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Posts Tagged ‘vaccines for pregnant women’

Evaluating the Safety of Flu Vaccination in Pregnancy

September 18, 2017 2 comments

The decision to get a flu vaccination in pregnancy is one that should be based on a complete evaluation of the scientific evidence that is available.  Flu shots have been safely administered to millions of pregnant women over many years, so how should expectant parents respond to a recent study that implies a connection between multiple flu vaccinations and the incidence of miscarriage in early pregnancy?  

To properly evaluate the significance of the latest data, we must consider the findings of this one report alongside the abundance of other science-based information we have, such as: 

  1. Why the Advisory Committee on Immunization Practices (ACIP) currently recommends flu vaccination among pregnant women.
  2. Data from the numerous studies that support the safety of the ACIP’s current recommendation of flu vaccine for pregnant women.
  3. Details of the “case-control” study in question and an examination of the study methods, findings and limitations.

Why the ACIP recommends flu vaccination among pregnant women.  

Currently the CDC’s Advisory Committee on Immunization Practices (ACIP) recommends that pregnant women get a flu vaccine during any trimester of pregnancy to help protect them and their newborns from the dangers of influenza.  Due to changes in the immune system, heart and lungs during pregnancy, expectant women are more prone to severe illness from flu, which has been known to result in premature delivery, low birth weight babies, miscarriage, hospitalization or even death.

Flu vaccination in pregnancy doesn’t just help protect the expectant mother from influenza, it is also the most effective way to pass critical immunity on to the baby during pregnancy.  This passive immunity can then protect the infant child from the dangers of influenza in the time before they are old enough to receive their own flu vaccination at six months of age.

The ACIP recommendation for flu vaccination during pregnancy is supported by other organizations as well, to include The American College of Obstetricians and Gynecologists (ACOG) and the American College of Nurse-Midwives (ACNM).

The studies that support the safety of flu vaccination in pregnancy. 

The ACIP is a committee which consists of 15 voting members who have expertise in vaccinology, immunology, pediatrics, internal medicine, nursing, family medicine, virology, public health, infectious diseases, and preventive medicine.  The Committee meets in person three times a year and subcommittees meet regularly throughout the year via conference call to discuss vaccine research and scientific data related to vaccine effectiveness and safety.

The current ACIP recommendation for flu vaccination during pregnancy is based on a thorough review of the evidence compiled from numerous studies, which include the following:

    • A review of reports to the Vaccine Adverse Reporting System (VAERS), a national vaccine safety surveillance program run by CDC and the Food and Drug Administration (FDA), (Moro et al, 2011) which found no unusual or unexpected patterns of reporting for pregnancy complications or adverse fetal outcomes among pregnant women and flu shots.
    • A study using Vaccine Safety Datalink (VSD) data (Irving et al, 2013) which found no increased risk of miscarriage among pregnant women who received flu vaccines in the 2005-06 or 2006-07 flu seasons. (The VSD is a collaborative program that monitors the safety of vaccines and conducts studies about rare and serious adverse events following immunization.)
    • A large study using VSD data (Kharbanda et al, 2013) which found no increased risk for adverse obstetric events (like chorioamnionitis, pre-eclampsia, or gestational hypertension) for pregnant women who received the flu vaccine from 2002 to 2009 compared to pregnant woman who were not vaccinated.
    • A VSD study (Nordin et al, 2014) which compared pregnant women who received the flu shot with an equal number of pregnant women who did not receive the flu shot during the 2004-05 and 2008-09 flu seasons. The study found no differences between the two groups in the rates of premature delivery or small for gestational age infants.
    • A large August 2017 study using VSD data which found that the babies of women who received the flu shot during their first trimester had no increased risk of having children with major birth defects.

The examination of vaccine safety is an ongoing process.  Before being approved for administration, vaccines undergo rigorous testing by their manufacturers, the FDA, and the FDA’s Center for Biologics Evaluation and Research. Clinical trials are performed before the vaccine is made available to the public, to confirm the vaccine’s safety and efficacy. Even after the vaccine receives FDA-approval, post-licensure studies are conducted on an ongoing basis to continually monitor the vaccine’s safety and to detect and respond to any rare adverse events.

While the studies conducted to date have not signaled any safety concerns, the ACIP and the CDC are committed to the continuous evaluation of the safety of all vaccines, to include those recommended for pregnant women.

This has led to the “case-control” study of flu vaccination and possible miscarriage which was recently published in the journal Vaccine on September 12, 2017 and reported on by The Washington Post, the Associated Press, and various other media outlets.  The study showed that women in early pregnancy who received two consecutive annual vaccines during 2010-11 and 2011-12, both of which included a 2009 pandemic H1N1 (H1N1pdm09) component, had an increased risk of spontaneous abortion (miscarriage) in the 28 days after receiving the second vaccine.

Details of the recently published study of women who had miscarriage following flu vaccination. 

Read more…

5 Things Expectant Parents Need to Know About Vaccines in Pregnancy

August 10, 2017 1 comment

The more we learn about fetal development, the more advice women seem to get on what to do, and what to avoid, while pregnant.  Of course, all this information can be overwhelming, especially when preparing for the arrival of your first child.  While well-meaning friends and family will provide a constant stream of advice, expectant couples should rely on credible medical sources such as the CDC, the American College of Obstetricians and Gynecologists (ACOG), and the American College of Nurse Midwives.   

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Here are 5 things these organizations say about the flu and Tdap vaccines routinely recommended during pregnancy:

1) Maternal vaccine recommendations serve a dual purpose.  

The first reason is to protect the mother.  Changes in a woman’s immune, heart, and lung functions during pregnancy make her more likely to get ill and suffer severe complications from illnesses as compared to non-pregnant women.  In fact, a pregnant woman is five times as likely to suffer complications or death from flu compared to non-pregnant women.  Additionally, if a woman should fall ill during pregnancy, she has a greater chance of hospitalization, spontaneous abortion or complications that can directly impact the health of her baby such as preterm labor and delivery, and low birth weight babies.

The second reason is to protect the baby.  If a woman becomes sick before, during, or even shortly after delivery, she can easily pass a disease on to her baby.  New moms spend a great deal of time in close proximity to their newborn babies, so it is understandable that they might share infections. But infections like flu and pertussis, also known as whooping cough, are not just a threat to a new mother.  They can also be extremely dangerous, and even deadly, to young children.

2) Vaccination timing is important.  

Getting vaccinated during each pregnancy (as opposed to before or after) enables a woman to pass on protective antibodies to her developing baby that can then provide short-term protection against flu and pertussis until the baby is old enough to get their own vaccines.  

The best time for a pregnant woman to get a Tdap vaccine is between 27 and 36 weeks of each pregnancy, with the earlier part of this time period being most preferable.  This preferred vaccination window is based on studies of the cord blood of babies whose mothers received Tdap vaccine in pregnancy and the associated levels of pertussis antibodies detected in that cord blood.  Often times, adults are unaware that they have a pertussis infection, which is why the infection can easily be passed on to babies.  Babies are especially vulnerable to the disease because they only begin getting their own DTaP vaccination to prevent pertussis at 2 months of age.  But even then, they need an additional four doses at 4 months, between 6-9 months, between 12-15 months and again between age 4-5 before they are fully immunized.  The antibodies they receive from their mother helps protect them in those early months after birth.

An inactivated flu shot is recommended for pregnant women at any trimester of each pregnancy.  However, the best time to get a flu vaccine is before the season begins, so that the mother, who herself is at great risk of flu complications, is fully protected before flu activity begins to elevate in her community.  . Since it takes about two weeks after vaccination for antibodies to develop in the body that protect against flu virus infection, it is best for pregnant women to get vaccinated by the end of October, if possible.  Unfortunately, flu vaccines are not recommended until a child is 6 months of age, which is why the protection a child gets from his or her mother is critical to keeping that child flu-free until they can receive their own vaccine.

3) Maternal vaccines protect against two serious illnesses; whooping cough and flu.

Read more…

How My Sister Helped Save My Daughter From Whooping Cough 

June 19, 2017 20 comments

TamaraSheffieldHeadShotBy Tamara Sheffield, MD, MPA, MPH, Medical Director, Community Health and Prevention, Intermountain Healthcare

In my role as a medical director at Intermountain Healthcare in Salt Lake City, Utah, I am responsible for Community Health and Prevention.  You could say that I’m a professional advocate for immunizations, since they prevent many illnesses, hospitalizations and even deaths.  In fact, maternal immunizations are one of today’s most promising new preventive health strategies.

By vaccinating pregnant women against certain diseases – like whooping cough (pertussis) and influenza – we are reducing the amount of illness, hospitalization, miscarriage and pre-term labor these women experience as a result of these diseases.

Additionally, maternal vaccines enable pregnant women to pass on protective antibodies to their unborn babies.  These antibodies provide newborns with early, short-term protection against pertussis or flu, during the time when they are too young to receive their own vaccines to prevent these diseases.

For instance, children must be six months of age before they can receive their first flu vaccination, and the DTaP vaccine, which helps prevent whooping cough in children, is administered as a series of five shots (with doses at 2, 4, 6, 15-18 months, and 4-6 years of age). Sadly, there are about 100 pediatric deaths due to influenza each year, and 90% of all deaths associated with whooping cough are among infants, mostly because the thick mucus that accompanies the infection has a severe impact on a baby’s ability to breath.

For an expectant woman, changes in the immune system, heart and lungs during pregnancy make them more prone to illness.  When a pregnant women gets ill, it raises her risk of complications, such as premature labor and delivery.  But research shows that mothers can help protect themselves and their babies by getting vaccinated during pregnancy.

The flu vaccine is recommended at any trimester of each pregnancy. An adult Tdap booster vaccine is recommended during each pregnancy as well – and studies show that the best time for optimal transfer of protective antibodies is at 27-to-36 weeks gestation. The ongoing research continues to indicate that these maternal immunizations are effective at reducing the number of flu and whooping cough-related illnesses, hospitalizations and deaths among infants.

The abundance of scientific evidence on this matter is one reason I am a strong advocate for maternal vaccinations.  However, I have a very personal reason to advocate for maternal vaccinations as well.

You see, I know an amazing 25-year-old young woman who nearly died from whooping cough when she was just three weeks old. 

Alicia Outside ICU at Phoenix Childrens' Hospital

Like many infants who suffer with whooping cough, this beautiful baby girl contracted it from a family member.  During the weeks before delivery, her mother developed a persistent cough that went undiagnosed, and she unknowingly passed whooping cough on to her baby.  Three weeks later, after a couple of incidents where the baby stopped breathing and turned blue, her parents rushed her to the hospital. Read more…

10 Things Parents Who Don’t Vaccinate Their Kids Should Know

It’s not uncommon for a parent who has lost a child to a vaccine preventable disease to try to spare other families from the same agonizing heartache. 

In some cases, these children may have suffered with a preventable disease because they were unvaccinated.  This could be the result of parents who did not have access to certain vaccines, parents who willfully refused a particular vaccine, or in the case of Riley Hughes, infants who were too young to be fully vaccinated.

Riley was a healthy baby boy born in Australia on February 13th, 2015.  At three weeks of age he started exhibiting cold-like symptoms with an occasional cough. When he was just 32 days old, Riley passed away in the arms of his parents.  

pertussis112315While in the hospital, Riley was diagnosed with pertussis, also known as whooping cough.  At that time, the U.S., the UK, Belgium and New Zealand, were already advising expectant women to get an adult Tdap vaccine at 28-32 weeks of pregnancy in order to transfer protective antibodies to their unborn babies.  This practice helps protect infants from pertussis at a time when they are most vulnerable to infection and subsequent complications.  It’s also the only way newborns can benefit from some protective antibodies before they are two months of age and begin receiving the first of five doses of DTaP vaccine to become fully vaccinated against pertussis.

Unfortunately, the Australian government hadn’t adopted this practice until shortly after Riley’s death. Since then, Riley’s parents have made it their mission to educate people about the dangers of whooping cough, and promote the need for vaccination so that no other family would have to suffer like they did.

Sadly, there are still some parents who choose not to vaccinate.  In a plea to these parents, Riley’s mom posted the following list of “things to know” on the Light for Riley Facebook page:

 


Ten things I want parents who don’t vaccinate their kids to know:

1. There are no cures for most of the diseases we vaccinate against.

2. Even if you choose not to vaccinate, please, please, please make yourselves aware of the symptoms of these potentially fatal diseases. Infections like meningococcal can kill within 24 hours, and every minute counts.

12244586_1518881475089295_4527321516860468835_o3. If you’re really worried about vaccine “toxins”, you don’t want to see what the toxins from Bordetella Pertussis (the bacteria responsible for whooping cough) can do. Trust me – I watched my newborn son die from it. Read more…

After Losing Babies to Pertussis Parents Make Plea for Prevention

January 28, 2016 17 comments

How is it that three families, who’ve never actually met one another, find themselves sharing words of consolation and encouragement at the same time each year?

How is it that these three families are forever bonded by their children, and the courage and compassion they have to share their stories?  

Carter, Callie and Brady were just infants when they had to say goodbye.  But during this week, back in 2010 and 2012, three babies lost their fight to pertussis, (more commonly known as whooping cough) and their families were forever changed.

In 2008, Every Child By Two (ECBT) launched a program called Vaccinate Your Baby, which was inspired in large part by the Romaguera family, who had contacted the organization several years earlier after having lost their baby Gabrielle to pertussis.

In the days and months following the death of Carter, Callie and Brady, the Dube, Van Tornhout and Alcaide families also reached out to Every Child By Two in hopes that they could turn their personal tragedies into a public health mission.

VYF_Full-InfographicToday, as Every Child By Two Parent Advocates, their commitment to pertussis prevention has undoubtedly helped bring about many positive and live-saving changes. They have not only raised awareness of the importance of adult Tdap boosters, but their efforts have helped alter the way in which the public is advised to protect newborns from pertussis.

Prior to the death of their children, none of these families were educated on the need for adult Tdap boosters.  They’ve since devoted a great amount of time to sharing their stories; in media interviews, in state legislative chambers,  on podiums at public health conferences, and in blogs and Facebook posts shared widely on social media.

New Recommendations Are Helping in the Fight Against Pertussis

Today, leading professional organizations such as the AAP, the American College of Nurse-Midwives (ACNM) and the American College of Obstetricians and Gynecologists (ACOG), all recommend that pregnant women receive Tdap boosters in the third trimester of each pregnancy. This not only helps to protect the expectant mom from contracting pertussis and passing it onto their newborn, it also provides passive immunity to the unborn baby.  This practice helps protect infants before they begin receiving their own pertussis immunizations through a series of five DTaP vaccine doses that begin at two months of age.

Before the DTaP shot was routinely administered to infants, about 8,000 people in the United States died each year from whooping cough. However, thanks to greater immunization coverage and greater public awareness, this number has dropped to fewer than 20 deaths per year. Unfortunately, because the bacteria is still widely circulating in our communities and not everyone is adequately protected, whooping cough still makes people very sick.  In 2014, as many as 30,000 people were diagnosed with pertussis and each year many are still hospitalized. The real danger is among children under 12 month of age.  About half of these infants who get whooping cough are hospitalized, and tragically approximately 1 out of 100 infants who are hospitalized will die.  So how can we better protect these babies?

Research Continues to Guide Vaccine Recommendations

Research indicates that family members are often the source of infection among infants, and most family members are passing on the infection without ever realizing they have  pertussis themselves. In one recent study, approximately 85% of infants with pertussis got if from a member of their immediate or extended family.  This is why Tdap boosters are now recommended for all family members and caregivers who spend time around babies.  In fact, families members should get their Tdap booster at least two weeks prior to the expected arrival of the baby, since it’s estimated that it takes that long to acquire immunity after getting the vaccine.

Most recently, the efforts and experiences of our Every Child By Two Parent Advocates have even helped inspire the expansion of the Vaccinate Your Baby program to the Vaccinate Your Family program.  When people of all ages are up-to-date on their recommended vaccines, they’re less likely to pass illness on to our vulnerable infant population.

We encourage everyone to visit the adult section of the Vaccinate Your Family website, where there are several resources that specifically help educate older individuals about the need for adult Tdap boosters, to include materials for grandparents who want to help protect their young grandbabies.

Please familiarize yourself with this Grandparent Toolkit and share these materials among your friends, family and colleagues.

Health & Safety Checklist

Tips for Soothing a Fussy Baby

Pledge for Family Members and Friends to Sign

Frequently Asked Questions

Questions to Ask Your Doctor About Vaccines

Every Child By Two stands with our Parent Advocates in our mission to ensure that no family should ever have to endure what they’ve been through.  This week, as we mark the anniversary of the passing of Carter, Callie and Brady, may we each share this video and the many resources on the Vaccinate Your Family website in an effort to educate the public about pertussis prevention.