any public	656	46.2	(�2.8)	46.2	(�4.1)
Private/military	688	46.1	(�2.8)	54.1	(�4.1)
None	113	7.8	(�1.5)	35.0	(�9.4)
Had influenza vaccination in previous season
Yes	644	44.8	(�2.8)	83.5	(�3.0)
No	813	55.2	(�2.7)	20.9	(�3.0)
Other high-risk conditions**
Yes	354	26.3	(�2.5)	58.2	(�5.6)
No	1,103	73.7	(�2.5)	45.7	(�3.2)
Offered influenza vaccination??
Yes	836	61.7	(�2.8)	70.8	(�3.3)
No	512	38.3	(�2.8)	14.4	(�3.1)

Response	Sample distribution						Vaccination coverage*
	Offer? (n = 836)			No offer (n = 512)			Offer (n = 836)		No offer (n = 512)
	No.	%�	(95% CI�)	No.	%	(95% CI)	%	(95% CI)	%	(95% CI)
Flu vaccine is somewhat/very effective in preventing flu	�
Yes	576	81.9	(�3.1)	168	53.8	(�6.0)	86.7**	(�3.0)	36.1**	(�7.6)
No	132	18.1	(�3.1)	147	46.2	(�5.9)	46.2	(�9.4)	4.5	(�3.4)
Agree/strongly agree that if a pregnant woman receives the flu vaccination, it will protect the baby from getting the flu after it is born	�
Yes	431	52.5	(�3.7)	146	29.0	(�4.3)	81.1**	(�3.9)	24.7**	(�7.4)
No	404	47.5	(�3.7)	364	71.0	(�4.2)	59.6	(�5.3)	10.4	(�3.2)
Flu vaccination is somewhat/very/completely safe for most adult women	�
Yes	774	92.6	(�1.9)	428	83.2	(�3.5)	73.6**	(�3.3)	16.1**	(�3.6)
No	61	7.4	(�2.0)	82	16.8	(�3.5)	39.0	(�13.3)	6.7	(�6.0)
Flu vaccination is somewhat/very/completely safe for pregnant women	�
Yes	645	77.8	(�3.1)	272	52.7	(�4.6)	80.6**	(�3.2)	21.9**	(�5.1)
No	190	22.2	(�3.0)	240	47.3	(�4.7)	37.7	(�7.4)	6.1	(�3.1)
Flu vaccination that a pregnant woman receives is somewhat/very/completely safe for her baby	�
Yes	618	75.1	(�3.2)	241	47.0	(�4.6)	81.7**	(�3.2)	23.3**	(�5.6)
No	217	24.9	(�3.1)	270	53.0	(�4.7)	38.9	(�7.0)	6.7	(�3.0)
Somewhat/very worried about getting sick from this season's flu vaccination	�
Yes	397	47.9	(�3.7)	194	37.2	(�4.4)	74.2	(�4.6)	13.4	(�5.0)
No	438	52.1	(�3.7)	317	62.8	(�4.5)	68.1	(�4.6)	15.1	(�4.0)
If a pregnant women gets the flu, it is somewhat/very likely to harm the baby	�
Yes	445	60.1	(�3.8)	258	61.7	(�5.0)	70.8	(�4.4)	17.1	(�4.8)
No	299	39.9	(�3.8)	171	38.3	(�4.9)	72.0	(�5.5)	15.0	(�5.6)

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