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Why you should recommend flu vaccine to "every single patient"

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Routinely raise the subject, especially with pregnant patients, ACOG says


OCTOBER 2010—ObGyns and other physicians who manage the care of pregnant women should routinely discuss the safety and benefits of seasonal influenza vaccination. That means raising the subject with “every single patient,” said Laura E. Riley, MD, who spoke on behalf of ACOG after a news conference sponsored by the National Foundation for Infectious Diseases (NFID) on October 7.

“That’s the job of providers, of doctors, to put it into perspective—for the patient’s sake as well as for the patient’s family,” said Dr. Riley, who is medical director of labor and delivery and director of ObGyn infectious disease at Massachusetts General Hospital in Boston.

Results of a recent consumer survey undertaken by NFID indicate that the advice of a physician strongly influences patient behavior. Among people who have already been vaccinated with the influenza vaccine or who plan to get vaccinated this season, 76% say they received a recommendation from a health-care provider; only 35% of those who do not plan to get vaccinated report receiving a recommendation from a health-care provider.

Expect flu to strike pregnant women hard

Vaccination against influenza is especially important for pregnant women, said Dr. Riley, for several reasons:

  • Mortality from influenza is five times higher among pregnant women who have not been vaccinated than it is among nonpregnant counterparts
  • Pregnant women who get the flu are more likely to be hospitalized for severe respiratory illness
  • Influenza increases the risk of preterm delivery.

If a patient is concerned about risks associated with being vaccinated against influenza, she can be reassured that benefits far outweigh any potential risks, Dr. Riley said.

“The risks of getting vaccinated in pregnancy aren’t any different than vaccination outside of pregnancy,” she said. “We’ve been giving millions of doses of seasonal flu vaccine to pregnant women for years—at least 10 years. And there’s never been any increase in concern over safety in terms of maternal disease.” The vaccine also is safe for babies, she added.

A new year, a new protocol

This year, for the first time, influenza vaccine is recommended for everyone 6 months of age and older. Infants younger than 6 months cannot be vaccinated, but they can benefit from the antibodies they receive from their vaccinated mothers (if the mothers were vaccinated during pregnancy, or if the infant is breastfeeding).

This year’s vaccine is an “all-in-one” product; patients do not need to get a separate H1N1 vaccine. The 2010 vaccine provides coverage against three strains of virus:

  • influenza B virus
  • influenza A H3N2
  • influenza A H1N1 (2009 variant).

These strains were chosen for inclusion in the vaccine because they are very similar to the viruses circulating in the United States and abroad,” said Daniel Jernigan, MD, MPH, who spoke at the news conference. Dr. Jernigan is deputy director of the influenza division at the National Center for Immunization and Respiratory Diseases at the Centers for Disease Control and Prevention.

The fact that the vaccine provides coverage so specific to what is happening in the community is “very good news,” he added. “We also know that the viruses that we’re seeing are susceptible to antiviral drugs.”


Don’t forget about pertussis

Although pertussis typically is not life-threatening in adults, adults and adolescents who have the disease can pass it to infants who have not been immunized—among whom it can be especially severe. In recent years, 91% of all deaths from pertussis have been in infants 6 months and younger. In addition, more than 50% of infants younger than 1 year who contract pertussis must be hospitalized.

For that reason, it is important that every woman be immunized with Tdap immediately postpartum if her last tetanus-diphtheria booster was more than 2 years earlier.

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