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Am J Manag Care. 2010 Mar;16(3):209-16.

Improving influenza immunization in pregnant women and healthcare workers.

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Kelsey-Seybold Clinic, Houston, TX, USA.



To evaluate the effect of several strategies to increase influenza immunization in a multispecialty clinic.


Retrospective electronic database analysis of influenza vaccinations in a 6-year period at Kelsey-Seybold Clinic in Houston, Texas.


We evaluated immunization rates in pregnant women and healthcare workers during 6 influenza seasons (2003-2004 to 2008-2009) after implementing the following strategies for pregnant women: assessing baseline immunization rates for obstetric providers, followed by direct encouragement and behavior modeling; implementing standing orders for influenza vaccination in pregnancy; and offering vaccination training to obstetricians and nurses. Further strategies implemented for healthcare workers included the following: conducting an employee survey about influenza knowledge, providing employee education based on survey findings and Centers for Disease Control and Prevention recommendations, making employee vaccines readily available and free of charge, designating immunization nurses to serve as clinical champions, monitoring and reporting the employee influenza vaccination rate, and recognizing the clinic with the highest employee vaccination rate.


Influenza vaccination coverage rates in pregnant women increased from 2.5% at baseline to 37.4% in 2008-2009. Employee influenza vaccination coverage rates increased from 36.0% in 2003-2004 to 64.0% in 2008-2009.


Low influenza vaccination rates in pregnant women and healthcare workers can be substantially improved using methods shown to be effective in other clinical settings.

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