Fears about the impact of swine flu upon pregnant women are generating alarm and some confusion. And not only in Australia. In Britain, various health and medical sources have been giving the public conflicting advice, according to this report in the British Medical Journal.
Meanwhile, Professor Peter McIntyre, Director, National Centre for Immunisation Research and Surveillance of Vaccine-Preventable Diseases, is concerned that the focus upon swine flu and pregnancy may be distracting attention from the risks of influenza generally for pregnant women. He writes:
“Pregnant women are at risk – not just from swine influenza, as highlighted in the media in recent days, but from influenza of any kind.
“Ordinary” seasonal influenza is also still circulating. Both vaccines and antiviral drugs are important.
With respect to vaccines, influenza vaccine has been recommended by the National Health and Medical Research Council for women in pregnancy for almost 10 years – but few receive it.
This is probably related to both lack of familiarity with the whole notion of vaccines in pregnancy by practitioners caring for pregnant women, as well as reluctance on the part of many, if not most, women to receive any treatment in pregnancy, either vaccine or drug.
Therefore it is important to emphasise that there is no theoretical or data-based reason to expect any adverse effects from vaccines which do not contain live organisms in pregnancy. In partcular, influenza vaccines are safe in pregnancy. The primary rationale is to provide protection for the mother but there is accumulating evidence that some protection is probably also afforded to the baby after birth.
Once a swine influenza vaccine is available, pregnant women will be a priority risk group, something which has been emphasised by recent publicity concerning severe cases in pregnant women.
It is important to remember that vaccines for “ordinary” influenza are available now and are recommended for pregnant women, who are especially at risk in the later stages of pregnancy, and that professional and public attitudes to using influenza vaccines in pregnancy need to change now.
With respect to antiviral drugs, it is important that pregnant women see their doctor early if influenza is a possibility as anti viral treatment is most beneficial early. Pregnant women also need to see their doctor if it is possible that their children have influenza, as this may be an opportunity for even earlier treatment. Given the potential severity of influenza in pregnancy, the benefits of treatment clearly exceed the risks.
Regarding risks for Indigenous communities, we know that influenza rates generally are much higher in Indigenous children and adults, with hospitalisations for influenza and pneumonia 3.5 times higher than in non-Indigenous Australians.
The biggest difference is in 25-49 year olds, where the rates are 8 times higher. This younger adult group is the very group now coming to light with swine flu but has been evident as an important risk group in earlier data. This is reflected in the recent announcement by the Commonwealth that free influenza vaccine will be provided under the National Immunsation Program for all Indigenous adults from 15 years of age as well as for all persons from 6 months of age who have conditions placing them at increased of severe influenza.
This group at increased risk, as mentioned above, includes pregnant women. This is especially so for pregnant Indigenous women, where we know that there are high rates of respiratory and ear disease in babies very early and that mothers themselves are significantly more likely to have health problems. The increased risk relates not only to medical conditions, but to general living conditions, and other risk factors such as high rates of cigarette smoking.
Indigenous people should be a priority group for access to both antivirals and to vaccine for the swine flu, when it becomes available. For the whole community, communication about risks and benefits will be crucial.”