Rates of flu are skyrocketing in the U.S., with the Centers for Disease Control and Prevention tracking high rates especially in the South, Midwest, Southwest, and West.
Lost in the flurry of news stories is the startling and alarming report from the CDC in December that only about one-third of pregnant women are getting flu shots. A startling 64 percent of pregnant women had not been vaccinated against the flu, despite recommendations from the CDC, the American Academy of Pediatrics, and the American College of Obstetricians and Gynecologists.
While 98 percent of pregnant women reported visiting a doctor or other medical professional at least once before or during pregnancy, the CDC found that only about 59 percent reported receiving a recommendation for and offer of flu vaccination from a doctor or other medical professional, while 16 percent received only a recommendation for — but no offer of — the vaccine. A whopping 26 percent received neither a recommendation for nor an offer of flu vaccination.
I work for a company that develops and manages obstetric and gynecology hospitalist programs at more than 100 hospitals across the country. Our doctors have been seeing an increase in pregnant women in the emergency department. At least one flu-related death of a pregnant woman, in Tennessee, has been reported.
Pregnant women and their unborn babies are especially vulnerable to influenza and are more likely to develop serious complications from it. About one-third of cases of pneumonia are caused by respiratory viruses, the most common of which is influenza. Pneumonia and other complications increase the risk of preterm labor. Babies in utero are also at risk of complications: Pregnant women who develop the flu are more likely to give birth to children with birth defects of the brain and spine.
Flu shots not only protect mothers, but also confer passive immunity on unborn babies, providing them with antibodies against the virus in the first six months after birth.
So why aren’t more pregnant women vaccinated against the flu?
Despite efforts by the medical community to quell public health myths, there is confusion about whether these vaccines are safe for pregnant women and their babies. Despite a wide body of evidence about the safety of flu vaccines for women and their babies, misinformation about thimerosal, an ethyl-mercury-based preservative used in multidose vials to safeguard against contamination of the vial, still circulates on the internet, despite multiple studies that demonstrate no evidence of harm. In addition, thimerosol-free versions of the vaccine are readily available.
A few simple steps can help keep pregnant women safer and healthier. First, having policies in place to let patients get the flu vaccine without a new order from a physician or midwife would serve as a stopgap for missed opportunities to vaccinate, particularly for the one-quarter of pregnant women who are not informed about the flu vaccine or offered it. Quality metrics for care organizations should also consider whether obstetricians are offering and providing medically recommended vaccinations as part of their quality review for patient safety.
If a pregnant woman begins to experience symptoms of the flu, such as cough, fever, sore throat, muscle or body aches, fatigue, or headaches, which can be subtle at first, she should be seen immediately by a physician or midwife to diagnose the flu, or rule it out, as early as possible. Pregnant women with the flu will see the best resolution of their symptoms when they are able to start on antiviral medication within 48 hours of symptom onset.
Keeping pregnant women out of the main emergency department to keep them from mingling with potentially infectious patients with flu-like symptoms is also important. When a pregnant woman is sick enough to necessitate a trip to the emergency department, having a dedicated obstetric emergency department can ensure that pregnant women are seen and triaged in the best location for them and can speed the diagnosis and treatment of the flu.
These are important takeaways as we reach the peak of the flu season. In the long run, though, we must channel our concerns about the low rate of pregnant women who get vaccinated against the flu into a broader dialogue on strategies for improvement. With intent and purpose, we can increase the vaccination rate and improve care and outcomes for pregnant women and their babies, even in the height of flu season.
Mark N. Simon, M.D., is chief medical officer of Ob Hospitalist Group, the nation’s largest provider of obstetric hospitalist programs.