Program Ups Vaccination Rate in Pregnant Women


KANSAS CITY, MO. — A staff and bilingual patient education program dramatically increased immunizations for pregnant women in Suffolk County, New York.

But progress in this massive county of 1.3 million residents could be thwarted by state legislation banning the use of vaccines containing thimerosal, Mary Koslap-Petraco said at the National Immunization Conference sponsored by the Centers for Disease Control and Prevention.

A staff education program was developed for obstetricians, nurse-practitioners, and registered nurses at prenatal clinics in all eight primary health centers and three satellite offices run by the Suffolk County Department of Health Services (DHS). The nursing staff then developed a bilingual teaching program in Spanish and English for the women attending the clinics.

The largest ethnic group in the county is Hispanic, many of whom are immigrants, followed by African American, white, Asian, and Native American. All of the patients were enrolled in the Medicaid prenatal assistance program.

Immunization status was checked for each pregnant woman for three targeted vaccines: tetanus and diphtheria (Td), hepatitis A/B, and influenza. Each woman was then offered an immunization, and given vaccine-specific education. A written immunization record was provided for each patient to take home, noting when her next vaccination was due.

“When we started this program, we really didn't vaccinate pregnant women with much more than flu shots, if we even did that,” said Ms. Koslap-Petraco, a certified pediatric nurse-practitioner, and coordinator of child health for Suffolk County, Hauppauge, N.Y.

In 2005, 954 flu shots and no Td or hepatitis vaccines were administered. In 2006, those numbers jumped to 1,381 influenza, 505 Td, and 1,307 hepatitis A/B vaccines.

Vaccination of pregnant women remains unsupported among many health care professionals, and the current legislative climate provides yet another reason not to vaccinate. In 2006, New York, Missouri, and Washington joined California, Delaware, Illinois, and Iowa in enacting legislation that would restrict the use of thimerosal-containing vaccines. The law is not effective in New York until July 1, 2008.

But Suffolk County passed its own local ordinance in 2006 prohibiting thimerosal-containing vaccines for children up to age 4 years and pregnant women who attend county health centers. The local law caused many nurses to stop immunizing pregnant women for influenza once the supply of thimerosal-free vaccine ran out, Ms. Koslap-Petraco said.

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