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Pregnant Women Unaware, Misinformed About Flu Shots

Ruzanna Harutyunyan's picture

Despite national health experts' long-standing recommendation that women receive a flu shot while pregnant, three-quarters of women responding to a new national survey are unaware or unsure of these recommendations, and only 20 percent of those who are currently pregnant plan to get a flu shot this influenza season. Results from the survey of pregnant women and new mothers, conducted on behalf of the National Women's Health Resource Center (NWHRC) by Harris Interactive showed that a significant proportion of women were unaware of higher health risks associated with influenza during pregnancy. Some women even question whether the flu shot itself can pose a health risk to themselves or their unborn baby.

These findings stand in stark contrast to scientific evidence demonstrating the protective benefits of influenza vaccination to pregnant women and to the four million babies born in the United States each year who could receive passive immunity from their mothers.

To close this disconcerting education and action gap, the NWHRC and the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) today launched "Flu-Free and A Mom-to-Be: Protect Yourself, Protect Your Baby—Get a Flu Shot!." The campaign is being supported by an educational grant from CSL Biotherapies.

"The lack of awareness and mistaken beliefs about the importance of flu vaccination during pregnancy and the risks of influenza to both mother and baby are major concerns," said Elizabeth Battaglino Cahill, RN, executive director of the NWHRC. "We are launching the 'Flu-Free and A Mom-to-Be' campaign to heighten awareness of the expert medical guidelines recommending flu vaccination for pregnant women and to encourage all moms-to-be and mothers who are nursing to get a flu shot."

For women who are pregnant or are planning to conceive during the flu season, it is vitally important that they get an influenza vaccination to protect both their health and the health of their baby. Because flu vaccination is not recommended for infants under 6 months old, it is doubly important that mothers get immunized to help reduce the risk of their babies developing potentially life-threatening complications due to influenza infection. A recent study published in the October 2008 issue of the New England Journal of Medicine found that mothers who were immunized against the flu during pregnancy reduced the chance of their baby contracting a respiratory illness with fever by 29 percent.

Both the Centers for Disease Control and Prevention (CDC) and the American College of Obstetrics and Gynecology (ACOG) recommend that all women who are pregnant during the flu season or recently gave birth be immunized against the flu. Pregnant women are more likely to be hospitalized from complications of influenza, especially in their third trimester, than non-pregnant women of the same age. Infants under 6 months have the highest rate of hospitalization from influenza among children in the U.S. That rate is even higher than in elderly and other high-risk groups, noted the October 2008 NEJM study.

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"Influenza is a serious health risk for everyone, but is even more serious for groups, such as pregnant women, because they do not have the same ability to fight off the virus that could potentially cause complications in the pregnancy," said Ashley Roman, MD, MPH, Clinical Assistant Professor, Department of Obstetrics and Gynecology, New York University Langone Medical Center. "As a practicing obstetrician, I always urge my patients to obtain their flu shot to protect themselves and their baby, and to explore thimerosal-free options if they are concerned about vaccine preservatives."

Survey Findings Reveal Barriers to Vaccination

The ground-breaking survey of 528 pregnant or new mothers clearly shows that influenza vaccination is not on many women's prenatal radar. In fact, more women responded that avoiding caffeine during pregnancy is important to prenatal health (68%) than getting a flu shot (56%). Even among those women with regular prenatal care or healthcare provision, 60 percent said they had never discussed getting a flu shot with their healthcare provider.

This communication gap is significant, as the survey found that a healthcare professional's recommendation is among the most important influences on a pregnant woman's decision to get a flu shot. Of women who decided not to receive a flu shot during pregnancy, 72 percent indicated they would get vaccinated if their healthcare professional recommended it.

Doubts and misperceptions about the safety of the flu shot to a pregnant mother and her baby's health are adding to the disconnect. Overall, half of women (49%) either believe the flu shot is not safe for pregnant women, or are uncertain about its safety. Only 18 percent believe it is safe to receive a flu shot at any stage of pregnancy. And, nearly half of all women (48%) said they are concerned about thimerosal, a mercury-based preservative, in flu shots. When asked if they were aware of a thimerosal-free flu shot option, fewer than one in five (19%) responded yes. Of those who decided not to be vaccinated while pregnant, 49 percent reported they would be likely to get the flu shot if a thimerosal-free option was available. In fact, seven states have banned the use of thimerosal-containing vaccines in children and pregnant women: California, Delaware, lllinois, Missouri, New York and Washington. Twenty-two other states have pending legislation regarding thimerosal-containing vaccines.

"This survey underscores the need for healthcare providers to prioritize influenza protection as part of their overall prenatal and newborn care plan with their patients," said Catherine Ruhl, CNM, MS, associate director of women's health programs at the Association of Women's Health, Obstetric and Neonatal Nurses. "It is clear that healthcare providers have a significant opportunity to improve vaccination rates in pregnant women and new mothers, including those who are breastfeeding, just by proactively recommending the flu shot, pointing out the benefits for the mom and baby, and discussing thimerosal-free vaccine options with women who are interested in avoiding mercury-based preservatives. We hope that the "Flu-Free and A Mom-to-Be" campaign tools and messages will help women and their healthcare providers overcome barriers to influenza vaccination for pregnant women."

The "Flu Free and A Mom-to-Be" campaign was launched to urge women who are pregnant or who are planning to conceive or who are new mothers to protect themselves with a flu shot during flu season. The program also aims to mobilize healthcare providers to educate and vaccinate their patients according to existing flu recommendations.



HOLD OFF on the recommendation of the Flu Vaccine for Everyone Flu vaccine manufactures inserts state other wise double check the facts by Heather L. Maurer The Centers for Disease Control and Prevention, the American Academy of Pediatrics and AGOG is recommending that children from the ages of 6 months through 18 years as well as pregnant women be vaccinated annually against the flu. AGOG is also recommending pregnant women receive the flu vaccine. However, have you read the influenza vaccine manufacturer product inserts outlining warnings and use in specific populations? There are important facts about influenza vaccine discussed in the vaccine manufacturers' product inserts that you need to know before you or your child gets a flu shot. On the FDA’s website (www.fda.gov/CBER/flu/Flu2008.htm), there is information about the 2008/2009 Season Lot release Status as of October 14, 2008 for influenza vaccines available for distribution. The specific flu vaccines they list (by trade name) are, Afluria, Fluarix, Flulaval, FluMist, Fluvirin and Fluzone. FluMist, which is a live virus nasal vaccine commonly used for children because of its ease in administering, warns: “Do not administer FluMist to children less than 24 months of age because of increased risk of hospitalization and wheezing observed in clinical trials. FluMist should not be administered to any individuals with asthma or children greater than five years of age with recurrent wheezing because of the potential for increased risk of wheezing post vaccination.” The Fluarix vaccine manufacturer product insert states, “Fluarix has not been evaluated for carcinogenic or mutagenic potential, or for impairment of fertility. Animal reproduction studies have not been conducted with Fluarix. It is not known whether Fluarix can cause fetal harm when administered to a pregnant woman or can affect reproduction capacity. Fluarix is not indicated for use in children.” Are parents asking doctors ahead of time which flu vaccine their child is getting? Do they know if their child is at high risk for having a vaccine reaction? In addition, how many parents and the general population know that flu vaccine carries a risk for getting the autoimmune disease Guillain-Barre Syndrome which can cause paralysis? Fluarix, states under the Warnings and Precautions, “If Guillain-Barre syndrome has occurred within six weeks of receipt of a prior influenza vaccine, the decision to give Fluarix should be based on careful consideration of the potential benefits and risks. Immunocompromised compromised persons may have a reduced immune response to Fluarix.” What about all of the people who have autoimmune diseases including diabetes, asthma, multiple sclerosis, Epstein-Barr, rheumatoid arthritis, and lupus to name a few. Are they at an increased risk for negative side effects? The government and various pediatric associations have stated that the influenza vaccine has been proven safe and effective for children. Still, a lot of parents don't like the idea of giving their children vaccines containing mercury. There are mercury-free influenza vaccines in single dose vials for children but parents have to make a special effort to ask pediatricians for it because mercury-free flu vaccines are in short supply. Five of the six FDA approved influenza vaccines listed on the FDA's website contain thimerosal including, Fluarix, Afluria, Fluzone, Flulaval, and Fluvirin. The live virus FluMist is the only one that does not contain mercury but it is not recommended for children under two years of age. According to the CDC’s website, Fluzone, Inactivated TIV, single dose pre-filled 0.25 MlSyringe or the Fluzone, Inactivated TIV, Single-dose pre-filled 0.5 mL syringe or vial doesn’t contain thimerosal preservative however the same trade name, Fluzone, Inactivated TIV multi-dose vial does contain thimerosal. The CDC’s website also lists Fluvirin, Inactivated TIV, multi-dose vial, recommended for children four years and older which contains thimerosal as well as their single-dose pre-filled 0.5 mL syringe. The CDC states, “Preservative free (1 mcg or less mercury/0.5 ml) which indicates there is trace amount of thimerosal in the vaccine. FluMist is the only one that doesn’t contain mercury however it is not recommended for children under two years of age and one of the side effects listed is wheezing. In 1999 the Public Health Service, FDA, NIH, CDC and HRSA issued the following statement, “As a precautionary measure, the Public Health Service (including the FDA, National Institutes of Health (NIH), Center for Disease Control and Prevention (CDC) and Health Resources and Services Administration (HRSA) and the American Academy of Pediatrics issued two Joint Statements, urging vaccine manufacturers to reduce or eliminate thimerosal in vaccines as soon as possible (CDC 1999) and (CDC 2000).” So why are these manufactures still using thimerosal, the mercury based preservative, in vaccines? In 2001, the American Academy of Pediatrics stated that “mercury in all of its forms is toxic to the fetus and children and efforts should be made to reduce exposure to the extent possible pregnant women and children as well as the general population.” So why is mercury is still put in most influenza vaccines on the market today? Why don't the vaccine manufacturers make ALL influenza vaccine mercury-free? In the product manufacturer inserts for Fluarix, Fluzone, Flulaval, FluMist, Fluarix and Afluria all state in the “Use in Specific Populations section” that the safety of these vaccines have not been established for pregnant women and nursing mothers. Flurarix manufacturers insert says, “Animal reproduction studies have not been conducted with Fluarix. It is not known whether Fluarix can case fetal harm when administered to pregnant women or can affect reproduction capacity. Fluarix should be given to pregnant women only if clearly needed.” Yet, the American College of Obstetricians and Gynecologists (AGOG) recommend in early October 2008 that women, including those who are pregnant, get their annual influenza vaccine. Why would any woman carrying a child put herself and her unborn child at risk by getting a vaccine the vaccine 's manufacturer does not recommend and cannot guarantee is safe for her or her child? Where is the Hippocratic Oath to "first, do not harm" when obstetricians and pediatricians are recommending influenza vaccine for pregnant women and children? Recent news reports have revealed that in the last few years, influenza vaccine was ineffective for most who received it because the influenza strains contains in the vaccines did not match the strains which were circulating in the U.S. In young children, effectiveness was as low as seven percent. The odds weren’t exactly in the favor of those who received it. If the government and manufacturers fail to choose the right influenza strains again this year, then we will have once again put a boat load of money into the pockets of one of the most wealthy and powerful industries out there - the pharmaceutical industry. And we will not have factored in the potential greater long term health costs that will be paid for the damage done to the brains and immune systems of many children and adults who were encouraged and even forced to use influenza vaccine.