H1N1 flu shots give pregnant women pause

H1N1 flu shots give pregnant women pause
Doctors will need to ease concerns about future reactions

Flu shots are never an easy sell to the pregnant women Dr. Katharine Taber sees at her Towson obstetrics practice.

These are women who worry about everything they put into their bodies, from tuna fish to coffee to pain relievers. So Taber has to explain how important it is that they get the tried-and-true seasonal flu vaccine, because a serious case of flu could be dangerous to their developing babies.

This year, Taber is working double-time on her salesmanship. Health officials have made pregnant women among the highest-priority groups to get the swine flu vaccine, which is still being tested, when it becomes available next month.

"It's tough," she said. "They're worried about the safety of the vaccine because it hasn't had a ton of testing. ... They're asking if Tylenol is OK and I'm telling them they have to get this new shot. The risk-benefit says the vaccine is safer [than getting the H1N1 virus] - take the vaccine. But they're skeptical."

That skepticism is something public health officials know they will be facing once the new vaccine is approved. Flu vaccination rates are notoriously low. Only about one in three Americans gets the seasonal flu shot, and the rates are even lower among groups at the highest risk for complications from the disease. Only one in five children younger than 2 is vaccinated, and the rate is lower among pregnant women.

Soon, doctors will have to convince expectant mothers and parents of babies and toddlers that even though they might not have gotten flu shots in the past, it is of the utmost importance to do so this year as H1N1 - a new and unpredictable virus - sweeps in with cooler weather.

Amanda Gleason is leery of having her daughter Naomi, who's nearly 2, vaccinated for swine flu because the girl is so young. Gleason thinks she protects her from germs by spending lots of time at their home in Hanover and by keeping her away from play areas at the mall, for example. And from what Gleason has seen, swine flu has been relatively mild. "Why do I want to risk Naomi getting the vaccine if [swine flu] is not as deadly as they're saying?" she said.

Experts have estimated that as many as half of Americans could come down with swine flu, up to 90,000 could die and that the number of seriously ill could overwhelm intensive-care units. In a typical year, seasonal flu kills about 36,000 people in the United States, many of them elderly, and 200,000 are hospitalized. So far, children and pregnant women appear to be disproportionately affected by the new pandemic virus, though cases generally have been mild. More than 550 people in the U.S. have died from the H1N1 virus since it emerged in April.

Officials at the federal Centers for Disease Control and Prevention, which is developing an education and outreach campaign for the swine flu vaccination rollout expected next month, know what they are up against. In June, they held focus groups with parents about getting a new shot for their school-age children.

"For the most part, we did hear a lot of hesitancy expressed around the 2009 H1N1 vaccine - concern among some of the moms about, for instance, the newness of it and the speed with which it's being developed," said Kris Sheedy, director of communications for the CDC's National Center for Immunization and Respiratory Diseases. "Some of them used the word ' guinea pig' - 'I don't want myself or my child to be a guinea pig.'

"It really did underscore the need for us to get the message out that every year, we develop new flu vaccines because the virus is ever-changing. This goes on every year, so essentially this 2009 H1N1 vaccine is basically a normal flu vaccine with a different strain."

For many, the point could be moot. Originally, the government hoped to have 125 million doses of vaccine available in October. Manufacturing glitches lowered the estimate to about 45 million. There could be shortages, and rationing is expected, as the highest-risk people will be at the front of the line.

If enough vaccine is available, Taber and Sheedy said, they will get H1N1 shots for themselves and their young children.

Several academic medical centers, including the University of Maryland and the Johns Hopkins Bloomberg School of Public Health, are testing the safety of the new vaccine. While the results are not yet in, many doctors say they are confident that if the vaccine is approved, there is no reason to worry about getting it.

That reassurance isn't enough for some. Laurie Harris of Reisterstown doesn't know yet what she will do. The stay-at-home mom has a 5-year-old son, with a second child due in January. She is uncomfortable with the idea of putting something unknown into her body and that of her kindergartner. "I'm scared of all vaccines," she said. But Harris said that if lots of people start coming down with the pandemic flu, she might change her mind. She will certainly talk to her doctor about it.

"If they thought it was best, I might do it," she said. "It would help if they said it was safe."

Her friend Monica Barnhart has never gotten a flu shot for her kids, ages 5 and 10. "I never even think about getting my kids one," she said, and neither has gotten the flu. But she says she'll consider the H1N1 vaccination. "I'd want to know the side effects," she said. "Do the benefits outweigh the risks?"

Dr. Karen L. Kotloff, who is leading a trial of the new H1N1 vaccine at the University of Maryland's Center for Vaccine Development, said the answer to that is clear. "There have been deaths in perfectly healthy children and adults," she said. "It's a very sad thing when a perfectly healthy pregnant woman dies of a vaccine-preventable disease. ... A little shot in the arm versus a visit to the ICU - that's a no-brainer."

Kotloff understands that people are wary of new vaccines that have not been widely circulated, that they fear that problems could erupt years into the future. In 1976, when there was a threat of swine flu, the government had to cut short its vaccination campaign after 10 weeks when the shot seemed to be triggering a rare side effect.

"Medical people have been a huge component who have volunteered for what we're doing - volunteering themselves and volunteering their children," Kotloff says of the 2009 version. "That says something."

"People are torn," said Dr. Elaine Lim, an obstetrician at St. Joseph Medical Center in Towson. Lim will be advising that her pregnant patients be vaccinated, based on the recommendation of her medical society, but she understands the angst. "If we don't really know much about the vaccine, it's hard to tell them it's 100 percent safe," she said. "I don't think anyone can really say for sure, because it's not really known."

The CDC's Sheedy said public opinion is starting to move in favor of getting vaccinated, with 55 percent of respondents in a recent Gallup poll saying they would do so. "Public interest in the vaccine is one of those uncertain factors," she said. "A lot of different things will impact it. It's quite possible it will change on a dime. All it will take is a couple of cases of well-publicized deaths, especially among children."

Gleason knows she is among that high-priority group. Not only does she care for her daughter Naomi, she is pregnant and due in March. And she works part time at Nighttime Pediatrics in Pasadena as a front-desk clerk, greeting coughing, sneezing, feverish patients.

Gleason figured she would get vaccinated after seeing a television news piece urging pregnant women to be vaccinated against the H1N1 virus. So when she went to see her obstetrician, she asked him about the swine flu shot. Her doctor warned her against it, saying the vaccine would contain live virus, "and the live virus is actually fatal to the fetus," Gleason recalled.

In truth, other doctors and vaccine experts said, the flu shot is not made from live virus. (The nasal spray vaccine, also being tested, is made from live virus and is not recommended for pregnant women). This is what Taber and other doctors will be up against.

"There's a lot of misinformation out there," Taber said.

Who's first in line
These are the highest priority groups recommended to receive H1N1 flu vaccine if there is a shortage:

•Pregnant women

•People who live with or care for children younger than 6 months old (babies can't be vaccinated)

•Health care workers and emergency medical personnel

•Children 6 months to 4 years old

•Children ages 5 through 18 who have chronic medical conditions

Source: Centers for Disease Control and Prevention