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Previously, we compiled a detailed guide to flu vaccinations for children and adults; today we will touch on the topic of vaccination for pregnant women. The article below was written by Elena Savinova, author of the telegram channel “About vaccinations without hysterics.”
Questions about whether pregnant women can and should be vaccinated against influenza are asked with enviable regularity. And although only the lazy did not give answers to them on the Russian-language popular medical Internet, they still continue to come. I decided to write a detailed post on this narrow topic. Nothing special - there will be quotes from the WHO position, Russian federal clinical recommendations (hereinafter referred to as RFCR) and scientific databases.
I’ll start with the fact that, as Sergei Butriy said, in any unclear situation, look at the WHO’s position on vaccines, in this case on influenza vaccines. Let's take a look at some of the provisions from this position (all quotes are taken from the WHO position, unless otherwise stated):
But... pregnant women can’t get vaccinated? That's what they told me at the housing complex
This is wrong. This is not at all true: pregnant women are not only allowed to get vaccinated, but they should be vaccinated. Flu vaccination is directly recommended by WHO and here's why:
Pregnant women are at increased risk of developing severe influenza and death, and the infection can also lead to complications such as stillbirth, neonatal death, premature birth, and low birth weight. When infected with the A(H1N1)pdm2009 strain, pregnant women in New York City were 7.2 times more likely to be hospitalized, and the hospitalization rate for severe influenza was 4.3 times higher than among nonpregnant women.
But the antenatal clinic told me!
Forget what they told you there. Even if this does not contribute to adherence to treatment, I will still write: with knowledge of vaccine prevention, everything is bad not only among the population, but even among some doctors. If a doctor in a residential complex says that vaccinations are prohibited for pregnant women, then he simply has not read the WHO documents and Russian recommendations, which leads to a practical conclusion: you should not listen to this doctor on matters of vaccination.
Is this even safe?
Randomized controlled trials (RCTs) in the United States and Bangladesh examining the safety of influenza vaccination during pregnancy did not demonstrate significant adverse reactions or intrauterine, perinatal, or infancy complications in women's offspring.
Is it possible at any time?
Yes:
Pregnant women should be vaccinated with TIV [trivalent inactivated vaccine - my translation] at any stage of pregnancy. This recommendation is based on evidence that people in this group are at significant risk of developing severe disease and evidence that seasonal influenza vaccine is safe to administer during pregnancy and is effective in preventing influenza in women and their infants, among whom the burden of disease is also high.
Is this safe for the child?
This is not only safe, but will also protect the baby in the first six months of his life, when he a) cannot get a flu vaccine due to his age and also b) will not be able to receive antiviral therapy if he suddenly gets sick with the flu. By age, vaccinations are exactly the same as with whooping cough.
Vaccination against influenza during pregnancy will protect both pregnant women and their newborns from infection.
Children younger than 6 months of age are not eligible for currently licensed influenza vaccines and should be protected against infection by vaccinating their mothers during pregnancy and ensuring their contacts are vaccinated to limit transmission of influenza viruses to infants.
RFKR:
Vaccination against influenza in children in the first six months of life is ineffective; To date, the use of antiviral therapy against influenza in children in the first six months of life is not permitted.
And not only am I pregnant, but I also have asthma, obesity, diarrhea and scrofula. I probably shouldn't get vaccinated against the flu?
You need it all the more. WHO position:
The risk of developing severe infection during pregnancy increases with concomitant asthma, diabetes and obesity.
RFKR:
The most important risk factors leading to hospitalization of pregnant women with influenza are: exacerbation of pre-existing bronchial asthma, obesity, diabetes mellitus, late pregnancy.
WHO pleas
For countries considering introducing or expanding seasonal influenza vaccination programmes, WHO recommends that pregnant women be the highest priority group for vaccination.
My commentary and translation into non-medical Russian. Further, the position talks about the following categories: young children, the elderly, the seriously ill, etc. This phrase means the following: WHO begs on its knees: dear health ministries of poor countries, well, if you don’t have the money to vaccinate the entire population, then at least Find a place to vaccinate pregnant women! They need it first!
Statistics from Russian recommendations
An analysis of cases of death from laboratory-confirmed influenza revealed that the most often aggravating circumstances were […] pregnancy - 4.5%, chronic lung diseases - 3.6%. The 1957 influenza A/H2N2/ pandemic killed more than 50% of women at different stages of pregnancy, which accounted for up to 10% of all deaths from this infection during the epidemic season.
Just think about the flu: it can be treated, especially since there are medications with proven effectiveness. They wrote on Meduza!
RFKR:
Influenza vaccination may reduce a pregnant woman's need to take antiviral medications, which are theoretically more dangerous than using an inactivated vaccine.
The use of antiviral therapy and vaccination against influenza in children under six months of age is unacceptable, therefore the lack of an alternative to effective protection against possible infection and severe consequences of the disease in infants makes vaccination of the expectant mother a priority.
Or maybe it’s still better to pass on antibodies to the baby through breast milk?
Antibodies are transferred to the baby primarily through the placenta. It is this mechanism that underlies influenza and whooping cough vaccination programs for pregnant women to protect unborn children. As for infants, firstly, only newborns (that is, children under about a month old) are able to absorb antibodies through the gastrointestinal tract, and even then this is not the main route of transmission of antibodies to infants. The main one is transplacental. Sad but true. It's sad, but it's true. Moreover, it is stated somewhere that human babies, unlike young rodents, ruminants, etc., do not receive antibodies through breast milk.
Second, to pass influenza virus antibodies to your newborn through breast milk, you need to have had the flu in your baby's first month, a virus that causes 3-5 million cases of severe illness and 250,000-500,000 deaths worldwide. It's a funny prospect, isn't it? Finally, if you catch an adenovirus, parainfluenza, or some other virus from the ARVI group, this will not protect the baby from the flu in any way.
What about thimerosal?
RFKR:
In 2009, WHO additionally reported that there was no evidence of a negative effect of thiomersal (a preservative component of some inactivated vaccines) on infants and adults, including pregnant women.
Okay, we persuaded you. Which influenza vaccine can pregnant women be vaccinated with?
Only inactivated vaccine. Live flu vaccines are prohibited for pregnant women. The WHO position mentions only trivalent vaccines approved for use in pregnant women, so with quadrivalent vaccines presented abroad, you should wait for now and opt for the trivalent one.
I live in Kukuevo. When asked about vaccination, the only gynecologist and therapist in Kukuevo had hair on their heads, and they sternly told me: we won’t vaccinate. Where should I run?
Well, what to do: print out the WHO position in Russian and RFKR, mark the necessary places with a marker and leave it for doctors to study.
What about the ones at home? Should they be vaccinated too?
RFKR:
All people who have direct contact with a pregnant woman (especially children in the first 5 years of life) should be vaccinated against influenza. This requirement reduces the risk of epidemiological contact between a pregnant woman and a sick person and increases the reliability of general and specific prevention of influenza in the family.
Who is still contraindicated for influenza vaccination?
People with hypersensitivity to eggs (those who have an anaphylactic reaction) and sulfites should not be vaccinated against influenza. Do not confuse an anaphylactic reaction with other allergic reactions to eggs. Medscape even writes separately that those who have hives on their eggs can get vaccinated against the flu.
Why is immunization carried out during pregnancy?
The danger threatens not only the pregnant woman, but also the fetus. Especially in the early stages, when the laying of all the tissues of the embryo and the formation of its organs and systems are just beginning. Viral intoxication (as well as medications used for treatment) has a serious impact on the child and leads to developmental pathologies. If a woman becomes infected during the last stages of pregnancy, she will most likely pass the infection on to her baby. Another problem is miscarriage or termination of pregnancy, which can provoke a severe form of the disease.
A woman who has been vaccinated will get sick much easier and without complications. Antibodies will be transferred to the child in the womb, and this will protect him not only inside, but also outside - at least 6 months after birth.
REFERENCE! According to medical data, vaccinating the mother reduces the risk of transmitting the infection to the baby by 63%.
Contraindications for vaccination in pregnant women
However, the vaccine also has a number of contraindications.
It is not recommended to do it in the first trimester.
In addition, the vaccine causes an allergic reaction in some people. But even in this case, it is recommended not to refuse vaccination, but to change the drug.
It is not recommended to do any vaccinations during the phase of exacerbation of acute chronic diseases: during this time, immunity will not be developed and vaccination will be useless.
Another contraindication is a severe allergy to chicken protein, which is included in many medications.
Introduction
The effectiveness and safety of any drug is assessed in clinical trials. It is during the study that the body’s reaction to the administration of the drug and the resulting effects, both positive and negative, are assessed. Only in clinical trials is it possible to confirm or refute the expected effect (hypothesis) obtained through theoretical research or experiments on animals or small groups of volunteers [1].
The standard for such studies is randomized controlled trials (RCTs). These studies allow the most accurate and reliable determination of the effectiveness and safety of a vaccine and/or drug [2].
RCT - randomized controlled trial.
Randomized - Participants are randomly assigned to an experimental group - where the study drug is used, and a control group - where a placebo is used. The distribution is carried out regardless of the severity of the disease, age or any other characteristics of the subjects.
Controlled - there are two groups - experimental and control - those who are compared and those with whom they are compared.
Blinding - participants and those assessing the outcome (the manifestation of changes in the participants) do not know what specific treatment is being given - whether they are receiving a drug or a placebo, so the influence of subjective opinion is minimized.
Observational studies, the majority of which, and the implementation of which seem less complex and costly than RCTs, can provide valuable information about the effect of vaccines / drugs on the human body, but due to certain limitations - the methodology of conducting, collecting information, the influence of subjective opinion and other factors - they cannot be considered as a standard [1,2]. In addition, data obtained in several observational studies may sometimes be completely inconsistent with the results of RCTs, which are much more reliable.
So, let's start the analysis.
