Is it OK for my wife to get a flu vaccine in the first trimester?

[rocketdodger]

We found a clinic that offers Thimerosal-free vaccines, but she is less than 5 weeks pregnant and we see all sorts of conflicting information online about how safe it is for the fetus at this early stage to have any vaccines at all.

Her doctor strongly recommends it, but there are also testimonials I have seen strongly recommending you wait until the second trimester.

Anyone have pertinent information and/or recommend one course of action over another? I value the knowledge here more than almost any other source on the internet, hence this thread.

Note that I haven't done much research myself yet, I wanted to throw this out there in the meantime.

 

[I Ratant]

Any medical advice you get from a non-medical forum is worth what you paid for it.
Nothing.
Your doctor is your source.

 

[Antiquehunter]

From quick looking around:

"Pregnant women are considered to be in the high-risk group of those most vulnerable to getting the flu and are strongly urged to get a flu shot, especially if you have an increased risk of pregnancy complications due to a medical condition. While some doctors may avoid administering a vaccine to a woman who is very early in her first trimester, it is generally thought to be safe to receive the vaccine at any point during pregnancy."

 

[JJM 777]

In Finland the state pays a free flu vaccine to "risk groups" (whose immunity is compromised), which include pregnant women, anyone over 65 years of age, and babies aged 6 to 35 months.

So I guess it is at least permissible, if not indeed recommendable.

http://www.thl.fi/en_US/web/en/ah1n1/generalinformation/swinefluvaccination/pregnantwomen
But:
http://www.gezondheidsraad.nl/sites/default/files/summary201014.pdf

 

[Bob001]

The CDC's flu shot page:

http://www.cdc.gov/flu/protect/keyfacts.htm

Note that pregnant women are among the groups that they especially recommend should get a shot.

 

[Capsid]

The antibodies your wife makes to the vaccine will also have benefit to the foetus and for the first 6 months after birth.

 

[rocketdodger]

Any medical advice you get from a non-medical forum is worth what you paid for it.
Nothing.
Your doctor is your source.

I put more stock in the opinions of certain posters here than any other forum on the internet. I've been here for over 5 years, I know who to ignore

 

[Bram Kaandorp]

My alarm bells went off when I read "thimerosal-free".

My question is "WHY?"

What's so wrong about thimerosal that you don't want to have it in a vaccine?

It doesn't cause autism, so that's not it.

And even if it does cause autism in 1/100 of all vaccinated children (in this case it isn't even the child itself that's vaccinated), that sounds seriously better that the death rates associated with not vaccinating.

I should know, I have autism, and I don't hate life.

But since it doesn't, what is your problem with it?

ETA: I didn't take into account allergic reactions to thimerosal. Sorry for that.

 

[rocketdodger]

My alarm bells went off when I read "thimerosal-free".

My question is "WHY?"

What's so wrong about thimerosal that you don't want to have it in a vaccine?

It doesn't cause autism, so that's not it.

And even if it does cause autism in 1/100 of all vaccinated children (in this case it isn't even the child itself that's vaccinated), that sounds seriously better that the death rates associated with not vaccinating.

I should know, I have autism, and I don't hate life.

But since it doesn't, what is your problem with it?

ETA: I didn't take into account allergic reactions to thimerosal. Sorry for that.

Why would you eat fresh fruit instead of buying a can at the store?

Because there is no reason to get a can unless you are 1) poor or 2) there is no fresh fruit left.

We found a clinic nearby that offers thimerosal-free shots so why not get those instead? We can pay for them. Why not?

 

[Bram Kaandorp]

Why would you eat fresh fruit instead of buying a can at the store?

Because there is no reason to get a can unless you are 1) poor or 2) there is no fresh fruit left.

We found a clinic nearby that offers thimerosal-free shots so why not get those instead? We can pay for them. Why not?

Well, if it's a question of distance, that's great. I mean, why travel far and wide for a vaccine if you can get it nearby?

Good choice.

Then again, what's the relevance of the "thimerosal-free" part? If it's purely distance, then thimerosal isn't part of the equation, is it?

 

[Skeptic Ginger]

Any medical advice you get from a non-medical forum is worth what you paid for it.
Nothing.
Your doctor is your source.

Nonsense! Why is advice from one's doctor any more reliable? Are we all liars? Have you not come to know anyone posting here?

The best advice is that backed up with reliable sources and frankly, as much respect as I have for my own physician's knowledge, I don't consider him infallible and when it matters I do my own research.

That annoyance with a short sighted statement about accepting knowledge from an authority, not a sign of perfect critical thinking, out of the way, here's an informed recommendation, rocketdodger:

The source of best advice is the Advisory Committee for Immunization Practices in the US or any similar public health advisory source from other countries that have such sources.

Here's a summary of the recommendation:

If flu season is in progress, yes, absolutely, the flu poses serious risk to pregnant women.

If flu season is not in progress and you have time to wait for the second semester, then wait, but the reason is not risk, it is prudence. There is an estimated 10-15%, give or take, of pregnancies that end in spontaneous miscarriages in the first trimester. When that occurs a woman who had a flu vaccine might always wonder if the vaccine caused it even though the evidence is that it would have been an unlikely cause.

Risk

Influenza-related excess deaths among pregnant women were reported during the pandemics of 1918--1919, 1957--1958, and 2009--2010 (48,101--106). Severe infections among postpartum women (those delivered within the previous 2 weeks) also were observed in the 2009--10 pandemic (48,107,108). Case reports and several epidemiologic studies also indicate that pregnancy increases the risk for seasonal influenza complications for the mother (109--114). The majority of studies that have attempted to assess the effect of influenza on pregnant women have measured changes in excess hospitalizations for respiratory illness during influenza season but not laboratory-confirmed influenza hospitalizations. Pregnant women have an increased number of medical visits for respiratory illnesses during influenza season compared with nonpregnant women (115). Hospitalized pregnant women with respiratory illness during influenza season have increased lengths of stay compared with hospitalized pregnant women without respiratory illness. Rates of hospitalization for respiratory illness were twice as common during influenza season (116). A retrospective cohort study of approximately 134,000 pregnant women conducted in Nova Scotia during 1990--2002 compared medical record data for pregnant women to data from the same women during the year before pregnancy. Among pregnant women, 0.4% were hospitalized, and 25% visited a clinician during pregnancy for a respiratory illness. The rate of third-trimester hospital admissions during the influenza season was five times higher than the rate during the influenza season in the year before pregnancy and more than twice as high as the rate during the noninfluenza season. An excess of 1,210 hospital admissions in the third trimester per 100,000 pregnant women with comorbidities and of 68 admissions per 100,000 women without comorbidities was reported (117). In one study, pregnant women with hospitalizations for respiratory symptoms did not have an increase in adverse perinatal outcomes or delivery complications (118); another study indicated an increase in delivery complications, including fetal distress, preterm labor, and cesarean delivery. However, infants born to women with laboratory-confirmed influenza during pregnancy do not have higher rates of low birth weight, congenital abnormalities, or lower Apgar scores compared with infants born to uninfected women (109,119).

In a case series conducted during the 2009 H1N1 pandemic, 56 deaths were reported among 280 women admitted to intensive care units (120). Among the deaths, 36 (64%) occurred in the third trimester. Pregnant women who received treatment >4 days after symptom onset were more likely than those treated within 2 days after symptom onset to be admitted to an intensive care unit (57% and 9%, respectively; relative risk [RR]: 6.0; 95% CI = 3.5--10.6) (120)....

...Persons at Risk for Medical Complications
Vaccination to prevent influenza is particularly important for persons who are at increased risk for severe complications from influenza or at higher risk for influenza-related outpatient, ED, or hospital visits. When vaccine supply is limited, vaccination efforts should focus on delivering vaccination to the following persons:...
women who are or will be pregnant during the influenza season;

Vaccine Risk

Pregnant Women and Neonates
FDA has classified TIV as a "Pregnancy Category C" medication, indicating that adequate animal reproduction studies have not been conducted. Available data do not indicate that influenza vaccine causes fetal harm when administered to a pregnant woman. One study of approximately 2,000 pregnant women who received TIV during pregnancy demonstrated no adverse fetal effects and no adverse effects during infancy or early childhood (258). A matched case-control study of 252 pregnant women who received TIV within the 6 months before delivery determined no adverse events after vaccination among pregnant women and no difference in pregnancy outcomes compared with 826 pregnant women who were not vaccinated (212). During 2000--2003, an estimated 2 million pregnant women were vaccinated, and only 20 adverse events among women who received TIV were reported to VAERS during this time, including nine injection-site reactions and eight systemic reactions (e.g., fever, headache, and myalgias). In addition, three miscarriages were reported, but these were not known to be related causally to vaccination (259). Similar results have been reported in certain smaller studies (211,213,260), and a recent international review of data on the safety of TIV concluded that no evidence exists to suggest harm to the fetus (261). The rate of adverse events associated with TIV was similar to the rate of adverse events among pregnant women who received pneumococcal polysaccharide vaccine in one small randomized controlled trial in Bangladesh, and no severe adverse events were reported in any study group (217)....

...The U.S. vaccine supply for infants and pregnant women is in a period of transition as manufacturers expand the availability of thimerosal-reduced or thimerosal-free vaccine to reduce the cumulative exposure of infants to mercury. Other environmental sources of mercury exposure are more difficult or impossible to avoid or eliminate (319). The benefits of influenza vaccination for all recommended groups, including pregnant women and young children, outweigh concerns on the basis of a theoretic risk from thimerosal exposure through vaccination. The risks for severe illness from influenza virus infection are elevated among both young children and pregnant women, and vaccination has been demonstrated to reduce the risk for severe influenza illness and subsequent medical complications. In contrast, no harm from exposure to vaccine containing thimerosal preservative has been demonstrated. For these reasons, persons recommended to receive TIV may receive any age- and risk factor--appropriate vaccine preparation, depending on availability. An analysis of VAERS reports identified no difference in the safety profile of preservative-containing compared with preservative-free TIV vaccines in infants aged 6--23 months (251).

Recommendation:

Pregnant and Postpartum Women
Vaccination of pregnant women protects women and newborns. The American College of Obstetricians and Gynecologists and the American Academy of Family Physicians also have previously recommended routine vaccination of all pregnant women (469). Women who are postpartum are also at risk for influenza complications and should be vaccinated (108). No preference is indicated for use of TIV that does not contain thimerosal as a preservative (see Vaccine Preservative [Thimerosal] in Multidose Vials of TIV) for any group recommended for vaccination, including pregnant and postpartum women. LAIV is not licensed for use in pregnant women, but postpartum women can receive LAIV or TIV. Pregnant and postpartum women do not need to avoid contact with persons recently vaccinated with LAIV.

Prevention and Control of Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2011 update but there are no changes for pregnant women per se

Recommendations for Vaccination

Routine annual influenza vaccination is recommended for all persons aged ≥6 months (1). To permit time for production of protective antibody levels (4,5), vaccination should optimally occur before onset of influenza activity in the community, and providers should offer vaccination as soon as vaccine is available. Vaccination also should continue to be offered throughout the influenza season.

Although influenza vaccine strains for the 2011--12 season are unchanged from those of 2010--11, annual vaccination is recommended even for those who received the vaccine for the previous season. Although in one study of children vaccinated against A/Hong Kong/68 (H3N2) virus, vaccine efficacy remained high against this strain 3 years later, the estimated efficacy of vaccine decreased over the seasons studied (6). Moreover, several studies have demonstrated that postvaccination antibody titers decline over the course of a year (7--10). Thus, annual vaccination is recommended for optimal protection against influenza.

Currently in the US there are sporadic cases of influenza in a few states. Activity is still low. Whichever country one is in, you can usually find current influenza surveillance reports for that area. Best to check for local data.

 

[Skeptic Ginger]

From quick looking around:

"Pregnant women are considered to be in the high-risk group of those most vulnerable to getting the flu and are strongly urged to get a flu shot, especially if you have an increased risk of pregnancy complications due to a medical condition. While some doctors may avoid administering a vaccine to a woman who is very early in her first trimester, it is generally thought to be safe to receive the vaccine at any point during pregnancy."

Valid advice.

 

[Skeptic Ginger]

The CDC's flu shot page:

http://www.cdc.gov/flu/protect/keyfacts.htm

Note that pregnant women are among the groups that they especially recommend should get a shot.

Another good source.

 

[Skeptic Ginger]

My alarm bells went off when I read "thimerosal-free".

My question is "WHY?"

What's so wrong about thimerosal that you don't want to have it in a vaccine?

It doesn't cause autism, so that's not it.

And even if it does cause autism in 1/100 of all vaccinated children (in this case it isn't even the child itself that's vaccinated), that sounds seriously better that the death rates associated with not vaccinating.

I should know, I have autism, and I don't hate life.

But since it doesn't, what is your problem with it?

ETA: I didn't take into account allergic reactions to thimerosal. Sorry for that.

In 20 years of giving thousands of vaccinations a year I've come across one person who reacted to thimerosal. Just an FYI.

The rationale for taking thimerosal out of pediatric vaccines was that with the addition of more and more vaccines to the pediatric regimens, in the first few months of life the mercury dose could exceed recommended daily limits on single days multiple vaccines were given to the tiniest kids. No harm was detected. Removing the thimerosal was a rational thing to do.

But concern about the amount of thimerosal in any single vaccine is not something based on rational decision making.

 

[Skeptic Ginger]

Why would you eat fresh fruit instead of buying a can at the store?

Because there is no reason to get a can unless you are 1) poor or 2) there is no fresh fruit left.

We found a clinic nearby that offers thimerosal-free shots so why not get those instead? We can pay for them. Why not?

For a pregnant woman, it is a rational decision under the circumstances you describe. I've been there. You worry about everything. Peace of mind is a valid reason sometimes.


BTW, Happy Birthday and congrats on your new family addition. Hope all goes well and we see some new pictures in the baby thread soon.

 

[rocketdodger]

Thanks for the replies everyone.

Especially Ginger -- I specifically had you in mind when I made this thread

 

[rocketdodger]

For a pregnant woman, it is a rational decision under the circumstances you describe. I've been there. You worry about everything. Peace of mind is a valid reason sometimes.

Exactly.

BTW, Happy Birthday and congrats on your new family addition. Hope all goes well and we see some new pictures in the baby thread soon.

Thanks, still some hurdles to overcome though! *crosses fingers*

 

[rocketdodger]

Then again, what's the relevance of the "thimerosal-free" part? If it's purely distance, then thimerosal isn't part of the equation, is it?

I would just rather not worry about it, that's all.

I understand there is no statistically valid evidence that there is anything wrong with it, but the logical fact is that it is still *extra* stuff added to something that is going inside one's body.

If possible, why not avoid injecting *extra* stuff if it has no benefit? Especially when the context is something as emotionally charged as this?

Note that this argument falls flat if there is something *else* added to other vaccines in place of thimerosal ....

 

[Bram Kaandorp]

I would just rather not worry about it, that's all.

I understand there is no statistically valid evidence that there is anything wrong with it, but the logical fact is that it is still *extra* stuff added to something that is going inside one's body.

If possible, why not avoid injecting *extra* stuff if it has no benefit? Especially when the context is something as emotionally charged as this?

I am not aware that thimerosal has no benefit.

But you're absolutely right about one thing. There's no sense in worrying about something if you can do without.

As long as it really has no benefit, and as long as the vaccine is just as good, power to you for making the decision.

 

[Skeptic Ginger]

You're welcome Rocket. And thanks, I'm flattered.