Pregnant? Flu Shot May Come With Some Hassle

LAURAN NEERGAARD Associated Press

Sept. 28, 2009, 10:13PM

WASHINGTON — It's hard for pregnant women to escape the message: You're at extra risk from swine flu — it could trigger premature labor, hospitalize you for weeks, even kill you — so be among the first in line for the vaccine next month. But only about one in seven pregnant women gets a flu shot each winter.

While health officials are working hard to raise that number, repeated swine flu warnings won't overcome a key obstacle: Many obstetricians don't vaccinate. And not only are women reluctant to hunt for flu shots elsewhere, historically some pharmacists and others have been wary of vaccinating them.

“Maybe this year we can change that culture,” says Dr. Anne Schuchat of the Centers for Disease Control and Prevention. “It's not supposed to happen that you, when you are pregnant, are fighting for your life on a respirator.”

Pregnant women make up 6 percent of H1N1-confirmed deaths even though they account for only 1 percent of the population, according to the CDC. They're at least four times as likely to be hospitalized as other flu sufferers.

Vaccine is a two-for-one deal during pregnancy: It can protect not just mom but the baby, too, for the first few months after birth. That's important because flu can easily kill newborns, yet babies can't be vaccinated until they're 6 months old. 

The American College of Obstetricians and Gynecologists has no count of how many OBs offer flu vaccine, though it's still considered a minority. An extra complication: Each state's health department will decide who offers the H1N1 vaccine, aiming for locations that vaccinate the most people. Those decisions haven't been made public yet. Even if your OB requested shots, he or she may not get any, at least from initial shipments. So the CDC and ACOG are urging OBs to partner with a hospital or drugstore to guarantee their patients a shot, a message the government will reiterate Tuesday in a swine flu seminar for OBs nationwide.

Yet providers who don't routinely treat pregnant women may not understand flu's risk and the shot's safety record, says Dr. Neil Silverman of the University of California, Los Angeles. Take pharmacists, expected to be key vaccinators. Silverman gets phone calls from women who say a pharmacist won't fill a flu-shot prescription. For every patient who calls, “I know there are at least two who just say, ‘Well, OK, I'm not going to do this,' and just walk away.”

The American Pharmacists Association is urging its members to follow the CDC's pregnancy guidelines, but a few stores may still balk, says association chief of staff Mitchel Rothholz.

Avoiding Swine Flu - Precautions If You're Pregnant

By Leah Chernikoff
DAILY NEWS STAFF WRITER

Daily News - Health

Wednesday, August 26th 2009, 2:54 AM

Children and the elderly are at "high risk" of serious complications from swine flu. But pregnant women are among the most vulnerable.

"We don't know the full epidemiology of swine flu because it's so new, but the small literature we do have seems to point to pregnant women as disproportionately affected by the virus," says Dr. Cynthia Gyamfi, assistant clinical professor of obstetrics and gynecology at Columbia University Medical Center.

The first swine-flu fatality in the U.S., on May 5, was a pregnant woman, Judy Trunnell, 33, of Texas.

"As the uterus grows during pregnancy, it compresses the diaphragm and the area where the lungs are, and there is less air movement in lungs, so any type of infection can fester longer when you're pregnant," says Gyamfi, who specializes in high-risk obstetrics.

With the President's Council of Advisers on Science and Technology predicting the resurgence of swine flu could kill as many as 90,000 Americans, mommies-to-be need to be extra-vigilant about the coming flu season, according to New York's top baby docs:

1. "Wash your hands, wash your hands, wash your hands," says Dr. Amos Grunebaum, director of obstetrics at New York-Presbyterian/Weill Cornell Medical Center. "We're all on top of each other in New York - that's how our patients got pregnant in the first place. We're on the subway, the bus, everything is crowded, and that increases your risk of becoming infected." Grunebaum recommends taking in the fresh air in Central Park and some loops around the reservoir in lieu of unnecessary trips undergound.

2. If you have a fever or think you have any symptoms, call your doctor and get treated immediately with antivirals like Tamiflu and the flu vaccine. "Mothers should keep in mind that there will be two vaccines for the next flu season - one for swine flu specifically, and one for the strain of flu that we think will be the most common. They should get both vaccines," says Gyamfi. And time is of the essence. "If mothers develop any flu-like symptoms - cough, sore throat, runny nose or fever - they should get treated with Tamiflu immediately, because it's most effective when started within 24 to 48 hours after symptoms begin," adds Grunebaum.

3. Avoid sick people. If a pregnant women is even exposed to someone who has H1N1, Grunebaum recommends taking a prophylactic dose of Tamiflu without waiting for culture results. If you are sick, Gyamfi advises determining your temperature before you take Tylenol to treat it, so you can get a sense of how sick you are and tell your doctor.

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