Flu Epidemic in the U.S. Vaccinate All Pregnant Women

by Tia Will

The Centers for Disease Control and Prevention (CDC) has declared a flu (influenza) epidemic in the United States. There has been antigenic drift in one of the strains of the virus seen circulating now versus the strain chosen for the vaccine. Therefore, it is extremely important for providers to promptly treat all patients with influenza-like-illness (ILI), even women who have been vaccinated. To date there have been 21 pediatric deaths and more than double the number of hospitalizations from the previous flu season. So far, among the 35 hospitalized women of childbearing age (15-44 years), 12 (34.3%) were pregnant. ACOG and CDC recommend everyone 6 months and older receive a flu shot each year. Vaccination is particularly important for pregnant women who are at higher risk of complications and severe illness from influenza. “

I realize that most of the readership of the Vanguard is not in the demographic of pregnant women. I think it is especially important for those who do not perceive personal risk to be aware of the importance of immunization to our families, neighbors, coworkers and fellow citizens.

I have heard many people stating that they do not intend to get the flu immunization this year because they have heard it is not effective because of the “antigenic drift” of this year’s most prominent type of viral influenza. While this is true, and the vaccine is less than optimally effective against the dominant strain, it is effective against the next most prevalent strain and does provide some protection against the most common strain in that those who are immunized tend to have less severe symptoms if they do contract the flu.

Even if you do not perceive that you need the flu vaccination for your own protection, I would strongly recommend that you get it for the protection of those you love including infants, pregnant women, those with respiratory illnesses and the elderly all of whom may benefit, or even have their life saved by your choice to get a flu shot.

About The Author

Tia is a graduate of UCDMC and long time resident of Davis who raised her two now adult children here. She is a local obstetrician gynecologist with special interests in preventive medicine and public health and safety. All articles and posts written by Tia are reflective only of her own opinions and are in no way a reflection of the opinions of her partners or her employer.

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  1. Miwok

    is not effective because of the “antigenic drift” of this year’s most prominent type of viral influenza. While this is true, and the vaccine is less than optimally effective against the dominant strain

    Isn’t this the logic that has rendered many antibiotics ineffective against infections? Thank you for posting this, it answered some questions for me, Doc!

  2. DavisBurns

    The last time anyone in my family got a flu shot was about 18 years ago.  I developed a lump where I got the shot that lasted many years.  Yes, it seems unlikely but it happened. I had fibromyalgia/chronic fatigue syndrome.  It got much worse. I haven’t had the flu these past 18 years.  My condition has improved in the past 6 years. My husband and one daughter have had bad colds a couple of times but no one has had the flu (unless you call a head cold the flu). My daughter and husband with genetic heart conditions don’t get flu shots for similar reasons, nor does my eldest daughter who has fibromyalgia and several other marginally functioning body systems.  No we aren’t opposed to all vaccinations. Our experience has been that we remain healthy if we don’t take flu shots. We haven’t ever been given any reasons that persuade us to take the shots.  We are only told that they are recommended.  I wonder if there is any data that shows there are individual like us that have adverse reactions and should not take them?

    1. Rich RifkinWDE 73

      Our experience has been that we remain healthy if we don’t take flu shots. We haven’t ever been given any reasons that persuade us to take the shots. 

      That “experience” is not evidence. If you have learned no reason to take the shots, and you are in one of the higher risk groups, chances are you don’t really understand what scientific evidence is. On the other hand, it is not unlikely that you are in a cohort which at low risk of dying from the flu. The public health problem is that you might spread the flu to someone who is at risk, but for other reasons cannot be vaccinated. Yet most of the risk is to your own private health, and you have to make those decisions for yourself, even if you don’t know the science. I’m sure the loved ones of the 36,000 or so Americans who do not get vaccinated and die each year from the flu wish their loved ones understood the scientific evidence.

      1. DavisBurns

        Rich, you are insufferably condescending. I know the difference between my experience and scientific evidence which is why I shared my experience–I had a large lump at the vaccination site FOR YEARS AND I MY HEALTH DECLINED DRAMATICALLY FOR SEVERAL YEARS. Not evidence, experience which may be an anomaly but I f you had the same experience, you might be disinclined to expose yourself again.

        I am, in fact, in at least one high risk group.  I’m not advocating others not get flu vaccinations.  Since I haven’t had the flu in 18 years, I haven’t put anyone at risk.  I am not in regular contact with groups that are at risk.  I am very aware that, should I get the flu, it could be more severe for me than if I had gotten vaccinated.

        I am not the only person in my immediate family who has had adverse reactions to a flu shot.  Three of us have similar chronic conditions which impact and limit our lives to varying degrees but ironically we rarely get sick.

        1. Rich RifkinWDE 73

          Davis Burns, please don’t take personal shots at me or anyone else who is a real person with a real name and a real Davisite, as long as you are posting anonymously. That is terribly condescending and rude.

          I did not mean to offend you. You clearly meant to do just that. My intent was to make clear the distinction between science and anecdote, because in your entire rundown of your family’s various ailments and reactions to having a flu shot, you did not state that there is a difference.

          All that said, I am aware that some people with some conditions (particularly allergies) are advised against taking a flu shot. But they are well less than 5% of the population, according to the CDC.

        2. Miwok

          Davis Burns, please don’t take personal shots at me or anyone else who is a real person with a real name and a real Davisite,

          Hi Rich, can you define “real Davisite? Do we have to be born here? Renting? Owning?


    2. Tia Will


      While I cannot speak to your individual case, whether or not to get a flu shot must be individualized. People who have had the extremely rare true “allergic” reaction to the shot or any of its components should of course not get it. I have counseled only one patient against it this year. She has never had the flu. More importantly with the exception of coming in for her screening exam, she lives in a distant rural community on a farm with her husband who does almost all of their shopping and other interactions with people in groups. She has no senior family members, no local grandchildren and rarely has visitors. She asked me if I thought it was “necessary” for her to get the shot. I answered honestly, “no”. For the vast majority of us who do interact with other human beings and are not allergic, my response is “yes”. A sore arm, a slight increase in temperature ( < 100.5) or a couple of days of fatigue do not compared in any way with the flu and should not be used as excuses to not take this single, potentially life saving step. While it may not be your life that you save, it may be that of the neighbor’s child, grandchild or adult family member with pulmonary disease. You may never know that you have saved a life, but it could be your action that makes the difference.  Immunizations are not only about the individual, but about the health of the community. That is the most compelling reason I can give.

      1. Frankly

        Interesting moral arguments being made here.  “Everyone should get a flu shot to prevent infecting others.”  I tend to rarely catch viruses, and when I do I rarely feel bad enough to miss any work.  I have had two flu shots in my life and both times I missed work because of flu-like symptoms that lasted for 2-3 days.  One doctor told me I must have caught another flu not in the formulary, or that I caught the flu but had milder symptoms because my immune system got a boost from the shot.  Another told me that the flu-like symptoms can vary in people… and that a minority of people will suffer similar to actually getting the flu, but would not be contagious.  An RN friend of mine suggested I had a strong allergic reaction in addition to catching the flu.  Regardless, I no longer get a flu shot.

        With a high risk family member in the house, I might… probably would.  But being told I should get a flu shot to prevent effecting others outside of my family seems very Orwellian.

        1. Tia Will


          With a high risk family member in the house, I might… probably would.  But being told I should get a flu shot to prevent effecting others outside of my family seems very Orwellian.”

          Perhaps it would not seem so to you if it were your family member whose life was saved by the neighbor who got their flu shot understanding the importance of immunization of the group for the good of the individual.

          I think it is critical for people to understand that immunization works not to just protect one individual, or individuals that they know, but that all are protected by the actions of those who choose immunization since it is the decrease in the disease in the population, not the individual, since it is this action that prevents the disease in infants, the acutely ill, and others who truly cannot receive the immunization. The refusal of those who could be immunized represents their reliance on others to protect them.

        2. Miwok

          Frankly, same for me. Once was in Basic Training when the “Swine Flu shot was killing old people, and the other after Basic at my Duty base, both times making hundreds of people sick. I questioned the nurse giving it, and asked if smaller people received smaller dosages. She said everyone gets the same.

          One small woman got very ill, to the hospital, one large guy didn’t feel it, and I was off work a few days both times. I never got a shot after that.

  3. Elizabeth Bowler

    Hopefully the specific influenza vaccine that is being recommended for pregnant women is the single dose mercury-free version rather than the multi-dose Thimerosal-containing one.

    1. Rich RifkinWDE 73

      I am not sure why you think that should be a concern. Here is a statement from the CDC website:

      The most recent and rigorous scientific research does not support the argument that thimerosal-containing vaccines are harmful. CDC and FDA continually evaluate new scientific information about the safety of vaccines.

      What pregnant women need to avoid is the nasal spray form of the vaccine.

      Here is a bit more from the CDC with regard to pregnant women and vaccination:

      Pregnant women have a higher risk for serious complications from influenza than non-pregnant women of reproductive age. Influenza vaccine will protect pregnant women, their unborn babies, and protect the baby after birth against the flu. To prevent influenza and complications in pregnant women, in 2004 the Centers for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices (ACIP) began recommending routine immunization of pregnant women with the flu shot at any stage of pregnancy. The nasal spray vaccine is not recommended for use in pregnant women. The seasonal flu shot has been given safely to millions of pregnant women over many years. Flu shots have not been shown to cause harm to pregnant women or their babies.
      Studies of several thousand pregnant women in scientific literature have assessed the safety of using the flu vaccine during pregnancy. These studies have shown no evidence of harm to pregnant women, to the unborn child (or fetus) or to newborns of vaccinated women. In fact, studies have shown that vaccinating a pregnant woman can give her baby antibodies to protect against flu for six months after they are born. In addition, the Food and Drug Administration’s (FDA) and CDC’s routine monitoring of adverse events has not raised safety concerns.


      1. Elizabeth Bowler

        Surely even common sense dictates that you don’t inject mercury, one of the most potent neurotoxins known, into a pregnant woman when there is a non-mercury alternative!

        1. Rich RifkinWDE 73

          There are some strange assumptions built into this comment, Elizabeth. First, you seem to think that the mercury in thimerosal-containing vaccines is itself harmful. But it isn’t. If it were, the CDC would say so. You then express worry about the neurotoxicity of mercury, but that is irrelevant if the mercury in  thimerosal-containing vaccines is harmless. And, based upon a great amount of scientific research, it has been found entirely harmless to human beings, including pregnant women. The CDC would surely recommend “a non-mercury alternative!” if there were any concern for pregnant women receiving  thimerosal-containing vaccines.

          On the other hand, the CDC does have a very clear directive to NOT GIVE NASAL SPRAY FLU VACCINES to pregnant women, because in that case, the science shows they can be dangerous.

        2. Elizabeth Bowler

          indeed, the brain is my particular area of medical specialty, so yes, I am concerned about neurotoxicity, especially in fetal brains – your cavalier attitude about mercury and fetal brain development is, quite frankly, shocking.  I suggest that you actually research the neurotoxicity of mercury before commenting further.



        3. Rich RifkinWDE 73

          your cavalier attitude about mercury and fetal brain development is, quite frankly, shocking.

          I am basing my opinion on what the CDC says. There is nothing cavalier in that. It is an acceptance of what the best science says. You have shown no studies or qualified authorities, accepted by the biological sciences or not, which make you believe what you do.

          If you think I have misrepresented what the CDC says, or I don’t understand what they have said, and you can point me to accepted evidence of your point of view, I am perfectly happy to be disabused. It does little good for you to call me “cavalier.” I’ll refrain from calling you names.

        4. Rich RifkinWDE 73

          FWIW, Elizabeth, the FDA also has addressed this issue here. This is what the FDA says:

          Is it safe for pregnant women to receive an influenza vaccine that contains thimerosal?
          Yes. A study of influenza vaccination examining over 2,000 pregnant women demonstrated no adverse fetal effects associated with influenza vaccine.

          I hope you don’t think the FDA and the CDC are “cavalier.” I think they follow the science.

      1. Elizabeth Bowler

        I’m glad to hear that you are doing that Tia, although I have unfortunately seen instances where the multi-dose has been used in pregnant women, which I find worrisome.

  4. ryankelly

    I get a flu shot every year without fail.  I even paid cash for it at a pharmacy when the Sutter Medical Group only bought enough vaccines for their high risk patients one year.  I have family members who suffer from asthma and elderly ones that develop pneumonia with every respiratory disease.  I do it for them, not myself.  My infecting them with the flu would be inexcusable and I take every precaution available to avoid this.   I do make sure that I am given the one dose version to avoid the mercury-based additive. Other than that, I have never had a bad reaction.

  5. Tia Will

    Just a quick update to help put the risks in perspective. Flu season is now in full swing across the country and is the incidence of the flu is climbing rapidly in California.

    Across the country the most recent death count for infants was 26 as of last Friday. Hospitalizations are running in the thousands as reported to the CDC. At the time that I wrote an article on the Ebola threat and the national and local responses, there were many posters here who did not think it the least bit “Orwellian” to impose even very tight restrictions on others who they felt were putting them at risk, even though Ebola has low transmissibility and was occurring a continent and ocean away. Yet some are unwilling to accept even a possibility of mild discomfort themselves in order to potentially save the life of another member of the community from a highly transmissible airborne disease. To me this is a clear misunderstanding of risk and risk reduction. I simply cannot believe that it is a blatant lack of caring about anyone but ones self.

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