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Mujeres embarazadas y la vacunación contra la influenza, encuesta de panel por Internet, Estados Unidos, noviembre del 2017

Hallazgos clave

  • As of early November 2017, influenza (flu) vaccination coverage among pregnant women before and during pregnancy was 35.6%.
  • Most pregnant women (97.9%) reported visiting a doctor or other medical professional at least once before or during pregnancy since July 1, 2017. Among these women, 58.7% reported receiving a recommendation for and offer of flu vaccination from a doctor or other medical professional, 15.6% received only a recommendation for and no offer of flu vaccination, and 25.7% did not receive a recommendation for or an offer of flu vaccination.
    • Vaccination coverage among these women was 52.4%, 26.1%, and 5.7%, respectively.
  • A change in survey methodology in November 2017 allowed more women to participate in the survey using a smartphone or other handheld device (73.4% compared with 16.5% in November 2016).
    • This shifted the characteristics of the survey sample, so comparisons of vaccination coverage from November 2017 to previous survey years cannot be made.

Conclusion/Recommendation

  • Almost two thirds of pregnant women have not been vaccinated against flu as of early November 2017.
  • Se alienta a los proveedores de atención médica a seguir recomendando enfáticamente y ofreciendo las vacunas inyectables contra la influenza a las mujeres embarazadas durante toda la temporada para proteger a las madres y a sus bebés.

Pregnant women are at increased risk for complications due to flu, particularly during the second and third trimesters. Additionally, infants younger than 6 months also are at high risk of serious flu illness but are too young to be vaccinated (1,2). Vaccination lowers the risk of flu illness in pregnant women and flu-related hospitalizations in their infants for the first several months of life (1,3-9). The Centers for Disease Control and Prevention (CDC), the American College of Obstetricians and Gynecologists, the American College of Nurse Midwives, and the American Academy of Family Physicians recommend flu shots for all women who are or will be pregnant during the flu season (1,3-5).

To estimate flu vaccination coverage by early November 2017, CDC analyzed data on flu vaccination from an Internet panel survey conducted November 1-8, 2017, among women who were pregnant any time since August 1, 2017. Los resultados de esta encuesta brindan información que se utilizará en las campañas de vacunación durante la Semana nacional de la vacunación contra la influenza (del 3 al 9 de diciembre del 2017). This report provides early estimates of vaccine uptake since July 2017 by pregnant women. En las dos temporadas de influenza anteriores, la cobertura de vacunación aumentó aproximadamente de 7 a 10 puntos porcentuales entre el principio y el final de la temporada. En septiembre del 2018 estarán disponibles los cálculos finales sobre la cobertura de vacunación de embarazadas en la temporada de influenza 2017-18.

¿Quién fue vacunado?

Cobertura por grupo etario

  • Younger pregnant women (18–24 years) had similar vaccination coverage (32.5%) compared with pregnant women 25–34 years (36.8%) and 35–49 years (37%).

Figura 1.

Figure 1: Flu vaccination coverage before and during pregnancy among women pregnant anytime August 1 – November 8, 2017, by age, Internet panel survey, United States

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Coverage by Pregnancy Status

  • Vaccination coverage was lower among pregnant women who reported being recently pregnant (women with a pregnancy that ended between August 1, 2017 and the time of the survey) (18.5%) and women who reported being in their first trimester (31.6%) at the time of the survey compared with pregnant women who reported being in their second (46.9%) or third (46.8%) trimesters at the time of the survey.

Figura 2.

Figure 2: Flu vaccination coverage before and during pregnancy among women pregnant any time August 1 – November 8, 2017, by pregnancy status at time of survey*, Internet panel survey, United States

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Cobertura por raza/etnia

  • Vaccination coverage among non-Hispanic white pregnant women (35.9%) was similar compared with non-Hispanic black pregnant women (31.5%) and Hispanic pregnant women (35.4%). Pregnant women reporting non-Hispanic other race/ethnicity had the highest coverage (45.1%).

Figura 3.

Figure 3: Flu vaccination coverage before and during pregnancy among women pregnant any time August 1 – November 8, 2017, by race/ethnicity, Internet panel survey, United States

Cobertura por educación

  • Vaccination coverage was lowest among pregnant women with some college education (28.1%), followed by pregnant women with a high school diploma or less (34.7%) and women with a college degree (39.1%), and highest among women with more than a college degree (45.8%).

Figura 4.

Figure 4:  Flu vaccination coverage before and during pregnancy among women pregnant any time August 1 – November 8, 2017, by education, Internet panel survey, United States

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Cobertura por tipo de seguro médico

  • Pregnant women who reported having only private/military insurance during pregnancy had higher vaccination coverage (40.3%) than pregnant women who reported having any type of public medical insurance (31%) and those who reported not having insurance (23.8%).
    • Approximately 1 in 25 (4.1%) pregnant women reported not having medical insurance.

Figura 5.

Figure 5: Flu vaccination coverage before and during pregnancy among women pregnant any time August 1 – November 8, 2017, by type of medical insurance, Internet panel survey, United States

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Coverage by Other High-Risk Conditions

  • Pregnant women with additional conditions that increase the risk of flu severity and complications had higher vaccination coverage (39.3%) than women with no additional high-risk conditions (32.8%).

Figura 6.

Figure 6: Flu vaccination coverage before and during pregnancy among women pregnant any time August 1 – November 8, 2017, by high-risk conditions† other than pregnancy, Internet panel survey, United States

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Cobertura según la recomendación y la oferta del proveedor de atención médica

  • Most pregnant women (97.9%) reported visiting a doctor or other medical professional at least once before or during pregnancy since July 1, 2017. Among these women, 58.7% reported receiving a recommendation for and offer of flu vaccination from a doctor or other medical professional, 15.6% received a recommendation but were not offered the vaccine, and 25.7% did not receive a recommendation for or offer of flu vaccination.
  • La mayor cobertura de vacunación contra la influenza entre embarazadas (52.4%) se registró entre las mujeres que dijeron que su médico u otro profesional de la salud les recomendó y ofreció la vacuna.
    • De las mujeres embarazadas que informaron que su médico u otro profesional de la salud les recomendó la vacuna, sin ofrecérselas, el 26.1% se vacunó.
    • Only 5.7% of pregnant women were vaccinated among those who reported they did not receive a recommendation for or offer of vaccination from their doctor or other medical professional.

Figura 7.

Figure 7: Flu vaccination coverage before and during pregnancy among women pregnant any time August 1 – November 8, 2017, and who visited a health care provider at least once since July 2017, by provider recommendation or offer of flu vaccination, United States

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Lugar de vacunación

The most commonly reported place for receiving flu vaccination before and during pregnancy among vaccinated women was in the office of an obstetrician/gynecologist (OB/GYN) or midwife (50.1%).

Figura 8.

Figure 8:  Reported place where women pregnant any time August 1–November 8, 2017, received flu vaccination before and during pregnancy, Internet panel survey, United States (n=805)

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Motivo principal para vacunarse

Respondents who had been vaccinated by the time of the survey were asked to report their main reason for receiving a flu vaccination.

  • The most commonly reported reason for receiving a flu vaccination was “to protect my baby from flu” (40.7%).
  • The second most commonly reported reason was “to protect myself from flu” (23.6%), and the third most commonly reported reason was that their health care provider recommended flu vaccination to them (15.1%).

Figura 9.

Figure 9: Reported main reason for receiving flu vaccination among women pregnant any time  August 1 – November 8, 2017, who were vaccinated before or during pregnancy (n=805)‡, Internet panel survey, United States

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Motivo principal para no vacunarse

Unvaccinated respondents who reported that they did not intend to be vaccinated during this flu season§ were asked their reasons for not receiving or not planning to get a flu vaccination.

  • The most commonly reported reason for not receiving vaccination was “I do not think the flu vaccine is effective in preventing the flu” (21.9%).
  • The second most commonly reported reason for not receiving vaccination was concern about getting sick from flu vaccination or worry about side effects of the vaccination (21.3%).
  • Two other reasons commonly reported by respondents were “concern about possible safety risks to my baby” (14.7%) and not being concerned about getting the flu (10.9%).
  • Las barreras de acceso, como la falta de seguro médico, el costo, la falta de tiempo, la falta de disponibilidad de la vacuna o el desconocimiento de los lugares en los que se ofrece se mencionaron con poca frecuencia como el motivo principal para no recibir la vacuna inyectable contra la influenza.

Figura 10.

Figure 10: Reported main reason for not receiving flu vaccination among women pregnant any time August 1 – November 8, 2017, who do not intend§ to receive flu vaccination for the rest of the flu season, Internet panel survey, United States (n=663)

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Motivos para no haberse vacunado

Unvaccinated respondents who reported that they intended to be vaccinated during this flu seasonwere asked their reasons for not yet receiving vaccination.

  • The most commonly reported reason for not yet receiving a flu vaccination was not having gotten around to it or not having the time (37.2%).
  • The next two most commonly reported reasons for not yet receiving flu vaccination was that they prefer to wait until after their pregnancy (23.7%) or prefer to wait until later in their pregnancy (22.9%).

Figura 11.

Figure 11: Reported reasons for not receiving flu vaccination|| among women pregnant any time August 1 – November 8, 2017, who intend¶  to receive flu vaccination this season, Internet panel survey, United States (n=537)

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Characteristics of Survey Respondents

  • A total of 2 254 women pregnant anytime from August 1-November 8, 2017, were included in the survey. More information by demographic subgroups can be found in the Demographic Table [XLS – 14 KB].
  • A higher proportion of women using a smartphone or other handheld device were included in the sample in November 2017 (73.4%) compared with November 2016 (16.5%).
    • Vaccination coverage among women who completed the survey on a handheld device was 32.3%, compared with 43.1% among women who completed the survey on a desktop or laptop computer and 53% among women who completed the survey on a tablet.
  • There were also increased numbers of pregnant women participating in the November 2017 survey who were younger, have less than a college degree, have public insurance, and who reported being recently, but not currently, pregnant at the time of the survey compared with November 2016.

¿Qué se puede hacer?

Overall, early 2017-18 season flu vaccination coverage before or during pregnancy among women pregnant any time from August 2017 through the time of the survey was 35.6%, suggesting that nearly two-thirds of pregnant women are not protected against influenza. Pregnant women may receive any licensed, recommended, age-appropriate influenza vaccine at any time during pregnancy, before and during the influenza season, as soon as vaccine is available. A strong provider recommendation with an offer of vaccination may help improve vaccination coverage, especially for pregnant women who were not vaccinated but intended to get vaccinated, including the 37% who had not had the opportunity or time and the 17% who reported not receiving a recommendation or offer of vaccination. CDC [280 KB, 2 pages], ACOGy el Colegio Estadounidense de Enfermeras-Comadronas provide resources to help providers recommend and offer vaccination or refer for vaccination. If a provider cannot offer vaccination in their office, a referral to the nearest site where a vaccination can be given can help a pregnant woman receive the necessary vaccines to protect themselves and their infant.

In September 2017, results of a study conducted during the 2010–11 and 2011–12 influenza seasons were published which reported an association of repeated flu vaccination during the first trimester with spontaneous abortion (10). Multiple earlier studies have indicated there is no association between flu vaccination and adverse pregnancy outcomes, including spontaneous abortion (11-15). Many pregnant women who had not been vaccinated but intended to get vaccinated this season reported preferring to wait until later in their pregnancy or after pregnancy. Since flu poses a danger to pregnant women and their infants, CDC, ACIP, and ACOG continue to recommend flu vaccination for pregnant women during any trimester to protect both pregnant women and their babies from flu infection (16-17). CDC y ACOG have posted information to help providers answer questions that may come up after their flu vaccination recommendation.

Para mejorar la cobertura de la vacunación contra la influenza entre las mujeres embarazadas:

Medical professionals are reminded to implement the National Vaccine Advisory Committee’s Standards for Adult Immunization Practice (18):

  • Evaluar en cada visita el estado de vacunación de las mujeres embarazadas.
    • Standing orders and provider reminders can be used to ensure patient vaccination status is assessed at every visit (19).
  • Recomendar enfáticamente la vacunación contra la influenza y brindar información acerca de:
    • El riesgo que corren las mujeres embarazadas y sus bebés de contraer influenza y las complicaciones relacionadas, como enfermedades graves en mujeres embarazadas y enfermedades relacionadas con la influenza y la hospitalización en sus bebés;
    • Los beneficios y los riesgos que representa la vacunación contra la influenza para las madres y sus bebés;
    • The protection transferred to infants by vaccination during pregnancy, since infants younger than 6 months old cannot be vaccinated themselves;
    • The well-established safety record of flu vaccine for pregnant women and their babies.
  • Offer flu vaccination or refer women to another provider who can give the flu vaccine.
  • Asegurarse de que la administración de la vacuna esté documentada en la historia clínica del paciente y en el registro de inmunización.

Los profesionales de la salud deben administrar la vacuna a las mujeres embarazadas y otras personas durante la temporada de influenza:

  • Peak flu activity in the United States most often occurs from December through February, however, activity can last as late as May.
  • Providers should strongly recommend their unvaccinated patients, including pregnant women and the contacts and caregivers of pregnant women and their infants, to receive a flu vaccination as soon as possible and before flu activity increases in their community.
  • Los proveedores deberían seguir ofreciendo las vacunas inyectables contra la influenza a las embarazadas sin vacunar durante toda la temporada de influenza, incluso si la actividad de la enfermedad ha disminuido en sus comunidades puesto que más de un tipo o subtipo de influenza puede causar enfermedades en una misma temporada de influenza.

La información está disponible en:

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Fuente de datos y métodos

CDC conducted an Internet panel survey from November 1-8, 2017 to provide early-season estimates of flu vaccination coverage and information on knowledge, attitudes, and behaviors related to flu vaccination among pregnant women. Women 18-49 years who were pregnant at any time since August 1, 2017, were recruited from SurveySpot, a general-population Internet panel. Eligible respondents were either pregnant at the time of the survey or had a pregnancy that ended between August 1, 2017 and the time of the survey. De los 2 333 miembros elegibles del panel que comenzaron la encuesta por Internet, 2 255 (96.7%) la completaron. One respondent was excluded from the analysis due to missing information about receipt of flu vaccination. Los datos fueron ponderados para reflejar la edad, la raza/etnia y la distribución geográfica de la población total de embarazadas en Estados Unidos (20-22). SurveySpot is the same recruitment mechanism that was used in the November 2016 survey; however, a change in survey methodology shifted the proportion of survey respondents using a smartphone or other handheld device to participate in the survey from less than 20% in 2016 to 73% in 2017. This change in survey methodology may explain the shifting of the sample to pregnant women of younger age, less education, and with public insurance compared with the last year's survey. Prior research has found that Americans who rely on smartphones for online access are more likely to be younger, have lower household income and lower levels of education, and be non-white compared with those who have other options, such as a desktop or laptop computer, for Internet access (23). These characteristics have also been found to be associated with lower vaccination coverage in pregnant women (24).

Survey respondents were asked if they had received a flu vaccination since July 1, 2017, and if so, in which month they received it, as well as whether they received the vaccination before, during, or after pregnancy. Pregnancy status questions included whether respondents were currently pregnant at the interview time or had been pregnant any time since August 1, 2017. Women who reported being vaccinated since July 1, 2017, and who were vaccinated before or during pregnancy were counted as vaccinated. A todas las encuestadas se les preguntó si su médico u otro profesional de la salud les había recomendado u ofrecido la vacuna contra la influenza. También se les preguntó acerca de sus actitudes y creencias sobre la influenza y la vacuna contra la misma.

Los análisis fueron ponderados mediante el procedimiento para encuestas del software SAS versión 9.3. Because the opt-in Internet panel sample was based on those who initially self-selected for participation in the panel rather than a random probability sample, statistical measures such as calculation of confidence intervals and tests of difference were not performed (25). Se consideró que una diferencia de 5 puntos porcentuales era una diferencia notable.

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Limitaciones

Estos resultados son preliminares y deben interpretarse con cautela. La encuesta de seguimiento de panel por Internet realizada en abril de 2018 evaluará la cobertura de vacunación contra la influenza al final de la temporada.

Los resultados en el informe están sujetos a varias limitaciones.

  • The sampling methodology changed from November 2016 to November 2017, including more pregnant women using smartphones and other handheld devices besides tablets to respond to the survey in the sample. This change limits the ability to make comparisons to estimates in prior years.
  • La muestra no fue necesariamente representativa de todas las embarazadas de los Estados Unidos, debido a que la encuesta fue realizada a un pequeño grupo de voluntarias que ya se encontraban inscritas en SurveySpot, en lugar de haber sido seleccionadas al azar.
  • Los cálculos podrían no ser imparciales después de ponderar los ajustes, debido a la exclusión de mujeres sin acceso a Internet y al proceso de autoselección para ingresar a los paneles y participar en la encuesta. Los cálculos pueden ser parciales si los procesos de selección para ingresar al panel por Internet y la decisión de la mujer de participar en esta encuesta en particular se relacionaran con la recepción de la vacuna.
  • Todos los resultados de la vacunación se basan en autoinformes y no están validados por revisión de registros médicos. Es probable que los cálculos de las encuestas de panel por Internet no se puedan comparar directamente con los obtenidos en encuestas basadas en la población debido a la diferencia en las muestras utilizadas en cada una.

A pesar de estas limitaciones, las encuestas de panel por Internet son herramientas de vigilancia útiles para evaluar de manera oportuna, a principios y al final de la temporada, la cobertura de vacunación contra la influenza, el nivel de conocimiento, la actitud, la práctica y datos sobre los impedimentos.

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AUTHORS: Helen Ding, MD, MSPH1; Carla L. Black, PhD2; Sarah W. Ball, ScD3;  Rebecca V. Fink, MPH3; Amy Parker Fiebelkorn, MSN, MPH2;  Katherine E. Kahn MPH4 ; Peng-Jun Lu, MD, PhD2; Walter W. Williams, MD, MPH2; Denise D’Angelo, MPH5, Lisa A. Grohskopf6; Stacie M Greby, DVM,MPH2

1CFD Research Corporation, Huntsville, AL; 2Immunization Services Division, National Center for Immunization and Respiratory Diseases, CDC; 3Abt Associates Inc., Cambridge, MA; 4Leidos, Atlanta, GA; 5Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC; 6Influenza Division, National Center for Immunization and Respiratory Diseases, CDC

Enlaces relacionados

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Referencias/Recursos

    1. Grohskopf LA, Sokolow LZ, Broder KR, et al. Prevention and control of seasonal influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices-United States, 2016-17 influenza season. MMWR Recomm Rep 2016;65(No. RR-05):1-54.
    2. Poehling KA, Edwards KM, Weinberg GA, et al. The underrecognized burden of influenza in young children. N Engl J Med 2006;355:31-40.
    3. Grohskopf LA, Sokolow LZ, Broder KR, et al. Prevention and control of seasonal influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices-United States, 2017-18 influenza season. MMWR Recomm Rep 2017;66(No. RR-02):1-20.
    4. Colegio Estadounidense de Obstetricia y Ginecología. Influenza vaccination during pregnancy. Opinión del Comité N.º 608 Obstet Gynecol 2014; 124:648-51. Declaración conjunta sobre la influenza para embarazadas.
    5. Colegio Estadounidense de Obstetricia y Ginecología. Inmunización para mujeres. Ingresado el 28 de noviembre del 2016.
    6. Zaman K, Roy E, Arifeen SE, et al. Effectiveness of maternal influenza immunization in mothers and infants. N Engl J Med 2006;355:31-40.
    7. Poehling KA, Szilagyi PG, Staat MA, et al. Impact of maternal immunization on influenza hospitalizations in infants. Am J Obstet Gynecol 2011;204(6 Supl 1):S141-8.
    8. Madhi SA, Nunes MC, Cutland CL. Influenza vaccination of pregnant women and protection of their infants. N Engl J Med. 2014 Dec 11;371(24):2340.
    9. Tapia MD, Sow SO, Tamboura B et al. Maternal immunisation with trivalent inactivated influenza vaccine for prevention of influenza in infants in Mali: a prospective, active-controlled, observer-blind, randomised phase 4 trial. Lancet Infect Dis. 2016 Sep;16(9):1026-35.
    10. Donahue JG, Kieke BA, King JP et al. Association of spontaneous abortion with receipt of inactivated influenza vaccine containing H1N1pdm09 in 2010-11 and 2011-12. Vacuna 35 (2017) 5314-5322
    11. Moro PL, Broder K, Zheteyeva Y, et al. Adverse events in pregnant women following administration of trivalent inactivated influenza vaccine and live attenuated influenza vaccine in the Vaccine Adverse Event Reporting System, 1990-2009. Am J Obstet Gynecol 2011;204:146.e1-7.
    12. Irving SA1, Kieke BA, Donahue JG et al. Trivalent inactivated influenza vaccine and spontaneous abortion. Obstet Gynecol. 2013 Jan;121(1):159-65.
    13. Kharbanda EO, Vazquez-Benitez G, Lipkind H et al. Inactivated Influenza Vaccine during Pregnancy and Risks for Adverse Obstetric Events. Obstetrics & Gynecology: September 2013 – Volume 122 – Issue 3 – p 659–667
    14. Nordin JD, Kharbanda EO, Vazquez-Benitez G et al. Maternal Influenza Vaccine and Risks for Preterm or Small for Gestational Age Birth. The Journal of Pediatrics. Volume 164, Issue 5, May 2014, Pages 1051-1057.e2
    15. Kharbanda EO, Vazquez-Benitez G, Romitti PA et al. First Trimester Influenza Vaccination and Risks for Major Structural Birth Defects in Offspring. J Pediatr. 2017 Aug;187:234-239.e4.
    16. ACOG. It is Safe to Receive Flu Shot during Pregnancy. https://www.acog.org/About-ACOG/News-Room/Statements/2017/It-is-Safe-to-Receive-Flu-Shot-During-Pregnancy 
    17. CDC. Flu Vaccination & Possible Safety Signal. https://www.cdc.gov/flu/professionals/vaccination/vaccination-possible-safety-signal.html.
    18. National Vaccine Advisory Committee. Recommendations from the National Vaccine Advisory Committee: Standards for Adult Immunization Practice. Public Health Rep 2014;129:115-23.
    19. The Guide to Community Preventive Services:  https://www.thecommunityguide.org/topic/vaccination. Consultado el 14 de noviembre del 2017.
    20. Guttmacher Institute. Total pregnancies by occurrence includes total births, abortions by occurrence and miscarriages Disponible en: http://www.guttmacher.org/datacenter.
    21. Martin JA, Hamilton BE, Osterman MJK, et al. Births: Final data for 2015. National vital statistics report; vol 66, no 1. Hyattsville, MD: National Center for Health Statistics. 2017. Disponible en: https://www.cdc.gov/nchs/data/nvsr/nvsr66/nvsr66_01.pdf.
    22. Curtin SC, Abma JC, & Kost K. 2010 pregnancy rates among U.S. women (supplemental table). NCHS Health E-Stat. 2015. Ingresado el 28 de noviembre del 2016.
    23. Pew Research Center. U.S. smartphone use in 2015. Disponible en: http://www.pewinternet.org/2015/04/01/us-smartphone-use-in-2015/. Consultado el 30 de noviembre del 2017.
    24. Ding H, Black CL, Ball S, et al. Influenza vaccination coverage among pregnant women-United States, 2016-17 influenza season. MMWR Morb Mort Wkly Rep 2017;66:1016-22.
    25. Asociación Estadounidense para la Investigación de la Opinión Pública. Report of the AAPOR Task Force on non-probability sampling. Consultado el 14 de noviembre del 2017.

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Notas a pie de página

*Excludes 6 currently pregnant women with unknown trimester of pregnancy.

Currently have conditions other than pregnancy associated with increased risk for serious medical complications from influenza, including chronic asthma, a lung condition other than asthma, a heart condition, non-gestational diabetes, a kidney condition, a liver condition, a weakened immune system caused by a chronic illness or by medicines taken for a chronic illness, or obesity.

Excludes 249 women who reported being vaccinated after their pregnancy ended.

§Includes unvaccinated respondents who reported that they probably or definitely do not intend to be vaccinated before the end of the flu season.

||Respondents could select more than one reason.

Includes unvaccinated respondents who reported that they probably or definitely will get vaccinated before the end of the flu season.

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