AAFP, Others Reiterate Need for Pregnant Women to Be Immunized Against Flu

Letter to Physicians Stresses Safety, Benefits of Vaccinations

By David Mitchell
Posted: 10/23/2009, 10:30 a.m.

The AAFP is again joining with other medical and public health organizations in an effort to emphasize the need for pregnant women to be vaccinated against novel influenza A (H1N1) and the seasonal flu.

The Academy; the American College of Obstetricians and Gynecologists, or ACOG; the AMA; and the CDC have issued a joint letter (2-page PDF; About PDFs) asking physicians to urge their pregnant patients to get vaccinated.

According to the CDC, pregnant women account for about 1 percent of the U.S. population, but they represent 6 percent of confirmed H1N1 cases. As of Aug. 21, 28 pregnant women had died from the novel virus, said the agency.

"What we've seen so far is that pregnant women are particularly at risk," said AAFP President Lori Heim, M.D., of Vass, N.C. "That's why the emphasis is on getting information out to pregnant women so they understand their risk status and to help them understand about the safety of the vaccines. There is a lot of misinformation and unnecessary fear about the vaccines."

This is the second time in recent weeks that AAFP has joined other national organizations in an attempt to raise awareness about the risks of influenza during pregnancy and the protection offered by immunizations. In September, the Academy and seven other national organizations with an interest in maternal and infant health issued a joint statement urging pregnant women to be vaccinated against the seasonal flu and H1N1.

The CDC's Advisory Committee on Immunization Practices, or ACIP, had previously determined that pregnant women are one of the at-risk groups that should be considered a high priority for immunization -- especially if the supply of H1N1 vaccine was limited. The ACIP has recommended that pregnant women receive the inactivated formulations of both the H1N1 and seasonal flu vaccines.

Pregnant women, however, have the lowest rates of coverage among adult populations recommended to receive influenza vaccinations, according to the CDC.

"We really need to counter the fear with the facts," Heim said. "This is how pregnant women can protect themselves and their babies."

The letter from AAFP, ACOG, AMA and CDC stresses the safety of the flu vaccines, pointing out that:

both seasonal flu and H1N1 vaccine can be given during any trimester and can be given at the same office visit in different arms;
although pregnant women should receive the inactivated vaccines as an injection and not the live attenuated vaccine in spray form, postpartum women can receive either form of the vaccine even if they are breastfeeding; and
despite a lack of evidence that the preservative thimerosal causes harm to mothers or their infants, single-dose, preservative-free units of the vaccines are available.

Results from H1N1 vaccine clinical trials involving pregnant women have not yet been released. However, Jesse Goodman, M.D., the FDA's acting chief scientist, said during an Oct. 16 media briefing that there is a long, excellent safety track record with pregnant women receiving seasonal flu vaccine, and the new H1N1 vaccine is being manufactured using the same process.

Anne Schuchat, M.D., director of the CDC's National Center for Immunization and Respiratory Diseases, said during the same media briefing that the risk for complications from flu during pregnancy has been striking.

"I think that if I were pregnant, I would not wait for the results of those trials if there was injectable vaccine available to me," she said.

In addition to mothers, other caregivers and close contacts of infants are recommended to receive the flu vaccinations.

The joint letter also reminds physicians that health care workers should receive vaccinations against both H1N1 and seasonal flu to protect themselves and their patients.

Physicians interested in providing the H1N1 vaccine should contact their state or local health departments.