Charleston Birth Place

2009 Influenza A H1N1 (Swine flu)

Weighing the Risks and Benefits:

Nothing in life is without risks. Like everything we do one must look at risk vs benefit before acting on anything including preventative medical interventions. What is difficult is getting accurate information to make a decision. What is different about H1N1 is it is much more infectious from human to human than the traditional seasonal flu and has a higher than anticipated mortality rate in certain populations. Some of the fatalities have occurred in otherwise healthy, young people. This virus will either make you mildly ill (most likely) or replicate quickly and will go from first symptom to death in just a matter of days (not likely). Pregnant women are among the higher than anticipated deaths.

Risks associated with getting H1N1 vaccine: serious reaction (not likely), not getting enough immunity to prevent H1N1(not likely), not getting as strong immunity than natural occurring immunity (likely).  There has also been concern regarding exposure to a minute amount of mercury in thimerosal (0.01%) a preservative used in multi dose vials to prevent accidental exposure to bacteria, fungus, or virus( see safety of the vaccine below). You can get a single dose vaccine that is thimerosal free but it is much harder to find. By far the highest risk of getting the vaccine is driving to the clinic and getting in a car accident.

Risk of not getting the H1N1 vaccine: contracting the virus and having a mild illness (very likely); being ill is not fun and you will miss work, etc... Contracting the virus and getting a life threatening illness (not likely but higher if pregnant, immunocompromised or under age 25). Pregnant women with the flu have an increased risk of giving birth prematurely. You could also spread the illness to a friend or family member that is in the higher risk group. Young babies under 6 months are at a much higher risk than most everyone from contracting a life threatening illness from this virus. Pregnant women who get the vaccine will pass the antibodies to the baby via the placenta and breast milk. Babies are not likely to get the virus if the other members of the family do not get it

Don't believe all the propaganda you hear and read. The media and people on both sides of this issue are guilty of scare tactics. Becoming overly anxious and stressed about the H1N1 flu is not healthy for you or your baby. Remember the chances of you developing a life threatening complication to you or your baby from the flu is low. 

Safety of the Vaccine:

Both the seasonal flu vaccine and the H1N1 vaccine are pregnancy cat B or C which means they are not contraindicated for use in pregnancy when there is a benefit to the mother and or baby. Most medications we routinely use in pregnancy are either pregnancy cat B or C. Many health organizations recommend both the seasonal and H1N1 vaccine in pregnant and new moms including, the American Medical Association (AMA), the Centers for Disease Control (CDC), the Federal Drug Administration (FDA), the American College of Family Physicians (ACFP), the American College of Obstetricians and Gynecologists (ACOG), the American College of Nurse Midwives (ACNM), the Association of Women's Health, Obstetrical, and Neonatal Nurses (AWHON), the March of Dimes, and the World Health Organization (WHO). The H1N1 injectable vaccine is an inactivated vaccine. The nasal spray (Flumist) is not an inactivated virus and is not recommended for use in pregnancy. Post partum and breastfeeding moms can receive either the injectable vaccine or the nasal spray. Studies of several thousand pregnant women in the scientific literature have shown that inactivated seasonal influenza vaccines are safe during pregnancy.  They have shown no evidence for harm to pregnant women, the pregnancy or to newborns of vaccinated women.  In addition, FDA and CDC’s routine monitoring of adverse events has not raised safety concerns. The FDA-approved H1N1 vaccines are made in the same licensed facilities and with the same manufacturing processes used to safely produce hundreds of millions of doses of seasonal influenza vaccine every year. In addition, before they can be used, all H1N1 vaccines must undergo the same rigorous FDA manufacturing oversight, product quality testing and lot release procedures that apply to seasonal influenza vaccines. Because of the scientific information in the literature, the fact that FDA-licensed manufacturers are producing the H1N1 vaccine following the same processes as for their seasonal influenza vaccines, and FDA-oversight of manufacturing, product quality testing and lot release procedures, FDA has a high degree of assurance of the safety of both seasonal and H1N1 vaccines for pregnant women. Potential side effects of the H1N vaccines are expected to be similar to those of seasonal influenza vaccines. The most common side effect is soreness at the injection site. Other side effects may include mild fever, body aches, and fatigue for a few days after the inoculation.  As with any medical product, unexpected or rare serious adverse events may occur. The H1N1 inactivated (flu-shot) vaccines that have been licensed are available in both single dose and multi-dose preparations.  Multi-dose preparations are formulated with thimerosal, a mercury-containing preservative used to ensure that the vaccine does not become contaminated after the vial has been opened.  Single dose preparations contain no thimerosal, or only trace amounts.  Studies have shown that there is no known harm from thimerosal preservative-containing vaccines. In 1999, FDA conducted a review of thimerosal in childhood vaccines and found no evidence of harm from the use of thimerosal as a vaccine preservative, other than local hypersensitivity reactions.  The Institute of Medicine’s Immunization Safety Review Committee reached a similar conclusion in 2001, based on a review of available data, and again in 2004, after reviewing studies performed after its 2001 report.  Since then, additional studies have been published confirming these findings.  Thus, pregnant women may receive either preservative-free or thimerosal preservative-containing influenza vaccine.  All influenza vaccines continue to be produced using eggs.  For this reason, a previous history of severe, life threatening allergies to eggs are a contraindication to the use of influenza vaccine.

Who should get the H1N1 vaccine?

It is recommended all persons get the seasonal flu vaccine. The H1N1 vaccine is recommended for pregnant women, people who live with or care for children younger than 6 months of age, healthcare and emergency medical services personnel, persons between the ages of 6 months and 24 years old, and people ages of 25 through 64 years of age who are at higher risk for 2009 H1N1 because of chronic health disorders or compromised immune systems.

Where can I get the flu vaccine?

You can call DHEC to schedule an appointment at your local health clinic at 843-953-0090. They have a very limited amount of the thimerosal free vaccines. Our OB/GYN physician Dr. Martin also has vaccines available to our clients but they are NOT thimerosal free you can call his office at 843-572-7123 to schedule an appointment.

How to protect yourself and your family from exposure to the flu:

As always a healthy diet and exercise will improve your overall health and increase your body's natural defense mechanisms. Hand washing is the most important of all preventative measures, when hand washing is unavailable use hand sanitizers. Avoid crowded places and persons who are ill. Cover your cough or sneeze with a tissue or with the crook of your arm and teach others to do so. If you are ill stay home so you can rest and recover and you do not infect others.

What are the flu symptoms and what should you do if you think you have the flu:

As of October 2009, 98% of persons with confirmed cases of flu (influenza A) are the H1N1 strain.  The symptoms of the H1N1 flu are the same as the seasonal flu: fever > 100.4, cough, headache, body aches, and sometimes nasal congestion, vomiting, and diarrhea. If you have symptoms of the flu we recommend you contact the birth center immediately. Antiviral medications such as Tamiflu can be used in pregnancy (pregnancy category C) to reduce the likely hood of developing a life threatening complication to you or your baby but need to be started within 48 hours of developing symptoms.