Flu jab when pregnant

[Beagle]

Hello,

When I was pregnant in winter 2010 my midwife said not to bother with the flu jab.

This time round I am with another practice and a bit under pressure to have a flu jab (and a whooping cough one). I'm pretty healthy and have never had a flu jab and feel a bit pressured to have this to be honest. I have looked at the NHS guidelines and obviously they are totally in favour of it. Am I just kidding myself that I don't need to consider this.

Any advise appreciated.

[Saila]

This is possibly one of those topics you should probably discuss with a doctor, rather than other mums on edf

Uptake of whooping cough has been very good due to current outbreak

[Dandrea]

regardless of whether you have the flu jab, you should most definitely have the whooping cough vaccine. we're in the midst of the worst whooping cough epidemic in many, many years and your little one can't be vaccinated against it until they're 2 months old... your vaccination will protect your little one in the interim. whooping cough is terrible for little ones and can be fatal.

[Saffron]

Beagle, I was pregnant during the 2009 H1N1 flu pandemic, when the flu vaccine for pregnant women was being widely offered and encouraged. I chose not to take the immunisation at that time for several reasons.

At the time the H1N1-imm was a newly formulated vaccine without a lot data in pregnancy. It is widely accepted that there is altered immunity in pregnancy, and immunising pregnant women is a complex biological issue. And, at the time, it was still being disputed whether 1 or 2 injections was necessary for full effect (since shown only 1 is needed). I was wary of having to accept 2 injections of a newly formulated imm without much pregnancy data behind it.

Also, I was not living in an area greatly affected by H1N1 or influenza in general. I was in Switzerland for the first 6 months of my pregnancy. Switzerland was not greatly affected by the 2009 H1N1 outbreak. If this was because of better hygeine or better vaccine uptake I don't know. However, had I fallen ill, the speed and quality of medical care available would have been second to none.

By the time I moved to London in the mid-autumn of 2009, the H1N1 pandemic had already begun to decline. I was not working or mixing with people in hospital or clinical environments, and I was not frequently communting to central areas of London during my pregnancy.

However, if I were to be pregnant again now, I would take the flu vaccine, for several reasons. I'm living in London, commuting centrally almost daily, and mixing frequently with people who have been in hospital or clinical environments where I could be more likely to be exposed to the flu virus.

While infection with influenza in pregnanct women is not common, when pregnant women do become infected, the outcome can be profoundly bad. Influenza in pregnancy is more likely to lead to severe respiratory complications. Influenza in pregnancy can also be detrimental to the foetus. For the 2009 H1N1 outbreak in the UK, pregnant women made up a disproportionately large number of the total cases of individuals hospitalised for infection with complications.

Because of these facts, and also because there is a lot more data on influenza immunisation in pregnancy now compared to 2009, I would feel that the small risk possible in taking the flu vaccine would far outweigh the risks involved with infection. So, personally, YES, I would feel confident having a flu vaccine in pregnancy now.

Whooping cough imms, I couldn't say Yes or No, because it wasn't available when I was pregnant. I had the impression that this vaccine has been well-researched over a number of years. A 2007 article in the The Lancet: Infectious Diseases reached the following conclusion:

Despite high vaccine coverage, the incidence of pertussis is increasing in a number of countries. Particularly alarming is the increase of pertussis in infants too young to be (fully) vaccinated, because the highest morbidity and mortality is observed in this category. Maternal vaccination offers the possibility to protect infants from birth until immunity is induced by active vaccination, and has been shown to be effective and safe for tetanus over long periods of time. Maternal vaccination studies with whole-cell pertussis vaccines have not shown serious adverse effects in mother and child. In one study, protection of newborn babies was found. Additional support for the efficacy of maternal vaccination comes from studies showing that transfer of antibodies confers protection against pertussis. Maternal vaccination might be an effective way to decrease morbidity and mortality caused by pertussis in newborn babies. (authors Mooi & Greef, vol 7, issue 9, http://www.sciencedirect.com/science/article/pii/S1473309907701135)

I would be inclined to take this vaccine were I pregnant, but I would probably feel more secure leaving some time between this and flu vacc. I wouldn't want the two imms on top of each other. That's just my personal take. You'll obviously want to talk it all through with your medical team. xx

[Beagle]

Hi Saffron,

Thank you for your informative post. It is in fact the swine flu element I have concerns about as it is recent and the information surrounding it has been misleading at times.

I want to make an informed decision what's surprised me is how hard is has been to find impartial information. There was no discussion with the midwife it was a you must have it conversation whereas what I wanted to know was why the recommendation had altered.

The whoooping cough vax is later in pregnancy, so I would have a window between both. I have less concerns about that because it has a direct bearing on my baby's immunity. I have found the reports I've seen much clearer.

Thanks again.

B

[Saffron]

Here are some rather disturbing stats...

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2760905/

Patients with novel H1N1 typically present with symptoms of an acute respiratory illness, including cough, sore throat, rhinorrhea, and fever. Other complaints may include headache, fatigue, body aches, vomiting, and diarrhea. Their clinical presentation can be complicated by development of a secondary bacterial infection (such as pneumonia). Symptoms commonly develop within 1 week of exposure, and patients are contagious for approximately 8 days thereafter.1 Most pregnant women will have an uncomplicated course, but there have been reports of adverse pregnancy outcome, including maternal death.

The risk of morbidity from seasonal influenza is higher among pregnant women.2?6,12,22,23 This phenomenon was also observed during the current outbreak, as pregnant women have had a higher rate of hospital admission than the general population. In keeping with previous influenza pandemics, mortality also appears to be higher in pregnant women, especially if infection occurs in the third trimester.5,24,25 In a case series of 1350 pregnant women infected during the 1918 pandemic, approximately 50% developed pneumonia, with a fatality rate of 27%. Most of the women who died were in the third trimester.24 The pandemic of 1957 was associated with an even higher mortality rate. In Minnesota, for example, 50% of all deaths in women of reproductive age occurred among pregnant women.25

Pregnancy-related complications of novel H1N1 infection include nonreassuring fetal testing (most commonly fetal tachycardia) and febrile morbidity. Hyperthermia in early pregnancy has been associated with neural tube defects and other congenital anomalies, and fever during labor and birth is a risk factor for neonatal seizures, newborn encephalopathy, cerebral palsy, and death.26,27 In a series of 5 pregnant women recently hospitalized for pandemic H1N1, the CDC reported that 2 women developed complications including spontaneous abortion (at 13 weeks) and premature rupture of membranes (at 35 weeks).2

(Ouch, those stats are really harsh! Perhaps I had "pregnancy goggles" on when I didn't take the flu vaccine in the past, but had I been in London for the duration of my pregnancy I do think I might have considered it. I would definitely take it now were I pregnant again.)

More interesting articles here:

http://www.nejm.org/doi/full/10.1056/NEJMp1003462

http://www.nejm.org/doi/full/10.1056/nejmc0912599

And here:

http://www.webmd.com/baby/news/20120710/h1n1-flu-shot-appears-safe-during-pregnancy

[Hackneyite]

The health protection agency gives some good advice here:

http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/SeasonalInfluenza/InformationForThePublic/influsw15vaccinationandpregnancyFAQ/

When you're pregnant the part of your immune system that fights viruses is weakened. This is unrelated to how healthy you are pre-, or during, pregnancy, or whether you've successfully fought viruses before; it's essentially a side effect of your immune system not fighting the baby inside you (50% of which is genetically different to you). As a result, pregnant women are particularly susceptible to the H1N1 virus, which is one of the strains of 'flu virus doing the rounds this year, and are more likely to get severe complications such as pneumonia.

I know all this because I'm an obstetrician and gynaecologist. 2 years ago, during the epidemic, I saw a previously fit and healthy pregnant woman tragically die from complications from H1N1. Her baby, which we'd had to deliver extremely prematurely, in an attempt to save her life, also died. Because of effective vaccination programmes, we often forget, in this day and age, that viruses can be deadly. I am currently pregnant, and was first in the queue for both the 'flu, and later, the pertussis vaccines. I really urge all pregnant women to do the same.

[bluesuperted]

The weird thing is, neither jab has been mentioned to me in either pregnancy (current one and one in 2009/2010) by my local midwives (Brierley and now the Lanes). I'm going to get the whopping cough vaccine as I did my own research on it and have a toddler plus a teacher husband so want baby to be protected but I find it really odd that no one at all has mentioned the flu jab and a friend of mine (also did her own research) was unable to even access to flu jab in time from DMC.

[Beagle]

bluesuperted, that's what puzzled me, I don't want to get vaccinated because my surgery or midwife is particularly pro flu jab that's why I am interested in anecdotal experience before deciding. I was incidentally lucky enough to be with one of those practices you mention last time round, we've since moved, which is why I wondered if it was a borough recommendation rather than a necessity. I'm not anti vaccine by any means, I was just curious to know what the current thinking is before making my decision.

[Hackneyite]

Practices not routinely offering the vaccination are the anomaly, rather than it being the other way around. Both flu and pertussis are part of the national vaccination programme rolled out by the Department of Health, and should be offered to all pregnant women; it's actually quite concerning that there are maternity providers that aren't routinely doing this. It might be worth feeding this back to King's, if your maternity care is mainly being provided in the community? As far as I'm aware, all hospital based maternity departments have a policy of advising women to have both vaccines.

For example, when the pertussis vaccination programme started this autumn, the Royal College of Obstetricians and Gynaecologists emailed all its members to give us the scientific advice from the Joint Committee on Vaccination and Immunisation (JCVI) so that we could counsel patients appropriately, and advise women to have the vaccination. So it isn't something that comes down to the personal opinion of your midwife or doctor, it should be as routine a part of your antenatal care as having blood tests at your booking appointment, or your ultrasound scans..... (both of which are as optional as taking up the vaccine, of course.....)

[Kes]

I've just had my baby but had both of the jabs while pregnant. I was with the brierly midwives but it was the nurse at my GP surgery who organised the jabs and I had to go in and ask for them as they hadn't had time to call people up at that point.

I have the flu jab every year anyway as I have asthma and have never had a problem with it.

When I was last pregnant in winter 2008/2009 (before the swine flu outbreak) I had a bit of a battle to get the flu jab as I was in the first trimester. At that point pregnant women weren't routinely given the flu jab but a major study had just been done into it and the advice was being changed. Unfortunately this information hadn't reached the practice nurse so I don't think midwives, nurses and even GPs Can always be relied to be up to date on these things.

Personally, having had flu in the past I didn't think twice about having the vaccination in pregnancy as I'd been so unwell with it and lost so much weight that I'm sure it would be a greater risk to the baby than the jab would be.

[simonethebeaver]

Oakwood recommended both to me in this pregnancy.

Having had flu several years ago, I jumped at the chance in both my pregnancies. I have never felt so ill. Having had a very heavy cold this time, which required a week off work, my only cheerful thought for a few days was that at least I wouldn't be getting flu! I do worry that people who have never had flu but THINK they have (I could easily have mistaken my cold for it) underestimate what a serious thing it can be.

[TE44]

Hi Beagle, After the recall of 160,000 flu vaccines, Agrippal and Fluad, made by Novartis, this vaccine was banned then

lifted. Here's the story.

http://www.telegraph.co.uk/health/healthnews/9645544/Thousand-of-flu-vaccines-recalled.html

From what I have gathered the particles were protein aggregates (clusters) see link below.

http://uk.reuters.com/article/2012/10/31/us-novartis-flu-idUKBRE89U13O20121031

Here's a bit about them, from a medical view, there should be a system to stop these clusters but somehow that didn't happen.

http://www.aapsj.org/view.asp?art=aapsj080366

Here is some information for doctors from the Novartis site.

http://www.novartis.com/newsroom/product-related-info-center/influenza-vaccines-information-center/information-for-doctors.shtml

I am not posting to scare you, I absolutely understand how hard it is to get informative information, maybe a good idea to look into the individual manufacturers flu vaccine. Best wishes.

[susyp]

I've also had flu and it is absolutely awfu.

and my daughter had it at 18 months and was hospitalised so don't underestimate how serious it can be in children - ie your unborn baby.

susypx

[Saffron]

So this was essentially a quality control issue with formulation, which has not been observed to cause any adverse effects acutely. Novartis withdrew products which it knew/suspected to be affected, and not all countries banned these products.

Quality control issues can happen with the formulation of any drug, not limited to, or exacerbated by, the production of immunising compounds.

Here's a link to the UK MHRA statement on recall, which was issued in Oct: http://www.mhra.gov.uk/Publications/Safetywarnings/DrugAlerts/CON199572 . Print it out and take it to your nurse/GP when you go to receive your jab, if you're worried.

Quoting MHRA:

At the request of MHRA, Novartis Vaccines and Diagnostics S.r.l. is executing a precautionary recall of the above batches. This is due to the presence, in one of the components, of visible protein aggregates that were identified following additional testing during the course of an investigation. Such protein aggregation can occur in influenza vaccines. The aggregation consists mostly of viral proteins expected in the vaccine, and when observed, aggregation is transient and disappears upon shaking as recommended in product labelling. No visible protein aggregates were detected at the time of product release in any of these UK batches.

Based on the information available, there is no evidence of any new safety concerns or of any impact on efficacy. No adverse reactions which may be associated with this issue have been reported to Novartis in connection with these batches. Those who have had a flu vaccine from these batches should have no cause for concern and there is no need for revaccination.

Remaining stocks of the affected batches should be quarantined and returned to the original supplier for credit.

TE44 Wrote:

-------------------------------------------------------

> Hi Beagle, After the recall of 160,000 flu

> vaccines, Agrippal and Fluad, made by Novartis,

> this vaccine was banned then

> lifted. Here's the story.

>

> http://www.telegraph.co.uk/health/healthnews/96455

> 44/Thousand-of-flu-vaccines-recalled.html

>

>

> From what I have gathered the particles were

> protein aggregates (clusters) see link below.

>

> http://uk.reuters.com/article/2012/10/31/us-novart

> is-flu-idUKBRE89U13O20121031

>

>

> Here's a bit about them, from a medical view,

> there should be a system to stop these clusters

> but somehow that didn't happen.

>

> http://www.aapsj.org/view.asp?art=aapsj080366

>

>

> Here is some information for doctors from the

> Novartis site.

>

> http://www.novartis.com/newsroom/product-related-i

> nfo-center/influenza-vaccines-information-center/i

> nformation-for-doctors.shtml

>

>

> I am not posting to scare you, I absolutely

> understand how hard it is to get informative

> information, maybe a good idea to look into the

> individual manufacturers flu vaccine. Best wishes.