ATLANTA (WOMENSENEWS)–When obstetrician Stuart Pancer advises his pregnant patients to get the H1N1 shot, he’s unusually persuasive.
"I tell my patients that I’ve seen a woman die from this and I haven’t seen very many women die," said Pancer, who has been a specialist in reproductive health care for 14 years and practices in suburban Atlanta.
At least 28 pregnant women with H1N1, commonly known as swine flu, died last year in the United States and another 100 were admitted to an intensive care unit through Aug. 21, according to the latest Centers for Disease Control and Prevention, or CDC, figures. Pregnant women are 7.7 times more likely to die from H1N1 compared with the general population, according to an August 2009 editorial in the medical journal Lancet.
However, pregnant women who get the H1N1 vaccine get sick less often and their babies are less likely to get sick with the flu than babies whose mothers did not get a flu shot, the CDC says.
This fall, Pancer was called to DeKalb Medical Center to tend to a Kentucky woman. Twenty-four weeks pregnant, she had arrived at the emergency room in this suburban Atlanta hospital with fever and shortness of breath. She quickly deteriorated, went into intensive care and began receiving intensive, specialized care.
Pancer performed an emergency Caesarian section on the woman in the intensive care unit, delivering a 26-week-old baby. A few days later, the mother was disconnected from life support. Her baby is doing well and living with its grandmother.
"We were all in a state of shock," said Pancer, whose patient was one of at least two pregnant women who died this fall at DeKalb Medical Center from complications of H1N1 influenza. News of the deaths spurred inoculations for H1N1.
When Pancer’s office was able to get supplies of the H1N1 vaccine, he began urging all of his patients to get it, free of charge.
Some Women Refused Shot
But some women refused, either saying they’ve never been sick with the flu or they just don’t like shots.
"It’s amazing to me that a little bit of scary information can overwhelm all of the good," said Pancer. "I tell them, ‘I saw her die.’ And they still say, ‘Well, you know, I’ll be careful.’ It’s very irrational."
Doctors have always been cautious about giving any medication to pregnant women because of the risk to the still-forming fetus. But a spike in deaths and hospitalizations of pregnant women with H1N1 changed that.
"We have an increasing number of obstetricians who are vaccinating their patients or at least knowing where their patients can be vaccinated," Thomas Frieden, director of the CDC, said in a recent news conference.
The CDC doesn’t know precisely how many pregnant women have already been inoculated against H1N1, but doctors and other health officials say they think women are rolling up their sleeves at a high rate.
It’s not too late to get the shot since flu season lasts until May.
Until recently, almost all of the flu cases health officials had seen were H1N1, but seasonal flu–protected by a seasonal flu shot–is emerging, the CDC’s Frieden said in December.
Pregnant women should get the H1N1 or seasonal flu shot, not the nasal spray version of the vaccine, which is made with live, weakened flu virus and is not approved for pregnant women, the CDC says.
However, after women have given birth, the nasal spray vaccine is safe for women, even if they are nursing.
Federal health officials and the medical community are pushing the vaccine, stressing evidence that shows it’s a far safer alternative than catching the flu.
"The seasonal flu vaccine has been used for many years in millions of pregnant women and we have not seen any increased adverse events for mothers and babies," said Naomi K. Tepper, an obstetrician-gynecologist and medical officer of the CDC’s Division of Reproductive Health.
Dire Side Effects Decades Ago
Some of the wariness about the new flu shot was spurred by the dire side effects of a previous swine flu vaccine administered decades ago.
In 1976, a vaccine for another type of swine flu seemed to trigger cases of Guillain-Barre syndrome, which results in muscle weakness and sometimes permanent paralysis. But the CDC says that of several studies evaluating other flu vaccines since 1976, only one showed an association with the syndrome. That study suggested that one person out of 1 million vaccinated persons may be at risk for the syndrome as a result of a flu vaccine.
The CDC and Food and Drug Administration are closely monitoring reactions to the current vaccine. They’re looking into 3,783 adverse events out of 52 million doses, most of which weren’t serious.
The 204 serious reactions included 13 deaths, a rate that isn’t different from seasonal flu vaccines, the CDC says. Health officials are also investigating 10 cases of Guillain-Barre syndrome reported after the H1N1 vaccine, but say the deaths don’t suggest that they were due to the vaccine. They also note that about 80 to 160 cases of the syndrome are expected to occur in the United States each week, regardless of vaccination.
"So far, with millions of people having received this vaccine, there has not been an increase in adverse events or any unusual events that would suggest any concern," said Tepper.
Pancer says when he questions women who resist the vaccine he can tell their information "came from the Internet and not from a medical professional or any other reliable source."
Study Suggests Safety
Flu vaccines are safe during all three trimesters of pregnancy, suggested a study published online in the American Journal of Obstetrics and Gynecology. Researchers at Emory University, Johns Hopkins University and Cincinnati Children’s Hospital Medical Center reviewed past studies of flu vaccination during pregnancy, as well as data about disease and death from flu infection. No study showed an increased risk of complications to the pregnant women or the fetus from inactivated flu vaccination.
But data from previous pandemics and seasonal epidemics confirmed that pregnant women are at increased risk of serious complications from the flu.
"Pregnant women are at increased risk from any version of the flu, and there’s so much more flu right now than there ever has been," said Kevin Ault, a specialist in women’s reproductive health care at both Atlanta’s Grady Hospital and the Emory Clinics.
The American College of Obstetricians and Gynecologists–a membership organization for physicians who specialize in women’s reproductive health care–has made a "concerted effort to get more ob-gyns to become vaccinators," says the organization’s president Gerald F. Joseph, Jr. He said few ob-gyns offered preventive vaccinations in the past, but vaccines for the human papillomavirus, or HPV, have opened the door for doctors to be vaccinators.
The organization is surveying its membership to find out how many of their patients were willing to get the H1N1 vaccine.
About half of pregnant women and other adults with health problems that put them at greater risk for complications don’t seek medical attention when they come down with H1N1 swine flu symptoms, according to a CDC survey.
"When we’ve asked flu experts from around the country and around the world what they think will happen in the rest of this flu season, about half think they will have a lot more cases between now and May and about half think we won’t," Frieden said. "The truth is we don’t know. Only time will tell. And that’s why vaccination remains the most important thing you can do to protect yourself and your family from H1N1 influenza."
Diane Loupe is a freelance writer and mother of two in Decatur, Ga. She has an M.A. in journalism from the University of Missouri, where she was a fellow of the Science Journalism Center.