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H1N1 and Seasonal Influenza Surveillance among American Indian Mothers using

Pregnancy Risk Assessment and Monitoring System (PRAMS) data

Myra Tucker, BSN, MPHDenise D’Angelo, MPH

Cheryl Prince, MPH, PhD

NCCDPHP/Division of Reproductive Health

June 20, 2012

Project Goal

Use PRAMS data to assess the H1N1 and seasonal influenza experience of American Indian (AI) women.

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Objectives

• Fund AI PRAMS influenza programs in 4 States

• Support state PRAMS AI coordinators• Establish PRAMS Tribal Oversight

Committees• Implement measures to improve AI response

rates• Analyze PRAMS AI influenza data by state

and share with tribal health leaders within each state

– Persons 50 years and older– Women who will be pregnant during influenza season– Persons with chronic diseases, immunosuppression – Residents of nursing homes and other long-term care

facilities– Children < 4 years of age (infants < 6 months cannot be

vaccinated)– Children on long-term aspirin therapy– American Indians and Alaska Natives (AI/AN)

* from the Advisory Committee on Immunization Practices (ACIP)

Persons at higher risk of influenza complications *

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Influenza mortality among AI/AN

The 2009 H1N1 pandemic influenza mortality rate among American Indians and Alaska Natives (AI/AN) was 4 times higher than the rate for all other racial/ethnic groups combined.

Pregnancy Risk Assessment and Monitoring System (PRAMS)

• Population-based surveillance system

• Women who have recently had a live birth

• Provides state-specific estimates on key maternal and child health indicators

• Only such system that solicits data from AI mothers

• Response rates among AI women are low

Tribal Supplement to 2011 PRAMS Cooperative Agreement

• May 2011 Award• 3 grantees: New Mexico, Oregon, Washington• Average funding: $50,000/year • Epidemiologist to work with states

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PRAMS Participation, 2011

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OK

AK

GA

FL

SC

AL

NC

CO

NM AR

IL

NY

ME

WV

WA

LA

UTOH

NE

HI

VT

MD

NYC

MS

OR MN

MI

TX

CT

NJ

WYWI

PA

TN

MO VA

DE

MA

Ongoing

Tribal Flu

New

IA

NH

RI

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Methods

Adapt South Dakota Tribal PRAMS model

Methods

• Assign state PRAMS AI coordinator • Establish PRAMS tribal oversight committee• Identify and implement activities to

increase response rates among AI women• Compare response rates and seasonal

influenza findings for 2012/2013 PRAMS to 2009/2010

• Report H1N1 and Seasonal Influenza Surveillance findings

Activities and Accomplishments

• May 2011, Oregon, New Mexico, and Washington were funded for a two year project to improve PRAMS surveillance among AI women

• Wyoming is participating without supplemental funding.

Note: The 2009 baseline PRAMS response rates for AI women in these 4 states ranged from 42%-64%.

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Activities and Accomplishments

• CDC epidemiologist consultant/project coordinator– Examining seasonal and 2009 H1N1 influenza

vaccination during pregnancy among AI women– Preparing state-specific briefs about influenza

vaccination– Conducting site visits to participating states

• Each state has secured a dedicated AI PRAMS project coordinator and has begun tribal engagement   

New Mexico

WIC Program Partnership

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Pregnancy Risk Assessment and Monitoring System

P M S R

Oregon

• Department of Human Services Tribal Quarterly meeting

• Northwest Portland Indian Health Board Partnership

Washington

Partnership with the American Indian Health Commission for Washington State

Wyoming

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Next Steps

• Establish PRAMS tribal oversight committee

• Identify and implement activities to increase response rates among AI women

• Compare response rates and seasonal influenza findings for 2012/2013 PRAMS to 2009/2010

• Report findings

Closing Comment

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Thank You