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Time to recommend and give,  rather than just “offer” flu and whooping cough vaccination in pregnancy.  

November 23, 2014

I recently attended a workshop lead by Public Health England  on the current status of flu and whooping cough vaccination. The presentation prompted me to write this blog as an exploration of how we as midwives currently provide this important health message to women.

I think we may be missing an opportunity to have an impact on both the mother and her baby’s health. I believe we may be offering women “choice” when it comes to important health interventions, when actually we should be promoting it, validating it and actively encouraging women to take up the flu and whooping cough vaccine programme.

Statistics

Women who contract influenza have an Increased risk of hospitalisations for complications during pregnancy (compared to non-pregnant)

1.7 fold in first trimester (2.9 fold higher for HR)

2.1 fold in second trimester (3.4 fold higher for HR)

5.1 fold in second trimester (7.9 fold higher for HR)

                                                                        (Public Health England 2014)

Evidence was most evident in the 2009 H1N1 influenza pandemic

There were 10 deaths in pregnant women in UK

A seven fold risk of death compared to non-pregnant women of child bearing age (RR: 7, 95% CI: 3-15)

Risk particularly high in immediate post-partum  (Public Health England 2014)

Influenza during pregnancy is also associated with:

Five fold higher risk of perinatal mortality (mainly stillbirth)

Four fold higher risk of prematurity

Increased risk of smaller neonatal size and low birth weight

                                                                                                     (Public Health England 2014)

The rate of whooping cough illness increased dramatically during 2012, however  with the provision of the whooping cough vaccine to mothers this has reduced dramatically. (Public Health England 2014)

The best way to protect children from both influenza and whooping cough i

is to vaccinate their mother when they are pregnant.

 

Uptake of vaccines in pregnancy

This is currently about 50% of the pregnant population (PHE 2014).  This means 50% are still at risk. The safety of the vaccines has been researched and researched, and there are no issues. We have been vaccinating women since 2009 without any consequences to them or their unborn child.

It is important that the flu vaccine changes for each flu vaccine season as different strains for influenza are appearing all the time.

It is important to note however and this should be shared with women, that the whooping cough vaccine actually contains 5 vaccines for whooping cough, diphtheria, polio, tetanus , and HIB(Haemophilus influenza type B family of bacteria that causes influenza and meningitis. This offers real protection for babies. It has been found to be the best way to protect newborn babies as they cannot receive the vaccine themselves until.

What can we do?

There is much more Midwives and other professionals can do to encourage, advise and ensure women have received the vaccine.

  1. There are proposals for Pharmacies to extend their vaccination programme – they already provide women with the flu vaccine on request for free. There are moves afoot to offer whooping cough too.
  2. When a woman buys a pregnancy test this is the ideal time to catch her and talk about early folic acid, eating for pregnancy, discussion of current medications they are on etc.
  3. If she is already pregnant and picking up other medications this is the ideal time to offer her the flu vaccination.
  4.  Midwives often complain about the large amount of healthy lifestyle information they have to impart to each woman at booking. I propose that we think about an early Health promotion group session early in pregnancy, possibly around 16wks.  The talk would be given to a group of women rather than individually.  This will save time at other appointments and I believe would be welcomed by midwives.

This could be the access point of flu vaccination too, either by a practice nurse, pharmacist or midwife ( if they have received training to give the vaccination).  This is the “grab ‘em while you’ve got ’em” principle of immunisation that is used in other parts of the world. To vaccinate large groups of people who are available to receive it, whilst they are there for other reasons.

Many hospitals are training staff to go out onto the wards to vaccinate staff on duty with seasonal flu vaccine, in order to ensure as many employees as possible receive the vaccine. Protecting themselves from the flu and the patients they care for.

  1. Whooping cough vaccine needs to be given between 28-32 wks gestation. Most women have an appointment at 28wks. This would be the ideal opportunity to offer, discuss and administer the vaccine. Offering it to rhesus negative women, who attend clinics for prophylactic Anti D would also be an opportunity.

These vaccines have proven to be very safe in pregnancy and offer a real opportunity to protect health.  I believe it is time for midwives as professionals to step up and to actively promote the take up of the vaccine and not just leave it to the mother’s choice. The choice if they do not accept the vaccine could be severe flu illness, or the baby contracting whooping cough as a small infant. This needs to be clear.

There is of course a chance that both mother and baby will be fine  without the mother having the vaccine.  But if we have a chance to protect them, surely as professionals we should take it. Parents are influenced by what professionals say. Advising that it is the mothers choice is too weak an argument, there is now strong evidence as to its beneficial effect.

Information on pregnancy vaccination programme  Influenza   Public Health England.

Information on whooping cough vaccination programme   Public Health England

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