Forum on Child and Family StatisticsVaccination: Influenza
Pregnant women and infants too young to be vaccinated have a disproportionate burden of influenza-associated hospitalization.1 The Centers for Disease Control and Prevention recommends that all women who are or might be pregnant during the influenza season receive an influenza vaccine, which can be administered any time during pregnancy, to both protect themselves and provide antibody protection for their infant.2 However, less than half of pregnant women received an influenza vaccination during the 2022–2023 influenza season.3 Data on vaccination coverage can be used to identify groups of women who may be more likely to be unvaccinated, which can inform interventions for increasing vaccination coverage. 1, 3 Vaccination coverage varies by race and Hispanic origin, education, and type of health insurance.
Figure 1: Percentage of women ages 18–49 pregnant during the influenza season (August–March) who received an influenza vaccination before or during pregnancy overall and by maternal race and Hispanic origin, 2012–2013 through 2021–2022 influenza seasons
NOTE: NH = non-Hispanic origin. Figure presents data from National Health Interview Survey (NHIS) years 2012–2022. Since 2012, questions have been included in the NHIS that can identify women ages 18–49 who were pregnant anytime from August through March of an influenza season, whether they received an influenza vaccination during this influenza season, and whether it was before or during their pregnancy. Kaplan–Meier survival analysis was used to calculate cumulative influenza vaccination coverage before and during pregnancy among women pregnant anytime during August–March for each influenza season during 2012–2022. NHIS data collected during August–July across 2 survey years were used to assess influenza vaccination coverage during July–March. For example, to calculate the percent vaccinated during the 2012–2013 influenza season, interview data collected during August 2012–July 2013 were analyzed, and respondents pregnant anytime during August 2012–March 2013 were included in the analysis; respondents who reported receiving an influenza vaccination during July 2012–June 2013 (before or during pregnancy) were considered vaccinated, with cumulative estimates through March 2013 being reported. Included as "Other, non-Hispanic" but not shown separately because of the small sample size are American Indian or Alaska Native, Asian, Native Hawaiian or Other Pacific Islander, and those who reported more than one race. Fluctuations in influenza vaccination coverage observed by race and Hispanic origin may be because of small sample sizes in certain groups. Reporting standards were not met for Black, non-Hispanic women in 2013–2014, 2019–2020, and 2021–2022 and for Other, non-Hispanic women in 2014–2015, 2015–2016, 2016–2017, and 2017–2018; estimates are considered unreliable and are not reported. The influenza questions were changed in 2016. As a result, data for 2016 onward are not strictly comparable with earlier data. In 2019, the NHIS questionnaire was redesigned, and other changes were made to weighting and design methodology. Therefore, data for 2019 onward are not strictly comparable with data for earlier years. An exception for combining data across the redesign was made for the influenza vaccination data because the influenza season runs from July to March. For more information on the2019 NHIS redesign, see https://www.cdc.gov/nchs/nhis/about/2019-questionnaire-redesign.html.
SOURCE: National Center for Health Statistics, National Health Interview Survey.
- Some 45% of women ages 18–49 who were pregnant during the 2021–2022 influenza season received an influenza vaccination before or during their pregnancy. Influenza vaccination coverage during the 2021–2022 season was 47% among White, non-Hispanic women, 50% among Hispanic women.
- Among White, non-Hispanic women, influenza vaccination coverage increased from the 2014–2015 season to the 2015–2016 season. Among Black, non-Hispanic women, influenza vaccination coverage decreased from the 2016–2017 season to the 2017–2018 season. There were no statistically significant differences in coverage by season among Hispanic women.
- During the 2015–2016 and 2017–2018 influenza seasons, Black, non-Hispanic women had lower influenza vaccination coverage than White, non-Hispanic women.
Figure 2: Percentage of women ages 18–49 pregnant during the influenza season (August–March) who received an influenza vaccination before or during pregnancy overall and by maternal education, 2012–2013 through 2021–2022 influenza seasons
NOTE: Figure presents data from National Health Interview Survey (NHIS) years 2012–2022. Since 2012, questions have been included in the NHIS that can identify women ages 18–49 who were pregnant anytime during August through March of an influenza season, whether they received an influenza vaccination during this influenza season, and whether it was before or during their pregnancy. Kaplan–Meier survival analysis was used to calculate cumulative influenza vaccination coverage before and during pregnancy among women pregnant anytime during August–March for each influenza season during 2012–2022. NHIS data collected during August–July across two survey years were used to assess influenza vaccination coverage during July–March. For example, to calculate the percent vaccinated during the 2012–2013 influenza season, interview data collected during August 2012–July 2013 were analyzed, and respondents pregnant anytime during August 2012–March 2013 were included in the analysis; respondents who reported receiving an influenza vaccination during July 2012–June 2013 (before or during pregnancy) were considered vaccinated, with cumulative estimates through March 2013 being reported. High school diploma or less includes women with no education or any education through high school graduation as well as GED or equivalent. Some college, no degree includes women who have taken some college-level classes after high school but have not yet earned a college degree. College degree includes women who have completed an associate's degree or a bachelor's degree. More than college degree includes women who have earned a master's degree, a professional degree, or a doctoral degree. Reporting standards were not met for women with some college, no degree in 2021–2022; estimate is considered unreliable and is not reported. The influenza questions were changed in 2016. As a result, data for 2016 onward are not strictly comparable with earlier data. In 2019, the NHIS questionnaire was redesigned and other changes were made to weighting and design methodology. Therefore, data for 2019 onward are not strictly comparable with data for earlier years. An exception for combining data across the redesign was made for the influenza vaccination data because the influenza season runs from July to March. For more information on the 2019 NHIS redesign, see https://www.cdc.gov/nchs/nhis/about/2019-questionnaire-redesign.html.
SOURCE: National Center for Health Statistics, National Health Interview Survey.
- Influenza vaccination coverage during the 2021–2022 season was 39% among women with a high school diploma or less education, 52% among women with a college degree, and 78% among women with more than a college degree.
- Among women with a high school diploma or less education, influenza vaccination coverage decreased from the 2016–2017 season to the 2017–2018 season but then increased in the 2018–2019 season. There were no statistically significant differences in coverage by season among women with more education.
- During most seasons, women with a high school diploma or less education had lower influenza vaccination coverage than women with a college degree or women with more than a college degree. During the 2019–2020 season, coverage for women with some college education but no degree was lower than for women with more than a college degree. During the 2018–2019 and 2021–2022 seasons, coverage was lower for women with a college education than for women with more than a college education.
Figure 3: Percentage of women ages 18–49 pregnant during the influenza season (August–March) who received an influenza vaccination before or during pregnancy overall and by type of health insurance, 2012–2013 through 2021–2022 influenza seasons
NOTE: Figure presents data from National Health Interview Survey (NHIS) years 2012–2022. Since 2012, the questions have been included in the NHIS that can identify women ages 18–49 who were pregnant anytime during August through March of an influenza season, whether they received an influenza vaccination during this influenza season, and whether it was before or during their pregnancy. Kaplan–Meier survival analysis was used to calculate cumulative influenza vaccination coverage before and during pregnancy among women pregnant anytime during August–March for each influenza season from 2012 through 2022. NHIS data collected during August–July across two survey years were used to assess influenza vaccination coverage during July–March. For example, to calculate the percent vaccinated during the 2012–2013 influenza season, interview data collected during August 2012–July 2013 were analyzed, and respondents pregnant anytime during August 2012–March 2013 were included in the analysis; respondents who reported receiving an influenza vaccination during July 2012–June 2013 (before or during pregnancy) were considered vaccinated, with cumulative estimates through March 2013 being reported. Any public includes women covered by Medicaid, Medicare, or a state-sponsored or other government-sponsored health plan. Private or military includes women who do not have public coverage but who have a military plan or any comprehensive private insurance plan (including health maintenance organizations and preferred provider organizations). These plans include those obtained through an employer, purchased directly, purchased through local or community programs, or purchased through the Health Insurance Marketplace or a state-based exchange. This classification of military plans differs from that of the National Center for Health Statistics, which classifies military plans as public insurance. The influenza questions were changed in 2016. As a result, data for 2016 onward are not strictly comparable with earlier data. In 2019, the NHIS questionnaire was redesigned, and other changes were made to weighting and design methodology. Therefore, data for 2019 onward are not strictly comparable with data for earlier years. An exception for combining data across the redesign was made for the influenza vaccination data because the influenza season runs from July to March. For more information on the 2019 NHIS redesign, see https://www.cdc.gov/nchs/nhis/about/2019-questionnaire-redesign.html.
SOURCE: National Center for Health Statistics, National Health Interview Survey.
- Influenza vaccination coverage during the 2021–2022 season was 55% among women with private or military health insurance and 30% among women with public health insurance.
- Among women with private or military health insurance, influenza vaccination coverage increased from the 2014–2015 season to the 2015–2016 season. Among women with public health insurance, coverage decreased from the 2016–2017 season to the 2017–2018 season. There were no other statistically significant differences in coverage by season.
- During most seasons, women with public health insurance had lower influenza vaccination coverage than women with private or military insurance.
1 Lindley MC, Kahn KE, Bardenheier BH, et al. Vital Signs: Burden and Prevention of Influenza and Pertussis Among Pregnant Women and Infants — United States. MMWR Morb Mortal Wkly Rep 2019;68:885–892.
2 Grohskopf LA, Blanton LH, Ferdinands JM, Chung JR, Broder KR, Talbot HK. Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices — United States, 2023–24 Influenza Season. MMWR Recomm Rep 2023;72(No. RR-2):1–25.
3 Razzaghi H, Kahn KE, Calhoun K, et al. Influenza, Tdap, and COVID-19 Vaccination Coverage and Hesitancy Among Pregnant Women — United States, April 2023. MMWR Morb Mortal Wkly Rep 2023;72:1065–1071.
Federal Interagency Forum on Child and Family Statistics
