Vulnerable Groups Within a Vulnerable Population: Awareness of the A(H1N1)pdm09 Pandemic and Willingness to Be Vaccinated Among Pregnant Women in Ivory Coast

Surveys during the 2009–2010 pandemic of influenza A virus subtype H1N1 (A[H1N1]pdm09) infection highlighted national and cultural differences in attitudes toward the pandemic [1]. Yet, relatively little information is available on the pandemic experience in the developing world. People living in poorer countries appear to have borne a disproportionately larger burden during prior pandemics [2] and may be at greater risk in future pandemics [3]. Pregnant women were especially vulnerable to severe illness during the recent pandemic of A(H1N1)pdm09 infection [4] and prior pandemics [5], and the World Health Organization (WHO) recommended that they be among the first groups to receive monovalent A(H1N1)pdm09 vaccine [6]. We conducted a cross-sectional intercept survey of pregnant women receiving prenatal care in 4 types of clinical settings in a large city in West Africa to assess awareness of the pandemic and awareness and acceptance of A(H1N1)pdm09 vaccine in February 2010, prior to the local availability of the vaccine. This survey also allowed us to examine how disparities in education and media access, which are especially evident in the developing world [7], affected awareness of the 2009–2010 pandemic and acceptance of the A(H1N1)pdm09 vaccine.