%PDF-1.3 1 0 obj << /Type /Catalog /Outlines 2 0 R /Pages 3 0 R >> endobj 2 0 obj << /Type /Outlines /Count 0 >> endobj 3 0 obj << /Type /Pages /Kids [6 0 R 171 0 R 269 0 R 292 0 R 308 0 R 432 0 R 440 0 R 454 0 R ] /Count 8 /Resources << /ProcSet 4 0 R /Font << /F1 8 0 R /F2 9 0 R /F3 10 0 R /F4 11 0 R /F5 12 0 R >> /XObject << /I1 13 0 R /I2 14 0 R /I3 273 0 R /I4 274 0 R /I5 277 0 R /I6 280 0 R /I7 281 0 R /I8 286 0 R /I9 287 0 R /I10 290 0 R /I11 291 0 R /I12 296 0 R /I13 297 0 R /I14 300 0 R /I15 301 0 R /I16 304 0 R /I17 305 0 R /I18 306 0 R /I19 307 0 R /I20 312 0 R /I21 313 0 R /I22 352 0 R /I23 353 0 R /I24 392 0 R /I25 393 0 R /I26 430 0 R /I27 431 0 R >> >> /MediaBox [0.000 0.000 612.000 792.000] >> endobj 4 0 obj [/PDF /Text /ImageC ] endobj 5 0 obj << /Creator (DOMPDF) /CreationDate (D:20180722213622+00'00') /ModDate (D:20180722213622+00'00') /Title (Factors Associated with Intention to Receive Influenza and Tetanus, Diphtheria, and Acellular Pertussis \(Tdap\) Vaccines during Pregnancy: A Focus on Vaccine Hesitancy and Perceptions of Disease Severity and Vaccine Safety PLOS Currents Outbreaks) >> endobj 6 0 obj << /Type /Page /Parent 3 0 R /Annots [ 15 0 R 17 0 R 19 0 R 21 0 R 23 0 R 25 0 R 27 0 R 29 0 R 31 0 R 33 0 R 35 0 R 37 0 R 39 0 R 41 0 R 43 0 R 45 0 R 47 0 R 49 0 R 51 0 R 53 0 R 55 0 R 57 0 R 59 0 R 61 0 R 63 0 R 65 0 R 67 0 R 69 0 R 71 0 R 73 0 R 75 0 R 77 0 R 79 0 R 81 0 R 83 0 R 85 0 R 87 0 R 89 0 R 91 0 R 93 0 R 95 0 R 97 0 R 99 0 R 101 0 R 103 0 R 105 0 R 107 0 R 109 0 R 111 0 R 113 0 R 115 0 R 117 0 R 119 0 R 121 0 R 123 0 R 125 0 R 127 0 R 129 0 R 131 0 R 133 0 R 135 0 R 137 0 R 139 0 R 141 0 R 143 0 R 145 0 R 147 0 R 149 0 R 151 0 R 153 0 R 155 0 R 157 0 R 159 0 R 161 0 R 163 0 R 165 0 R 167 0 R 169 0 R ] /Contents 7 0 R >> endobj 7 0 obj << /Length 26651 >> stream q 375.000 0 0 39.000 222.000 738.000 cm /I2 Do Q q 15.000 634.458 577.500 103.542 re W n 0.267 0.267 0.267 rg BT 15.000 718.042 Td /F2 21.0 Tf [(Factors Associated with Intention to Receive Influenza and )] TJ ET BT 15.000 693.094 Td /F2 21.0 Tf [(Tetanus, Diphtheria, and Acellular Pertussis \(Tdap\) Vaccines )] TJ ET BT 15.000 668.146 Td /F2 21.0 Tf [(during Pregnancy: A Focus on Vaccine Hesitancy and )] TJ ET BT 15.000 643.198 Td /F2 21.0 Tf [(Perceptions of Disease Severity and Vaccine Safety)] TJ ET Q 0.271 0.267 0.267 rg BT 15.000 625.192 Td /F3 9.8 Tf [(February 25, 2015)] TJ ET BT 93.263 625.192 Td /F3 9.8 Tf [()] TJ ET 0.267 0.267 0.267 rg BT 98.138 625.192 Td /F3 9.8 Tf [(Research Article)] TJ ET BT 26.250 613.351 Td /F1 9.8 Tf [(Allison T. Chamberlain)] TJ ET 0.271 0.267 0.267 rg BT 124.316 613.351 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 129.737 613.351 Td /F1 9.8 Tf [(Katherine Seib)] TJ ET 0.271 0.267 0.267 rg BT 193.687 613.351 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 199.108 613.351 Td /F1 9.8 Tf [(Kevin A. Ault)] TJ ET 0.271 0.267 0.267 rg BT 254.927 613.351 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 260.347 613.351 Td /F1 9.8 Tf [(Walter A. Orenstein)] TJ ET 0.271 0.267 0.267 rg BT 345.416 613.351 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 350.837 613.351 Td /F1 9.8 Tf [(Paula M. Frew)] TJ ET 0.271 0.267 0.267 rg BT 413.686 613.351 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 419.107 613.351 Td /F1 9.8 Tf [(Fauzia Malik)] TJ ET 0.271 0.267 0.267 rg BT 473.824 613.351 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 479.245 613.351 Td /F1 9.8 Tf [(Marielysse Corts)] TJ ET 0.271 0.267 0.267 rg BT 557.255 613.351 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 26.250 601.446 Td /F1 9.8 Tf [(Pat Cota)] TJ ET 0.271 0.267 0.267 rg BT 64.187 601.446 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 69.608 601.446 Td /F1 9.8 Tf [(Ellen A. S. Whitney)] TJ ET 0.271 0.267 0.267 rg BT 153.058 601.446 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 158.480 601.446 Td /F1 9.8 Tf [(Lisa C. Flowers)] TJ ET 0.271 0.267 0.267 rg BT 225.657 601.446 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 231.078 601.446 Td /F1 9.8 Tf [(Ruth L. Berkelman)] TJ ET 0.271 0.267 0.267 rg BT 311.818 601.446 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 317.239 601.446 Td /F1 9.8 Tf [(Saad B. Omer)] TJ ET 0.271 0.267 0.267 rg BT 26.250 589.542 Td /F1 9.8 Tf [(Chamberlain AT, Seib K, Ault KA, Orenstein WA, Frew PM, Malik F, Corts M, Cota P, Whitney EAS, Flowers LC, Berkelman )] TJ ET BT 26.250 577.637 Td /F1 9.8 Tf [(RL, Omer SB. Factors Associated with Intention to Receive Influenza and Tetanus, Diphtheria, and Acellular Pertussis \(Tdap\) )] TJ ET BT 26.250 565.732 Td /F1 9.8 Tf [(Vaccines during Pregnancy: A Focus on Vaccine Hesitancy and Perceptions of Disease Severity and Vaccine Safety. PLOS )] TJ ET BT 26.250 553.827 Td /F1 9.8 Tf [(Currents Outbreaks. 2015 Feb 25 . Edition 1. doi: 10.1371/currents.outbreaks.d37b61bceebae5a7a06d40a301cfa819.)] TJ ET q 15.000 24.505 577.500 526.941 re W n 0.271 0.267 0.267 rg BT 26.250 524.725 Td /F4 12.0 Tf [(Abstract)] TJ ET BT 26.250 504.771 Td /F4 9.8 Tf [(BACKGROUND:)] TJ ET BT 100.984 504.771 Td /F1 9.8 Tf [(Improving influenza and tetanus, diphtheria and acellular pertussis \(Tdap\) vaccine coverage among pregnant )] TJ ET BT 26.250 492.866 Td /F1 9.8 Tf [(women is needed.)] TJ ET BT 26.250 473.461 Td /F4 9.8 Tf [(PURPOSE:)] TJ ET BT 77.174 473.461 Td /F1 9.8 Tf [(To assess factors associated with intention to receive influenza and/or Tdap vaccinations during pregnancy with a )] TJ ET BT 26.250 461.556 Td /F1 9.8 Tf [(focus on perceptions of influenza and pertussis disease severity and influenza vaccine safety.)] TJ ET BT 26.250 442.152 Td /F4 9.8 Tf [(METHODS:)] TJ ET BT 78.247 442.152 Td /F1 9.8 Tf [(Participants were 325 pregnant women in Georgia recruited from December 2012 April 2013 who had not yet )] TJ ET BT 26.250 430.247 Td /F1 9.8 Tf [(received a 2012/2013 influenza vaccine or a Tdap vaccine while pregnant. Women completed a survey assessing influenza )] TJ ET BT 26.250 418.342 Td /F1 9.8 Tf [(vaccination history, likelihood of receiving antenatal influenza and/or Tdap vaccines, and knowledge, attitudes and beliefs about )] TJ ET BT 26.250 406.437 Td /F1 9.8 Tf [(influenza, pertussis, and their associated vaccines.)] TJ ET BT 26.250 387.033 Td /F4 9.8 Tf [(RESULTS:)] TJ ET BT 77.710 387.033 Td /F1 9.8 Tf [(Seventy-three percent and 81% of women believed influenza and pertussis, respectively, would be serious during )] TJ ET BT 26.250 375.128 Td /F1 9.8 Tf [(pregnancy while 87% and 92% believed influenza and pertussis, respectively, would be serious to their infants. Perception of )] TJ ET BT 26.250 363.223 Td /F1 9.8 Tf [(pertussis severity for their infant was strongly associated with an intention to receive a Tdap vaccine before delivery \(p=0.004\). )] TJ ET BT 26.250 351.318 Td /F1 9.8 Tf [(Despite perceptions of disease severity for themselves and their infants, only 34% and 44% intended to receive antenatal )] TJ ET BT 26.250 339.414 Td /F1 9.8 Tf [(influenza and Tdap vaccines, respectively. Forty-six percent had low perceptions of safety regarding the influenza vaccine )] TJ ET BT 26.250 327.509 Td /F1 9.8 Tf [(during pregnancy, and compared to women who perceived the influenza vaccine as safe, women who perceived the vaccine as )] TJ ET BT 26.250 315.604 Td /F1 9.8 Tf [(unsafe were less likely to intend to receive antenatal influenza \(48% vs. 20%; p < 0.001\) or Tdap \(53% vs. 33%; p < 0.001\) )] TJ ET BT 26.250 303.699 Td /F1 9.8 Tf [(vaccinations.)] TJ ET BT 26.250 284.295 Td /F4 9.8 Tf [(CONCLUSIONS:)] TJ ET BT 101.540 284.295 Td /F1 9.8 Tf [(Results from this baseline survey suggest that while pregnant women who remain unvaccinated against )] TJ ET BT 26.250 272.390 Td /F1 9.8 Tf [(influenza within the first three months of the putative influenza season may be aware of the risks influenza and pertussis pose to )] TJ ET BT 26.250 260.485 Td /F1 9.8 Tf [(themselves and their infants, many remain reluctant to receive influenza and Tdap vaccines antenatally. To improve vaccine )] TJ ET BT 26.250 248.580 Td /F1 9.8 Tf [(uptake in the obstetric setting, our findings support development of evidence-based vaccine promotion interventions which )] TJ ET BT 26.250 236.676 Td /F1 9.8 Tf [(emphasize vaccine safety during pregnancy and mention disease severity in infancy.)] TJ ET BT 26.250 200.073 Td /F4 12.0 Tf [(Funding Statement)] TJ ET BT 26.250 180.119 Td /F1 9.8 Tf [(Allison Chamberlain, Katherine Seib, Paula Frew, Marielysse Corts, Ellen Whitney, Ruth Berkelman, and Saad Omer were )] TJ ET BT 26.250 168.214 Td /F1 9.8 Tf [(supported by the Centers for Disease Control and Prevention \(CDC\), grant # 5P01TP000300 and supplemental funding from )] TJ ET BT 26.250 156.309 Td /F1 9.8 Tf [(the Rollins School of Public Health for their work on this project.)] TJ ET BT 26.250 127.207 Td /F4 12.0 Tf [(Related Articles)] TJ ET BT 26.250 107.253 Td /F1 9.8 Tf [(The article is part of the )] TJ ET BT 130.838 107.253 Td /F5 9.8 Tf [(PLOS Currents Outbreaks )] TJ ET BT 247.341 107.253 Td /F1 9.8 Tf [()] TJ ET 0.267 0.267 0.267 rg BT 250.588 107.253 Td /F1 9.8 Tf [(Vaccine Hesitancy Collection)] TJ ET 0.271 0.267 0.267 rg BT 376.294 107.253 Td /F1 9.8 Tf [(.)] TJ ET BT 26.250 70.650 Td /F4 12.0 Tf [(Introduction)] TJ ET BT 26.250 50.696 Td /F1 9.8 Tf [(Respiratory infections like influenza and pertussis during pregnancy can pose serious risks to mother and infant.)] TJ ET 0.267 0.267 0.267 rg BT 509.080 52.203 Td /F4 8.7 Tf [(1)] TJ ET 0.271 0.267 0.267 rg BT 513.898 54.584 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 516.308 52.203 Td /F4 8.7 Tf [(2)] TJ ET 0.271 0.267 0.267 rg BT 521.126 54.584 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 523.536 52.203 Td /F4 8.7 Tf [(3)] TJ ET 0.271 0.267 0.267 rg BT 528.354 54.584 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 530.764 52.203 Td /F4 8.7 Tf [(4)] TJ ET 0.271 0.267 0.267 rg BT 535.582 54.584 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 537.992 52.203 Td /F4 8.7 Tf [(5)] TJ ET 0.271 0.267 0.267 rg BT 542.810 54.584 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 545.220 52.203 Td /F4 8.7 Tf [(6)] TJ ET 0.271 0.267 0.267 rg BT 550.038 54.584 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 552.448 52.203 Td /F4 8.7 Tf [(7)] TJ ET 0.271 0.267 0.267 rg BT 557.266 54.584 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 559.676 52.203 Td /F4 8.7 Tf [(8)] TJ ET 0.271 0.267 0.267 rg BT 26.250 38.791 Td /F1 9.8 Tf [(Pregnant women are at increased risk of complications from influenza, and infants are not recommended to receive an influenza )] TJ ET Q q 15.000 634.458 577.500 103.542 re W n 0.267 0.267 0.267 rg BT 15.000 718.042 Td /F2 21.0 Tf [(Factors Associated with Intention to Receive Influenza and )] TJ ET BT 15.000 693.094 Td /F2 21.0 Tf [(Tetanus, Diphtheria, and Acellular Pertussis \(Tdap\) Vaccines )] TJ ET BT 15.000 668.146 Td /F2 21.0 Tf [(during Pregnancy: A Focus on Vaccine Hesitancy and )] TJ ET BT 15.000 643.198 Td /F2 21.0 Tf [(Perceptions of Disease Severity and Vaccine Safety)] TJ ET Q 0.271 0.267 0.267 rg BT 15.000 625.192 Td /F3 9.8 Tf [(February 25, 2015)] TJ ET BT 93.263 625.192 Td /F3 9.8 Tf [()] TJ ET 0.267 0.267 0.267 rg BT 98.138 625.192 Td /F3 9.8 Tf [(Research Article)] TJ ET BT 26.250 613.351 Td /F1 9.8 Tf [(Allison T. Chamberlain)] TJ ET 0.271 0.267 0.267 rg BT 124.316 613.351 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 129.737 613.351 Td /F1 9.8 Tf [(Katherine Seib)] TJ ET 0.271 0.267 0.267 rg BT 193.687 613.351 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 199.108 613.351 Td /F1 9.8 Tf [(Kevin A. Ault)] TJ ET 0.271 0.267 0.267 rg BT 254.927 613.351 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 260.347 613.351 Td /F1 9.8 Tf [(Walter A. Orenstein)] TJ ET 0.271 0.267 0.267 rg BT 345.416 613.351 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 350.837 613.351 Td /F1 9.8 Tf [(Paula M. Frew)] TJ ET 0.271 0.267 0.267 rg BT 413.686 613.351 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 419.107 613.351 Td /F1 9.8 Tf [(Fauzia Malik)] TJ ET 0.271 0.267 0.267 rg BT 473.824 613.351 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 479.245 613.351 Td /F1 9.8 Tf [(Marielysse Corts)] TJ ET 0.271 0.267 0.267 rg BT 557.255 613.351 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 26.250 601.446 Td /F1 9.8 Tf [(Pat Cota)] TJ ET 0.271 0.267 0.267 rg BT 64.187 601.446 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 69.608 601.446 Td /F1 9.8 Tf [(Ellen A. S. Whitney)] TJ ET 0.271 0.267 0.267 rg BT 153.058 601.446 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 158.480 601.446 Td /F1 9.8 Tf [(Lisa C. Flowers)] TJ ET 0.271 0.267 0.267 rg BT 225.657 601.446 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 231.078 601.446 Td /F1 9.8 Tf [(Ruth L. Berkelman)] TJ ET 0.271 0.267 0.267 rg BT 311.818 601.446 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 317.239 601.446 Td /F1 9.8 Tf [(Saad B. Omer)] TJ ET 0.271 0.267 0.267 rg BT 26.250 589.542 Td /F1 9.8 Tf [(Chamberlain AT, Seib K, Ault KA, Orenstein WA, Frew PM, Malik F, Corts M, Cota P, Whitney EAS, Flowers LC, Berkelman )] TJ ET BT 26.250 577.637 Td /F1 9.8 Tf [(RL, Omer SB. Factors Associated with Intention to Receive Influenza and Tetanus, Diphtheria, and Acellular Pertussis \(Tdap\) )] TJ ET BT 26.250 565.732 Td /F1 9.8 Tf [(Vaccines during Pregnancy: A Focus on Vaccine Hesitancy and Perceptions of Disease Severity and Vaccine Safety. PLOS )] TJ ET BT 26.250 553.827 Td /F1 9.8 Tf [(Currents Outbreaks. 2015 Feb 25 . Edition 1. doi: 10.1371/currents.outbreaks.d37b61bceebae5a7a06d40a301cfa819.)] TJ ET q 15.000 24.505 577.500 526.941 re W n 0.271 0.267 0.267 rg BT 26.250 524.725 Td /F4 12.0 Tf [(Abstract)] TJ ET BT 26.250 504.771 Td /F4 9.8 Tf [(BACKGROUND:)] TJ ET BT 100.984 504.771 Td /F1 9.8 Tf [(Improving influenza and tetanus, diphtheria and acellular pertussis \(Tdap\) vaccine coverage among pregnant )] TJ ET BT 26.250 492.866 Td /F1 9.8 Tf [(women is needed.)] TJ ET BT 26.250 473.461 Td /F4 9.8 Tf [(PURPOSE:)] TJ ET BT 77.174 473.461 Td /F1 9.8 Tf [(To assess factors associated with intention to receive influenza and/or Tdap vaccinations during pregnancy with a )] TJ ET BT 26.250 461.556 Td /F1 9.8 Tf [(focus on perceptions of influenza and pertussis disease severity and influenza vaccine safety.)] TJ ET BT 26.250 442.152 Td /F4 9.8 Tf [(METHODS:)] TJ ET BT 78.247 442.152 Td /F1 9.8 Tf [(Participants were 325 pregnant women in Georgia recruited from December 2012 April 2013 who had not yet )] TJ ET BT 26.250 430.247 Td /F1 9.8 Tf [(received a 2012/2013 influenza vaccine or a Tdap vaccine while pregnant. Women completed a survey assessing influenza )] TJ ET BT 26.250 418.342 Td /F1 9.8 Tf [(vaccination history, likelihood of receiving antenatal influenza and/or Tdap vaccines, and knowledge, attitudes and beliefs about )] TJ ET BT 26.250 406.437 Td /F1 9.8 Tf [(influenza, pertussis, and their associated vaccines.)] TJ ET BT 26.250 387.033 Td /F4 9.8 Tf [(RESULTS:)] TJ ET BT 77.710 387.033 Td /F1 9.8 Tf [(Seventy-three percent and 81% of women believed influenza and pertussis, respectively, would be serious during )] TJ ET BT 26.250 375.128 Td /F1 9.8 Tf [(pregnancy while 87% and 92% believed influenza and pertussis, respectively, would be serious to their infants. Perception of )] TJ ET BT 26.250 363.223 Td /F1 9.8 Tf [(pertussis severity for their infant was strongly associated with an intention to receive a Tdap vaccine before delivery \(p=0.004\). )] TJ ET BT 26.250 351.318 Td /F1 9.8 Tf [(Despite perceptions of disease severity for themselves and their infants, only 34% and 44% intended to receive antenatal )] TJ ET BT 26.250 339.414 Td /F1 9.8 Tf [(influenza and Tdap vaccines, respectively. Forty-six percent had low perceptions of safety regarding the influenza vaccine )] TJ ET BT 26.250 327.509 Td /F1 9.8 Tf [(during pregnancy, and compared to women who perceived the influenza vaccine as safe, women who perceived the vaccine as )] TJ ET BT 26.250 315.604 Td /F1 9.8 Tf [(unsafe were less likely to intend to receive antenatal influenza \(48% vs. 20%; p < 0.001\) or Tdap \(53% vs. 33%; p < 0.001\) )] TJ ET BT 26.250 303.699 Td /F1 9.8 Tf [(vaccinations.)] TJ ET BT 26.250 284.295 Td /F4 9.8 Tf [(CONCLUSIONS:)] TJ ET BT 101.540 284.295 Td /F1 9.8 Tf [(Results from this baseline survey suggest that while pregnant women who remain unvaccinated against )] TJ ET BT 26.250 272.390 Td /F1 9.8 Tf [(influenza within the first three months of the putative influenza season may be aware of the risks influenza and pertussis pose to )] TJ ET BT 26.250 260.485 Td /F1 9.8 Tf [(themselves and their infants, many remain reluctant to receive influenza and Tdap vaccines antenatally. To improve vaccine )] TJ ET BT 26.250 248.580 Td /F1 9.8 Tf [(uptake in the obstetric setting, our findings support development of evidence-based vaccine promotion interventions which )] TJ ET BT 26.250 236.676 Td /F1 9.8 Tf [(emphasize vaccine safety during pregnancy and mention disease severity in infancy.)] TJ ET BT 26.250 200.073 Td /F4 12.0 Tf [(Funding Statement)] TJ ET BT 26.250 180.119 Td /F1 9.8 Tf [(Allison Chamberlain, Katherine Seib, Paula Frew, Marielysse Corts, Ellen Whitney, Ruth Berkelman, and Saad Omer were )] TJ ET BT 26.250 168.214 Td /F1 9.8 Tf [(supported by the Centers for Disease Control and Prevention \(CDC\), grant # 5P01TP000300 and supplemental funding from )] TJ ET BT 26.250 156.309 Td /F1 9.8 Tf [(the Rollins School of Public Health for their work on this project.)] TJ ET BT 26.250 127.207 Td /F4 12.0 Tf [(Related Articles)] TJ ET BT 26.250 107.253 Td /F1 9.8 Tf [(The article is part of the )] TJ ET BT 130.838 107.253 Td /F5 9.8 Tf [(PLOS Currents Outbreaks )] TJ ET BT 247.341 107.253 Td /F1 9.8 Tf [()] TJ ET 0.267 0.267 0.267 rg BT 250.588 107.253 Td /F1 9.8 Tf [(Vaccine Hesitancy Collection)] TJ ET 0.271 0.267 0.267 rg BT 376.294 107.253 Td /F1 9.8 Tf [(.)] TJ ET BT 26.250 70.650 Td /F4 12.0 Tf [(Introduction)] TJ ET BT 26.250 50.696 Td /F1 9.8 Tf [(Respiratory infections like influenza and pertussis during pregnancy can pose serious risks to mother and infant.)] TJ ET 0.267 0.267 0.267 rg BT 509.080 52.203 Td /F4 8.7 Tf [(1)] TJ ET 0.271 0.267 0.267 rg BT 513.898 54.584 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 516.308 52.203 Td /F4 8.7 Tf [(2)] TJ ET 0.271 0.267 0.267 rg BT 521.126 54.584 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 523.536 52.203 Td /F4 8.7 Tf [(3)] TJ ET 0.271 0.267 0.267 rg BT 528.354 54.584 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 530.764 52.203 Td /F4 8.7 Tf [(4)] TJ ET 0.271 0.267 0.267 rg BT 535.582 54.584 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 537.992 52.203 Td /F4 8.7 Tf [(5)] TJ ET 0.271 0.267 0.267 rg BT 542.810 54.584 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 545.220 52.203 Td /F4 8.7 Tf [(6)] TJ ET 0.271 0.267 0.267 rg BT 550.038 54.584 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 552.448 52.203 Td /F4 8.7 Tf [(7)] TJ ET 0.271 0.267 0.267 rg BT 557.266 54.584 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 559.676 52.203 Td /F4 8.7 Tf [(8)] TJ ET 0.271 0.267 0.267 rg BT 26.250 38.791 Td /F1 9.8 Tf [(Pregnant women are at increased risk of complications from influenza, and infants are not recommended to receive an influenza )] TJ ET Q q 15.000 634.458 577.500 103.542 re W n 0.267 0.267 0.267 rg BT 15.000 718.042 Td /F2 21.0 Tf [(Factors Associated with Intention to Receive Influenza and )] TJ ET BT 15.000 693.094 Td /F2 21.0 Tf [(Tetanus, Diphtheria, and Acellular Pertussis \(Tdap\) Vaccines )] TJ ET BT 15.000 668.146 Td /F2 21.0 Tf [(during Pregnancy: A Focus on Vaccine Hesitancy and )] TJ ET BT 15.000 643.198 Td /F2 21.0 Tf [(Perceptions of Disease Severity and Vaccine Safety)] TJ ET Q 0.271 0.267 0.267 rg BT 15.000 625.192 Td /F3 9.8 Tf [(February 25, 2015)] TJ ET BT 93.263 625.192 Td /F3 9.8 Tf [()] TJ ET 0.267 0.267 0.267 rg BT 98.138 625.192 Td /F3 9.8 Tf [(Research Article)] TJ ET BT 26.250 613.351 Td /F1 9.8 Tf [(Allison T. Chamberlain)] TJ ET 0.271 0.267 0.267 rg BT 124.316 613.351 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 129.737 613.351 Td /F1 9.8 Tf [(Katherine Seib)] TJ ET 0.271 0.267 0.267 rg BT 193.687 613.351 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 199.108 613.351 Td /F1 9.8 Tf [(Kevin A. Ault)] TJ ET 0.271 0.267 0.267 rg BT 254.927 613.351 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 260.347 613.351 Td /F1 9.8 Tf [(Walter A. Orenstein)] TJ ET 0.271 0.267 0.267 rg BT 345.416 613.351 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 350.837 613.351 Td /F1 9.8 Tf [(Paula M. Frew)] TJ ET 0.271 0.267 0.267 rg BT 413.686 613.351 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 419.107 613.351 Td /F1 9.8 Tf [(Fauzia Malik)] TJ ET 0.271 0.267 0.267 rg BT 473.824 613.351 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 479.245 613.351 Td /F1 9.8 Tf [(Marielysse Corts)] TJ ET 0.271 0.267 0.267 rg BT 557.255 613.351 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 26.250 601.446 Td /F1 9.8 Tf [(Pat Cota)] TJ ET 0.271 0.267 0.267 rg BT 64.187 601.446 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 69.608 601.446 Td /F1 9.8 Tf [(Ellen A. S. Whitney)] TJ ET 0.271 0.267 0.267 rg BT 153.058 601.446 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 158.480 601.446 Td /F1 9.8 Tf [(Lisa C. Flowers)] TJ ET 0.271 0.267 0.267 rg BT 225.657 601.446 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 231.078 601.446 Td /F1 9.8 Tf [(Ruth L. Berkelman)] TJ ET 0.271 0.267 0.267 rg BT 311.818 601.446 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 317.239 601.446 Td /F1 9.8 Tf [(Saad B. Omer)] TJ ET 0.271 0.267 0.267 rg BT 26.250 589.542 Td /F1 9.8 Tf [(Chamberlain AT, Seib K, Ault KA, Orenstein WA, Frew PM, Malik F, Corts M, Cota P, Whitney EAS, Flowers LC, Berkelman )] TJ ET BT 26.250 577.637 Td /F1 9.8 Tf [(RL, Omer SB. Factors Associated with Intention to Receive Influenza and Tetanus, Diphtheria, and Acellular Pertussis \(Tdap\) )] TJ ET BT 26.250 565.732 Td /F1 9.8 Tf [(Vaccines during Pregnancy: A Focus on Vaccine Hesitancy and Perceptions of Disease Severity and Vaccine Safety. PLOS )] TJ ET BT 26.250 553.827 Td /F1 9.8 Tf [(Currents Outbreaks. 2015 Feb 25 . Edition 1. doi: 10.1371/currents.outbreaks.d37b61bceebae5a7a06d40a301cfa819.)] TJ ET q 15.000 24.505 577.500 526.941 re W n 0.271 0.267 0.267 rg BT 26.250 524.725 Td /F4 12.0 Tf [(Abstract)] TJ ET BT 26.250 504.771 Td /F4 9.8 Tf [(BACKGROUND:)] TJ ET BT 100.984 504.771 Td /F1 9.8 Tf [(Improving influenza and tetanus, diphtheria and acellular pertussis \(Tdap\) vaccine coverage among pregnant )] TJ ET BT 26.250 492.866 Td /F1 9.8 Tf [(women is needed.)] TJ ET BT 26.250 473.461 Td /F4 9.8 Tf [(PURPOSE:)] TJ ET BT 77.174 473.461 Td /F1 9.8 Tf [(To assess factors associated with intention to receive influenza and/or Tdap vaccinations during pregnancy with a )] TJ ET BT 26.250 461.556 Td /F1 9.8 Tf [(focus on perceptions of influenza and pertussis disease severity and influenza vaccine safety.)] TJ ET BT 26.250 442.152 Td /F4 9.8 Tf [(METHODS:)] TJ ET BT 78.247 442.152 Td /F1 9.8 Tf [(Participants were 325 pregnant women in Georgia recruited from December 2012 April 2013 who had not yet )] TJ ET BT 26.250 430.247 Td /F1 9.8 Tf [(received a 2012/2013 influenza vaccine or a Tdap vaccine while pregnant. Women completed a survey assessing influenza )] TJ ET BT 26.250 418.342 Td /F1 9.8 Tf [(vaccination history, likelihood of receiving antenatal influenza and/or Tdap vaccines, and knowledge, attitudes and beliefs about )] TJ ET BT 26.250 406.437 Td /F1 9.8 Tf [(influenza, pertussis, and their associated vaccines.)] TJ ET BT 26.250 387.033 Td /F4 9.8 Tf [(RESULTS:)] TJ ET BT 77.710 387.033 Td /F1 9.8 Tf [(Seventy-three percent and 81% of women believed influenza and pertussis, respectively, would be serious during )] TJ ET BT 26.250 375.128 Td /F1 9.8 Tf [(pregnancy while 87% and 92% believed influenza and pertussis, respectively, would be serious to their infants. Perception of )] TJ ET BT 26.250 363.223 Td /F1 9.8 Tf [(pertussis severity for their infant was strongly associated with an intention to receive a Tdap vaccine before delivery \(p=0.004\). )] TJ ET BT 26.250 351.318 Td /F1 9.8 Tf [(Despite perceptions of disease severity for themselves and their infants, only 34% and 44% intended to receive antenatal )] TJ ET BT 26.250 339.414 Td /F1 9.8 Tf [(influenza and Tdap vaccines, respectively. Forty-six percent had low perceptions of safety regarding the influenza vaccine )] TJ ET BT 26.250 327.509 Td /F1 9.8 Tf [(during pregnancy, and compared to women who perceived the influenza vaccine as safe, women who perceived the vaccine as )] TJ ET BT 26.250 315.604 Td /F1 9.8 Tf [(unsafe were less likely to intend to receive antenatal influenza \(48% vs. 20%; p < 0.001\) or Tdap \(53% vs. 33%; p < 0.001\) )] TJ ET BT 26.250 303.699 Td /F1 9.8 Tf [(vaccinations.)] TJ ET BT 26.250 284.295 Td /F4 9.8 Tf [(CONCLUSIONS:)] TJ ET BT 101.540 284.295 Td /F1 9.8 Tf [(Results from this baseline survey suggest that while pregnant women who remain unvaccinated against )] TJ ET BT 26.250 272.390 Td /F1 9.8 Tf [(influenza within the first three months of the putative influenza season may be aware of the risks influenza and pertussis pose to )] TJ ET BT 26.250 260.485 Td /F1 9.8 Tf [(themselves and their infants, many remain reluctant to receive influenza and Tdap vaccines antenatally. To improve vaccine )] TJ ET BT 26.250 248.580 Td /F1 9.8 Tf [(uptake in the obstetric setting, our findings support development of evidence-based vaccine promotion interventions which )] TJ ET BT 26.250 236.676 Td /F1 9.8 Tf [(emphasize vaccine safety during pregnancy and mention disease severity in infancy.)] TJ ET BT 26.250 200.073 Td /F4 12.0 Tf [(Funding Statement)] TJ ET BT 26.250 180.119 Td /F1 9.8 Tf [(Allison Chamberlain, Katherine Seib, Paula Frew, Marielysse Corts, Ellen Whitney, Ruth Berkelman, and Saad Omer were )] TJ ET BT 26.250 168.214 Td /F1 9.8 Tf [(supported by the Centers for Disease Control and Prevention \(CDC\), grant # 5P01TP000300 and supplemental funding from )] TJ ET BT 26.250 156.309 Td /F1 9.8 Tf [(the Rollins School of Public Health for their work on this project.)] TJ ET BT 26.250 127.207 Td /F4 12.0 Tf [(Related Articles)] TJ ET BT 26.250 107.253 Td /F1 9.8 Tf [(The article is part of the )] TJ ET BT 130.838 107.253 Td /F5 9.8 Tf [(PLOS Currents Outbreaks )] TJ ET BT 247.341 107.253 Td /F1 9.8 Tf [()] TJ ET 0.267 0.267 0.267 rg BT 250.588 107.253 Td /F1 9.8 Tf [(Vaccine Hesitancy Collection)] TJ ET 0.271 0.267 0.267 rg BT 376.294 107.253 Td /F1 9.8 Tf [(.)] TJ ET BT 26.250 70.650 Td /F4 12.0 Tf [(Introduction)] TJ ET BT 26.250 50.696 Td /F1 9.8 Tf [(Respiratory infections like influenza and pertussis during pregnancy can pose serious risks to mother and infant.)] TJ ET 0.267 0.267 0.267 rg BT 509.080 52.203 Td /F4 8.7 Tf [(1)] TJ ET 0.271 0.267 0.267 rg BT 513.898 54.584 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 516.308 52.203 Td /F4 8.7 Tf [(2)] TJ ET 0.271 0.267 0.267 rg BT 521.126 54.584 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 523.536 52.203 Td /F4 8.7 Tf [(3)] TJ ET 0.271 0.267 0.267 rg BT 528.354 54.584 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 530.764 52.203 Td /F4 8.7 Tf [(4)] TJ ET 0.271 0.267 0.267 rg BT 535.582 54.584 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 537.992 52.203 Td /F4 8.7 Tf [(5)] TJ ET 0.271 0.267 0.267 rg BT 542.810 54.584 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 545.220 52.203 Td /F4 8.7 Tf [(6)] TJ ET 0.271 0.267 0.267 rg BT 550.038 54.584 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 552.448 52.203 Td /F4 8.7 Tf [(7)] TJ ET 0.271 0.267 0.267 rg BT 557.266 54.584 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 559.676 52.203 Td /F4 8.7 Tf [(8)] TJ ET 0.271 0.267 0.267 rg BT 26.250 38.791 Td /F1 9.8 Tf [(Pregnant women are at increased risk of complications from influenza, and infants are not recommended to receive an influenza )] TJ ET Q q 0.000 0.000 0.000 rg BT 291.710 19.825 Td /F1 11.0 Tf [(1)] TJ ET BT 25.000 19.825 Td /F1 11.0 Tf [(PLOS Currents Outbreaks)] TJ ET Q endstream endobj 8 0 obj << /Type /Font /Subtype /Type1 /Name /F1 /BaseFont /Helvetica /Encoding /WinAnsiEncoding >> endobj 9 0 obj << /Type /Font /Subtype /Type1 /Name /F2 /BaseFont /Times-Bold /Encoding /WinAnsiEncoding >> endobj 10 0 obj << /Type /Font /Subtype /Type1 /Name 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<< /Type /Page /Parent 3 0 R /Annots [ 173 0 R 175 0 R 177 0 R 179 0 R 181 0 R 183 0 R 185 0 R 187 0 R 189 0 R 191 0 R 193 0 R 195 0 R 197 0 R 199 0 R 201 0 R 203 0 R 205 0 R 207 0 R 209 0 R 211 0 R 213 0 R 215 0 R 217 0 R 219 0 R 221 0 R 223 0 R 225 0 R 227 0 R 229 0 R 231 0 R 233 0 R 235 0 R 237 0 R 239 0 R 241 0 R 243 0 R 245 0 R 247 0 R 249 0 R 251 0 R 253 0 R 255 0 R 257 0 R 259 0 R 261 0 R 263 0 R 265 0 R 267 0 R ] /Contents 172 0 R >> endobj 172 0 obj << /Length 30979 >> stream 0.271 0.267 0.267 rg q 15.000 47.459 577.500 729.541 re W n 0.271 0.267 0.267 rg BT 26.250 767.476 Td /F1 9.8 Tf [(vaccine until 6 months of age.)] TJ ET 0.267 0.267 0.267 rg BT 155.233 768.983 Td /F4 8.7 Tf [(9)] TJ ET 0.271 0.267 0.267 rg BT 160.051 767.476 Td /F1 9.8 Tf [( For pertussis, infants under 2 months of age, prior to the recommended age for vaccination, )] TJ ET BT 26.250 755.571 Td /F1 9.8 Tf [(have the highest rates of hospitalization and death.)] TJ ET 0.267 0.267 0.267 rg BT 246.298 757.079 Td /F4 8.7 Tf [(10)] TJ ET 0.271 0.267 0.267 rg BT 255.935 755.571 Td /F1 9.8 Tf [( Antenatal vaccination against these diseases not only protects mothers, )] TJ ET BT 26.250 743.667 Td /F1 9.8 Tf [(but studies have suggested protection can be conferred to infants through maternal-fetal transfer of antibodies through the )] TJ ET BT 26.250 731.762 Td /F1 9.8 Tf [(placenta.)] TJ ET 0.267 0.267 0.267 rg BT 65.816 733.269 Td /F4 8.7 Tf [(12)] TJ ET 0.271 0.267 0.267 rg BT 75.453 735.650 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 77.862 733.269 Td /F4 8.7 Tf [(13)] TJ ET 0.271 0.267 0.267 rg BT 87.500 731.762 Td /F1 9.8 Tf [( Influenza vaccination during pregnancy can also protect against adverse fetal outcomes like preterm birth and )] TJ ET BT 26.250 719.857 Td /F1 9.8 Tf [(small for gestational age as well as respiratory illnesses during infancy.)] TJ ET 0.267 0.267 0.267 rg BT 332.400 721.364 Td /F4 8.7 Tf [(14)] TJ ET 0.271 0.267 0.267 rg BT 342.037 723.745 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 344.447 721.364 Td /F4 8.7 Tf [(15)] TJ ET 0.271 0.267 0.267 rg BT 26.250 700.452 Td /F1 9.8 Tf [(Antenatal influenza vaccination recommendations have been in place since the 1960s)] TJ ET 0.267 0.267 0.267 rg BT 398.563 701.960 Td /F4 8.7 Tf [(16)] TJ ET 0.271 0.267 0.267 rg BT 408.201 700.452 Td /F1 9.8 Tf [( , and in the U.S., the Centers for )] TJ ET BT 26.250 688.548 Td /F1 9.8 Tf [(Disease Control and Prevention \(CDC\) began recommending tetanus, diphtheria, and acellular pertussis \(Tdap\) vaccination )] TJ ET BT 26.250 676.643 Td /F1 9.8 Tf [(during pregnancy, preferably in the third or late second trimester, in 2011.)] TJ ET 0.267 0.267 0.267 rg BT 343.271 678.150 Td /F4 8.7 Tf [(17)] TJ ET 0.271 0.267 0.267 rg BT 352.909 676.643 Td /F1 9.8 Tf [( Based on previous research among pregnant )] TJ ET BT 26.250 664.738 Td /F1 9.8 Tf [(women and healthy adults, both vaccines are considered safe during pregnancy.)] TJ ET 0.267 0.267 0.267 rg BT 373.633 666.245 Td /F4 8.7 Tf [(18)] TJ ET 0.271 0.267 0.267 rg BT 383.270 668.626 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 385.679 666.245 Td /F4 8.7 Tf [(19)] TJ ET 0.271 0.267 0.267 rg BT 395.317 668.626 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 397.726 666.245 Td /F4 8.7 Tf [(20)] TJ ET 0.271 0.267 0.267 rg BT 407.363 668.626 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 409.773 666.245 Td /F4 8.7 Tf [(21)] TJ ET 0.271 0.267 0.267 rg BT 419.410 668.626 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 421.819 666.245 Td /F4 8.7 Tf [(22)] TJ ET 0.271 0.267 0.267 rg BT 431.457 668.626 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 433.866 666.245 Td /F4 8.7 Tf [(23)] TJ ET 0.271 0.267 0.267 rg BT 443.503 668.626 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 445.913 666.245 Td /F4 8.7 Tf [(24)] TJ ET 0.271 0.267 0.267 rg BT 455.550 664.738 Td /F1 9.8 Tf [( Despite CDC )] TJ ET BT 26.250 652.833 Td /F1 9.8 Tf [(recommendations, coverage estimates for both vaccines remain suboptimal in the U.S. The influenza vaccine coverage rate )] TJ ET BT 26.250 640.929 Td /F1 9.8 Tf [(estimated by CDC among pregnant women is the U.S. for the 2012 2013 season was 50.5%, and while coverage rates for )] TJ ET BT 26.250 629.024 Td /F1 9.8 Tf [(antenatal Tdap vaccination are not yet available, estimates range between 2.6% 10% \(CDC, unpublished data, 2012\).)] TJ ET BT 26.250 609.619 Td /F1 9.8 Tf [(Vaccinating pregnant women is a challenge. Studies exploring barriers to vaccinating women in the obstetric setting suggest )] TJ ET BT 26.250 597.714 Td /F1 9.8 Tf [(that logistic barriers such as lack of storage space, knowledge gaps regarding vaccine safety or vaccine recommendations, and )] TJ ET BT 26.250 585.810 Td /F1 9.8 Tf [(vaccine hesitancy all contribute to immunization decision-making.)] TJ ET 0.267 0.267 0.267 rg BT 308.015 587.317 Td /F4 8.7 Tf [(25)] TJ ET 0.271 0.267 0.267 rg BT 317.653 585.810 Td /F1 9.8 Tf [( The aim of this descriptive analysis is to identify factors )] TJ ET BT 26.250 573.905 Td /F1 9.8 Tf [(associated with an intention to receive influenza and/or Tdap vaccines during pregnancy among women who remained )] TJ ET BT 26.250 562.000 Td /F1 9.8 Tf [(unvaccinated against influenza within the first three months \(September November\) of the putative 2012/2013 influenza )] TJ ET BT 26.250 550.095 Td /F1 9.8 Tf [(season in the U.S.)] TJ ET BT 26.250 513.493 Td /F4 12.0 Tf [(Methods)] TJ ET BT 26.250 493.539 Td /F1 9.8 Tf [(Pregnant women included in these analyses were enrolled as part of a larger group-randomized trial entitled the Emory )] TJ ET BT 26.250 481.634 Td /F1 9.8 Tf [(MOMVAX study to evaluate the effectiveness of a comprehensive, evidence-based vaccine education and promotion package )] TJ ET BT 26.250 469.729 Td /F1 9.8 Tf [(on increasing antenatal influenza and Tdap vaccination in the obstetric setting. Women were recruited between December 11, )] TJ ET BT 26.250 457.824 Td /F1 9.8 Tf [(2012 and April 22, 2013 from 11 obstetric practices in Georgia participating in the Emory MOMVAX study. Recruiting women )] TJ ET BT 26.250 445.920 Td /F1 9.8 Tf [(who remained unvaccinated against influenza by December likely increased the number of vaccine-hesitant women in our )] TJ ET BT 26.250 434.015 Td /F1 9.8 Tf [(sample since women more likely to seek or accept vaccinations would have already received an influenza vaccination.)] TJ ET BT 26.250 414.610 Td /F1 9.8 Tf [(Following provision of informed consent, women were given a 28-item baseline survey in English to complete in the waiting )] TJ ET BT 26.250 402.705 Td /F1 9.8 Tf [(area. These survey results are the focus of this paper. The survey included questions on demographics, influenza vaccine )] TJ ET BT 26.250 390.801 Td /F1 9.8 Tf [(history, and knowledge, attitudes, and beliefs about influenza, pertussis and their accompanying vaccines during pregnancy. )] TJ ET BT 26.250 378.896 Td /F1 9.8 Tf [(Perceptions of influenza vaccine safety were assessed through the level of agreement with the statement Getting a flu vaccine )] TJ ET BT 26.250 366.991 Td /F1 9.8 Tf [(while pregnant seems risky. Perceptions of influenza and pertussis severity were assessed through the question How serious )] TJ ET BT 26.250 355.086 Td /F1 9.8 Tf [(do you think it would be if you got the following illnesses while pregnant? Likewise, perceptions of influenza and pertussis )] TJ ET BT 26.250 343.182 Td /F1 9.8 Tf [(severity during infancy were assessed through the question After delivery, how serious do you think it would be if your newborn )] TJ ET BT 26.250 331.277 Td /F1 9.8 Tf [(baby got the following illnesses within their first 6 months? A team of clinicians, behavioral researchers, and communication )] TJ ET BT 26.250 319.372 Td /F1 9.8 Tf [(specialists reviewed the questionnaire items to ensure clarity and adequacy of comprehension prior to administration.)] TJ ET BT 26.250 299.967 Td /F1 9.8 Tf [(Women were recruited by trained study personnel from the waiting areas of each participating practice. Eligibility criteria for )] TJ ET BT 26.250 288.063 Td /F1 9.8 Tf [(participation were: being between 18 years and 50 years old, English-reading, currently pregnant, had not yet received a 2012 )] TJ ET BT 26.250 276.158 Td /F1 9.8 Tf [(2013 seasonal influenza vaccine, and had not yet received a Tdap vaccine during their current pregnancy. After screening, )] TJ ET BT 26.250 264.253 Td /F1 9.8 Tf [(written informed consent was obtained from each eligible woman interested in enrolling prior to administration of the baseline )] TJ ET BT 26.250 252.348 Td /F1 9.8 Tf [(survey. While the intent was to complete the baseline survey prior to exposure to any intervention materials under evaluation in )] TJ ET BT 26.250 240.444 Td /F1 9.8 Tf [(the MOMVAX study, if a woman was unable to finish the baseline survey prior to being called back for her scheduled )] TJ ET BT 26.250 228.539 Td /F1 9.8 Tf [(appointment, she could complete the survey following her appointment. If, however, the woman returned to complete the )] TJ ET BT 26.250 216.634 Td /F1 9.8 Tf [(baseline survey and indicated she had received an influenza and/or Tdap vaccine during her visit, she was no longer eligible for )] TJ ET BT 26.250 204.729 Td /F1 9.8 Tf [(enrollment. At the time of enrollment and completion of the baseline survey, no attempts were made by the study personnel to )] TJ ET BT 26.250 192.825 Td /F1 9.8 Tf [(provide any information about influenza, pertussis or their respective vaccinations.)] TJ ET BT 26.250 173.420 Td /F1 9.8 Tf [(The Institutional Review Boards of Emory University and the Medical Center of Central Georgia reviewed and approved this )] TJ ET BT 26.250 161.515 Td /F1 9.8 Tf [(study. SAS version 9.3 statistical software \(SAS Institute, Cary, NC\) was used in 2013 for data analysis, including frequency )] TJ ET BT 26.250 149.610 Td /F1 9.8 Tf [(calculations and proportion comparisons with chi-square and Fishers exact tests. Women for whom survey data were missing )] TJ ET BT 26.250 137.706 Td /F1 9.8 Tf [(on any given variable were retained in the denominator for univariate frequency calculations; missing data occurring in <1% of )] TJ ET BT 26.250 125.801 Td /F1 9.8 Tf [(women were excluded from bivariate analyses, unless otherwise noted. Bivariate associations with a p-value < 0.05 were )] TJ ET BT 26.250 113.896 Td /F1 9.8 Tf [(considered statistically significant.)] TJ ET BT 26.250 77.294 Td /F4 12.0 Tf [(Results)] TJ ET BT 26.250 57.339 Td /F1 9.8 Tf [(One-thousand four-hundred and thirty-six women were screened between December 11, 2012 April 22, 2013. [Figure 1])] TJ ET Q q 15.000 47.459 577.500 729.541 re W n 0.271 0.267 0.267 rg BT 26.250 767.476 Td /F1 9.8 Tf [(vaccine until 6 months of age.)] TJ ET 0.267 0.267 0.267 rg BT 155.233 768.983 Td /F4 8.7 Tf [(9)] TJ ET 0.271 0.267 0.267 rg BT 160.051 767.476 Td /F1 9.8 Tf [( For pertussis, infants under 2 months of age, prior to the recommended age for vaccination, )] TJ ET BT 26.250 755.571 Td /F1 9.8 Tf [(have the highest rates of hospitalization and death.)] TJ ET 0.267 0.267 0.267 rg BT 246.298 757.079 Td /F4 8.7 Tf [(10)] TJ ET 0.271 0.267 0.267 rg BT 255.935 755.571 Td /F1 9.8 Tf [( Antenatal vaccination against these diseases not only protects mothers, )] TJ ET BT 26.250 743.667 Td /F1 9.8 Tf [(but studies have suggested protection can be conferred to infants through maternal-fetal transfer of antibodies through the )] TJ ET BT 26.250 731.762 Td /F1 9.8 Tf [(placenta.)] TJ ET 0.267 0.267 0.267 rg BT 65.816 733.269 Td /F4 8.7 Tf [(12)] TJ ET 0.271 0.267 0.267 rg BT 75.453 735.650 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 77.862 733.269 Td /F4 8.7 Tf [(13)] TJ ET 0.271 0.267 0.267 rg BT 87.500 731.762 Td /F1 9.8 Tf [( Influenza vaccination during pregnancy can also protect against adverse fetal outcomes like preterm birth and )] TJ ET BT 26.250 719.857 Td /F1 9.8 Tf [(small for gestational age as well as respiratory illnesses during infancy.)] TJ ET 0.267 0.267 0.267 rg BT 332.400 721.364 Td /F4 8.7 Tf [(14)] TJ ET 0.271 0.267 0.267 rg BT 342.037 723.745 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 344.447 721.364 Td /F4 8.7 Tf [(15)] TJ ET 0.271 0.267 0.267 rg BT 26.250 700.452 Td /F1 9.8 Tf [(Antenatal influenza vaccination recommendations have been in place since the 1960s)] TJ ET 0.267 0.267 0.267 rg BT 398.563 701.960 Td /F4 8.7 Tf [(16)] TJ ET 0.271 0.267 0.267 rg BT 408.201 700.452 Td /F1 9.8 Tf [( , and in the U.S., the Centers for )] TJ ET BT 26.250 688.548 Td /F1 9.8 Tf [(Disease Control and Prevention \(CDC\) began recommending tetanus, diphtheria, and acellular pertussis \(Tdap\) vaccination )] TJ ET BT 26.250 676.643 Td /F1 9.8 Tf [(during pregnancy, preferably in the third or late second trimester, in 2011.)] TJ ET 0.267 0.267 0.267 rg BT 343.271 678.150 Td /F4 8.7 Tf [(17)] TJ ET 0.271 0.267 0.267 rg BT 352.909 676.643 Td /F1 9.8 Tf [( Based on previous research among pregnant )] TJ ET BT 26.250 664.738 Td /F1 9.8 Tf [(women and healthy adults, both vaccines are considered safe during pregnancy.)] TJ ET 0.267 0.267 0.267 rg BT 373.633 666.245 Td /F4 8.7 Tf [(18)] TJ ET 0.271 0.267 0.267 rg BT 383.270 668.626 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 385.679 666.245 Td /F4 8.7 Tf [(19)] TJ ET 0.271 0.267 0.267 rg BT 395.317 668.626 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 397.726 666.245 Td /F4 8.7 Tf [(20)] TJ ET 0.271 0.267 0.267 rg BT 407.363 668.626 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 409.773 666.245 Td /F4 8.7 Tf [(21)] TJ ET 0.271 0.267 0.267 rg BT 419.410 668.626 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 421.819 666.245 Td /F4 8.7 Tf [(22)] TJ ET 0.271 0.267 0.267 rg BT 431.457 668.626 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 433.866 666.245 Td /F4 8.7 Tf [(23)] TJ ET 0.271 0.267 0.267 rg BT 443.503 668.626 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 445.913 666.245 Td /F4 8.7 Tf [(24)] TJ ET 0.271 0.267 0.267 rg BT 455.550 664.738 Td /F1 9.8 Tf [( Despite CDC )] TJ ET BT 26.250 652.833 Td /F1 9.8 Tf [(recommendations, coverage estimates for both vaccines remain suboptimal in the U.S. The influenza vaccine coverage rate )] TJ ET BT 26.250 640.929 Td /F1 9.8 Tf [(estimated by CDC among pregnant women is the U.S. for the 2012 2013 season was 50.5%, and while coverage rates for )] TJ ET BT 26.250 629.024 Td /F1 9.8 Tf [(antenatal Tdap vaccination are not yet available, estimates range between 2.6% 10% \(CDC, unpublished data, 2012\).)] TJ ET BT 26.250 609.619 Td /F1 9.8 Tf [(Vaccinating pregnant women is a challenge. Studies exploring barriers to vaccinating women in the obstetric setting suggest )] TJ ET BT 26.250 597.714 Td /F1 9.8 Tf [(that logistic barriers such as lack of storage space, knowledge gaps regarding vaccine safety or vaccine recommendations, and )] TJ ET BT 26.250 585.810 Td /F1 9.8 Tf [(vaccine hesitancy all contribute to immunization decision-making.)] TJ ET 0.267 0.267 0.267 rg BT 308.015 587.317 Td /F4 8.7 Tf [(25)] TJ ET 0.271 0.267 0.267 rg BT 317.653 585.810 Td /F1 9.8 Tf [( The aim of this descriptive analysis is to identify factors )] TJ ET BT 26.250 573.905 Td /F1 9.8 Tf [(associated with an intention to receive influenza and/or Tdap vaccines during pregnancy among women who remained )] TJ ET BT 26.250 562.000 Td /F1 9.8 Tf [(unvaccinated against influenza within the first three months \(September November\) of the putative 2012/2013 influenza )] TJ ET BT 26.250 550.095 Td /F1 9.8 Tf [(season in the U.S.)] TJ ET BT 26.250 513.493 Td /F4 12.0 Tf [(Methods)] TJ ET BT 26.250 493.539 Td /F1 9.8 Tf [(Pregnant women included in these analyses were enrolled as part of a larger group-randomized trial entitled the Emory )] TJ ET BT 26.250 481.634 Td /F1 9.8 Tf [(MOMVAX study to evaluate the effectiveness of a comprehensive, evidence-based vaccine education and promotion package )] TJ ET BT 26.250 469.729 Td /F1 9.8 Tf [(on increasing antenatal influenza and Tdap vaccination in the obstetric setting. Women were recruited between December 11, )] TJ ET BT 26.250 457.824 Td /F1 9.8 Tf [(2012 and April 22, 2013 from 11 obstetric practices in Georgia participating in the Emory MOMVAX study. Recruiting women )] TJ ET BT 26.250 445.920 Td /F1 9.8 Tf [(who remained unvaccinated against influenza by December likely increased the number of vaccine-hesitant women in our )] TJ ET BT 26.250 434.015 Td /F1 9.8 Tf [(sample since women more likely to seek or accept vaccinations would have already received an influenza vaccination.)] TJ ET BT 26.250 414.610 Td /F1 9.8 Tf [(Following provision of informed consent, women were given a 28-item baseline survey in English to complete in the waiting )] TJ ET BT 26.250 402.705 Td /F1 9.8 Tf [(area. These survey results are the focus of this paper. The survey included questions on demographics, influenza vaccine )] TJ ET BT 26.250 390.801 Td /F1 9.8 Tf [(history, and knowledge, attitudes, and beliefs about influenza, pertussis and their accompanying vaccines during pregnancy. )] TJ ET BT 26.250 378.896 Td /F1 9.8 Tf [(Perceptions of influenza vaccine safety were assessed through the level of agreement with the statement Getting a flu vaccine )] TJ ET BT 26.250 366.991 Td /F1 9.8 Tf [(while pregnant seems risky. Perceptions of influenza and pertussis severity were assessed through the question How serious )] TJ ET BT 26.250 355.086 Td /F1 9.8 Tf [(do you think it would be if you got the following illnesses while pregnant? Likewise, perceptions of influenza and pertussis )] TJ ET BT 26.250 343.182 Td /F1 9.8 Tf [(severity during infancy were assessed through the question After delivery, how serious do you think it would be if your newborn )] TJ ET BT 26.250 331.277 Td /F1 9.8 Tf [(baby got the following illnesses within their first 6 months? A team of clinicians, behavioral researchers, and communication )] TJ ET BT 26.250 319.372 Td /F1 9.8 Tf [(specialists reviewed the questionnaire items to ensure clarity and adequacy of comprehension prior to administration.)] TJ ET BT 26.250 299.967 Td /F1 9.8 Tf [(Women were recruited by trained study personnel from the waiting areas of each participating practice. Eligibility criteria for )] TJ ET BT 26.250 288.063 Td /F1 9.8 Tf [(participation were: being between 18 years and 50 years old, English-reading, currently pregnant, had not yet received a 2012 )] TJ ET BT 26.250 276.158 Td /F1 9.8 Tf [(2013 seasonal influenza vaccine, and had not yet received a Tdap vaccine during their current pregnancy. After screening, )] TJ ET BT 26.250 264.253 Td /F1 9.8 Tf [(written informed consent was obtained from each eligible woman interested in enrolling prior to administration of the baseline )] TJ ET BT 26.250 252.348 Td /F1 9.8 Tf [(survey. While the intent was to complete the baseline survey prior to exposure to any intervention materials under evaluation in )] TJ ET BT 26.250 240.444 Td /F1 9.8 Tf [(the MOMVAX study, if a woman was unable to finish the baseline survey prior to being called back for her scheduled )] TJ ET BT 26.250 228.539 Td /F1 9.8 Tf [(appointment, she could complete the survey following her appointment. If, however, the woman returned to complete the )] TJ ET BT 26.250 216.634 Td /F1 9.8 Tf [(baseline survey and indicated she had received an influenza and/or Tdap vaccine during her visit, she was no longer eligible for )] TJ ET BT 26.250 204.729 Td /F1 9.8 Tf [(enrollment. At the time of enrollment and completion of the baseline survey, no attempts were made by the study personnel to )] TJ ET BT 26.250 192.825 Td /F1 9.8 Tf [(provide any information about influenza, pertussis or their respective vaccinations.)] TJ ET BT 26.250 173.420 Td /F1 9.8 Tf [(The Institutional Review Boards of Emory University and the Medical Center of Central Georgia reviewed and approved this )] TJ ET BT 26.250 161.515 Td /F1 9.8 Tf [(study. SAS version 9.3 statistical software \(SAS Institute, Cary, NC\) was used in 2013 for data analysis, including frequency )] TJ ET BT 26.250 149.610 Td /F1 9.8 Tf [(calculations and proportion comparisons with chi-square and Fishers exact tests. Women for whom survey data were missing )] TJ ET BT 26.250 137.706 Td /F1 9.8 Tf [(on any given variable were retained in the denominator for univariate frequency calculations; missing data occurring in <1% of )] TJ ET BT 26.250 125.801 Td /F1 9.8 Tf [(women were excluded from bivariate analyses, unless otherwise noted. Bivariate associations with a p-value < 0.05 were )] TJ ET BT 26.250 113.896 Td /F1 9.8 Tf [(considered statistically significant.)] TJ ET BT 26.250 77.294 Td /F4 12.0 Tf [(Results)] TJ ET BT 26.250 57.339 Td /F1 9.8 Tf [(One-thousand four-hundred and thirty-six women were screened between December 11, 2012 April 22, 2013. [Figure 1])] TJ ET Q q 15.000 47.459 577.500 729.541 re W n 0.271 0.267 0.267 rg BT 26.250 767.476 Td /F1 9.8 Tf [(vaccine until 6 months of age.)] TJ ET 0.267 0.267 0.267 rg BT 155.233 768.983 Td /F4 8.7 Tf [(9)] TJ ET 0.271 0.267 0.267 rg BT 160.051 767.476 Td /F1 9.8 Tf [( For pertussis, infants under 2 months of age, prior to the recommended age for vaccination, )] TJ ET BT 26.250 755.571 Td /F1 9.8 Tf [(have the highest rates of hospitalization and death.)] TJ ET 0.267 0.267 0.267 rg BT 246.298 757.079 Td /F4 8.7 Tf [(10)] TJ ET 0.271 0.267 0.267 rg BT 255.935 755.571 Td /F1 9.8 Tf [( Antenatal vaccination against these diseases not only protects mothers, )] TJ ET BT 26.250 743.667 Td /F1 9.8 Tf [(but studies have suggested protection can be conferred to infants through maternal-fetal transfer of antibodies through the )] TJ ET BT 26.250 731.762 Td /F1 9.8 Tf [(placenta.)] TJ ET 0.267 0.267 0.267 rg BT 65.816 733.269 Td /F4 8.7 Tf [(12)] TJ ET 0.271 0.267 0.267 rg BT 75.453 735.650 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 77.862 733.269 Td /F4 8.7 Tf [(13)] TJ ET 0.271 0.267 0.267 rg BT 87.500 731.762 Td /F1 9.8 Tf [( Influenza vaccination during pregnancy can also protect against adverse fetal outcomes like preterm birth and )] TJ ET BT 26.250 719.857 Td /F1 9.8 Tf [(small for gestational age as well as respiratory illnesses during infancy.)] TJ ET 0.267 0.267 0.267 rg BT 332.400 721.364 Td /F4 8.7 Tf [(14)] TJ ET 0.271 0.267 0.267 rg BT 342.037 723.745 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 344.447 721.364 Td /F4 8.7 Tf [(15)] TJ ET 0.271 0.267 0.267 rg BT 26.250 700.452 Td /F1 9.8 Tf [(Antenatal influenza vaccination recommendations have been in place since the 1960s)] TJ ET 0.267 0.267 0.267 rg BT 398.563 701.960 Td /F4 8.7 Tf [(16)] TJ ET 0.271 0.267 0.267 rg BT 408.201 700.452 Td /F1 9.8 Tf [( , and in the U.S., the Centers for )] TJ ET BT 26.250 688.548 Td /F1 9.8 Tf [(Disease Control and Prevention \(CDC\) began recommending tetanus, diphtheria, and acellular pertussis \(Tdap\) vaccination )] TJ ET BT 26.250 676.643 Td /F1 9.8 Tf [(during pregnancy, preferably in the third or late second trimester, in 2011.)] TJ ET 0.267 0.267 0.267 rg BT 343.271 678.150 Td /F4 8.7 Tf [(17)] TJ ET 0.271 0.267 0.267 rg BT 352.909 676.643 Td /F1 9.8 Tf [( Based on previous research among pregnant )] TJ ET BT 26.250 664.738 Td /F1 9.8 Tf [(women and healthy adults, both vaccines are considered safe during pregnancy.)] TJ ET 0.267 0.267 0.267 rg BT 373.633 666.245 Td /F4 8.7 Tf [(18)] TJ ET 0.271 0.267 0.267 rg BT 383.270 668.626 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 385.679 666.245 Td /F4 8.7 Tf [(19)] TJ ET 0.271 0.267 0.267 rg BT 395.317 668.626 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 397.726 666.245 Td /F4 8.7 Tf [(20)] TJ ET 0.271 0.267 0.267 rg BT 407.363 668.626 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 409.773 666.245 Td /F4 8.7 Tf [(21)] TJ ET 0.271 0.267 0.267 rg BT 419.410 668.626 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 421.819 666.245 Td /F4 8.7 Tf [(22)] TJ ET 0.271 0.267 0.267 rg BT 431.457 668.626 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 433.866 666.245 Td /F4 8.7 Tf [(23)] TJ ET 0.271 0.267 0.267 rg BT 443.503 668.626 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 445.913 666.245 Td /F4 8.7 Tf [(24)] TJ ET 0.271 0.267 0.267 rg BT 455.550 664.738 Td /F1 9.8 Tf [( Despite CDC )] TJ ET BT 26.250 652.833 Td /F1 9.8 Tf [(recommendations, coverage estimates for both vaccines remain suboptimal in the U.S. The influenza vaccine coverage rate )] TJ ET BT 26.250 640.929 Td /F1 9.8 Tf [(estimated by CDC among pregnant women is the U.S. for the 2012 2013 season was 50.5%, and while coverage rates for )] TJ ET BT 26.250 629.024 Td /F1 9.8 Tf [(antenatal Tdap vaccination are not yet available, estimates range between 2.6% 10% \(CDC, unpublished data, 2012\).)] TJ ET BT 26.250 609.619 Td /F1 9.8 Tf [(Vaccinating pregnant women is a challenge. Studies exploring barriers to vaccinating women in the obstetric setting suggest )] TJ ET BT 26.250 597.714 Td /F1 9.8 Tf [(that logistic barriers such as lack of storage space, knowledge gaps regarding vaccine safety or vaccine recommendations, and )] TJ ET BT 26.250 585.810 Td /F1 9.8 Tf [(vaccine hesitancy all contribute to immunization decision-making.)] TJ ET 0.267 0.267 0.267 rg BT 308.015 587.317 Td /F4 8.7 Tf [(25)] TJ ET 0.271 0.267 0.267 rg BT 317.653 585.810 Td /F1 9.8 Tf [( The aim of this descriptive analysis is to identify factors )] TJ ET BT 26.250 573.905 Td /F1 9.8 Tf [(associated with an intention to receive influenza and/or Tdap vaccines during pregnancy among women who remained )] TJ ET BT 26.250 562.000 Td /F1 9.8 Tf [(unvaccinated against influenza within the first three months \(September November\) of the putative 2012/2013 influenza )] TJ ET BT 26.250 550.095 Td /F1 9.8 Tf [(season in the U.S.)] TJ ET BT 26.250 513.493 Td /F4 12.0 Tf [(Methods)] TJ ET BT 26.250 493.539 Td /F1 9.8 Tf [(Pregnant women included in these analyses were enrolled as part of a larger group-randomized trial entitled the Emory )] TJ ET BT 26.250 481.634 Td /F1 9.8 Tf [(MOMVAX study to evaluate the effectiveness of a comprehensive, evidence-based vaccine education and promotion package )] TJ ET BT 26.250 469.729 Td /F1 9.8 Tf [(on increasing antenatal influenza and Tdap vaccination in the obstetric setting. Women were recruited between December 11, )] TJ ET BT 26.250 457.824 Td /F1 9.8 Tf [(2012 and April 22, 2013 from 11 obstetric practices in Georgia participating in the Emory MOMVAX study. Recruiting women )] TJ ET BT 26.250 445.920 Td /F1 9.8 Tf [(who remained unvaccinated against influenza by December likely increased the number of vaccine-hesitant women in our )] TJ ET BT 26.250 434.015 Td /F1 9.8 Tf [(sample since women more likely to seek or accept vaccinations would have already received an influenza vaccination.)] TJ ET BT 26.250 414.610 Td /F1 9.8 Tf [(Following provision of informed consent, women were given a 28-item baseline survey in English to complete in the waiting )] TJ ET BT 26.250 402.705 Td /F1 9.8 Tf [(area. These survey results are the focus of this paper. The survey included questions on demographics, influenza vaccine )] TJ ET BT 26.250 390.801 Td /F1 9.8 Tf [(history, and knowledge, attitudes, and beliefs about influenza, pertussis and their accompanying vaccines during pregnancy. )] TJ ET BT 26.250 378.896 Td /F1 9.8 Tf [(Perceptions of influenza vaccine safety were assessed through the level of agreement with the statement Getting a flu vaccine )] TJ ET BT 26.250 366.991 Td /F1 9.8 Tf [(while pregnant seems risky. Perceptions of influenza and pertussis severity were assessed through the question How serious )] TJ ET BT 26.250 355.086 Td /F1 9.8 Tf [(do you think it would be if you got the following illnesses while pregnant? Likewise, perceptions of influenza and pertussis )] TJ ET BT 26.250 343.182 Td /F1 9.8 Tf [(severity during infancy were assessed through the question After delivery, how serious do you think it would be if your newborn )] TJ ET BT 26.250 331.277 Td /F1 9.8 Tf [(baby got the following illnesses within their first 6 months? A team of clinicians, behavioral researchers, and communication )] TJ ET BT 26.250 319.372 Td /F1 9.8 Tf [(specialists reviewed the questionnaire items to ensure clarity and adequacy of comprehension prior to administration.)] TJ ET BT 26.250 299.967 Td /F1 9.8 Tf [(Women were recruited by trained study personnel from the waiting areas of each participating practice. Eligibility criteria for )] TJ ET BT 26.250 288.063 Td /F1 9.8 Tf [(participation were: being between 18 years and 50 years old, English-reading, currently pregnant, had not yet received a 2012 )] TJ ET BT 26.250 276.158 Td /F1 9.8 Tf [(2013 seasonal influenza vaccine, and had not yet received a Tdap vaccine during their current pregnancy. After screening, )] TJ ET BT 26.250 264.253 Td /F1 9.8 Tf [(written informed consent was obtained from each eligible woman interested in enrolling prior to administration of the baseline )] TJ ET BT 26.250 252.348 Td /F1 9.8 Tf [(survey. While the intent was to complete the baseline survey prior to exposure to any intervention materials under evaluation in )] TJ ET BT 26.250 240.444 Td /F1 9.8 Tf [(the MOMVAX study, if a woman was unable to finish the baseline survey prior to being called back for her scheduled )] TJ ET BT 26.250 228.539 Td /F1 9.8 Tf [(appointment, she could complete the survey following her appointment. If, however, the woman returned to complete the )] TJ ET BT 26.250 216.634 Td /F1 9.8 Tf [(baseline survey and indicated she had received an influenza and/or Tdap vaccine during her visit, she was no longer eligible for )] TJ ET BT 26.250 204.729 Td /F1 9.8 Tf [(enrollment. At the time of enrollment and completion of the baseline survey, no attempts were made by the study personnel to )] TJ ET BT 26.250 192.825 Td /F1 9.8 Tf [(provide any information about influenza, pertussis or their respective vaccinations.)] TJ ET BT 26.250 173.420 Td /F1 9.8 Tf [(The Institutional Review Boards of Emory University and the Medical Center of Central Georgia reviewed and approved this )] TJ ET BT 26.250 161.515 Td /F1 9.8 Tf [(study. SAS version 9.3 statistical software \(SAS Institute, Cary, NC\) was used in 2013 for data analysis, including frequency )] TJ ET BT 26.250 149.610 Td /F1 9.8 Tf [(calculations and proportion comparisons with chi-square and Fishers exact tests. Women for whom survey data were missing )] TJ ET BT 26.250 137.706 Td /F1 9.8 Tf [(on any given variable were retained in the denominator for univariate frequency calculations; missing data occurring in <1% of )] TJ ET BT 26.250 125.801 Td /F1 9.8 Tf [(women were excluded from bivariate analyses, unless otherwise noted. Bivariate associations with a p-value < 0.05 were )] TJ ET BT 26.250 113.896 Td /F1 9.8 Tf [(considered statistically significant.)] TJ ET BT 26.250 77.294 Td /F4 12.0 Tf [(Results)] TJ ET BT 26.250 57.339 Td /F1 9.8 Tf [(One-thousand four-hundred and thirty-six women were screened between December 11, 2012 April 22, 2013. [Figure 1])] TJ ET Q q 0.000 0.000 0.000 rg BT 291.710 19.825 Td /F1 11.0 Tf [(2)] TJ ET BT 25.000 19.825 Td /F1 11.0 Tf [(PLOS Currents Outbreaks)] TJ ET Q endstream endobj 173 0 obj << /Type /Annot /Subtype /Link /A 174 0 R /Border [0 0 0] /H /I /Rect [ 155.2328 768.1817 160.0514 777.0000 ] >> endobj 174 0 obj << /Type /Action >> endobj 175 0 obj << /Type /Annot /Subtype /Link /A 176 0 R /Border [0 0 0] /H /I /Rect [ 246.2978 756.2769 255.9351 765.0952 ] >> endobj 176 0 obj << /Type /Action >> endobj 177 0 obj << /Type /Annot /Subtype /Link /A 178 0 R /Border [0 0 0] /H /I /Rect [ 65.8155 732.4674 75.4528 741.2858 ] >> endobj 178 0 obj << /Type /Action >> endobj 179 0 obj << /Type /Annot /Subtype /Link /A 180 0 R /Border [0 0 0] /H /I /Rect [ 77.8622 732.4674 87.4995 741.2858 ] >> endobj 180 0 obj << /Type /Action >> endobj 181 0 obj << /Type /Annot /Subtype /Link /A 182 0 R /Border [0 0 0] /H /I /Rect [ 332.4000 720.5627 342.0373 729.3810 ] >> endobj 182 0 obj << /Type /Action >> 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women were enrolled and completed the baseline survey. Among )] TJ ET BT 26.250 429.417 Td /F1 9.8 Tf [(1,037 pregnant women screened, 609 \(59%\) and 212 \(20%\) were ineligible because they had already received a 2012 2013 )] TJ ET BT 26.250 417.512 Td /F1 9.8 Tf [(influenza vaccine or a Tdap vaccine, respectively. The mean age of participants was 27.2 years and the mean parity was 1.1 )] TJ ET BT 26.250 405.607 Td /F1 9.8 Tf [(children. Approximately 47% of participants were Caucasian/White and 41% were African American/Black. [Table 1])] TJ ET 0.965 0.965 0.965 rg 26.250 -202.024 555.000 597.750 re f 0.267 0.267 0.267 rg 0.267 0.267 0.267 RG 26.250 395.726 m 581.250 395.726 l 581.250 394.976 l 26.250 394.976 l f q 450.000 0 0 582.000 35.250 -196.024 cm /I5 Do Q q 35.250 -202.024 537.000 0.000 re W n Q Q q 15.000 -202.024 577.500 979.024 re W n 0.965 0.965 0.965 rg 26.250 458.345 555.000 318.655 re f 0.267 0.267 0.267 rg 0.267 0.267 0.267 RG 26.250 777.000 m 581.250 777.000 l 581.250 776.250 l 26.250 776.250 l f 26.250 458.345 m 581.250 458.345 l 581.250 459.095 l 26.250 459.095 l f q 225.000 0 0 273.750 35.250 493.500 cm /I7 Do Q q 35.250 469.595 537.000 17.905 re W n 0.271 0.267 0.267 rg BT 35.250 477.976 Td /F4 9.8 Tf [(Fig. 1: Schematic of study population included and excluded from baseline survey analyses.)] TJ ET Q BT 26.250 441.321 Td /F1 9.8 Tf [(Three-hundred eighty-eight women were eligible, and 325 women were enrolled and completed the baseline survey. Among )] TJ ET BT 26.250 429.417 Td /F1 9.8 Tf [(1,037 pregnant women screened, 609 \(59%\) and 212 \(20%\) were ineligible because they had already received a 2012 2013 )] TJ ET BT 26.250 417.512 Td /F1 9.8 Tf [(influenza vaccine or a Tdap vaccine, respectively. The mean age of participants was 27.2 years and the mean parity was 1.1 )] TJ ET BT 26.250 405.607 Td /F1 9.8 Tf [(children. Approximately 47% of participants were Caucasian/White and 41% were African American/Black. [Table 1])] TJ ET 0.965 0.965 0.965 rg 26.250 -202.024 555.000 597.750 re f 0.267 0.267 0.267 rg 0.267 0.267 0.267 RG 26.250 395.726 m 581.250 395.726 l 581.250 394.976 l 26.250 394.976 l f q 450.000 0 0 582.000 35.250 -196.024 cm /I5 Do Q q 35.250 -202.024 537.000 0.000 re W n Q Q q 15.000 -202.024 577.500 979.024 re W n 0.965 0.965 0.965 rg 26.250 458.345 555.000 318.655 re f 0.267 0.267 0.267 rg 0.267 0.267 0.267 RG 26.250 777.000 m 581.250 777.000 l 581.250 776.250 l 26.250 776.250 l f 26.250 458.345 m 581.250 458.345 l 581.250 459.095 l 26.250 459.095 l f q 225.000 0 0 273.750 35.250 493.500 cm /I9 Do Q q 35.250 469.595 537.000 17.905 re W n 0.271 0.267 0.267 rg BT 35.250 477.976 Td /F4 9.8 Tf [(Fig. 1: Schematic of study population included and excluded from baseline survey analyses.)] TJ ET Q BT 26.250 441.321 Td /F1 9.8 Tf [(Three-hundred eighty-eight women were eligible, and 325 women were enrolled and completed the baseline survey. Among )] TJ ET BT 26.250 429.417 Td /F1 9.8 Tf [(1,037 pregnant women screened, 609 \(59%\) and 212 \(20%\) were ineligible because they had already received a 2012 2013 )] TJ ET BT 26.250 417.512 Td /F1 9.8 Tf [(influenza vaccine or a Tdap vaccine, respectively. The mean age of participants was 27.2 years and the mean parity was 1.1 )] TJ ET BT 26.250 405.607 Td /F1 9.8 Tf [(children. Approximately 47% of participants were Caucasian/White and 41% were African American/Black. [Table 1])] TJ ET 0.965 0.965 0.965 rg 26.250 -202.024 555.000 597.750 re f 0.267 0.267 0.267 rg 0.267 0.267 0.267 RG 26.250 395.726 m 581.250 395.726 l 581.250 394.976 l 26.250 394.976 l f q 450.000 0 0 582.000 35.250 -196.024 cm /I5 Do Q q 35.250 -202.024 537.000 0.000 re W n Q Q q 225.000 0 0 273.750 35.250 493.500 cm /I11 Do Q q 450.000 0 0 582.000 35.250 -196.024 cm /I5 Do Q q 0.000 0.000 0.000 rg BT 291.710 19.825 Td /F1 11.0 Tf [(3)] TJ ET BT 25.000 19.825 Td /F1 11.0 Tf [(PLOS Currents Outbreaks)] TJ ET Q endstream endobj 271 0 obj << /Type /Annot /Subtype /Link /A 272 0 R /Border [0 0 0] /H /I /Rect [ 35.2500 493.5000 260.2500 767.2500 ] >> endobj 272 0 obj << /Type /Action /S /URI /URI (http://currents.plos.org/outbreaks/files/2014/03/Figure1_031014.png) >> endobj 273 0 obj << /Type /XObject /Subtype /Image /Width 300 /Height 365 /Filter /FlateDecode /DecodeParms << /Predictor 15 /Colors 1 /Columns 300 /BitsPerComponent 8>> /ColorSpace /DeviceGray /BitsPerComponent 8 /Length 14235>> stream xj]l۶m[-I$I$I$#IFH$I$I$I2$IFF1c;r\nooo?̙3sfΜijΙ3^{g_k=G싏}@/>(G* -B'R899`/SnĶ_ݘLA[iER%mUW3X,Y3 PbTcyǫlG( ?K{z KxtA ,?T+[d}B F^8X{$P-*wG2z+yTGwD`+ԍ=4б>ly=8)NKXP @pͥppYŴ*=)_VJ6P9|^ù"T:9N%,l>?5°UUr\Hޅ,+$wМZ[z}Qe쪇Gľ~;13ٷG>Njzl+ocjzivUF V /pj[bJ"2@2*F#((RMüoW5H>!T2,dEDruUM ܇CcANh!pDCWof .`S Ds;P[fwcL+1a5 ӢTIWF΍Nx6 A` دEO/] 4+*n }c Ky `\m#xbﻨpEwTp"xab_|?P싏'? 7(XIsOO ??sZM>?} [ZtlTkZAS5~n|a‘ HƽiCGǎ+G{ڳi` b,1JR cx4KNb'GtfFd ,ZGVfفJnفD;%7156D=79XQр/q3P^ x{Ӿ-ZYXǂ2QR](:x?=7AX''/EAէ''/ො6yaONG''* +lr&a ˬ4l ĭKX[vd STnSOWU&}GKE8 F"%x(vg6Qh"[jrTh!ZsFJK)1v8-ɹZ~QŚb{oYY|Թk(cn0z@ [Y&kb(5swI@C|#rpf/y@y6+oT8+@ 4.BJpIDc*oJ*MI0/@,ZʟKBFQhUD=7yX9h h`2lQ)񁰆㎣!%֑[lw{L+kX}23: reO S(vg6\'xMG\>pxXqPcΨ4 mo 1ޭI:ꝛj5.A3 |]r|rA̞*9vkRH_.5W }m_,ľ͇Z$ٶn-RIɩNBe4P V +޳fU"OƂwPгcFfo~HW:>py7PbbpyXI6XKq G3?"x' ;P87N,8ߩF FZCGzM;+s5=Cxlj|K+h$/@Eƹ]x> ů+zzBtbnmV# @gb#&/"Qԙ_]Y!ܭê47s0%dWiIKf>|P5jѢP[I~{RPcw3g`YqP}OD K{>L':&pR0ım ycӆ0s!v8GZv־]`-khR֨z&Ll/~.FY]5n,Z0F[5 A3dܐ֋[b&'%dfrsY'=a(Q)zا )`OqsMcMʦe> RI(+_/o}pռI>QoF z6o6x Wql_:lW'6^:n`X׵O+SѡMYvY'e@(Ӑt gFsnDh&:jRHuw/AО*Y6QU9 -]n `{6i}bM& gB|SqX1mAtK6.Q WːA: ɳ̇g!e@숒FAvҧ |/g&l )Ř)^~xyZ!rW(^} baGVXO7X+ u^~u]Xdq°l"M<9b`X!9Y`-+ ݒd t$) '}Gw(?6܂U|?8j~Ai/S@\;jWN۰_>Or[!B',P BE~ ,{#e`絩^=,I}~a .j ֻJ/ fQ3 \74=,g:J6oB_ZQ w9|#s-Νk}r;7077qOD 1(qMJR%1H36? 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NgXD Xș5-07:,Yһ\ͮ3kc Y#ᾬjPB}PDwvE~XG:F֏nh}g/&5gtߗ[Bp{k6^[\=UC#Wa);|kEP"㲆Lb1ʼQ~p2 1 9XB34{s bQ "#Wx^ӧmԘ~HLj:Ϣh0ڤfD/4۝ 4[!8\Κ}M,+m_3RH枫@/a)Np4RX ܜ m,tmw+UTLS T&KXs)VfJd\z^+KXrX[ҥ5a]|u :TxF0P ^25[Q~/jxl1T(AAvqBbHk V F)͠@Fف"kZAoV+Yl+Nٸ~հD 2ۧ32 T_A}tSJg(H~W CTBf9kh$wU\rXjPfz ]ޯ{հ' XQ0\?,ˊ3JG a,amc D Qԕ/*W A+@EH'ˑwٔ;$gԩ9`A79t{ u:9֏9 b̏U}ܟ'oG*W hW k4#@7O D4/"H+P. No}ҝ?xZAoVk0zZGܜSk[M, endstream endobj 291 0 obj << /Type /XObject /Subtype /Image /Width 300 /Height 365 /SMask 290 0 R /Filter /FlateDecode /DecodeParms << /Predictor 15 /Colors 3 /Columns 300 /BitsPerComponent 8>> /ColorSpace /DeviceRGB /BitsPerComponent 8 /Length 342>> stream x  Om7 endstream endobj 292 0 obj << /Type /Page /Parent 3 0 R /Annots [ 294 0 R 298 0 R 302 0 R ] /Contents 293 0 R >> endobj 293 0 obj << /Length 18672 >> stream q 15.000 51.097 577.500 725.903 re W n 0.965 0.965 0.965 rg 26.250 744.514 555.000 32.486 re f 0.267 0.267 0.267 rg 0.267 0.267 0.267 RG 26.250 744.514 m 581.250 744.514 l 581.250 745.264 l 26.250 745.264 l f q 35.250 755.764 537.000 21.236 re W n 0.271 0.267 0.267 rg BT 35.250 766.011 Td /F4 9.8 Tf [(Table 1: Maternal characteristics and associations with intention to receive antenatal influenza and Tdap vaccines)] TJ ET Q BT 26.250 727.490 Td /F1 9.8 Tf [(The proportion of participants reporting at least some type of private health insurance was approximately equivalent to the )] TJ ET BT 26.250 715.585 Td /F1 9.8 Tf [(proportion reporting no insurance or coverage only by Medicaid \(43.4% vs. 42.5%\).)] TJ ET BT 26.250 696.180 Td /F1 9.8 Tf [(More than half \(57%\) of the women reported not having received a seasonal influenza vaccine in the past five years, while )] TJ ET BT 26.250 684.276 Td /F1 9.8 Tf [(another 19% reported having only received a seasonal influenza vaccine once in the past five years. [Table 1] Sixty percent of )] TJ ET BT 26.250 672.371 Td /F1 9.8 Tf [(participants considered their OB/GYN their primary care physician, yet two-hundred sixteen \(66%\) reported never having )] TJ ET BT 26.250 660.466 Td /F1 9.8 Tf [(received any type of vaccine in an OB/GYN doctors office. Thirty women \(9%\) reported having received a seasonal and/or )] TJ ET BT 26.250 648.561 Td /F1 9.8 Tf [(H1N1 influenza vaccine in an OB/GYNs office before. Over one quarter \(26%\) reported feeling hesitant \(i.e. worried or )] TJ ET BT 26.250 636.657 Td /F1 9.8 Tf [(concerned\) about receiving vaccines recommended by their physician during pregnancy.)] TJ ET BT 26.250 617.252 Td /F1 9.8 Tf [(White women were significantly more likely to intend to receive a Tdap vaccine during their current pregnancy than women of )] TJ ET BT 26.250 605.347 Td /F1 9.8 Tf [(other races, and intention to receive an influenza vaccine was significantly associated with the number of times treated by a )] TJ ET BT 26.250 593.442 Td /F1 9.8 Tf [(healthcare provider in the past year. [Table 1] Intention to receive antenatal influenza and/or Tdap vaccines was also )] TJ ET BT 26.250 581.538 Td /F1 9.8 Tf [(significantly associated with previous receipt of influenza vaccination in the past five years. There were no significant differences )] TJ ET BT 26.250 569.633 Td /F1 9.8 Tf [(in proportions of women enrolled in control arm practices versus intervention arm practices on perceptions of disease severity )] TJ ET BT 26.250 557.728 Td /F1 9.8 Tf [(during pregnancy, perceptions of disease severity for their newborn, intended likelihood of antenatal influenza vaccine receipt, )] TJ ET BT 26.250 545.823 Td /F1 9.8 Tf [(intended likelihood of antenatal Tdap vaccine receipt, vaccine hesitancy, or perceptions of safety of influenza vaccination during )] TJ ET BT 26.250 533.919 Td /F1 9.8 Tf [(pregnancy \(data available upon request\).)] TJ ET BT 26.250 514.514 Td /F1 9.8 Tf [(Two-hundred sixty five women \(82%\) agreed with the statement Influenza is a concern for pregnant women, and 238 \(73%\) )] TJ ET BT 26.250 502.609 Td /F1 9.8 Tf [(believed influenza infection would be serious or very serious during pregnancy. Two-hundred sixty two \(81%\) believed )] TJ ET BT 26.250 490.704 Td /F1 9.8 Tf [(contracting pertussis during pregnancy would be serious or very serious. Additionally, 87% and 92% believed influenza and )] TJ ET BT 26.250 478.800 Td /F1 9.8 Tf [(pertussis, respectively, would be serious or very serious to their newborn within the first six months of life.)] TJ ET BT 26.250 459.395 Td /F1 9.8 Tf [(Despite perceptions of severity, only 112 \(34%\) and 143 \(44%\) reported they were likely to receive an influenza vaccine or Tdap )] TJ ET BT 26.250 447.490 Td /F1 9.8 Tf [(vaccine, respectively, during their current pregnancy. [Figure 2])] TJ ET 0.965 0.965 0.965 rg 26.250 200.145 555.000 237.464 re f 0.267 0.267 0.267 rg 0.267 0.267 0.267 RG 26.250 437.609 m 581.250 437.609 l 581.250 436.859 l 26.250 436.859 l f 26.250 200.145 m 581.250 200.145 l 581.250 200.895 l 26.250 200.895 l f q 225.000 0 0 168.750 35.250 259.109 cm /I13 Do Q q 35.250 211.395 537.000 41.714 re W n 0.271 0.267 0.267 rg BT 35.250 243.585 Td /F4 9.8 Tf [(Fig. 2: A\). Perceived severity of influenza and pertussis during pregnancy and intention to get vaccinated during )] TJ ET BT 35.250 231.681 Td /F4 9.8 Tf [(pregnancy B\) Perceived severity of influenza and pertussis during first 6 months of infancy and intention to get )] TJ ET BT 35.250 219.776 Td /F4 9.8 Tf [(vaccinated during pregnancy)] TJ ET Q BT 26.250 183.121 Td /F1 9.8 Tf [(Perception of influenza disease severity for themselves or their newborns was not significantly associated with an intention to )] TJ ET BT 26.250 171.216 Td /F1 9.8 Tf [(receive an influenza vaccine during pregnancy, but perception of pertussis severity for their infant was strongly associated with )] TJ ET BT 26.250 159.312 Td /F1 9.8 Tf [(intention of antenatal Tdap vaccination \(p=0.004\). [Figure 2])] TJ ET BT 26.250 139.907 Td /F1 9.8 Tf [(Regarding influenza vaccine safety, 149 women \(46%\) agreed with the statement Getting an influenza vaccine while pregnant )] TJ ET BT 26.250 128.002 Td /F1 9.8 Tf [(seems risky. Compared to women who perceived the vaccine as safe, women who had low perceptions of influenza vaccine )] TJ ET BT 26.250 116.097 Td /F1 9.8 Tf [(safety were significantly less likely to intend to receive an influenza vaccine \(48% vs. 20%; p < 0.001\) or a Tdap vaccine \(53% )] TJ ET BT 26.250 104.193 Td /F1 9.8 Tf [(vs. 33%; p < 0.001\) during their current pregnancy. [Figure 3])] TJ ET BT 26.250 84.788 Td /F1 9.8 Tf [(While a lower perception of influenza vaccine safety was associated with a higher probability of non-intention to be vaccinated, )] TJ ET BT 26.250 72.883 Td /F1 9.8 Tf [(substantial proportions of women who perceived the influenza vaccine as safe still did not intend to be vaccinated \(52% and )] TJ ET BT 26.250 60.978 Td /F1 9.8 Tf [(47% for influenza and Tdap, respectively\). [Figure 3])] TJ ET Q q 15.000 51.097 577.500 725.903 re W n 0.965 0.965 0.965 rg 26.250 744.514 555.000 32.486 re f 0.267 0.267 0.267 rg 0.267 0.267 0.267 RG 26.250 744.514 m 581.250 744.514 l 581.250 745.264 l 26.250 745.264 l f q 35.250 755.764 537.000 21.236 re W n 0.271 0.267 0.267 rg BT 35.250 766.011 Td /F4 9.8 Tf [(Table 1: Maternal characteristics and associations with intention to receive antenatal influenza and Tdap vaccines)] TJ ET Q BT 26.250 727.490 Td /F1 9.8 Tf [(The proportion of participants reporting at least some type of private health insurance was approximately equivalent to the )] TJ ET BT 26.250 715.585 Td /F1 9.8 Tf [(proportion reporting no insurance or coverage only by Medicaid \(43.4% vs. 42.5%\).)] TJ ET BT 26.250 696.180 Td /F1 9.8 Tf [(More than half \(57%\) of the women reported not having received a seasonal influenza vaccine in the past five years, while )] TJ ET BT 26.250 684.276 Td /F1 9.8 Tf [(another 19% reported having only received a seasonal influenza vaccine once in the past five years. [Table 1] Sixty percent of )] TJ ET BT 26.250 672.371 Td /F1 9.8 Tf [(participants considered their OB/GYN their primary care physician, yet two-hundred sixteen \(66%\) reported never having )] TJ ET BT 26.250 660.466 Td /F1 9.8 Tf [(received any type of vaccine in an OB/GYN doctors office. Thirty women \(9%\) reported having received a seasonal and/or )] TJ ET BT 26.250 648.561 Td /F1 9.8 Tf [(H1N1 influenza vaccine in an OB/GYNs office before. Over one quarter \(26%\) reported feeling hesitant \(i.e. worried or )] TJ ET BT 26.250 636.657 Td /F1 9.8 Tf [(concerned\) about receiving vaccines recommended by their physician during pregnancy.)] TJ ET BT 26.250 617.252 Td /F1 9.8 Tf [(White women were significantly more likely to intend to receive a Tdap vaccine during their current pregnancy than women of )] TJ ET BT 26.250 605.347 Td /F1 9.8 Tf [(other races, and intention to receive an influenza vaccine was significantly associated with the number of times treated by a )] TJ ET BT 26.250 593.442 Td /F1 9.8 Tf [(healthcare provider in the past year. [Table 1] Intention to receive antenatal influenza and/or Tdap vaccines was also )] TJ ET BT 26.250 581.538 Td /F1 9.8 Tf [(significantly associated with previous receipt of influenza vaccination in the past five years. There were no significant differences )] TJ ET BT 26.250 569.633 Td /F1 9.8 Tf [(in proportions of women enrolled in control arm practices versus intervention arm practices on perceptions of disease severity )] TJ ET BT 26.250 557.728 Td /F1 9.8 Tf [(during pregnancy, perceptions of disease severity for their newborn, intended likelihood of antenatal influenza vaccine receipt, )] TJ ET BT 26.250 545.823 Td /F1 9.8 Tf [(intended likelihood of antenatal Tdap vaccine receipt, vaccine hesitancy, or perceptions of safety of influenza vaccination during )] TJ ET BT 26.250 533.919 Td /F1 9.8 Tf [(pregnancy \(data available upon request\).)] TJ ET BT 26.250 514.514 Td /F1 9.8 Tf [(Two-hundred sixty five women \(82%\) agreed with the statement Influenza is a concern for pregnant women, and 238 \(73%\) )] TJ ET BT 26.250 502.609 Td /F1 9.8 Tf [(believed influenza infection would be serious or very serious during pregnancy. Two-hundred sixty two \(81%\) believed )] TJ ET BT 26.250 490.704 Td /F1 9.8 Tf [(contracting pertussis during pregnancy would be serious or very serious. Additionally, 87% and 92% believed influenza and )] TJ ET BT 26.250 478.800 Td /F1 9.8 Tf [(pertussis, respectively, would be serious or very serious to their newborn within the first six months of life.)] TJ ET BT 26.250 459.395 Td /F1 9.8 Tf [(Despite perceptions of severity, only 112 \(34%\) and 143 \(44%\) reported they were likely to receive an influenza vaccine or Tdap )] TJ ET BT 26.250 447.490 Td /F1 9.8 Tf [(vaccine, respectively, during their current pregnancy. [Figure 2])] TJ ET 0.965 0.965 0.965 rg 26.250 200.145 555.000 237.464 re f 0.267 0.267 0.267 rg 0.267 0.267 0.267 RG 26.250 437.609 m 581.250 437.609 l 581.250 436.859 l 26.250 436.859 l f 26.250 200.145 m 581.250 200.145 l 581.250 200.895 l 26.250 200.895 l f q 225.000 0 0 168.750 35.250 259.109 cm /I15 Do Q q 35.250 211.395 537.000 41.714 re W n 0.271 0.267 0.267 rg BT 35.250 243.585 Td /F4 9.8 Tf [(Fig. 2: A\). Perceived severity of influenza and pertussis during pregnancy and intention to get vaccinated during )] TJ ET BT 35.250 231.681 Td /F4 9.8 Tf [(pregnancy B\) Perceived severity of influenza and pertussis during first 6 months of infancy and intention to get )] TJ ET BT 35.250 219.776 Td /F4 9.8 Tf [(vaccinated during pregnancy)] TJ ET Q BT 26.250 183.121 Td /F1 9.8 Tf [(Perception of influenza disease severity for themselves or their newborns was not significantly associated with an intention to )] TJ ET BT 26.250 171.216 Td /F1 9.8 Tf [(receive an influenza vaccine during pregnancy, but perception of pertussis severity for their infant was strongly associated with )] TJ ET BT 26.250 159.312 Td /F1 9.8 Tf [(intention of antenatal Tdap vaccination \(p=0.004\). [Figure 2])] TJ ET BT 26.250 139.907 Td /F1 9.8 Tf [(Regarding influenza vaccine safety, 149 women \(46%\) agreed with the statement Getting an influenza vaccine while pregnant )] TJ ET BT 26.250 128.002 Td /F1 9.8 Tf [(seems risky. Compared to women who perceived the vaccine as safe, women who had low perceptions of influenza vaccine )] TJ ET BT 26.250 116.097 Td /F1 9.8 Tf [(safety were significantly less likely to intend to receive an influenza vaccine \(48% vs. 20%; p < 0.001\) or a Tdap vaccine \(53% )] TJ ET BT 26.250 104.193 Td /F1 9.8 Tf [(vs. 33%; p < 0.001\) during their current pregnancy. [Figure 3])] TJ ET BT 26.250 84.788 Td /F1 9.8 Tf [(While a lower perception of influenza vaccine safety was associated with a higher probability of non-intention to be vaccinated, )] TJ ET BT 26.250 72.883 Td /F1 9.8 Tf [(substantial proportions of women who perceived the influenza vaccine as safe still did not intend to be vaccinated \(52% and )] TJ ET BT 26.250 60.978 Td /F1 9.8 Tf [(47% for influenza and Tdap, respectively\). [Figure 3])] TJ ET Q q 15.000 51.097 577.500 725.903 re W n 0.965 0.965 0.965 rg 26.250 744.514 555.000 32.486 re f 0.267 0.267 0.267 rg 0.267 0.267 0.267 RG 26.250 744.514 m 581.250 744.514 l 581.250 745.264 l 26.250 745.264 l f q 35.250 755.764 537.000 21.236 re W n 0.271 0.267 0.267 rg BT 35.250 766.011 Td /F4 9.8 Tf [(Table 1: Maternal characteristics and associations with intention to receive antenatal influenza and Tdap vaccines)] TJ ET Q BT 26.250 727.490 Td /F1 9.8 Tf [(The proportion of participants reporting at least some type of private health insurance was approximately equivalent to the )] TJ ET BT 26.250 715.585 Td /F1 9.8 Tf [(proportion reporting no insurance or coverage only by Medicaid \(43.4% vs. 42.5%\).)] TJ ET BT 26.250 696.180 Td /F1 9.8 Tf [(More than half \(57%\) of the women reported not having received a seasonal influenza vaccine in the past five years, while )] TJ ET BT 26.250 684.276 Td /F1 9.8 Tf [(another 19% reported having only received a seasonal influenza vaccine once in the past five years. [Table 1] Sixty percent of )] TJ ET BT 26.250 672.371 Td /F1 9.8 Tf [(participants considered their OB/GYN their primary care physician, yet two-hundred sixteen \(66%\) reported never having )] TJ ET BT 26.250 660.466 Td /F1 9.8 Tf [(received any type of vaccine in an OB/GYN doctors office. Thirty women \(9%\) reported having received a seasonal and/or )] TJ ET BT 26.250 648.561 Td /F1 9.8 Tf [(H1N1 influenza vaccine in an OB/GYNs office before. Over one quarter \(26%\) reported feeling hesitant \(i.e. worried or )] TJ ET BT 26.250 636.657 Td /F1 9.8 Tf [(concerned\) about receiving vaccines recommended by their physician during pregnancy.)] TJ ET BT 26.250 617.252 Td /F1 9.8 Tf [(White women were significantly more likely to intend to receive a Tdap vaccine during their current pregnancy than women of )] TJ ET BT 26.250 605.347 Td /F1 9.8 Tf [(other races, and intention to receive an influenza vaccine was significantly associated with the number of times treated by a )] TJ ET BT 26.250 593.442 Td /F1 9.8 Tf [(healthcare provider in the past year. [Table 1] Intention to receive antenatal influenza and/or Tdap vaccines was also )] TJ ET BT 26.250 581.538 Td /F1 9.8 Tf [(significantly associated with previous receipt of influenza vaccination in the past five years. There were no significant differences )] TJ ET BT 26.250 569.633 Td /F1 9.8 Tf [(in proportions of women enrolled in control arm practices versus intervention arm practices on perceptions of disease severity )] TJ ET BT 26.250 557.728 Td /F1 9.8 Tf [(during pregnancy, perceptions of disease severity for their newborn, intended likelihood of antenatal influenza vaccine receipt, )] TJ ET BT 26.250 545.823 Td /F1 9.8 Tf [(intended likelihood of antenatal Tdap vaccine receipt, vaccine hesitancy, or perceptions of safety of influenza vaccination during )] TJ ET BT 26.250 533.919 Td /F1 9.8 Tf [(pregnancy \(data available upon request\).)] TJ ET BT 26.250 514.514 Td /F1 9.8 Tf [(Two-hundred sixty five women \(82%\) agreed with the statement Influenza is a concern for pregnant women, and 238 \(73%\) )] TJ ET BT 26.250 502.609 Td /F1 9.8 Tf [(believed influenza infection would be serious or very serious during pregnancy. Two-hundred sixty two \(81%\) believed )] TJ ET BT 26.250 490.704 Td /F1 9.8 Tf [(contracting pertussis during pregnancy would be serious or very serious. Additionally, 87% and 92% believed influenza and )] TJ ET BT 26.250 478.800 Td /F1 9.8 Tf [(pertussis, respectively, would be serious or very serious to their newborn within the first six months of life.)] TJ ET BT 26.250 459.395 Td /F1 9.8 Tf [(Despite perceptions of severity, only 112 \(34%\) and 143 \(44%\) reported they were likely to receive an influenza vaccine or Tdap )] TJ ET BT 26.250 447.490 Td /F1 9.8 Tf [(vaccine, respectively, during their current pregnancy. [Figure 2])] TJ ET 0.965 0.965 0.965 rg 26.250 200.145 555.000 237.464 re f 0.267 0.267 0.267 rg 0.267 0.267 0.267 RG 26.250 437.609 m 581.250 437.609 l 581.250 436.859 l 26.250 436.859 l f 26.250 200.145 m 581.250 200.145 l 581.250 200.895 l 26.250 200.895 l f q 225.000 0 0 168.750 35.250 259.109 cm /I17 Do Q q 35.250 211.395 537.000 41.714 re W n 0.271 0.267 0.267 rg BT 35.250 243.585 Td /F4 9.8 Tf [(Fig. 2: A\). Perceived severity of influenza and pertussis during pregnancy and intention to get vaccinated during )] TJ ET BT 35.250 231.681 Td /F4 9.8 Tf [(pregnancy B\) Perceived severity of influenza and pertussis during first 6 months of infancy and intention to get )] TJ ET BT 35.250 219.776 Td /F4 9.8 Tf [(vaccinated during pregnancy)] TJ ET Q BT 26.250 183.121 Td /F1 9.8 Tf [(Perception of influenza disease severity for themselves or their newborns was not significantly associated with an intention to )] TJ ET BT 26.250 171.216 Td /F1 9.8 Tf [(receive an influenza vaccine during pregnancy, but perception of pertussis severity for their infant was strongly associated with )] TJ ET BT 26.250 159.312 Td /F1 9.8 Tf [(intention of antenatal Tdap vaccination \(p=0.004\). [Figure 2])] TJ ET BT 26.250 139.907 Td /F1 9.8 Tf [(Regarding influenza vaccine safety, 149 women \(46%\) agreed with the statement Getting an influenza vaccine while pregnant )] TJ ET BT 26.250 128.002 Td /F1 9.8 Tf [(seems risky. Compared to women who perceived the vaccine as safe, women who had low perceptions of influenza vaccine )] TJ ET BT 26.250 116.097 Td /F1 9.8 Tf [(safety were significantly less likely to intend to receive an influenza vaccine \(48% vs. 20%; p < 0.001\) or a Tdap vaccine \(53% )] TJ ET BT 26.250 104.193 Td /F1 9.8 Tf [(vs. 33%; p < 0.001\) during their current pregnancy. [Figure 3])] TJ ET BT 26.250 84.788 Td /F1 9.8 Tf [(While a lower perception of influenza vaccine safety was associated with a higher probability of non-intention to be vaccinated, )] TJ ET BT 26.250 72.883 Td /F1 9.8 Tf [(substantial proportions of women who perceived the influenza vaccine as safe still did not intend to be vaccinated \(52% and )] TJ ET BT 26.250 60.978 Td /F1 9.8 Tf [(47% for influenza and Tdap, respectively\). [Figure 3])] TJ ET Q q 225.000 0 0 168.750 35.250 259.109 cm /I19 Do Q q 0.000 0.000 0.000 rg BT 291.710 19.825 Td /F1 11.0 Tf [(4)] TJ ET BT 25.000 19.825 Td /F1 11.0 Tf [(PLOS Currents Outbreaks)] TJ ET Q endstream endobj 294 0 obj << /Type /Annot /Subtype /Link /A 295 0 R /Border [0 0 0] /H /I /Rect [ 35.2500 259.1092 260.2500 427.8592 ] >> endobj 295 0 obj << /Type /Action /S /URI /URI (http://currents.plos.org/outbreaks/files/2014/03/Figure-2_031014.png) >> endobj 296 0 obj << /Type /XObject /Subtype /Image /Width 300 /Height 225 /Filter /FlateDecode /DecodeParms << /Predictor 15 /Colors 1 /Columns 300 /BitsPerComponent 8>> /ColorSpace /DeviceGray /BitsPerComponent 8 /Length 479>> stream xA 7 !Stk:'fffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffff볯 endstream endobj 297 0 obj << /Type /XObject /Subtype /Image /Width 300 /Height 225 /SMask 296 0 R /Filter /FlateDecode /DecodeParms << /Predictor 15 /Colors 3 /Columns 300 /BitsPerComponent 8>> /ColorSpace /DeviceRGB /BitsPerComponent 8 /Length 14782>> stream xOhcK}QA`g -rE.ȅwaː<.C24P ^܅y܅AK#94^SQ(B4C4A!M08N[%;CqiI>G W_*DvWHK'a$cF";N#sSk&!v3tyT`4R92뛊nzPDSJ )"p8L i5RRJyqY"58BƘ6$!BMRꜣ"sICo_HV<1!ҳ6_?B!^kv> ,x=ׄ2hy&pBfW1S&Oc MoK\?P!kmah_C@ bmx֮DJ)nwιP?`inv gZ4K׃\]ra#hCۨ7]/\b7_w8cL^I!mQ)eec bmfvܭ~xc# U0ƬL[gm MF )"ȳfnۉ ("01#01#sPCqXYXG u{{<>9)%BHtcXDv}+aBfjā@賢ޑ݂ +1yLVa(m u!mN*@OtEI=)2^DC/Bu٘ #I4{yGss&\{x|B>{_Go A !=|ypEDC"'8892,&87sw.?tF"74UZ/"9B`-dϽk35^B֒3K)597SBB /#W\!ڢ~}؀y %b'&YgJsfز_t3>]"YТ#֦)iPRv* R*{*c;q _ËK6B31R 3P0Bp%=: C e:X'y7wڅRm"PoG4ۡݐ*R<{OmfjW)v{C{!-+kNpfj<; V 51ƬLBZk;*.$Y !!,HvBCku޴x.]7wPi ?䖪L^0P_ż^]^8Mg l( e0f.A^I7s(xZsbg?J >2ٱ(nfLMP35IA{!K8|Cb]!$yn9==DAa7 !X4PW!du&}4Bg?3 [qYPJkǙ֊n^fNU=|QFʰf 6sn(A~ Aa; )#PYm4jQgl^8OBIB9/ SA\BWd2pR,K ɥۛIG|F{ud$uwB!`7%_~繪Ov35se`0Av绾݀|1ߘ1^7=F_ ^O^I$_i3Kkb_^p1{X3 [ Q^I8<􏘩ᜇf Bܯ쩐pc)h7+!܃lWW#JH~_Jh4ey"4fY1āȲlZF軺sΩSɑ>G(V8ruW֪z[}݅n5}ny{֠ AWУ>00I^:J#LJZBg }.6ED#ri3c H*)hڢ("Mb&*|AyͿc2it&@98cKڌ4k$@BO: Ao۞%4T=kRRJip epAj-:uK# !loreӆJh5) 9n{ @JYM;Y-o!fʹUF|B_}Ζ2c@}m @"XqU^R6hcQڪm - wB~Xa}Ā66;W:fkMqE1Aoosb}gp\70k0yTN! iHXn*hSw<87)-J%׊F6jYBlz~BBr//-֫nI@Pˏ} 1'{]x|-08RAɲ,=yFd2B\~==i!W2dK}v@֒z6CJ)^;P:P<§^O_Sp<[Prwa_UpxEnֿЯ|p3?]ʠBJ 6 yhgvE/?{+⥫5w:X*<(3˵&yq B70tE[} ^],+\Ε{ΡOӜtWytZ+a$[QT(px#3CвWT\E~unE ח+Ox1d=y99AH:WZ\BJYōGkݒKlYjJpVJj(!4M*sV͝9?~!M2!-VJ㜫"d2H(mNCZm}zozϽ/=xc~;@BhR?!=w۩ 9;h:hکB9}@RZ\٫l!*C)]4o-aZٶE뉧Ij5,Sz|XOM|ۑ/N)|sT!_rs77LSKr%)k1/c]hƿZ{}yyyNsec62$_'Ʉ63BѰSl<{Oeq*.?gF~?hڤ?hǚU? 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In contrast, this study suggests that among pregnant women who remain unvaccinated )] TJ ET BT 26.250 425.836 Td /F1 9.8 Tf [(against influenza by December \(when most women willing to get vaccinated probably would have already received the influenza )] TJ ET BT 26.250 413.931 Td /F1 9.8 Tf [(vaccine\), a hesitancy that surpasses general concerns about vaccine safety remains.)] TJ ET BT 26.250 394.527 Td /F1 9.8 Tf [(While results from this survey underscore findings from other studies which describe influenza vaccine hesitancy among )] TJ ET BT 26.250 382.622 Td /F1 9.8 Tf [(pregnant women, the influenza-based findings presented here are juxtaposed with new insights on perceptions of Tdap )] TJ ET BT 26.250 370.717 Td /F1 9.8 Tf [(vaccination during pregnancy.)] TJ ET 0.267 0.267 0.267 rg BT 155.769 372.224 Td /F4 8.7 Tf [(25)] TJ ET 0.271 0.267 0.267 rg BT 165.406 374.605 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 167.816 372.224 Td /F4 8.7 Tf [(32)] TJ ET 0.271 0.267 0.267 rg BT 177.453 374.605 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 179.862 372.224 Td /F4 8.7 Tf [(33)] TJ ET 0.271 0.267 0.267 rg BT 189.500 374.605 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 191.909 372.224 Td /F4 8.7 Tf [(34)] TJ ET 0.271 0.267 0.267 rg BT 201.546 374.605 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 203.956 372.224 Td /F4 8.7 Tf [(35)] TJ ET 0.271 0.267 0.267 rg BT 213.593 370.717 Td /F1 9.8 Tf [( Most women enrolled in this study were aware of the dangers influenza and )] TJ ET BT 26.250 358.812 Td /F1 9.8 Tf [(pertussis pose to themselves and their infants, yet over one-quarter indicated hesitancy about receiving any vaccines )] TJ ET BT 26.250 346.908 Td /F1 9.8 Tf [(recommended during pregnancy. Nearly half of women perceived the influenza vaccine as unsafe during pregnancy, and more )] TJ ET BT 26.250 335.003 Td /F1 9.8 Tf [(women were likely to receive a Tdap vaccine than an influenza vaccine for all levels of perceived disease severity for )] TJ ET BT 26.250 323.098 Td /F1 9.8 Tf [(themselves. Since contracting influenza is more common and poses a greater threat to pregnant women than pertussis, it is )] TJ ET BT 26.250 311.193 Td /F1 9.8 Tf [(concerning that more women perceived pertussis as more serious during pregnancy than influenza.)] TJ ET 0.267 0.267 0.267 rg BT 454.889 312.701 Td /F4 8.7 Tf [(9)] TJ ET 0.271 0.267 0.267 rg BT 26.250 291.789 Td /F1 9.8 Tf [(Even though 60% of participants consider their OB/GYN to be their primary care physician, only one-third reported ever )] TJ ET BT 26.250 279.884 Td /F1 9.8 Tf [(receiving a vaccine from their OB/GYN. These data mirror findings from other healthcare utilization studies and illuminate a gap )] TJ ET BT 26.250 267.979 Td /F1 9.8 Tf [(in both service and expectation in the adult immunization system.)] TJ ET 0.267 0.267 0.267 rg BT 307.498 269.486 Td /F4 8.7 Tf [(36)] TJ ET 0.271 0.267 0.267 rg BT 317.136 271.867 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 319.545 269.486 Td /F4 8.7 Tf [(37)] TJ ET 0.271 0.267 0.267 rg BT 329.183 267.979 Td /F1 9.8 Tf [( Continuing to make vaccination a routine part of )] TJ ET BT 26.250 256.074 Td /F1 9.8 Tf [(womens health can help normalize vaccination within the obstetric setting.)] TJ ET 0.267 0.267 0.267 rg BT 347.591 257.582 Td /F4 8.7 Tf [(38)] TJ ET 0.271 0.267 0.267 rg BT 357.228 256.074 Td /F1 9.8 Tf [( As obstetric healthcare providers become more )] TJ ET BT 26.250 244.170 Td /F1 9.8 Tf [(accustomed to and comfortable with providing vaccines, women \(pregnant or otherwise\) will have greater access to and )] TJ ET BT 26.250 232.265 Td /F1 9.8 Tf [(possibly acceptance of vaccines.)] TJ ET BT 26.250 212.860 Td /F1 9.8 Tf [(It is important to note the chronological context of this survey in relation to recent changes in antenatal Tdap recommendations )] TJ ET BT 26.250 200.955 Td /F1 9.8 Tf [(in the U.S. While the U.S. Advisory Committee on Immunization Practices \(ACIP\) first recommended provision of Tdap at every )] TJ ET BT 26.250 189.051 Td /F1 9.8 Tf [(pregnancy in October 2012, there were gaps between when this recommendation was made and when it was published.)] TJ ET 0.267 0.267 0.267 rg BT 544.872 190.558 Td /F4 8.7 Tf [(39)] TJ ET 0.271 0.267 0.267 rg BT 554.509 192.939 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 556.919 190.558 Td /F4 8.7 Tf [(40)] TJ ET 0.271 0.267 0.267 rg BT 566.556 192.939 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 568.965 190.558 Td /F4 8.7 Tf [(41)] TJ ET 0.271 0.267 0.267 rg BT 26.250 177.146 Td /F1 9.8 Tf [(Since this survey was administered between December 2012 and April 2013, data were collected during the initial rollout of )] TJ ET BT 26.250 165.241 Td /F1 9.8 Tf [(these new recommendations. By virtue of its timing, this survey provides a baseline assessment of pregnant womens )] TJ ET BT 26.250 153.336 Td /F1 9.8 Tf [(perceptions towards pertussis and Tdap in the U.S., thereby enabling changes in perceptions to be measured from this point )] TJ ET BT 26.250 141.432 Td /F1 9.8 Tf [(forward.)] TJ ET BT 26.250 122.027 Td /F1 9.8 Tf [(This study has some important limitations. Since data were collected by self-report and not verified with medical records or )] TJ ET BT 26.250 110.122 Td /F1 9.8 Tf [(vaccine registry data, there is potential for recall bias. Any recall bias which may have been introduced is assumed to have been )] TJ ET BT 26.250 98.217 Td /F1 9.8 Tf [(non-differential with respect to characteristics likely to be associated with intention to receive antenatal influenza and/or Tdap )] TJ ET BT 26.250 86.313 Td /F1 9.8 Tf [(vaccines. Additionally, while we excluded women who indicated having received an influenza and/or Tdap vaccine before )] TJ ET BT 26.250 74.408 Td /F1 9.8 Tf [(completing her baseline survey, some women enrolled from intervention arm practices could have been exposed to the vaccine )] TJ ET BT 26.250 62.503 Td /F1 9.8 Tf [(promotion materials under evaluation in the MOMVAX study prior to completing their baseline surveys. Since we did not find )] TJ ET BT 26.250 50.598 Td /F1 9.8 Tf [(any significant differences between arms of the MOMVAX study on baseline measures of perceptions of disease severity, )] TJ ET BT 26.250 38.694 Td /F1 9.8 Tf [(intended likelihood of vaccine receipt, vaccine hesitancy, or perceptions of safety of influenza vaccination during pregnancy, we )] TJ ET Q q 15.000 24.408 577.500 752.592 re W n 0.965 0.965 0.965 rg 26.250 551.440 555.000 225.560 re f 0.267 0.267 0.267 rg 0.267 0.267 0.267 RG 26.250 777.000 m 581.250 777.000 l 581.250 776.250 l 26.250 776.250 l f 26.250 551.440 m 581.250 551.440 l 581.250 552.190 l 26.250 552.190 l f q 225.000 0 0 168.750 35.250 598.500 cm /I23 Do Q q 35.250 562.690 537.000 29.810 re W n 0.271 0.267 0.267 rg BT 35.250 582.976 Td /F4 9.8 Tf [(Fig. 3: Perception of safety of influenza vaccine during pregnancy and intention to receive influenza or Tdap )] TJ ET BT 35.250 571.071 Td /F4 9.8 Tf [(vaccinations during pregnancy)] TJ ET Q BT 26.250 517.219 Td /F4 12.0 Tf [(Discussion)] TJ ET BT 26.250 497.265 Td /F1 9.8 Tf [(Antenatal vaccination against influenza and pertussis not only protects the mother from contracting these diseases, but it is also )] TJ ET BT 26.250 485.360 Td /F1 9.8 Tf [(the first step towards protecting infants during their first 3 months of life.)] TJ ET 0.267 0.267 0.267 rg BT 334.594 486.867 Td /F4 8.7 Tf [(26)] TJ ET 0.271 0.267 0.267 rg BT 344.231 485.360 Td /F1 9.8 Tf [( Efforts have been made in the U.S. by the American )] TJ ET BT 26.250 473.455 Td /F1 9.8 Tf [(Congress of Obstetrics and Gynecology \(ACOG\) and other public health entities to stress the importance of influenza and Tdap )] TJ ET BT 26.250 461.550 Td /F1 9.8 Tf [(vaccination during pregnancy.)] TJ ET 0.267 0.267 0.267 rg BT 155.769 463.058 Td /F4 8.7 Tf [(27)] TJ ET 0.271 0.267 0.267 rg BT 165.406 465.439 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 167.816 463.058 Td /F4 8.7 Tf [(28)] TJ ET 0.271 0.267 0.267 rg BT 177.453 465.439 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 179.862 463.058 Td /F4 8.7 Tf [(29)] TJ ET 0.271 0.267 0.267 rg BT 189.500 465.439 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 191.909 463.058 Td /F4 8.7 Tf [(30)] TJ ET 0.271 0.267 0.267 rg BT 201.546 465.439 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 203.956 463.058 Td /F4 8.7 Tf [(31)] TJ ET 0.271 0.267 0.267 rg BT 213.593 461.550 Td /F1 9.8 Tf [( With nearly 60% of pregnant women screened for this study ineligible to enroll )] TJ ET BT 26.250 449.646 Td /F1 9.8 Tf [(because they reported having already received a 2012 2013 influenza vaccine, efforts in promoting antenatal influenza )] TJ ET BT 26.250 437.741 Td /F1 9.8 Tf [(vaccination have been successful. In contrast, this study suggests that among pregnant women who remain unvaccinated )] TJ ET BT 26.250 425.836 Td /F1 9.8 Tf [(against influenza by December \(when most women willing to get vaccinated probably would have already received the influenza )] TJ ET BT 26.250 413.931 Td /F1 9.8 Tf [(vaccine\), a hesitancy that surpasses general concerns about vaccine safety remains.)] TJ ET BT 26.250 394.527 Td /F1 9.8 Tf [(While results from this survey underscore findings from other studies which describe influenza vaccine hesitancy among )] TJ ET BT 26.250 382.622 Td /F1 9.8 Tf [(pregnant women, the influenza-based findings presented here are juxtaposed with new insights on perceptions of Tdap )] TJ ET BT 26.250 370.717 Td /F1 9.8 Tf [(vaccination during pregnancy.)] TJ ET 0.267 0.267 0.267 rg BT 155.769 372.224 Td /F4 8.7 Tf [(25)] TJ ET 0.271 0.267 0.267 rg BT 165.406 374.605 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 167.816 372.224 Td /F4 8.7 Tf [(32)] TJ ET 0.271 0.267 0.267 rg BT 177.453 374.605 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 179.862 372.224 Td /F4 8.7 Tf [(33)] TJ ET 0.271 0.267 0.267 rg BT 189.500 374.605 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 191.909 372.224 Td /F4 8.7 Tf [(34)] TJ ET 0.271 0.267 0.267 rg BT 201.546 374.605 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 203.956 372.224 Td /F4 8.7 Tf [(35)] TJ ET 0.271 0.267 0.267 rg BT 213.593 370.717 Td /F1 9.8 Tf [( Most women enrolled in this study were aware of the dangers influenza and )] TJ ET BT 26.250 358.812 Td /F1 9.8 Tf [(pertussis pose to themselves and their infants, yet over one-quarter indicated hesitancy about receiving any vaccines )] TJ ET BT 26.250 346.908 Td /F1 9.8 Tf [(recommended during pregnancy. Nearly half of women perceived the influenza vaccine as unsafe during pregnancy, and more )] TJ ET BT 26.250 335.003 Td /F1 9.8 Tf [(women were likely to receive a Tdap vaccine than an influenza vaccine for all levels of perceived disease severity for )] TJ ET BT 26.250 323.098 Td /F1 9.8 Tf [(themselves. Since contracting influenza is more common and poses a greater threat to pregnant women than pertussis, it is )] TJ ET BT 26.250 311.193 Td /F1 9.8 Tf [(concerning that more women perceived pertussis as more serious during pregnancy than influenza.)] TJ ET 0.267 0.267 0.267 rg BT 454.889 312.701 Td /F4 8.7 Tf [(9)] TJ ET 0.271 0.267 0.267 rg BT 26.250 291.789 Td /F1 9.8 Tf [(Even though 60% of participants consider their OB/GYN to be their primary care physician, only one-third reported ever )] TJ ET BT 26.250 279.884 Td /F1 9.8 Tf [(receiving a vaccine from their OB/GYN. These data mirror findings from other healthcare utilization studies and illuminate a gap )] TJ ET BT 26.250 267.979 Td /F1 9.8 Tf [(in both service and expectation in the adult immunization system.)] TJ ET 0.267 0.267 0.267 rg BT 307.498 269.486 Td /F4 8.7 Tf [(36)] TJ ET 0.271 0.267 0.267 rg BT 317.136 271.867 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 319.545 269.486 Td /F4 8.7 Tf [(37)] TJ ET 0.271 0.267 0.267 rg BT 329.183 267.979 Td /F1 9.8 Tf [( Continuing to make vaccination a routine part of )] TJ ET BT 26.250 256.074 Td /F1 9.8 Tf [(womens health can help normalize vaccination within the obstetric setting.)] TJ ET 0.267 0.267 0.267 rg BT 347.591 257.582 Td /F4 8.7 Tf [(38)] TJ ET 0.271 0.267 0.267 rg BT 357.228 256.074 Td /F1 9.8 Tf [( As obstetric healthcare providers become more )] TJ ET BT 26.250 244.170 Td /F1 9.8 Tf [(accustomed to and comfortable with providing vaccines, women \(pregnant or otherwise\) will have greater access to and )] TJ ET BT 26.250 232.265 Td /F1 9.8 Tf [(possibly acceptance of vaccines.)] TJ ET BT 26.250 212.860 Td /F1 9.8 Tf [(It is important to note the chronological context of this survey in relation to recent changes in antenatal Tdap recommendations )] TJ ET BT 26.250 200.955 Td /F1 9.8 Tf [(in the U.S. While the U.S. Advisory Committee on Immunization Practices \(ACIP\) first recommended provision of Tdap at every )] TJ ET BT 26.250 189.051 Td /F1 9.8 Tf [(pregnancy in October 2012, there were gaps between when this recommendation was made and when it was published.)] TJ ET 0.267 0.267 0.267 rg BT 544.872 190.558 Td /F4 8.7 Tf [(39)] TJ ET 0.271 0.267 0.267 rg BT 554.509 192.939 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 556.919 190.558 Td /F4 8.7 Tf [(40)] TJ ET 0.271 0.267 0.267 rg BT 566.556 192.939 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 568.965 190.558 Td /F4 8.7 Tf [(41)] TJ ET 0.271 0.267 0.267 rg BT 26.250 177.146 Td /F1 9.8 Tf [(Since this survey was administered between December 2012 and April 2013, data were collected during the initial rollout of )] TJ ET BT 26.250 165.241 Td /F1 9.8 Tf [(these new recommendations. By virtue of its timing, this survey provides a baseline assessment of pregnant womens )] TJ ET BT 26.250 153.336 Td /F1 9.8 Tf [(perceptions towards pertussis and Tdap in the U.S., thereby enabling changes in perceptions to be measured from this point )] TJ ET BT 26.250 141.432 Td /F1 9.8 Tf [(forward.)] TJ ET BT 26.250 122.027 Td /F1 9.8 Tf [(This study has some important limitations. Since data were collected by self-report and not verified with medical records or )] TJ ET BT 26.250 110.122 Td /F1 9.8 Tf [(vaccine registry data, there is potential for recall bias. Any recall bias which may have been introduced is assumed to have been )] TJ ET BT 26.250 98.217 Td /F1 9.8 Tf [(non-differential with respect to characteristics likely to be associated with intention to receive antenatal influenza and/or Tdap )] TJ ET BT 26.250 86.313 Td /F1 9.8 Tf [(vaccines. Additionally, while we excluded women who indicated having received an influenza and/or Tdap vaccine before )] TJ ET BT 26.250 74.408 Td /F1 9.8 Tf [(completing her baseline survey, some women enrolled from intervention arm practices could have been exposed to the vaccine )] TJ ET BT 26.250 62.503 Td /F1 9.8 Tf [(promotion materials under evaluation in the MOMVAX study prior to completing their baseline surveys. Since we did not find )] TJ ET BT 26.250 50.598 Td /F1 9.8 Tf [(any significant differences between arms of the MOMVAX study on baseline measures of perceptions of disease severity, )] TJ ET BT 26.250 38.694 Td /F1 9.8 Tf [(intended likelihood of vaccine receipt, vaccine hesitancy, or perceptions of safety of influenza vaccination during pregnancy, we )] TJ ET Q q 15.000 24.408 577.500 752.592 re W n 0.965 0.965 0.965 rg 26.250 551.440 555.000 225.560 re f 0.267 0.267 0.267 rg 0.267 0.267 0.267 RG 26.250 777.000 m 581.250 777.000 l 581.250 776.250 l 26.250 776.250 l f 26.250 551.440 m 581.250 551.440 l 581.250 552.190 l 26.250 552.190 l f q 225.000 0 0 168.750 35.250 598.500 cm /I25 Do Q q 35.250 562.690 537.000 29.810 re W n 0.271 0.267 0.267 rg BT 35.250 582.976 Td /F4 9.8 Tf [(Fig. 3: Perception of safety of influenza vaccine during pregnancy and intention to receive influenza or Tdap )] TJ ET BT 35.250 571.071 Td /F4 9.8 Tf [(vaccinations during pregnancy)] TJ ET Q BT 26.250 517.219 Td /F4 12.0 Tf [(Discussion)] TJ ET BT 26.250 497.265 Td /F1 9.8 Tf [(Antenatal vaccination against influenza and pertussis not only protects the mother from contracting these diseases, but it is also )] TJ ET BT 26.250 485.360 Td /F1 9.8 Tf [(the first step towards protecting infants during their first 3 months of life.)] TJ ET 0.267 0.267 0.267 rg BT 334.594 486.867 Td /F4 8.7 Tf [(26)] TJ ET 0.271 0.267 0.267 rg BT 344.231 485.360 Td /F1 9.8 Tf [( Efforts have been made in the U.S. by the American )] TJ ET BT 26.250 473.455 Td /F1 9.8 Tf [(Congress of Obstetrics and Gynecology \(ACOG\) and other public health entities to stress the importance of influenza and Tdap )] TJ ET BT 26.250 461.550 Td /F1 9.8 Tf [(vaccination during pregnancy.)] TJ ET 0.267 0.267 0.267 rg BT 155.769 463.058 Td /F4 8.7 Tf [(27)] TJ ET 0.271 0.267 0.267 rg BT 165.406 465.439 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 167.816 463.058 Td /F4 8.7 Tf [(28)] TJ ET 0.271 0.267 0.267 rg BT 177.453 465.439 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 179.862 463.058 Td /F4 8.7 Tf [(29)] TJ ET 0.271 0.267 0.267 rg BT 189.500 465.439 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 191.909 463.058 Td /F4 8.7 Tf [(30)] TJ ET 0.271 0.267 0.267 rg BT 201.546 465.439 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 203.956 463.058 Td /F4 8.7 Tf [(31)] TJ ET 0.271 0.267 0.267 rg BT 213.593 461.550 Td /F1 9.8 Tf [( With nearly 60% of pregnant women screened for this study ineligible to enroll )] TJ ET BT 26.250 449.646 Td /F1 9.8 Tf [(because they reported having already received a 2012 2013 influenza vaccine, efforts in promoting antenatal influenza )] TJ ET BT 26.250 437.741 Td /F1 9.8 Tf [(vaccination have been successful. In contrast, this study suggests that among pregnant women who remain unvaccinated )] TJ ET BT 26.250 425.836 Td /F1 9.8 Tf [(against influenza by December \(when most women willing to get vaccinated probably would have already received the influenza )] TJ ET BT 26.250 413.931 Td /F1 9.8 Tf [(vaccine\), a hesitancy that surpasses general concerns about vaccine safety remains.)] TJ ET BT 26.250 394.527 Td /F1 9.8 Tf [(While results from this survey underscore findings from other studies which describe influenza vaccine hesitancy among )] TJ ET BT 26.250 382.622 Td /F1 9.8 Tf [(pregnant women, the influenza-based findings presented here are juxtaposed with new insights on perceptions of Tdap )] TJ ET BT 26.250 370.717 Td /F1 9.8 Tf [(vaccination during pregnancy.)] TJ ET 0.267 0.267 0.267 rg BT 155.769 372.224 Td /F4 8.7 Tf [(25)] TJ ET 0.271 0.267 0.267 rg BT 165.406 374.605 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 167.816 372.224 Td /F4 8.7 Tf [(32)] TJ ET 0.271 0.267 0.267 rg BT 177.453 374.605 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 179.862 372.224 Td /F4 8.7 Tf [(33)] TJ ET 0.271 0.267 0.267 rg BT 189.500 374.605 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 191.909 372.224 Td /F4 8.7 Tf [(34)] TJ ET 0.271 0.267 0.267 rg BT 201.546 374.605 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 203.956 372.224 Td /F4 8.7 Tf [(35)] TJ ET 0.271 0.267 0.267 rg BT 213.593 370.717 Td /F1 9.8 Tf [( Most women enrolled in this study were aware of the dangers influenza and )] TJ ET BT 26.250 358.812 Td /F1 9.8 Tf [(pertussis pose to themselves and their infants, yet over one-quarter indicated hesitancy about receiving any vaccines )] TJ ET BT 26.250 346.908 Td /F1 9.8 Tf [(recommended during pregnancy. Nearly half of women perceived the influenza vaccine as unsafe during pregnancy, and more )] TJ ET BT 26.250 335.003 Td /F1 9.8 Tf [(women were likely to receive a Tdap vaccine than an influenza vaccine for all levels of perceived disease severity for )] TJ ET BT 26.250 323.098 Td /F1 9.8 Tf [(themselves. Since contracting influenza is more common and poses a greater threat to pregnant women than pertussis, it is )] TJ ET BT 26.250 311.193 Td /F1 9.8 Tf [(concerning that more women perceived pertussis as more serious during pregnancy than influenza.)] TJ ET 0.267 0.267 0.267 rg BT 454.889 312.701 Td /F4 8.7 Tf [(9)] TJ ET 0.271 0.267 0.267 rg BT 26.250 291.789 Td /F1 9.8 Tf [(Even though 60% of participants consider their OB/GYN to be their primary care physician, only one-third reported ever )] TJ ET BT 26.250 279.884 Td /F1 9.8 Tf [(receiving a vaccine from their OB/GYN. These data mirror findings from other healthcare utilization studies and illuminate a gap )] TJ ET BT 26.250 267.979 Td /F1 9.8 Tf [(in both service and expectation in the adult immunization system.)] TJ ET 0.267 0.267 0.267 rg BT 307.498 269.486 Td /F4 8.7 Tf [(36)] TJ ET 0.271 0.267 0.267 rg BT 317.136 271.867 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 319.545 269.486 Td /F4 8.7 Tf [(37)] TJ ET 0.271 0.267 0.267 rg BT 329.183 267.979 Td /F1 9.8 Tf [( Continuing to make vaccination a routine part of )] TJ ET BT 26.250 256.074 Td /F1 9.8 Tf [(womens health can help normalize vaccination within the obstetric setting.)] TJ ET 0.267 0.267 0.267 rg BT 347.591 257.582 Td /F4 8.7 Tf [(38)] TJ ET 0.271 0.267 0.267 rg BT 357.228 256.074 Td /F1 9.8 Tf [( As obstetric healthcare providers become more )] TJ ET BT 26.250 244.170 Td /F1 9.8 Tf [(accustomed to and comfortable with providing vaccines, women \(pregnant or otherwise\) will have greater access to and )] TJ ET BT 26.250 232.265 Td /F1 9.8 Tf [(possibly acceptance of vaccines.)] TJ ET BT 26.250 212.860 Td /F1 9.8 Tf [(It is important to note the chronological context of this survey in relation to recent changes in antenatal Tdap recommendations )] TJ ET BT 26.250 200.955 Td /F1 9.8 Tf [(in the U.S. While the U.S. Advisory Committee on Immunization Practices \(ACIP\) first recommended provision of Tdap at every )] TJ ET BT 26.250 189.051 Td /F1 9.8 Tf [(pregnancy in October 2012, there were gaps between when this recommendation was made and when it was published.)] TJ ET 0.267 0.267 0.267 rg BT 544.872 190.558 Td /F4 8.7 Tf [(39)] TJ ET 0.271 0.267 0.267 rg BT 554.509 192.939 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 556.919 190.558 Td /F4 8.7 Tf [(40)] TJ ET 0.271 0.267 0.267 rg BT 566.556 192.939 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 568.965 190.558 Td /F4 8.7 Tf [(41)] TJ ET 0.271 0.267 0.267 rg BT 26.250 177.146 Td /F1 9.8 Tf [(Since this survey was administered between December 2012 and April 2013, data were collected during the initial rollout of )] TJ ET BT 26.250 165.241 Td /F1 9.8 Tf [(these new recommendations. By virtue of its timing, this survey provides a baseline assessment of pregnant womens )] TJ ET BT 26.250 153.336 Td /F1 9.8 Tf [(perceptions towards pertussis and Tdap in the U.S., thereby enabling changes in perceptions to be measured from this point )] TJ ET BT 26.250 141.432 Td /F1 9.8 Tf [(forward.)] TJ ET BT 26.250 122.027 Td /F1 9.8 Tf [(This study has some important limitations. Since data were collected by self-report and not verified with medical records or )] TJ ET BT 26.250 110.122 Td /F1 9.8 Tf [(vaccine registry data, there is potential for recall bias. Any recall bias which may have been introduced is assumed to have been )] TJ ET BT 26.250 98.217 Td /F1 9.8 Tf [(non-differential with respect to characteristics likely to be associated with intention to receive antenatal influenza and/or Tdap )] TJ ET BT 26.250 86.313 Td /F1 9.8 Tf [(vaccines. 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Continuing to promote, discuss, and offer influenza vaccine )] TJ ET BT 26.250 640.929 Td /F1 9.8 Tf [(repeatedly and late into an influenza season is especially important for women who may be hesitant, but still interested in )] TJ ET BT 26.250 629.024 Td /F1 9.8 Tf [(receiving an influenza vaccine. Likewise, continuing to discuss and promote Tdap vaccination throughout pregnancy can remind )] TJ ET BT 26.250 617.119 Td /F1 9.8 Tf [(and encourage women to receive a Tdap vaccination before delivery. Since patient education on antenatal vaccination is likely )] TJ ET BT 26.250 605.214 Td /F1 9.8 Tf [(to come from obstetricians, continuing to develop and evaluate nuanced tools for promoting influenza and Tdap vaccines during )] TJ ET BT 26.250 593.310 Td /F1 9.8 Tf [(pregnancy is needed.)] TJ ET BT 26.250 556.707 Td /F4 12.0 Tf [(Competing Interest)] TJ ET BT 26.250 536.753 Td /F1 9.8 Tf [(Allison Chamberlain, Katherine Seib, Paula Frew, Marielysse Corts, Ellen Whitney, Ruth Berkelman, Saad Omer, Walter )] TJ ET BT 26.250 524.848 Td /F1 9.8 Tf [(Orenstein, Fauzia Malik, Pat Cota and Lisa Flowers have no conflicts of interest to report. Kevin Ault has acted as a consultant )] TJ ET BT 26.250 512.943 Td /F1 9.8 Tf [(on maternal immunization with the Centers for Disease Control and Prevention, the National Institute of Allergy and Infectious )] TJ ET BT 26.250 501.039 Td /F1 9.8 Tf [(Diseases and the American College of Obstetricians and Gynecologists. He also serves on a data safety and monitoring )] TJ ET BT 26.250 489.134 Td /F1 9.8 Tf [(committee with Novartis.)] TJ ET BT 26.250 452.531 Td /F4 12.0 Tf [(Acknowledgements)] TJ ET BT 26.250 432.577 Td /F1 9.8 Tf [(We would like to thank Emory Rollins School of Public Health graduate research assistants Kristin Bratton, Anna Gajewski, )] TJ ET BT 26.250 420.672 Td /F1 9.8 Tf [(Jaime Hamil, Isabelle Hutchings, Beatrice Jang, Swati Jha, Swati Mishra, Alyssa Parr, Kaitlyn Pruitt, and Chika Obidike and )] TJ ET BT 26.250 408.768 Td /F1 9.8 Tf [(University of Georgia graduate research assistants Alethea Chiappone, Hannah Demmitt and Jenessa Teague for their )] TJ ET BT 26.250 396.863 Td /F1 9.8 Tf [(assistance in recruiting the participants in this study and/or managing data. This study was supported by a grant from the )] TJ ET BT 26.250 384.958 Td /F1 9.8 Tf [(Centers for Disease Control and Prevention \(CDC\), grant # 5P01TP000300, to the Emory Preparedness and Emergency )] TJ ET BT 26.250 373.053 Td /F1 9.8 Tf [(Response Research Center, Emory University, Atlanta, GA. Its contents are solely the responsibility of the authors and do not )] TJ ET BT 26.250 361.149 Td /F1 9.8 Tf [(necessarily represent the official views of the CDC.)] TJ ET BT 26.250 332.046 Td /F4 12.0 Tf [(References)] TJ ET BT 26.250 304.592 Td /F1 9.8 Tf [(1.)] TJ ET BT 38.132 304.592 Td /F1 9.8 Tf [(Jamieson DJ, Theiler RN, Rasmussen SA. Emerging Infections and Pregnancy. Emerg Infect Dis 2006; 12\(11\):1638-1643.)] TJ ET BT 26.250 285.187 Td /F1 9.8 Tf [(2.)] TJ ET BT 38.132 285.187 Td /F1 9.8 Tf [( Dodds L, McNeil SA, Fell DB, Allen VM, Coombs A, Scott J, et al. Impact of influenza exposure on rates of hospital )] TJ ET BT 26.250 273.282 Td /F1 9.8 Tf [(admissions and physician visits because of respiratory illness among pregnant women. CMAJ 2007; 176\(4\):463-468.)] TJ ET BT 26.250 253.878 Td /F1 9.8 Tf [(3.)] TJ ET BT 38.132 253.878 Td /F1 9.8 Tf [(Neuzil KM, Reed GW, Mitchel EF, Simonsen L, Griffin MR. Impact of influenza on acute cardiopulmonary hospitalizations in )] TJ ET BT 26.250 241.973 Td /F1 9.8 Tf [(pregnant women. Am J of Epidemiol 1998; 148\(11\):1094-1102.)] TJ ET BT 26.250 222.568 Td /F1 9.8 Tf [(4.)] TJ ET BT 38.132 222.568 Td /F1 9.8 Tf [(Rasmussen SA, Jamieson DJ, Bresee JS. Pandemic influenza and pregnant women. Emerg Infect Dis 2008; 14\(1\):95-100.)] TJ ET BT 26.250 203.163 Td /F1 9.8 Tf [(5.)] TJ ET BT 38.132 203.163 Td /F1 9.8 Tf [(Harris JW. Influenza occurring in pregnant women: A statistical study of thirteen hundred and fifty cases. JAMA 1919; )] TJ ET BT 26.250 191.259 Td /F1 9.8 Tf [(72\(14\):978-980.)] TJ ET BT 26.250 171.854 Td /F1 9.8 Tf [(6.)] TJ ET BT 38.132 171.854 Td /F1 9.8 Tf [(Nuzum JW, Pilot I, Stangl FH, Bonar BE. Pandemic influenza and pneumonia in a large civil hospital. JAMA 1918; )] TJ ET BT 26.250 159.949 Td /F1 9.8 Tf [(71\(19\):1562-1565.)] TJ ET BT 26.250 140.544 Td /F1 9.8 Tf [(7.)] TJ ET BT 38.132 140.544 Td /F1 9.8 Tf [(Hardy JM, Azarowicz EN, Mannini A, Medearis DN, Cooke RE. The effect of Asian influenza on the outcome of pregnancy, )] TJ ET BT 26.250 128.640 Td /F1 9.8 Tf [(Baltimore, 1957-1958. Am J Public Health Nations Health 1961; 51\(8\):1182-1188.)] TJ ET BT 26.250 109.235 Td /F1 9.8 Tf [(8.)] TJ ET BT 38.132 109.235 Td /F1 9.8 Tf [(Mendez-Figueroa H, Raker C, Anderson BL. Neonatal characteristics and outcomes of pregnancies complicated by influenza )] TJ ET BT 26.250 97.330 Td /F1 9.8 Tf [(infection during the 2009 pandemic. Am J Obstet Gynecol 2011; 204\(6, Supplement\):S58-S63.)] TJ ET BT 26.250 77.925 Td /F1 9.8 Tf [(9.)] TJ ET BT 38.132 77.925 Td /F1 9.8 Tf [(Centers for Disease Control and Prevention. Prevention and control of influenza with vaccines: recommendations of the )] TJ ET BT 26.250 66.021 Td /F1 9.8 Tf [(Advisory Committee on Immunization Practices \(ACIP\), 2010. Morb Mortal Wkly Recomm Rep 2010; 59\(rr08\):1-62.)] TJ ET BT 26.250 46.616 Td /F1 9.8 Tf [(10.)] TJ ET BT 43.553 46.616 Td /F1 9.8 Tf [(Cortese MM, Baughman AL, Zhang R, Srivastava PU, Wallace GS. Pertussis hospitalizations among infants in the United )] TJ ET Q q 15.000 32.330 577.500 744.670 re W n 0.271 0.267 0.267 rg BT 26.250 767.476 Td /F1 9.8 Tf [(do not believe limited exposure to promotional intervention materials related to the MOMVAX study prior to completion of the )] TJ ET BT 26.250 755.571 Td /F1 9.8 Tf [(baseline survey had a differential impact on the women enrolled from intervention arm practices versus control arm practices. )] TJ ET BT 26.250 743.667 Td /F1 9.8 Tf [(This study was also U.S.-based, so while results may be applicable to other countries, it may be important to replicate this type )] TJ ET BT 26.250 731.762 Td /F1 9.8 Tf [(of survey among late-acceptors of antenatal influenza vaccines in other regions as well.)] TJ ET BT 26.250 712.357 Td /F1 9.8 Tf [(To further improve antenatal influenza vaccine coverage and to encourage antenatal Tdap vaccination, promotional efforts )] TJ ET BT 26.250 700.452 Td /F1 9.8 Tf [(tailored specifically to late acceptors of influenza vaccination or vaccine-hesitant women is important. Other studies which have )] TJ ET BT 26.250 688.548 Td /F1 9.8 Tf [(tested messaging techniques have started to emphasize this need to adapt messages based upon individuals preconceptions )] TJ ET BT 26.250 676.643 Td /F1 9.8 Tf [(and attitudes towards vaccination.)] TJ ET 0.267 0.267 0.267 rg BT 173.114 678.150 Td /F4 8.7 Tf [(42)] TJ ET 0.271 0.267 0.267 rg BT 182.752 676.643 Td /F1 9.8 Tf [( Since these results show that perceiving pertussis as serious for their infant is strongly )] TJ ET BT 26.250 664.738 Td /F1 9.8 Tf [(associated with intention to receive an antenatal Tdap vaccine, explaining disease effects on infants may be an effective )] TJ ET BT 26.250 652.833 Td /F1 9.8 Tf [(promotional strategy for women reluctant to receive vaccines. Continuing to promote, discuss, and offer influenza vaccine )] TJ ET BT 26.250 640.929 Td /F1 9.8 Tf [(repeatedly and late into an influenza season is especially important for women who may be hesitant, but still interested in )] TJ ET BT 26.250 629.024 Td /F1 9.8 Tf [(receiving an influenza vaccine. Likewise, continuing to discuss and promote Tdap vaccination throughout pregnancy can remind )] TJ ET BT 26.250 617.119 Td /F1 9.8 Tf [(and encourage women to receive a Tdap vaccination before delivery. Since patient education on antenatal vaccination is likely )] TJ ET BT 26.250 605.214 Td /F1 9.8 Tf [(to come from obstetricians, continuing to develop and evaluate nuanced tools for promoting influenza and Tdap vaccines during )] TJ ET BT 26.250 593.310 Td /F1 9.8 Tf [(pregnancy is needed.)] TJ ET BT 26.250 556.707 Td /F4 12.0 Tf [(Competing Interest)] TJ ET BT 26.250 536.753 Td /F1 9.8 Tf [(Allison Chamberlain, Katherine Seib, Paula Frew, Marielysse Corts, Ellen Whitney, Ruth Berkelman, Saad Omer, Walter )] TJ ET BT 26.250 524.848 Td /F1 9.8 Tf [(Orenstein, Fauzia Malik, Pat Cota and Lisa Flowers have no conflicts of interest to report. Kevin Ault has acted as a consultant )] TJ ET BT 26.250 512.943 Td /F1 9.8 Tf [(on maternal immunization with the Centers for Disease Control and Prevention, the National Institute of Allergy and Infectious )] TJ ET BT 26.250 501.039 Td /F1 9.8 Tf [(Diseases and the American College of Obstetricians and Gynecologists. He also serves on a data safety and monitoring )] TJ ET BT 26.250 489.134 Td /F1 9.8 Tf [(committee with Novartis.)] TJ ET BT 26.250 452.531 Td /F4 12.0 Tf [(Acknowledgements)] TJ ET BT 26.250 432.577 Td /F1 9.8 Tf [(We would like to thank Emory Rollins School of Public Health graduate research assistants Kristin Bratton, Anna Gajewski, )] TJ ET BT 26.250 420.672 Td /F1 9.8 Tf [(Jaime Hamil, Isabelle Hutchings, Beatrice Jang, Swati Jha, Swati Mishra, Alyssa Parr, Kaitlyn Pruitt, and Chika Obidike and )] TJ ET BT 26.250 408.768 Td /F1 9.8 Tf [(University of Georgia graduate research assistants Alethea Chiappone, Hannah Demmitt and Jenessa Teague for their )] TJ ET BT 26.250 396.863 Td /F1 9.8 Tf [(assistance in recruiting the participants in this study and/or managing data. This study was supported by a grant from the )] TJ ET BT 26.250 384.958 Td /F1 9.8 Tf [(Centers for Disease Control and Prevention \(CDC\), grant # 5P01TP000300, to the Emory Preparedness and Emergency )] TJ ET BT 26.250 373.053 Td /F1 9.8 Tf [(Response Research Center, Emory University, Atlanta, GA. Its contents are solely the responsibility of the authors and do not )] TJ ET BT 26.250 361.149 Td /F1 9.8 Tf [(necessarily represent the official views of the CDC.)] TJ ET BT 26.250 332.046 Td /F4 12.0 Tf [(References)] TJ ET BT 26.250 304.592 Td /F1 9.8 Tf [(1.)] TJ ET BT 38.132 304.592 Td /F1 9.8 Tf [(Jamieson DJ, Theiler RN, Rasmussen SA. Emerging Infections and Pregnancy. Emerg Infect Dis 2006; 12\(11\):1638-1643.)] TJ ET BT 26.250 285.187 Td /F1 9.8 Tf [(2.)] TJ ET BT 38.132 285.187 Td /F1 9.8 Tf [( Dodds L, McNeil SA, Fell DB, Allen VM, Coombs A, Scott J, et al. Impact of influenza exposure on rates of hospital )] TJ ET BT 26.250 273.282 Td /F1 9.8 Tf [(admissions and physician visits because of respiratory illness among pregnant women. CMAJ 2007; 176\(4\):463-468.)] TJ ET BT 26.250 253.878 Td /F1 9.8 Tf [(3.)] TJ ET BT 38.132 253.878 Td /F1 9.8 Tf [(Neuzil KM, Reed GW, Mitchel EF, Simonsen L, Griffin MR. Impact of influenza on acute cardiopulmonary hospitalizations in )] TJ ET BT 26.250 241.973 Td /F1 9.8 Tf [(pregnant women. Am J of Epidemiol 1998; 148\(11\):1094-1102.)] TJ ET BT 26.250 222.568 Td /F1 9.8 Tf [(4.)] TJ ET BT 38.132 222.568 Td /F1 9.8 Tf [(Rasmussen SA, Jamieson DJ, Bresee JS. Pandemic influenza and pregnant women. Emerg Infect Dis 2008; 14\(1\):95-100.)] TJ ET BT 26.250 203.163 Td /F1 9.8 Tf [(5.)] TJ ET BT 38.132 203.163 Td /F1 9.8 Tf [(Harris JW. Influenza occurring in pregnant women: A statistical study of thirteen hundred and fifty cases. JAMA 1919; )] TJ ET BT 26.250 191.259 Td /F1 9.8 Tf [(72\(14\):978-980.)] TJ ET BT 26.250 171.854 Td /F1 9.8 Tf [(6.)] TJ ET BT 38.132 171.854 Td /F1 9.8 Tf [(Nuzum JW, Pilot I, Stangl FH, Bonar BE. Pandemic influenza and pneumonia in a large civil hospital. JAMA 1918; )] TJ ET BT 26.250 159.949 Td /F1 9.8 Tf [(71\(19\):1562-1565.)] TJ ET BT 26.250 140.544 Td /F1 9.8 Tf [(7.)] TJ ET BT 38.132 140.544 Td /F1 9.8 Tf [(Hardy JM, Azarowicz EN, Mannini A, Medearis DN, Cooke RE. The effect of Asian influenza on the outcome of pregnancy, )] TJ ET BT 26.250 128.640 Td /F1 9.8 Tf [(Baltimore, 1957-1958. Am J Public Health Nations Health 1961; 51\(8\):1182-1188.)] TJ ET BT 26.250 109.235 Td /F1 9.8 Tf [(8.)] TJ ET BT 38.132 109.235 Td /F1 9.8 Tf [(Mendez-Figueroa H, Raker C, Anderson BL. Neonatal characteristics and outcomes of pregnancies complicated by influenza )] TJ ET BT 26.250 97.330 Td /F1 9.8 Tf [(infection during the 2009 pandemic. Am J Obstet Gynecol 2011; 204\(6, Supplement\):S58-S63.)] TJ ET BT 26.250 77.925 Td /F1 9.8 Tf [(9.)] TJ ET BT 38.132 77.925 Td /F1 9.8 Tf [(Centers for Disease Control and Prevention. Prevention and control of influenza with vaccines: recommendations of the )] TJ ET BT 26.250 66.021 Td /F1 9.8 Tf [(Advisory Committee on Immunization Practices \(ACIP\), 2010. Morb Mortal Wkly Recomm Rep 2010; 59\(rr08\):1-62.)] TJ ET BT 26.250 46.616 Td /F1 9.8 Tf [(10.)] TJ ET BT 43.553 46.616 Td /F1 9.8 Tf [(Cortese MM, Baughman AL, Zhang R, Srivastava PU, Wallace GS. Pertussis hospitalizations among infants in the United )] TJ ET Q q 15.000 32.330 577.500 744.670 re W n 0.271 0.267 0.267 rg BT 26.250 767.476 Td /F1 9.8 Tf [(do not believe limited exposure to promotional intervention materials related to the MOMVAX study prior to completion of the )] TJ ET BT 26.250 755.571 Td /F1 9.8 Tf [(baseline survey had a differential impact on the women enrolled from intervention arm practices versus control arm practices. )] TJ ET BT 26.250 743.667 Td /F1 9.8 Tf [(This study was also U.S.-based, so while results may be applicable to other countries, it may be important to replicate this type )] TJ ET BT 26.250 731.762 Td /F1 9.8 Tf [(of survey among late-acceptors of antenatal influenza vaccines in other regions as well.)] TJ ET BT 26.250 712.357 Td /F1 9.8 Tf [(To further improve antenatal influenza vaccine coverage and to encourage antenatal Tdap vaccination, promotional efforts )] TJ ET BT 26.250 700.452 Td /F1 9.8 Tf [(tailored specifically to late acceptors of influenza vaccination or vaccine-hesitant women is important. Other studies which have )] TJ ET BT 26.250 688.548 Td /F1 9.8 Tf [(tested messaging techniques have started to emphasize this need to adapt messages based upon individuals preconceptions )] TJ ET BT 26.250 676.643 Td /F1 9.8 Tf [(and attitudes towards vaccination.)] TJ ET 0.267 0.267 0.267 rg BT 173.114 678.150 Td /F4 8.7 Tf [(42)] TJ ET 0.271 0.267 0.267 rg BT 182.752 676.643 Td /F1 9.8 Tf [( Since these results show that perceiving pertussis as serious for their infant is strongly )] TJ ET BT 26.250 664.738 Td /F1 9.8 Tf [(associated with intention to receive an antenatal Tdap vaccine, explaining disease effects on infants may be an effective )] TJ ET BT 26.250 652.833 Td /F1 9.8 Tf [(promotional strategy for women reluctant to receive vaccines. Continuing to promote, discuss, and offer influenza vaccine )] TJ ET BT 26.250 640.929 Td /F1 9.8 Tf [(repeatedly and late into an influenza season is especially important for women who may be hesitant, but still interested in )] TJ ET BT 26.250 629.024 Td /F1 9.8 Tf [(receiving an influenza vaccine. Likewise, continuing to discuss and promote Tdap vaccination throughout pregnancy can remind )] TJ ET BT 26.250 617.119 Td /F1 9.8 Tf [(and encourage women to receive a Tdap vaccination before delivery. Since patient education on antenatal vaccination is likely )] TJ ET BT 26.250 605.214 Td /F1 9.8 Tf [(to come from obstetricians, continuing to develop and evaluate nuanced tools for promoting influenza and Tdap vaccines during )] TJ ET BT 26.250 593.310 Td /F1 9.8 Tf [(pregnancy is needed.)] TJ ET BT 26.250 556.707 Td /F4 12.0 Tf [(Competing Interest)] TJ ET BT 26.250 536.753 Td /F1 9.8 Tf [(Allison Chamberlain, Katherine Seib, Paula Frew, Marielysse Corts, Ellen Whitney, Ruth Berkelman, Saad Omer, Walter )] TJ ET BT 26.250 524.848 Td /F1 9.8 Tf [(Orenstein, Fauzia Malik, Pat Cota and Lisa Flowers have no conflicts of interest to report. Kevin Ault has acted as a consultant )] TJ ET BT 26.250 512.943 Td /F1 9.8 Tf [(on maternal immunization with the Centers for Disease Control and Prevention, the National Institute of Allergy and Infectious )] TJ ET BT 26.250 501.039 Td /F1 9.8 Tf [(Diseases and the American College of Obstetricians and Gynecologists. He also serves on a data safety and monitoring )] TJ ET BT 26.250 489.134 Td /F1 9.8 Tf [(committee with Novartis.)] TJ ET BT 26.250 452.531 Td /F4 12.0 Tf [(Acknowledgements)] TJ ET BT 26.250 432.577 Td /F1 9.8 Tf [(We would like to thank Emory Rollins School of Public Health graduate research assistants Kristin Bratton, Anna Gajewski, )] TJ ET BT 26.250 420.672 Td /F1 9.8 Tf [(Jaime Hamil, Isabelle Hutchings, Beatrice Jang, Swati Jha, Swati Mishra, Alyssa Parr, Kaitlyn Pruitt, and Chika Obidike and )] TJ ET BT 26.250 408.768 Td /F1 9.8 Tf [(University of Georgia graduate research assistants Alethea Chiappone, Hannah Demmitt and Jenessa Teague for their )] TJ ET BT 26.250 396.863 Td /F1 9.8 Tf [(assistance in recruiting the participants in this study and/or managing data. This study was supported by a grant from the )] TJ ET BT 26.250 384.958 Td /F1 9.8 Tf [(Centers for Disease Control and Prevention \(CDC\), grant # 5P01TP000300, to the Emory Preparedness and Emergency )] TJ ET BT 26.250 373.053 Td /F1 9.8 Tf [(Response Research Center, Emory University, Atlanta, GA. Its contents are solely the responsibility of the authors and do not )] TJ ET BT 26.250 361.149 Td /F1 9.8 Tf [(necessarily represent the official views of the CDC.)] TJ ET BT 26.250 332.046 Td /F4 12.0 Tf [(References)] TJ ET BT 26.250 304.592 Td /F1 9.8 Tf [(1.)] TJ ET BT 38.132 304.592 Td /F1 9.8 Tf [(Jamieson DJ, Theiler RN, Rasmussen SA. Emerging Infections and Pregnancy. Emerg Infect Dis 2006; 12\(11\):1638-1643.)] TJ ET BT 26.250 285.187 Td /F1 9.8 Tf [(2.)] TJ ET BT 38.132 285.187 Td /F1 9.8 Tf [( Dodds L, McNeil SA, Fell DB, Allen VM, Coombs A, Scott J, et al. Impact of influenza exposure on rates of hospital )] TJ ET BT 26.250 273.282 Td /F1 9.8 Tf [(admissions and physician visits because of respiratory illness among pregnant women. CMAJ 2007; 176\(4\):463-468.)] TJ ET BT 26.250 253.878 Td /F1 9.8 Tf [(3.)] TJ ET BT 38.132 253.878 Td /F1 9.8 Tf [(Neuzil KM, Reed GW, Mitchel EF, Simonsen L, Griffin MR. Impact of influenza on acute cardiopulmonary hospitalizations in )] TJ ET BT 26.250 241.973 Td /F1 9.8 Tf [(pregnant women. Am J of Epidemiol 1998; 148\(11\):1094-1102.)] TJ ET BT 26.250 222.568 Td /F1 9.8 Tf [(4.)] TJ ET BT 38.132 222.568 Td /F1 9.8 Tf [(Rasmussen SA, Jamieson DJ, Bresee JS. Pandemic influenza and pregnant women. Emerg Infect Dis 2008; 14\(1\):95-100.)] TJ ET BT 26.250 203.163 Td /F1 9.8 Tf [(5.)] TJ ET BT 38.132 203.163 Td /F1 9.8 Tf [(Harris JW. Influenza occurring in pregnant women: A statistical study of thirteen hundred and fifty cases. JAMA 1919; )] TJ ET BT 26.250 191.259 Td /F1 9.8 Tf [(72\(14\):978-980.)] TJ ET BT 26.250 171.854 Td /F1 9.8 Tf [(6.)] TJ ET BT 38.132 171.854 Td /F1 9.8 Tf [(Nuzum JW, Pilot I, Stangl FH, Bonar BE. Pandemic influenza and pneumonia in a large civil hospital. JAMA 1918; )] TJ ET BT 26.250 159.949 Td /F1 9.8 Tf [(71\(19\):1562-1565.)] TJ ET BT 26.250 140.544 Td /F1 9.8 Tf [(7.)] TJ ET BT 38.132 140.544 Td /F1 9.8 Tf [(Hardy JM, Azarowicz EN, Mannini A, Medearis DN, Cooke RE. The effect of Asian influenza on the outcome of pregnancy, )] TJ ET BT 26.250 128.640 Td /F1 9.8 Tf [(Baltimore, 1957-1958. Am J Public Health Nations Health 1961; 51\(8\):1182-1188.)] TJ ET BT 26.250 109.235 Td /F1 9.8 Tf [(8.)] TJ ET BT 38.132 109.235 Td /F1 9.8 Tf [(Mendez-Figueroa H, Raker C, Anderson BL. Neonatal characteristics and outcomes of pregnancies complicated by influenza )] TJ ET BT 26.250 97.330 Td /F1 9.8 Tf [(infection during the 2009 pandemic. Am J Obstet Gynecol 2011; 204\(6, Supplement\):S58-S63.)] TJ ET BT 26.250 77.925 Td /F1 9.8 Tf [(9.)] TJ ET BT 38.132 77.925 Td /F1 9.8 Tf [(Centers for Disease Control and Prevention. Prevention and control of influenza with vaccines: recommendations of the )] TJ ET BT 26.250 66.021 Td /F1 9.8 Tf [(Advisory Committee on Immunization Practices \(ACIP\), 2010. Morb Mortal Wkly Recomm Rep 2010; 59\(rr08\):1-62.)] TJ ET BT 26.250 46.616 Td /F1 9.8 Tf [(10.)] TJ ET BT 43.553 46.616 Td /F1 9.8 Tf [(Cortese MM, Baughman AL, Zhang R, Srivastava PU, Wallace GS. Pertussis hospitalizations among infants in the United )] TJ ET Q q 0.000 0.000 0.000 rg BT 291.710 19.825 Td /F1 11.0 Tf [(6)] TJ ET BT 25.000 19.825 Td /F1 11.0 Tf [(PLOS Currents Outbreaks)] TJ ET Q endstream endobj 434 0 obj << /Type /Annot /Subtype /Link /A 435 0 R /Border [0 0 0] /H /I /Rect [ 173.1142 677.3484 182.7516 686.1668 ] >> endobj 435 0 obj << /Type /Action >> endobj 436 0 obj << /Type /Annot /Subtype /Link /A 437 0 R /Border [0 0 0] /H /I /Rect [ 173.1142 677.3484 182.7516 686.1668 ] >> endobj 437 0 obj << /Type /Action >> endobj 438 0 obj << /Type /Annot /Subtype /Link /A 439 0 R /Border [0 0 0] /H /I /Rect [ 173.1142 677.3484 182.7516 686.1668 ] >> endobj 439 0 obj << /Type /Action >> endobj 440 0 obj << /Type /Page /Parent 3 0 R /Annots [ 442 0 R 444 0 R 446 0 R 448 0 R 450 0 R 452 0 R ] /Contents 441 0 R >> endobj 441 0 obj << /Length 23536 >> stream 0.271 0.267 0.267 rg q 15.000 37.214 577.500 739.786 re W n 0.271 0.267 0.267 rg BT 26.250 767.476 Td /F1 9.8 Tf [(States, 1993 to 2004. Pediatrics 2008; 121\(3\): 484-492.)] TJ ET BT 26.250 748.071 Td /F1 9.8 Tf [(11.)] TJ ET BT 43.553 748.071 Td /F1 9.8 Tf [(Faulkner A, Skoff T, Martin S, Cassiday P, Tondella ML, Liang JL, et al. Chapter 10: Pertussis. In: Roush SW, McIntyre L, )] TJ ET BT 26.250 736.167 Td /F1 9.8 Tf [(Baldy LM, editors. Manual for the Surveillance of Vaccine-Preventable Diseases. 5th ed. Atlanta [GA]: Centers for Disease )] TJ ET BT 26.250 724.262 Td /F1 9.8 Tf [(Control and Prevention; 2011. p. 1-12.)] TJ ET BT 26.250 704.857 Td /F1 9.8 Tf [(12.)] TJ ET BT 43.553 704.857 Td /F1 9.8 Tf [(Reuman PD, Ayoub EM, Small PA. Effect of passive maternal antibody on influenza illness in children: a prospectove study )] TJ ET BT 26.250 692.952 Td /F1 9.8 Tf [(of influenza A in mother-infant pairs. Pediatr Infect Dis J 1987; 6\(4\):398-403.)] TJ ET BT 26.250 673.548 Td /F1 9.8 Tf [(13.)] TJ ET BT 43.553 673.548 Td /F1 9.8 Tf [(Zaman K, Roy E, Arifeen SE, Rahman M, Raqib R, Wilson E, et al. Effectiveness of maternal influenza immunization in )] TJ ET BT 26.250 661.643 Td /F1 9.8 Tf [(mothers and infants. New Engl J Med 2008; 359\(15\):1555-1564.)] TJ ET BT 26.250 642.238 Td /F1 9.8 Tf [(14.)] TJ ET BT 43.553 642.238 Td /F1 9.8 Tf [(Omer SB, Goodman D, Steinhoff MC, Rochat R, Klugman KP, Stoll BJ, et al. Maternal influenza immunization and reduced )] TJ ET BT 26.250 630.333 Td /F1 9.8 Tf [(likelihood of prematurity and small for gestational age births: a retrospective cohort study. PLoS Med 2011; 8\(5\):e1000441.)] TJ ET BT 26.250 610.929 Td /F1 9.8 Tf [(15.)] TJ ET BT 43.553 610.929 Td /F1 9.8 Tf [(Henkle E, Steinhoff MC, Omer SB, Roy E, Arifeen SE, Raqib R, et al. The effect of exclusive breast-feeding on respiratory )] TJ ET BT 26.250 599.024 Td /F1 9.8 Tf [(illness in young infants in a maternal immunization trial in Bangladesh. Pediatr Infect Dis J 2013; 32\(5\):431-435)] TJ ET BT 26.250 579.619 Td /F1 9.8 Tf [(16.)] TJ ET BT 43.553 579.619 Td /F1 9.8 Tf [(Kennedy ED, Ahluwalia IB, Ding H, Lu P, Singleton JA, Bridges CB. Monitoring seasonal influenza vaccination coverage )] TJ ET BT 26.250 567.714 Td /F1 9.8 Tf [(among pregnant women in the United States. Am J Obstet Gynecol 2012; 207\(3, Supplement\):S9-S16.)] TJ ET BT 26.250 548.310 Td /F1 9.8 Tf [(17.)] TJ ET BT 43.553 548.310 Td /F1 9.8 Tf [(Centers for Disease Control and Prevention. Updated recommendations for use of tetanus toxoid, reduced diphtheria toxoid )] TJ ET BT 26.250 536.405 Td /F1 9.8 Tf [(and acellular pertussis vaccine \(Tdap\) in pregnant women and persons who have or anticipate having close contact with an )] TJ ET BT 26.250 524.500 Td /F1 9.8 Tf [(infant aged <12 months --- Advisory Committee on Immunization Practices \(ACIP\), 2011. Morb Mortal Wkly Rep. October 21 )] TJ ET BT 26.250 512.595 Td /F1 9.8 Tf [(2011; 60\(41\):1424-1426.)] TJ ET BT 26.250 493.191 Td /F1 9.8 Tf [(18.)] TJ ET BT 43.553 493.191 Td /F1 9.8 Tf [(Munoz FM. Safety of influenza vaccines in pregnant women. Am J Obstet Gynecol 2012; 207\(3, Supplement\):S33-S37.)] TJ ET BT 26.250 473.786 Td /F1 9.8 Tf [(19.)] TJ ET BT 43.553 473.786 Td /F1 9.8 Tf [(Bednarczyk RA, Adjaye-Gbewonyo D, Omer SB. Safety of influenza immunization during pregnancy for the fetus and the )] TJ ET BT 26.250 461.881 Td /F1 9.8 Tf [(neonate. Am J Obstet Gynecol 2012; 207\(3, Supplement\):S38-S46.)] TJ ET BT 26.250 442.476 Td /F1 9.8 Tf [(20.)] TJ ET BT 43.553 442.476 Td /F1 9.8 Tf [(Moro PL, Broder K, Zheteyeva Y, Walton K, Rohan P, Sutherland A, et al. Adverse events in pregnant women following )] TJ ET BT 26.250 430.572 Td /F1 9.8 Tf [(administration of trivalent inactivated influenza vaccine and live attenuated influenza vaccine in the Vaccine Adverse Event )] TJ ET BT 26.250 418.667 Td /F1 9.8 Tf [(Reporting System, 1990-2009. Am J Obstet Gynecol 2011; 204\(2\):146.e1-7.)] TJ ET BT 26.250 399.262 Td /F1 9.8 Tf [(21.)] TJ ET BT 43.553 399.262 Td /F1 9.8 Tf [(Munoz FM, Greisinger AJ, Wehmanen OA, Mouzoon ME, Hoyle JC, Smith FA, et al. Safety of influenza vaccination during )] TJ ET BT 26.250 387.357 Td /F1 9.8 Tf [(pregnancy. Am J Obstet Gynecol 2005; 192\(4\):1098-1106.)] TJ ET BT 26.250 367.953 Td /F1 9.8 Tf [(22.)] TJ ET BT 43.553 367.953 Td /F1 9.8 Tf [(Beytout J, Launay O, Guiso N, Fiquet A, Baudin M, Richard P, et al. Safety of Tdap-IPV given one month after Td-IPV )] TJ ET BT 26.250 356.048 Td /F1 9.8 Tf [(booster in healthy young adults: A placebo-controlled trial. Hum Vaccines 2009; 5\(5\):315-321.)] TJ ET BT 26.250 336.643 Td /F1 9.8 Tf [(23.)] TJ ET BT 43.553 336.643 Td /F1 9.8 Tf [(Talbot EA, Brown KH, Kirkland KB, Baughman AL, Halperin SA, Broder KR. The safety of immunizing with )] TJ ET BT 26.250 324.738 Td /F1 9.8 Tf [(tetanusdiphtheriaacellular pertussis vaccine \(Tdap\) less than 2 years following previous tetanus vaccination: Experience )] TJ ET BT 26.250 312.834 Td /F1 9.8 Tf [(during a mass vaccination campaign of healthcare personnel during a respiratory illness outbreak. Vaccine 2010; 28\(50\):8001-)] TJ ET BT 26.250 300.929 Td /F1 9.8 Tf [(8007.)] TJ ET BT 26.250 281.524 Td /F1 9.8 Tf [(24.)] TJ ET BT 43.553 281.524 Td /F1 9.8 Tf [(Tamma PD, Ault KA, del Rio C, Steinhoff MC, Halsey NA, Omer SB. Safety of influenza vaccination during pregnancy. Am J )] TJ ET BT 26.250 269.619 Td /F1 9.8 Tf [(Obstet Gynecol 2009; 201\(6\):547-552.)] TJ ET BT 26.250 250.215 Td /F1 9.8 Tf [(25.)] TJ ET BT 43.553 250.215 Td /F1 9.8 Tf [(Yudin M, Salaripour M, Sgro M. Pregnant women's knowledge of influenza and the use and safety of the influenza vaccine )] TJ ET BT 26.250 238.310 Td /F1 9.8 Tf [(during pregnancy. J Obstet Gynaecol Can 2009; 31\(2\):120-125.)] TJ ET BT 26.250 218.905 Td /F1 9.8 Tf [(26.)] TJ ET BT 43.553 218.905 Td /F1 9.8 Tf [(Steinhoff MC, Omer SB. A review of fetal and infant protection associated with antenatal influenza immunization. Am J )] TJ ET BT 26.250 207.000 Td /F1 9.8 Tf [(Obstet Gynecol 2012; 207\(3, Supplement\):S21-S27.)] TJ ET BT 26.250 187.596 Td /F1 9.8 Tf [(27.)] TJ ET BT 43.553 187.596 Td /F1 9.8 Tf [(American Congress of Obstetricians and Gynecologists. Physician Script Concerning Tdap Vaccination. Washington, DC: )] TJ ET BT 26.250 175.691 Td /F1 9.8 Tf [(American Congress of Obstetricians and Gynecologists; 2012.)] TJ ET BT 26.250 156.286 Td /F1 9.8 Tf [(28.)] TJ ET BT 43.553 156.286 Td /F1 9.8 Tf [(American Congress of Obstetricians and Gynecologists. Physician Script on Influenza Immunization During Pregnancy. )] TJ ET BT 26.250 144.381 Td /F1 9.8 Tf [(Washington, DC: American Congress of Obstetricians and Gynecologists; 2012.)] TJ ET BT 26.250 124.977 Td /F1 9.8 Tf [(29.)] TJ ET BT 43.553 124.977 Td /F1 9.8 Tf [(U.S. Department of Health and Human Services. Who's at risk: pregnant women. Available at: http://www.flu.gov/at-)] TJ ET BT 26.250 113.072 Td /F1 9.8 Tf [(risk/pregnant/index.html#. Accessed October 8, 2013.)] TJ ET 0.267 0.267 0.267 rg BT 26.250 104.586 Td /F1 7.5 Tf [(REFERENCE LINK)] TJ ET 0.271 0.267 0.267 rg BT 26.250 86.036 Td /F1 9.8 Tf [(30.)] TJ ET BT 43.553 86.036 Td /F1 9.8 Tf [(Centers for Disease Control and Prevention. Pregnancy and whooping cough. Available at: )] TJ ET BT 26.250 74.131 Td /F1 9.8 Tf [(http://www.cdc.gov/vaccines/adults/rec-vac/pregnant/whooping-cough/get-vaccinated.html. Accessed October 8, 2013.)] TJ ET 0.267 0.267 0.267 rg BT 26.250 65.645 Td /F1 7.5 Tf [(REFERENCE LINK)] TJ ET 0.271 0.267 0.267 rg BT 26.250 47.095 Td /F1 9.8 Tf [(31.)] TJ ET BT 43.553 47.095 Td /F1 9.8 Tf [(Duff P. Influenza vaccine: A safe bet for mother and baby. Obstet Gynecol 2013; 121\(3\):503-504.)] TJ ET Q q 15.000 37.214 577.500 739.786 re W n 0.271 0.267 0.267 rg BT 26.250 767.476 Td /F1 9.8 Tf [(States, 1993 to 2004. Pediatrics 2008; 121\(3\): 484-492.)] TJ ET BT 26.250 748.071 Td /F1 9.8 Tf [(11.)] TJ ET BT 43.553 748.071 Td /F1 9.8 Tf [(Faulkner A, Skoff T, Martin S, Cassiday P, Tondella ML, Liang JL, et al. Chapter 10: Pertussis. In: Roush SW, McIntyre L, )] TJ ET BT 26.250 736.167 Td /F1 9.8 Tf [(Baldy LM, editors. Manual for the Surveillance of Vaccine-Preventable Diseases. 5th ed. Atlanta [GA]: Centers for Disease )] TJ ET BT 26.250 724.262 Td /F1 9.8 Tf [(Control and Prevention; 2011. p. 1-12.)] TJ ET BT 26.250 704.857 Td /F1 9.8 Tf [(12.)] TJ ET BT 43.553 704.857 Td /F1 9.8 Tf [(Reuman PD, Ayoub EM, Small PA. Effect of passive maternal antibody on influenza illness in children: a prospectove study )] TJ ET BT 26.250 692.952 Td /F1 9.8 Tf [(of influenza A in mother-infant pairs. Pediatr Infect Dis J 1987; 6\(4\):398-403.)] TJ ET BT 26.250 673.548 Td /F1 9.8 Tf [(13.)] TJ ET BT 43.553 673.548 Td /F1 9.8 Tf [(Zaman K, Roy E, Arifeen SE, Rahman M, Raqib R, Wilson E, et al. Effectiveness of maternal influenza immunization in )] TJ ET BT 26.250 661.643 Td /F1 9.8 Tf [(mothers and infants. New Engl J Med 2008; 359\(15\):1555-1564.)] TJ ET BT 26.250 642.238 Td /F1 9.8 Tf [(14.)] TJ ET BT 43.553 642.238 Td /F1 9.8 Tf [(Omer SB, Goodman D, Steinhoff MC, Rochat R, Klugman KP, Stoll BJ, et al. Maternal influenza immunization and reduced )] TJ ET BT 26.250 630.333 Td /F1 9.8 Tf [(likelihood of prematurity and small for gestational age births: a retrospective cohort study. PLoS Med 2011; 8\(5\):e1000441.)] TJ ET BT 26.250 610.929 Td /F1 9.8 Tf [(15.)] TJ ET BT 43.553 610.929 Td /F1 9.8 Tf [(Henkle E, Steinhoff MC, Omer SB, Roy E, Arifeen SE, Raqib R, et al. The effect of exclusive breast-feeding on respiratory )] TJ ET BT 26.250 599.024 Td /F1 9.8 Tf [(illness in young infants in a maternal immunization trial in Bangladesh. Pediatr Infect Dis J 2013; 32\(5\):431-435)] TJ ET BT 26.250 579.619 Td /F1 9.8 Tf [(16.)] TJ ET BT 43.553 579.619 Td /F1 9.8 Tf [(Kennedy ED, Ahluwalia IB, Ding H, Lu P, Singleton JA, Bridges CB. Monitoring seasonal influenza vaccination coverage )] TJ ET BT 26.250 567.714 Td /F1 9.8 Tf [(among pregnant women in the United States. Am J Obstet Gynecol 2012; 207\(3, Supplement\):S9-S16.)] TJ ET BT 26.250 548.310 Td /F1 9.8 Tf [(17.)] TJ ET BT 43.553 548.310 Td /F1 9.8 Tf [(Centers for Disease Control and Prevention. Updated recommendations for use of tetanus toxoid, reduced diphtheria toxoid )] TJ ET BT 26.250 536.405 Td /F1 9.8 Tf [(and acellular pertussis vaccine \(Tdap\) in pregnant women and persons who have or anticipate having close contact with an )] TJ ET BT 26.250 524.500 Td /F1 9.8 Tf [(infant aged <12 months --- Advisory Committee on Immunization Practices \(ACIP\), 2011. Morb Mortal Wkly Rep. October 21 )] TJ ET BT 26.250 512.595 Td /F1 9.8 Tf [(2011; 60\(41\):1424-1426.)] TJ ET BT 26.250 493.191 Td /F1 9.8 Tf [(18.)] TJ ET BT 43.553 493.191 Td /F1 9.8 Tf [(Munoz FM. Safety of influenza vaccines in pregnant women. Am J Obstet Gynecol 2012; 207\(3, Supplement\):S33-S37.)] TJ ET BT 26.250 473.786 Td /F1 9.8 Tf [(19.)] TJ ET BT 43.553 473.786 Td /F1 9.8 Tf [(Bednarczyk RA, Adjaye-Gbewonyo D, Omer SB. Safety of influenza immunization during pregnancy for the fetus and the )] TJ ET BT 26.250 461.881 Td /F1 9.8 Tf [(neonate. Am J Obstet Gynecol 2012; 207\(3, Supplement\):S38-S46.)] TJ ET BT 26.250 442.476 Td /F1 9.8 Tf [(20.)] TJ ET BT 43.553 442.476 Td /F1 9.8 Tf [(Moro PL, Broder K, Zheteyeva Y, Walton K, Rohan P, Sutherland A, et al. Adverse events in pregnant women following )] TJ ET BT 26.250 430.572 Td /F1 9.8 Tf [(administration of trivalent inactivated influenza vaccine and live attenuated influenza vaccine in the Vaccine Adverse Event )] TJ ET BT 26.250 418.667 Td /F1 9.8 Tf [(Reporting System, 1990-2009. Am J Obstet Gynecol 2011; 204\(2\):146.e1-7.)] TJ ET BT 26.250 399.262 Td /F1 9.8 Tf [(21.)] TJ ET BT 43.553 399.262 Td /F1 9.8 Tf [(Munoz FM, Greisinger AJ, Wehmanen OA, Mouzoon ME, Hoyle JC, Smith FA, et al. Safety of influenza vaccination during )] TJ ET BT 26.250 387.357 Td /F1 9.8 Tf [(pregnancy. Am J Obstet Gynecol 2005; 192\(4\):1098-1106.)] TJ ET BT 26.250 367.953 Td /F1 9.8 Tf [(22.)] TJ ET BT 43.553 367.953 Td /F1 9.8 Tf [(Beytout J, Launay O, Guiso N, Fiquet A, Baudin M, Richard P, et al. Safety of Tdap-IPV given one month after Td-IPV )] TJ ET BT 26.250 356.048 Td /F1 9.8 Tf [(booster in healthy young adults: A placebo-controlled trial. Hum Vaccines 2009; 5\(5\):315-321.)] TJ ET BT 26.250 336.643 Td /F1 9.8 Tf [(23.)] TJ ET BT 43.553 336.643 Td /F1 9.8 Tf [(Talbot EA, Brown KH, Kirkland KB, Baughman AL, Halperin SA, Broder KR. The safety of immunizing with )] TJ ET BT 26.250 324.738 Td /F1 9.8 Tf [(tetanusdiphtheriaacellular pertussis vaccine \(Tdap\) less than 2 years following previous tetanus vaccination: Experience )] TJ ET BT 26.250 312.834 Td /F1 9.8 Tf [(during a mass vaccination campaign of healthcare personnel during a respiratory illness outbreak. Vaccine 2010; 28\(50\):8001-)] TJ ET BT 26.250 300.929 Td /F1 9.8 Tf [(8007.)] TJ ET BT 26.250 281.524 Td /F1 9.8 Tf [(24.)] TJ ET BT 43.553 281.524 Td /F1 9.8 Tf [(Tamma PD, Ault KA, del Rio C, Steinhoff MC, Halsey NA, Omer SB. Safety of influenza vaccination during pregnancy. Am J )] TJ ET BT 26.250 269.619 Td /F1 9.8 Tf [(Obstet Gynecol 2009; 201\(6\):547-552.)] TJ ET BT 26.250 250.215 Td /F1 9.8 Tf [(25.)] TJ ET BT 43.553 250.215 Td /F1 9.8 Tf [(Yudin M, Salaripour M, Sgro M. Pregnant women's knowledge of influenza and the use and safety of the influenza vaccine )] TJ ET BT 26.250 238.310 Td /F1 9.8 Tf [(during pregnancy. J Obstet Gynaecol Can 2009; 31\(2\):120-125.)] TJ ET BT 26.250 218.905 Td /F1 9.8 Tf [(26.)] TJ ET BT 43.553 218.905 Td /F1 9.8 Tf [(Steinhoff MC, Omer SB. A review of fetal and infant protection associated with antenatal influenza immunization. Am J )] TJ ET BT 26.250 207.000 Td /F1 9.8 Tf [(Obstet Gynecol 2012; 207\(3, Supplement\):S21-S27.)] TJ ET BT 26.250 187.596 Td /F1 9.8 Tf [(27.)] TJ ET BT 43.553 187.596 Td /F1 9.8 Tf [(American Congress of Obstetricians and Gynecologists. Physician Script Concerning Tdap Vaccination. Washington, DC: )] TJ ET BT 26.250 175.691 Td /F1 9.8 Tf [(American Congress of Obstetricians and Gynecologists; 2012.)] TJ ET BT 26.250 156.286 Td /F1 9.8 Tf [(28.)] TJ ET BT 43.553 156.286 Td /F1 9.8 Tf [(American Congress of Obstetricians and Gynecologists. Physician Script on Influenza Immunization During Pregnancy. )] TJ ET BT 26.250 144.381 Td /F1 9.8 Tf [(Washington, DC: American Congress of Obstetricians and Gynecologists; 2012.)] TJ ET BT 26.250 124.977 Td /F1 9.8 Tf [(29.)] TJ ET BT 43.553 124.977 Td /F1 9.8 Tf [(U.S. Department of Health and Human Services. Who's at risk: pregnant women. Available at: http://www.flu.gov/at-)] TJ ET BT 26.250 113.072 Td /F1 9.8 Tf [(risk/pregnant/index.html#. Accessed October 8, 2013.)] TJ ET 0.267 0.267 0.267 rg BT 26.250 104.586 Td /F1 7.5 Tf [(REFERENCE LINK)] TJ ET 0.271 0.267 0.267 rg BT 26.250 86.036 Td /F1 9.8 Tf [(30.)] TJ ET BT 43.553 86.036 Td /F1 9.8 Tf [(Centers for Disease Control and Prevention. Pregnancy and whooping cough. Available at: )] TJ ET BT 26.250 74.131 Td /F1 9.8 Tf [(http://www.cdc.gov/vaccines/adults/rec-vac/pregnant/whooping-cough/get-vaccinated.html. Accessed October 8, 2013.)] TJ ET 0.267 0.267 0.267 rg BT 26.250 65.645 Td /F1 7.5 Tf [(REFERENCE LINK)] TJ ET 0.271 0.267 0.267 rg BT 26.250 47.095 Td /F1 9.8 Tf [(31.)] TJ ET BT 43.553 47.095 Td /F1 9.8 Tf [(Duff P. Influenza vaccine: A safe bet for mother and baby. Obstet Gynecol 2013; 121\(3\):503-504.)] TJ ET Q q 15.000 37.214 577.500 739.786 re W n 0.271 0.267 0.267 rg BT 26.250 767.476 Td /F1 9.8 Tf [(States, 1993 to 2004. Pediatrics 2008; 121\(3\): 484-492.)] TJ ET BT 26.250 748.071 Td /F1 9.8 Tf [(11.)] TJ ET BT 43.553 748.071 Td /F1 9.8 Tf [(Faulkner A, Skoff T, Martin S, Cassiday P, Tondella ML, Liang JL, et al. Chapter 10: Pertussis. In: Roush SW, McIntyre L, )] TJ ET BT 26.250 736.167 Td /F1 9.8 Tf [(Baldy LM, editors. Manual for the Surveillance of Vaccine-Preventable Diseases. 5th ed. Atlanta [GA]: Centers for Disease )] TJ ET BT 26.250 724.262 Td /F1 9.8 Tf [(Control and Prevention; 2011. p. 1-12.)] TJ ET BT 26.250 704.857 Td /F1 9.8 Tf [(12.)] TJ ET BT 43.553 704.857 Td /F1 9.8 Tf [(Reuman PD, Ayoub EM, Small PA. Effect of passive maternal antibody on influenza illness in children: a prospectove study )] TJ ET BT 26.250 692.952 Td /F1 9.8 Tf [(of influenza A in mother-infant pairs. Pediatr Infect Dis J 1987; 6\(4\):398-403.)] TJ ET BT 26.250 673.548 Td /F1 9.8 Tf [(13.)] TJ ET BT 43.553 673.548 Td /F1 9.8 Tf [(Zaman K, Roy E, Arifeen SE, Rahman M, Raqib R, Wilson E, et al. Effectiveness of maternal influenza immunization in )] TJ ET BT 26.250 661.643 Td /F1 9.8 Tf [(mothers and infants. New Engl J Med 2008; 359\(15\):1555-1564.)] TJ ET BT 26.250 642.238 Td /F1 9.8 Tf [(14.)] TJ ET BT 43.553 642.238 Td /F1 9.8 Tf [(Omer SB, Goodman D, Steinhoff MC, Rochat R, Klugman KP, Stoll BJ, et al. Maternal influenza immunization and reduced )] TJ ET BT 26.250 630.333 Td /F1 9.8 Tf [(likelihood of prematurity and small for gestational age births: a retrospective cohort study. PLoS Med 2011; 8\(5\):e1000441.)] TJ ET BT 26.250 610.929 Td /F1 9.8 Tf [(15.)] TJ ET BT 43.553 610.929 Td /F1 9.8 Tf [(Henkle E, Steinhoff MC, Omer SB, Roy E, Arifeen SE, Raqib R, et al. The effect of exclusive breast-feeding on respiratory )] TJ ET BT 26.250 599.024 Td /F1 9.8 Tf [(illness in young infants in a maternal immunization trial in Bangladesh. Pediatr Infect Dis J 2013; 32\(5\):431-435)] TJ ET BT 26.250 579.619 Td /F1 9.8 Tf [(16.)] TJ ET BT 43.553 579.619 Td /F1 9.8 Tf [(Kennedy ED, Ahluwalia IB, Ding H, Lu P, Singleton JA, Bridges CB. Monitoring seasonal influenza vaccination coverage )] TJ ET BT 26.250 567.714 Td /F1 9.8 Tf [(among pregnant women in the United States. Am J Obstet Gynecol 2012; 207\(3, Supplement\):S9-S16.)] TJ ET BT 26.250 548.310 Td /F1 9.8 Tf [(17.)] TJ ET BT 43.553 548.310 Td /F1 9.8 Tf [(Centers for Disease Control and Prevention. Updated recommendations for use of tetanus toxoid, reduced diphtheria toxoid )] TJ ET BT 26.250 536.405 Td /F1 9.8 Tf [(and acellular pertussis vaccine \(Tdap\) in pregnant women and persons who have or anticipate having close contact with an )] TJ ET BT 26.250 524.500 Td /F1 9.8 Tf [(infant aged <12 months --- Advisory Committee on Immunization Practices \(ACIP\), 2011. Morb Mortal Wkly Rep. October 21 )] TJ ET BT 26.250 512.595 Td /F1 9.8 Tf [(2011; 60\(41\):1424-1426.)] TJ ET BT 26.250 493.191 Td /F1 9.8 Tf [(18.)] TJ ET BT 43.553 493.191 Td /F1 9.8 Tf [(Munoz FM. Safety of influenza vaccines in pregnant women. Am J Obstet Gynecol 2012; 207\(3, Supplement\):S33-S37.)] TJ ET BT 26.250 473.786 Td /F1 9.8 Tf [(19.)] TJ ET BT 43.553 473.786 Td /F1 9.8 Tf [(Bednarczyk RA, Adjaye-Gbewonyo D, Omer SB. Safety of influenza immunization during pregnancy for the fetus and the )] TJ ET BT 26.250 461.881 Td /F1 9.8 Tf [(neonate. Am J Obstet Gynecol 2012; 207\(3, Supplement\):S38-S46.)] TJ ET BT 26.250 442.476 Td /F1 9.8 Tf [(20.)] TJ ET BT 43.553 442.476 Td /F1 9.8 Tf [(Moro PL, Broder K, Zheteyeva Y, Walton K, Rohan P, Sutherland A, et al. Adverse events in pregnant women following )] TJ ET BT 26.250 430.572 Td /F1 9.8 Tf [(administration of trivalent inactivated influenza vaccine and live attenuated influenza vaccine in the Vaccine Adverse Event )] TJ ET BT 26.250 418.667 Td /F1 9.8 Tf [(Reporting System, 1990-2009. Am J Obstet Gynecol 2011; 204\(2\):146.e1-7.)] TJ ET BT 26.250 399.262 Td /F1 9.8 Tf [(21.)] TJ ET BT 43.553 399.262 Td /F1 9.8 Tf [(Munoz FM, Greisinger AJ, Wehmanen OA, Mouzoon ME, Hoyle JC, Smith FA, et al. Safety of influenza vaccination during )] TJ ET BT 26.250 387.357 Td /F1 9.8 Tf [(pregnancy. Am J Obstet Gynecol 2005; 192\(4\):1098-1106.)] TJ ET BT 26.250 367.953 Td /F1 9.8 Tf [(22.)] TJ ET BT 43.553 367.953 Td /F1 9.8 Tf [(Beytout J, Launay O, Guiso N, Fiquet A, Baudin M, Richard P, et al. Safety of Tdap-IPV given one month after Td-IPV )] TJ ET BT 26.250 356.048 Td /F1 9.8 Tf [(booster in healthy young adults: A placebo-controlled trial. Hum Vaccines 2009; 5\(5\):315-321.)] TJ ET BT 26.250 336.643 Td /F1 9.8 Tf [(23.)] TJ ET BT 43.553 336.643 Td /F1 9.8 Tf [(Talbot EA, Brown KH, Kirkland KB, Baughman AL, Halperin SA, Broder KR. The safety of immunizing with )] TJ ET BT 26.250 324.738 Td /F1 9.8 Tf [(tetanusdiphtheriaacellular pertussis vaccine \(Tdap\) less than 2 years following previous tetanus vaccination: Experience )] TJ ET BT 26.250 312.834 Td /F1 9.8 Tf [(during a mass vaccination campaign of healthcare personnel during a respiratory illness outbreak. Vaccine 2010; 28\(50\):8001-)] TJ ET BT 26.250 300.929 Td /F1 9.8 Tf [(8007.)] TJ ET BT 26.250 281.524 Td /F1 9.8 Tf [(24.)] TJ ET BT 43.553 281.524 Td /F1 9.8 Tf [(Tamma PD, Ault KA, del Rio C, Steinhoff MC, Halsey NA, Omer SB. Safety of influenza vaccination during pregnancy. Am J )] TJ ET BT 26.250 269.619 Td /F1 9.8 Tf [(Obstet Gynecol 2009; 201\(6\):547-552.)] TJ ET BT 26.250 250.215 Td /F1 9.8 Tf [(25.)] TJ ET BT 43.553 250.215 Td /F1 9.8 Tf [(Yudin M, Salaripour M, Sgro M. Pregnant women's knowledge of influenza and the use and safety of the influenza vaccine )] TJ ET BT 26.250 238.310 Td /F1 9.8 Tf [(during pregnancy. J Obstet Gynaecol Can 2009; 31\(2\):120-125.)] TJ ET BT 26.250 218.905 Td /F1 9.8 Tf [(26.)] TJ ET BT 43.553 218.905 Td /F1 9.8 Tf [(Steinhoff MC, Omer SB. A review of fetal and infant protection associated with antenatal influenza immunization. Am J )] TJ ET BT 26.250 207.000 Td /F1 9.8 Tf [(Obstet Gynecol 2012; 207\(3, Supplement\):S21-S27.)] TJ ET BT 26.250 187.596 Td /F1 9.8 Tf [(27.)] TJ ET BT 43.553 187.596 Td /F1 9.8 Tf [(American Congress of Obstetricians and Gynecologists. Physician Script Concerning Tdap Vaccination. 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Available at: )] TJ ET BT 26.250 74.131 Td /F1 9.8 Tf [(http://www.cdc.gov/vaccines/adults/rec-vac/pregnant/whooping-cough/get-vaccinated.html. Accessed October 8, 2013.)] TJ ET 0.267 0.267 0.267 rg BT 26.250 65.645 Td /F1 7.5 Tf [(REFERENCE LINK)] TJ ET 0.271 0.267 0.267 rg BT 26.250 47.095 Td /F1 9.8 Tf [(31.)] TJ ET BT 43.553 47.095 Td /F1 9.8 Tf [(Duff P. Influenza vaccine: A safe bet for mother and baby. 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