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To Vaccinate or Not to Vaccinate: Influenza Vaccination During Pregnancy

I recently followed a listserve discussion, the topic of which revolved around the influenza vaccine and its safety/efficacy/recommendation during pregnancy.

Vaccination has, of course, been a dicey topic approached within this blog community in the past—a divisive topic to be sure.  But when we are considering vaccination of a pregnant woman—the stakes feel even higher, with two (or more) individuals being involved.

There are certainly many resources out there which question the safety of childhood vaccination such as this one.  Likewise, numerous resources abound, describing the justification for and safety of vaccination.

If nothing else, the decision about whether or not to vaccinate—for a pregnant woman hoping to avoid influenza, or a parent hoping to protect their child from various illnesses—becomes a cost-benefit analysis:  Is the potential (physical/health) cost of vaccination worth the benefit of avoiding a given disease?

Now entering flu season, this debate over whether or not to vaccinate includes the influenza vaccine and pregnant women.  From the listserve, here are the comments of Dr. Mark Sloan, pediatrician and author of the *fabulous* book, Birth Day:

 

 

Here’s a pediatrician’s perspective:  This is my 32nd flu season working with children, and I strongly recommend influenza vaccine to the pregnant women I encounter, both for their own health and that of their babies. Infants (0-6 months) with influenza have a 30-fold increased risk of hospitalization compared with children ages 5-17 years. They’re much more prone to bacterial complications too, like pneumonia, and they have the highest mortality rate of any age group except the > 65 year old demographic. If a mother catches influenza, it’s almost a given that her baby will, too.

Personal experience: We hospitalized 15 children with influenza from our pediatric clinic last year – 8 were less than 6 months old. 6 of the 8 had no risk factors for severe disease, and 4 of that 6 were solely breast fed.

It’s good to emphasize less obvious complications as well. For example, even in milder cases, influenza can disrupt breast feeding from the baby’s perspective, whether from fussiness, lack of appetite, frequent cough, nasal congestion, or general exhaustion. And a mother with influenza can easily become dehydrated, compromising her milk supply. All in all, influenza is an excellent disease to avoid, and the best way to do that is vaccination.”

 

 

Those who may have experienced influenza in the past year or so will likely vividly recall the misery of high fevers, body aches, exhaustion, cough, lost time at work, etc., etc.  But, beyond the woeful symptoms caused by influenza, contracting the virus while pregnant can have additional negative effects on the mother and fetus.  The Organization of Teratology Information Specialists (OTIS) has this to say about influenza during pregnancy:

 

 

The influenza virus itself has not been shown to cause birth defects. However, having a high fever during pregnancy may increase the risk for birth defects. Therefore, fever during pregnancy should be treated. Acetaminophen is the drug of choice for reducing fever during pregnancy. Tylenol® is one brand of acetaminophen.  Being very sick from the flu may increase the risk of pregnancy complications such as miscarriage or premature delivery. It is important to talk with your doctor if you are pregnant and have symptoms of the flu.”

 

 

(You can read the rest of the information form OTIS regarding influenza/flu vaccine during pregnancy here.)

There are, of course, many, MANY more resources out there—both supporting and advising against—influenza vaccination in pregnant women, such as this paper published in the 2006 Journal of American Physicians and Surgeons.  Many of the dissenting opinions are based on a concern for inclusion of neurotoxic Thimerosal—a mercury-based ingredient used to preserve the vaccine and disallow bacterial growth within the vaccine vial.  Per the CDC, this year’s flu vaccine does contain Thimerosal in the multi-dose vials but does not contain the preservative in the single dose vials.  So, for pregnant women seeking influenza vaccination that is free of Thimerosal—asking for a vaccination from a single dose vial would be advisable.

 

As always, regardless of whether you (or someone you know) chooses to vaccinate or not, the other important prevention methods still hold:  wash your hands often, avoid touching your eyes/nose/mouth whenever possible, avoid being around people you know to be sick with the flu, stay well-hydrated, focus on eating healthy foods, and get plenty of rest.

I know many readers will have their own two cents to add to this discussion.  I encourage you to do so, including references to your pro/con points, as well as respectful and professional dialogue.

Wishing you all (and the expectant families with which you interact) good health!

 

 

Posted by:  Kimmelin Hull, PA, LCCE, FACCE

News about Pregnancy, Vaccinations , , , , , , ,

  1. avatar
    Alethea
    October 31st, 2011 at 10:38 | #1

    What is the data regarding gestation and vaccination? Should a woman in her first trimester receive a flu vaccine, or is more advisable to wait until the 2nd trimester?

  2. October 31st, 2011 at 11:00 | #2

    The CDC is now recommending that it is even safe during the first trimester: http://www.cdc.gov/vaccinesafety/Concerns/pregnancy_influenza.html

    I’m sure you can find other sources saying otherwise, but that is based on research as recent as this month (October 2011).

  3. avatar
    Nicole
    October 31st, 2011 at 11:34 | #3

    What I find extremely frustrating about this debate all over the internet and in person, is that very few professionals have anything to say about VITAMIN D. Drives me up the wall that a pediatrician like you quoted isn’t advocating higher levels of vitamin D for everyone!! Something safe, simple and natural can be just as effective in preventing the flu and doesn’t carry ANY of the risks of vaccination. Why oh why oh why aren’t the CDC, and the WHO, and our Academies of Pediatricians both in the USA and Canada, NOT SHARING THE VITAMIN D info??? It drives me crazy!

    Just as a personal note: 2 years ago when the swine flu was thought to be a pandemic etc, I did alot of research and finally determined that the H1N1 vaccine was not appropriate for me, my husband or four children. Instead, I felt that we could protect ourselves with the measures you listed in your blog, as well as higher than recommended doses of Vitamin D and Omega’s. My husband and I for the last two flu seasons, take between 5,000 – 7,000 IU’s of Vitamin D per day (from October – April), and an Omega 3 supplement, my 13 and 15 yr olds take 2,000 IU’s of vitamin D, and my 10 and 7 yr old take 800-1200 IU’s of vitamin D (and all 4 kids also take an Omega 3 supplement). I also have an “Antiviral” supplement in the house to take when we feel the beginnings of being ill ………….. and in these two years, NO ONE in my family has gotten ill or had the influenza. And if we did contract a virus, we were just “under the weather” for a day or two, not down and out with a horrible illness. This year, we plan on doing the same thing.

    I just wish our medical community would start being more health -conscious in a preventative way that didn’t include spending multi-millions of dollars on a vaccine that has never truly been proven safe for pregnant women and babies.

  4. avatar
    Diasen
    October 31st, 2011 at 12:08 | #4

    @Nicole
    You’re right about the Vit D being such a critical piece and not being discussed at all. I recently found I had a severe def. in my 2nd trimester and taking 4000 IU over a period of 3 weeks set me to normalcy again. While Deficiencies can cause respiratory illnesses etc.. fixing it is so easy. I have to however enter a note of caution with overdosages ( above 100ng/ml) and the issue of kidney stones esp. with prolonged usage and with people with existing kidney problems. It is so much simpler to sit in the sun with your arms and legs exposed to sunlight for 15 minutes. No risk of overdosage there. Again, Darker skinned people need more exposure.

  5. October 31st, 2011 at 12:40 | #5

    I got a flu shot a few years ago while pregnant, and I am SO glad I did. My son was born in October, and my husband came down with the flu in December, when our son was only two months old. Neither my son (who was exclusively breastfed) nor I got sick. In addition, I was around lots of babies that winter (new parenting groups!), and I was glad that the odds of me catching the flu and passing it on to one of them was slim.

    I will say that the flu shot made me a little more miserable than it has other years. But 28 hours of cold-like symptoms was worth not getting the flu when my husband did.

    @Nicole, I also do take vitamin supplements, and our pediatrician strongly recommended vitamin D supplements to boost my son’s immune system. However, we didn’t start the vitamin D supplements until well after our exposure to the flu.

  6. October 31st, 2011 at 15:58 | #6

    You raise a good point about vitamin D. There is mounting evidence that a lack of D can worsen asthma, and that it may play a role in fighting virus infections, like influenza. I recommend vitamin D supplementation for all the breast fed babies I care for in my practice. (Formula is already supplemented with vitamin D.)

    However, there isn’t yet any convincing evidence that vitamin D supplementation alone is protective against influenza in children, especially babies in the 0-6 month age group, when the developing immune system is particularly susceptible to attack by the influenza virus.

    Vitamin D supplementation is important for young babies. Even more important is making sure that those who care for babies are vaccinated against influenza. When dealing with an infection as serious as influenza, it’s best to cover all the bases, prevention-wise.
    Mark Sloan MD
    @Nicole

  7. avatar
    Nicole (a different one!)
    October 31st, 2011 at 16:58 | #7

    Is there any published research on Vitamin D as a preventative measure for flu? I understand completely that you believe it to have helped you, Nicole. However, realistically it is entirely possible that you would not have gotten the flu without your Vit D megadoses. I mean, the experience of 6 people over 2 flu seasons is hardly a scientific trial.
    “The plural of anecdote is not data”

  8. avatar
    Jeanne Ohm
    October 31st, 2011 at 17:34 | #8

    Nicole,
    Great points! keeping ourselves healthy is the best protection against any diseases. We have six children, three grandchildren and would never consider vaccines especially in pregnancy. We eat well, love well and are well-adjusted (chiropractically)
    To all–become informed… there are many resources to follow up with. On Mercola’s site this week, there is a special, free showing of the documentary: the Greater Good..
    Read about the film here and follow the links to view: http://pathwaystofamilywellness.org/item/greater-good-screening-locations.html
    Another great resource is the NAtional Vaccine Information Center: http://www.nvic.org
    Blessings to all.
    Jeanne Ohm, DC

  9. October 31st, 2011 at 17:49 | #9

    This is not the only vaccine being recommended to pregnant women. I just had a Health Department advisory cross my desk last week, urging all pregnant woment to get the TDaP vaccine while pregnant, to protect both themselves and their babies after birth.

  10. October 31st, 2011 at 17:52 | #10

    Question for the pediatrician: Do you take into consideration the baby’s exposure to other people? For example, if the mother stays home with the baby, and the siblings, if any, also are home with the baby rather than in day care, would this not reduce risk of influenza? Other exposures could be minimized by not taking the baby to public places, such as the grocery store, or church, when it is very young. I cared for a Korean couple whose culture taught that the mother should not go out with the baby for the first three months after birth. Makes good sense to me.

  11. avatar
    nome
    October 31st, 2011 at 18:38 | #11

    I don’t think anyone argues that having the flu is a great thing but the efficacy of the vaccine and why the paper that comes with the vaccine still says it is not recommended for pregnant women.

  12. November 1st, 2011 at 00:22 | #12

    @Nicole (a different one!)
    yes there is

    http://www.ncbi.nlm.nih.gov/pubmed/20219962

    http://www.ncbi.nlm.nih.gov/pubmed/16959053

    Aloia JF, Li-Ng M. Re: epidemic influenza and vitamin D. Epidemiol Infect. 2007;135(7):1095-6; author reply 1097-8.

    Urashima M, Segawa T, Okazaki M, Kurihara M, Wada Y, Ida H. Randomized trial of vitamin D supplementation to prevent seasonal influenza A in schoolchildren. Am J Clin Nutr. 2010;91(5):1255-60.

    Sabetta JR, DePetrillo P, Cipriani RJ, Smardin J, Burns LA, Landry ML. Serum 25-hydroxyvitamin d and the incidence of acute viral respiratory tract infections in healthy adults. PLoS One. 2010;5(6):e11088.

    and I cannot access this right now but it probably has more links
    drlindashelton.wordpress.com/2009/05/09/vitamin-d-supplements-shown-to-reduce-influenza-infections/

  13. November 1st, 2011 at 00:30 | #13

    Also it very much pays to find out what brand of flu vaccine, and do your RESEARCH- all the package inserts are available online. Look at the possible adverse events. Look at the Cochrane Collaboration’s data (not just the plain language summary, which if you read the study will see is is kind of factually untrue! –But read the actual study data which is shocking!) Some of the harms are viewable in this slide presentation (slide ten) http://www.slideshare.net/rafabravo/vaccines-forpreventinginfluenzaclinical-9798854 and accuses the ACIP of basically malfeasance in misrepresenting the previous Cochrane Collaboration reports. I’d be glad to send the full report to anyone who cannot download it through the Wiley online (used to be free, now it’s a pay document). email me at lioracc {at} yahoo.com

    And remember that Flu Shot drives in community centers may use multi dose vials which usually DO contain mercury.

  14. November 1st, 2011 at 00:33 | #14

    Cochrane found NO evidence of reduction of viral transmission, nor complications of influenza.

    They found you’d need to vaccinate 100 people in real world conditions, to prevent ONE set of influenza symptoms- incredibly low.

    You can listen to a Cochrane overview of this meta analysis here
    http://www.cochrane.org/podcasts/issue-7-july-2010/vaccines-preventing-influenza-healthy-adults

  15. avatar
    Wendy
    November 1st, 2011 at 09:20 | #15

    As a long-time follower and tremendous fan of this blog, I have to say that I was quite disappointed at the lack of depth and “digging” that went into this piece. Making a case for the influenza vaccine by citing CDC opinions—and one pediatrician—is no different from discussing VBAC safety by merely quoting ACOG and one obstetrician. And yes, we know that there are various opinions. What kind of *science* goes behind these views? This post discussion needs a lot more intellectual “meat” to it. For example:

    1. The package insert for the influenza vaccine warns that it has not been tested on pregnant women. While flu vaccine proponents may dismiss this statement as a CYA gesture by the drug companies, skeptics will wonder why they would bother with CYA when the federal government has made it clear that vaccine manufacturers are free from liability. And undoubtedly, pregnant women will question why their doctors are recommending an under-researched medical intervention. What research, if any, is justifying the routine practice and safety of vaccinating pregnant women against influenza?

    2. Various studies have confirmed that when drug companies sponsor research on their products—either directly through authoring and/or underwriting or indirectly by hiring ghost-writers—results are overwhelming favorable to their product. Numerous physicians, most notably former NEJM editor Marcia Angell, have blown the whistle on this practice; unfortunately, however, it still prevails. With regard to *any* studies on the influenza vaccine, who funded them? What other conflicts of interest, if any, go behind these studies? Were they disclosed to the public?

    3. The Cochrane Review, the organization referenced by Liora that engages in purely independent research, has meta-analyzed routine influenza vaccination on multiple occasions and diverse populations. Go to cochrane.org and enter “influenza vaccination.” You’ll be appalled by their conclusions pointing to the overall inefficacy of this vaccine in high-risk and low-risk populations alike—ranging from children with asthma to healthy adults. This should come as no surprise in light of the recent research indicating that the influenza vaccine is only 59% effective.

    Even more appallingly, the flu shot proponents that I hear online and in major media rarely even ADDRESS this evidence, not even to dismiss it as “weak” or “flawed.” It’s as though this data never existed! I dug up the Cochrane data on my own, a step that I highly doubt most pregnant women out there are taking.

    When physicians and public health authorities are pushing and even mandating a medical intervention such as influenza vaccination, the burden of proof rightly rests on their shoulders. And so far, as a pregnant woman entering flu season, I’m not satisfied with what I’m seeing. We know that this vaccine is weak in its effectiveness. We do NOT know how safe it is for pregnant women and their unborn. For me, this risk-benefit ratio is a no-brainer. While emphatically not a member of the anti-vaccine camp, I will not be getting this vaccine until I see more adequate science to justify it.

    Dig a little deeper, S&S! Let’s remain true to that “Science” portion of the blog title!

  16. November 1st, 2011 at 10:08 | #16

    There has been little discussion here about the public health benefits of vaccinating. It is not simply a personal health trade-off within one’s family; it is also about protecting the wider community. I spent many years living in a largely non-vaccinating community right next to a poor city where many children when unvaccinated because of issues of access/communication/etc., and I always felt that it was terribly irresponsible for the wealthy non-vaccinating community to put the nearby poorer community at risk by eliminating the benefits of herd immunity. It is worth considering who else around you might be at risk if you don’t vaccinate — grandparents? Older babysitters? Immunocompromised neighbors? Friends/relatives of older siblings who attend school?

  17. avatar
    Walker Karraa, MFA, MA, CD
    November 1st, 2011 at 10:36 | #17

    Lara—you said it all. Last year, I posted pertussis information from public health sector on a local doula association here in Los Angeles. California was in the midst of a pertussis (whooping cough) epidemic. As doulas who work with immunocompromised populations (pregnant and newborn infants) and in immunocompromised facilities (99% of births in LA are hospital birhs)–it seemed a good idea to share CDC, and LAPH information.

    I received a personal email from the board of directors of the doula association informing me the discussion was closed. In essence, I was kicked off the thread, and told not to post any other information on vaccinations. Interestingly, the post that put the doula association over the top was a link to the Gates foundation and an interview with Melinda Gates regarding her work with polio in the Congo.

    The doula backlash, and assumed power over the domain of public health was enough to turn me off for good. And I am glad. I do not want to be associated with that association any more.

    How do issues such as this effect doula and childbirth educator communities?

  18. avatar
    Walker Karraa, MFA, MA, CD
    November 1st, 2011 at 10:42 | #18

    Dear Kimmelin,
    Thank you for going where no others are willing to go. You bring this to our readers with a sound, professional, and thought-provoking evidence and resources. I would like to ask you to repost this. Also, I interviewed OTIS teratogen specialist Sonia Alvarado for Giving Birth With Confidence last year and she brought good information for consumers to the table. At the time, I interviewed her about vaccinations, and eventually that section stayed out, as it was too controversial.

    I am so happy to see Lamaze expanding it’s ability to address so many current and crucial issues. You rock.

  19. avatar
    Nicole
    November 1st, 2011 at 11:58 | #19

    @Nicole (a different one!)
    Well, obviously it’s not a scientific study. :-) I was just relating my own personal experience. The http://www.vitamindcouncil.org is a great place to start when researching the benefits of vitamin D. I’m sure a quick google search “vitamin D and flu prevention” would come up with some current research and studies. Your point about not getting the flu even without vitamin D doses is valid ….but the same can be said for those who get vaccinated. :-) Even with vaccination, they may not have gotten the flu anyways. Therefore, how can it be adequately said that the vaccine does prevent the flu? :-)

  20. November 1st, 2011 at 12:27 | #20

    @Liora
    Liora, I think it is important to point out that these findings you refer to above are based on studies that included healthy adults, ages 50-65 (not pregnant women of childbearing age who have a downgraded immune system as a normal function of pregnancy).

    To me, what is more concerning in the Cochrane Review you site, is the prevalence of industry funding of these studies–meaning a large portion of the studies analyzed in this Review were funded by the very industry that produces the vaccines. But that, alas, is the topic for another post…

  21. November 1st, 2011 at 12:28 | #21

    @Lara
    Lara,

    Thank you for raising this very important point. Vaccination really is a community health issue, whether we want to agree with that sentiment or not. “Herd immunity” is only as good as the number of people in the herd who’ve been immunized.

  22. November 1st, 2011 at 12:39 | #22

    @ Wendy, you make some compelling points and I offer you kudos for taking the time and effort to look into this issue for yourself in a in-depth way.
    With this blog being titled “Science & Sensibility” sometimes we err on the side of discussing the sensibility part of things…which is often times where our readership comes in. (And, yes, as in today’s post by Darline Turner-Lee, we also often critique and discuss the science side of things.)
    In truth: we do want to hear from you (the readership of this blog site)…what are your thoughts on a given topic? What elements of that topic would you like to see covered? Thus, your apropos statement.

    Thank you for adding to the conversation. Input from the readership is often where the real “meat” comes in.

  23. November 1st, 2011 at 12:48 | #23

    @Walker Karraa, MFA, MA, CD
    Walker,
    Interestingly, I just received a letter from our children’s school yesterday warning about yet another pertussis outbreak in our community–this will be three years in a row. A good friend of mine, a doula, was sick with pertussis for three months last year. I happen to know she was very concerned about her interactions with her clients during the midst of that illness.

  24. November 1st, 2011 at 13:46 | #24

    Thanks for doing this Kimmelin. It’s very important! But you knew I would think that way, right?

    @ Wendy, ACOG and the CDC are two very different organizations. ACOG is a non-profit trade group for its members, and it funds itself — it’s not part of our government. The CDC is part of our government and is entrusted with maintaining public health. Sometimes childbirth workers cite the CDC re: breastfeeding, but not about vaccinating? Science is science, and the CDC does strong science. However, I won’t try to change your or anyone else’s mind about the motives of the CDC and our government.

    @Walker, I feel like I kind of walk a line in my childbirthing community, but we are small and pretty reliant on each other, regardless of how we come down on a specific topic.

    And that’s the question for me, too — what are our obligations, as healthworkers who are paid by clients to give them relevant, accurate information?

    What if the research about a particular topic shows one thing and I, personally, have done another with my children?

    I now share the NIH’s info about safe sleeping for (not with!) babies, even though I slept with all of my babies. What if the AAP changed their position about circumcision being primarily a cultural or religious decision and not so much medically based? I’m personally anti-circ, with the caveat that if my family lived in southern Africa, I would strongly consider it due to AIDS prevention.

    Ultimately, I do think it’s important to share what the majority of the evidence shows as well as a little about any contradictory info (not a 50/50 time split here!), and where to get further info on specific topics/how to evaluate sources. And then, I let go. They will make the best decision for their families, as my partner and I have for ours. Peace!

  25. avatar
    Jeanne Ohm
    November 1st, 2011 at 15:02 | #25

    Lara,
    It is important to note that the herd immunity theory has never been proven for vaccinated groups…herd immunity has only been shown to be in cases of natural immunity where the population naturally acquired the virus and became naturally immune to it. This is a frequent argument used to put “guilt” on those who make informed choices about vaccines and it is just not substantiated by the literature.
    Interesting read… http://www.whale.to/a/herd.html

  26. avatar
    Wendy
    November 1st, 2011 at 16:06 | #26

    @Kimmelin,

    re: Your post to Liora, The Cochrane Collabortion earned its reputation within the medical community precisely because it refuses to accept industry funding and vows to keep its research as independent as possible; industry independence is largely its raison d’etre. When Cochrane researchers discover a conflict of interest, they are quick to disclose it to their readers. The Cochrane Collabortion is emphatic about this stance: http://www.cochrane.org/about-us So out of curiousity, specifically hat conflicts of interests did you find in Liora’s link? Even if you did spot one, I don’t see how industry funding could possibly be responsible for conclusions that are unfavorable to a pharmaceutical product.

    As an example, take the Cochrane meta-analysis on healthy adults: http://www2.cochrane.org/reviews/en/ab001269.html As part of its normal protocol, Cochrane discloses that a significant number of the studies examined in this analysis were industry funded (therefore to be taken with a grain of Morton salt), and nonetheless came to a conclusion with only marginal support for vaccinating healthy adults against influenza: “Influenza vaccines have a modest effect in reducing influenza symptoms and working days lost. There is no evidence that they affect complications, such as pneumonia, or transmission.”

    One of the reasons that I follow this blog so religiously is because the bloggers exhibit a refreshingly healthy skepticism. Whether it’s ACOG’s recommendation for an on-staff anesthesiologists for VBACs or the Wax, et. al meta-analysis on home birth, you and your co-bloggers normally don’t take singular, authoritative statements at face value. I was hoping to see the same standard applied to authoritative recommendations for routine influenza vaccination of pregnant women.

    Respectfully, I don’t see a lot of *sensibility* in consenting to a medical intervention that lacks any solid *science* attesting to its safety and effectiveness. I, for one, would like to see a Cochrane (or other independent) meta-analysis (or other well-designed study) specifically focusing on routine influenza vaccination for pregnant women. But at a minimum, would you or another blogger be willing to write another post specifically addressing the *science* (or lack thereof) justifying routine influenza vaccination of pregnant women? When you do, please take into careful consideration the links that I am referencing both in this comment and more that I’m about to make in this thread. Perhaps you or another blogger has special access to the more detailed papers behind these abstracts!

    Again, the burden of proof is on those wanting me to consent to this intervention. I’m hearing a lot of opinions and recommendations. But where is the science? Apparently, I’m not the only one looking for it: http://www.bmj.com/content/333/7574/912.full

  27. avatar
    Walker Karraa, MFA, MA, CD
    November 1st, 2011 at 16:15 | #27

    Hi all

    I dare say we are usually more comfortable finding blaming mechanisms for medical establishment, with or without evidence, than looking at the more critical issues facing mothers today such as noted in Darlene’s post today, or the recent post on suicide rates higher than mortality rates due to traditional OB complications.

    When will we see the interrelated nature of our work, and reach beyond convention (just as our founders did) to make substantial changes for women? We are losing relevance, and without expanding our ‘natural birth’ paradigm to the socio-cultural, racial, psychological issues facing the majority of women today, we will become obsolete.

    Are we interested in birth? Or are we interested in women, children, families, and the health of our sisters in the field?

  28. avatar
    Wendy
    November 1st, 2011 at 16:21 | #28

    @Lara,

    Vaccines are a tricky and complex topic that cannot be summarized under blanket generalizations; each vaccine is unique, and each target disease is unique. While you can make a case for protecting the larger community with the MMR vaccine (one that I do get for my children), you cannot say that about vaccinating against tetanus. And as I’m about to demonstrate, it’s far too great of a stretch to make that argument about influenza. You stated:

    “There has been little discussion here about the public health benefits of vaccinating. It is not simply a personal health trade-off within one’s family; it is also about protecting the wider community.”

    When it comes to the influenza vaccine, this is simply not the case. First of all, we now know that the flu shot is only 59% effective in adults ages 18-65: http://www.cidrap.umn.edu/cidrap/content/influenza/general/news/oct2511lancet.html Attaining enough compliance for “herd immunity” will be next to impossible if you factor in religious and medical reasons for avoiding the vaccine. With the weakness of this vaccine, the vaccinated can easily spread the flu to the vaccinated.

    Second of all, you should really read this piece in detail: http://www.theatlantic.com/magazine/archive/2009/11/does-the-vaccine-matter/7723/ But the part that I’d like to highlight here is that these two investigative journalists pulled up government records and discovered that in years of influenza vaccine shortage, there were no changes in morbidity. From the article:

    “THE HISTORY OF FLU VACCINATION suggests other reasons to doubt claims that it dramatically reduces mortality. In 2004, for example, vaccine production fell behind, causing a 40 percent drop in immunization rates. Yet mortality did not rise. In addition, vaccine “mismatches” occurred in 1968 and 1997: in both years, the vaccine that had been produced in the summer protected against one set of viruses, but come winter, a different set was circulating. In effect, nobody was vaccinated. Yet death rates from all causes, including flu and the various illnesses it can exacerbate, did not budge. Sumit Majumdar, a physician and researcher at the University of Alberta, in Canada, offers another historical observation: rising rates of vaccination of the elderly over the past two decades have not coincided with a lower overall mortality rate. In 1989, only 15 percent of people over age 65 in the U.S. and Canada were vaccinated against flu. Today, more than 65 percent are immunized. Yet death rates among the elderly during flu season have increased rather than decreased.”

  29. avatar
    Wendy
    November 1st, 2011 at 16:23 | #29

    @Lucy Juedes
    Regardless of which body issues an opinion or what its motives were, there needs to be sound science buttressing the recommendation.

  30. avatar
    Wendy
    November 1st, 2011 at 16:44 | #30

    @Walker Karraa, MFA, MA, CD

    As a mother of 2 (and soon 3!), I get the DTaP vaccination for my children. Nonetheless, while I realize that this is getting tangential to the topic of the flu vaccine for pregnant women, I thought I’d share the following:

    1.The pertussis outbreak in California occurred primarily in vaccinated individuals: http://www.nctimes.com/news/local/sdcounty/article_1e57b3db-8302-5313-99b3-f15d48b8829f.html

    2.In a more recent case on Long Island, 100% were vaccinated: http://abclocal.go.com/wabc/story?section=news%2Flocal%2Flong_island&id=8203711

    3. There are plenty of examples of the aforementioned phenomenon in western Europe, as well. Apparently, pertussis is spreading not because of non-vaccinated individuals, but because of a weak vaccine. We know that the pertussis vaccine either wanes after 3 years ( http://www.inewsource.org/2011/09/19/whooping-cough-vaccine-fades-after-3-years/ )or, due to a mutated and vaccine-resistant strain of the bacteria, doesn’t work at all (http://www.bmj.com/content/316/7125/91.2.full ) Incidently, there have been no revisions to the DtaP vaccine to address any mutated strains, as the chief resercher, the Netherlands-based Frits Mooi, addresses in this article from a San Diego State University think tank: http://www.inewsource.org/2010/12/14/blurred-lines-of-influence/

    4. To date, there is no evidence showing that the pertussis vaccine prevents transmission. The very pharmaceutical company that produced those “I-Did-It-for-So-and-So” commercials (trying to convince adults to get the vaccine in order to protect small children) admits this in its vaccine package insert. I can no longer track down a copy online, so you’ll either have to get a hard copy or take my word for it. ;-)

    So while your public health message to the doulas certainly shouldn’t have been censored, it may not have been entirely accurate, as I’ve yet to see any public health authority demonstrate that it’s keeping up on these new scientific findings.

  31. November 1st, 2011 at 19:01 | #31

    Wendy,

    I was actually agreeing with Liora’s concern, and the conflict of interest pointed out in the Cochrane Review that studies “proving” safety of a vaccine that were funded by a vaccine maker ought to be called suspect for that fact alone. My only point was that the review Liora pointed to was one that looked at studies of flu vaccination in a different population than that which we are discussing in this blog post. The studies were done on “healthy adults”, ages 50-65, as opposed to pregnant women/women of childbearing age.

    Pregnancy causes a certain amount of immune system down regulation–to ensure the woman’s body does not sense the fetus as “foreign” and subsequently attack it. Resultantly, a pregnant woman can be considered somewhat immunosuppressed–making this subset of individuals different than the “healthy” adult subjects who were apart of the reviewed studies. (Personally–I don’t like differentiating pregnant women and other adults as “unhealthy” and “healthy” in this way, as it is completely contrary to my personal belief that pregnancy is an inherently “healthy” process–or a state of heightened health (in most cases) but, for the sake of this conversation, we are looking at individuals in two different camps.

    So I’m actually not disagreeing on this point–just validating it from a different perspective.

  32. November 1st, 2011 at 19:11 | #32

    @Kimmelin Hull
    Hi Kimmelin,
    As you point out, the Cochrane study referred to above examines the effectiveness of influenza vaccine in preventing disease in healthy 50-65 year-olds, not in high-risk groups like pregnant women and young children.

    Other studies…

    1) A Cochrane review cited a 2009 study titled “Influenza immunization in pregnancy” (Obstetrics & Gynecology, 114(2,Pt 1):365-8, 2009 Aug) which looked at the effectiveness of the vaccine in two at-risk groups: healthy women in pregnancy and their 0-6 month old babies. Their findings:

    • Influenza vaccination reduced influenza-like illness by more than 30% in both mothers and their infants, and also:
    • Reduced laboratory-proven influenza infections in 0-6 month-olds by 63%.

    That’s not 100%, of course, but it translates into significantly less misery for the families in the vaccinated group.

    2) Another Cochrane review from April, 2008 (“Vaccines for preventing influenza in healthy children”): http://www2.cochrane.org/reviews/en/ab004879.html

    • Nasal spray influenza vaccine (live virus, weakened) prevented 82% of illnesses in children 2 and older.
    • Injected killed virus vaccine was 59% effective.

    Again, not 100% but this is a significant risk reduction for the vaccinated children.

    3) Finally, here’s a real-world example from Boston and Montreal of how effective influenza vaccine is for children:

    http://www.nytimes.com/2011/09/20/health/research/20prevention.html?_r=2&ref=science

    Mark Sloan MD

  33. November 2nd, 2011 at 08:49 | #33

    I once knew a woman who got the flu shot while pregnant and her child wasn’t able to walk for about a year after he was born. Then I knew another woman who didn’t get the shot but took a lot of vitamin D and her child met all the development milestones on time. Clearly, there is an advantage of vitamin D over the flu vaccine. And then there was this third woman, in her late forties, who got the flu vaccine and had a child with Down syndrome.

    (Did you see what I did there? Because that’s exactly what anti-vaccine, alternative medicine types do. They focus on the bad – or twist the good to seem bad – and then hype up the normal.)

  34. November 2nd, 2011 at 10:24 | #34

    S&S reader, Vicki Honer, wrote in asking me to post these interviews between Dr. Mercola and Barbara Loe Fisher (from the Institute of Medicine) in which vaccine efficacy and the concept of herd immunity are discussed. Of note: the pertussis outbreak of 2010 is also discussed in the second interview (which Walker and I alluded to in a couple of our comments)
    http://articles.mercola.com/sites/articles/archive/2011/11/01/more-parents-waking-up-to-vaccine-dangers.aspx?e_cid=20111101_DNL_art_1

  35. November 2nd, 2011 at 10:32 | #35

    @Kimmelin Hull
    Oh, well, Mercola and Barb, two authorities on the issue of immunization. Wonder why they haven’t published any peer-reviewed studies?

    Oh, that’s right…

  36. avatar
    Walker Karraa, MFA, MA, CD
    November 2nd, 2011 at 12:29 | #36

    I appreciate your noting the lack of peer-review regarding Mercola–and interpretation of the antivax strategies we see employed so often–particuarly by the #antivax pseudo-scientists.

    I want to offer that the manager of this site is not representing herself as neither a proponent for nor against vaccination, but rather offer an avenue for discussion. I look forward to reading what epidemiologists, teratogen specialists might have to offer to the discussion.

    We would all benefit from reading Darlene’s post today as a reminder of the benefits and risks of scientific research. The implications for both health and horror, and the applications of compassion, service, and instruments of change that are needed for all women (not just first-world, white women in ‘to vax or not to vax’ angst, and the care providers–us included–who benefit from that angst). I know I am going deep here, but we have to. It is all interrelated. @Reuben

  37. November 2nd, 2011 at 12:42 | #37

    @Walker Karraa, MFA, MA, CD
    Walker, you nailed it: I see my role in these debates as more of a facilitator than anything else. While we often try to make Science & Sensibility a venue of straight forward education (such as Darline’s posts from today and yesterday, as you aptly suggest) it also serves as a forum for discussion. Thank you for reminding readers of this important distinction!

  38. avatar
    Wendy
    November 2nd, 2011 at 17:53 | #38

    @Kimmelin Hull

    Apologies. I did misread your post and thank you for clarifying.

  39. avatar
    Laura
    November 19th, 2011 at 20:57 | #39

    I just saw this article and it reminded me of this post. Researchers are studying the effectiveness of passive immunity through breastfeeding: http://www.healthnewsdigest.com/news/Children_s_Health_200/Can_Mothers_Milk_Protect_Babies_from_Flu.shtml

  40. November 20th, 2011 at 10:33 | #40

    @Laura
    Thanks for posting, Laura!

  1. November 26th, 2011 at 09:18 | #1