First and foremost, congratulations on the pregnancy! I hope the rest of your gestation goes well and you deliver a happy, healthy and flu-free newborn! Now, to answer your question about the 2009 H1N1 Influenza Type-A Virus, or as it is most commonly known “Swine Flu.” This particular strain of the Influenza Type-A Virus has been known to cause higher infection and mortality rates in persons who are most commonly known to be typically unaffected past simple uncomplicated symptoms from the seasonal flu. Thus, persons in population groups considered at higher risk for infection, disability and death with the seasonal flu can be expected to suffer prolonged illness and even more severe complications, including death, when exposed to and infected with the 2009 H1N1 Influenza Type-A Virus.
Groups and individuals that are considered at moderate to higher risk for infection, disability and death include persons who: are less then 16 or over 50 years of age, live in highly populated areas (apartments, prisons, college dormitories, institutional facilities, etc), cannot easily access healthcare or live in poor socioeconomic areas, those who are generally unable to care for themselves, have preexisting heart or lung disease, are already in some form of immunosuppression or immunocompromisation, and women in any stage of pregnancy or those who breastfeed and persons who commonly come into contact with the ill and injured (healthcare workers). Within these subsets, rates of severe infection that cause prolonged illness, chronic disability and even death are higher then those who are not able to fit into any one of those listed. Vaccination against the 2009 H1N1 Influenza Type-A Virus is strongly suggested within this group as their immune system may not be competent enough to prevent severe infection.
You asked about the safety of the 2009 H1N1 Influenza Type-A Virus in pregnancy and its safety to mother and fetus. All medications dispensed within the United States are regulated by the FDA and the USP (United States Pharmacopeia) and are tested for safety in pregnancy using an A-D & X scale. The rating of A is for drugs tested on humans that were safe during pregnancy, B indicates the same but only tested on animals, where as a rating of D and X constitute medications that should be taken only when a conditions exists where the mother may die due to illness as it may be harmful or has demonstrated to be harmful to the fetus. Currently, the 2009 H1N1 Influenza Type-A Virus Vaccination (monvalent inactivated – shot) has carries a rating of Pregnancy Safety Class A and the Live Attenuated Influenza Vaccine (LAIV – nasal spray) Class A or Class B (ask your doctor which you are getting). Those who are pregnant SHOULD NOT receive the LAIV when pregnant but can after delivery even when breastfeeding.
Every vaccination is made basically the same way. A selected virus is taken and protein (or “PARTS”) of the virus, are cultured and replicated. These “parts” are not enough to cause the symptoms or the actual infection they vaccinate against, as they are incomplete structures of a whole. These inactivated “parts” are then injected or instilled into the nasal passage (LAIV) and absorbed by the body which then produces cells that can identify (antibodies) the foreign cells (antigens) and eliminate them. Think of it in this matter, a clown (virus) just robbed a bank. As he flees bystanders (antibodies) use the physical characteristics that make him stand out (antigens) so they can identify him for the police (white blood cells). As plain and simple as that is, you immune system is quite complicated.
Any medication that could cause fetal harm or death (teratogenic or embryocidal) would be clearly labeled and marked Pregnancy Safety Class C, D or X. All vaccinations against the 2009 H1N1 Influenza Type-A Virus do not show, using the most recent and available clinical data, from the latest published reports by the Centers for Disease Control and the National Institute of Health, to cause any form or risk to an embryo or fetus in the first or later stages of pregnancy. However, women who are subsequently infected and made ill from the 2009 H1N1 Influenza Type-A Virus previous to vaccination have a higher rate or mother mortality and fetal demise then other at-risk groups. Although there is a statistically small, if not negligible, rate of possible adverse reaction to ANY vaccination, the risks of infection (illness, disability and death) from declination of vaccination may be much greater then that of an adverse reaction. You need to speak to you qualified healthcare provider well versed in pharmacology to know which is which. If your Nurse Midwife doesn’t know enough, talk to a pharmacist or family practitioner.
I hope this was enough to get you to realize it’s well worth the time and effort to get vaccinated. The low risk to your baby and protection against this proven killer is a no-brainer when you look at the data. Keep in mind we’re just now starting the actual “flu season” and this virus came up months before during the “off season.” Imagine how much worse this will be in December! Stay happy, stay aware, stay informed and stay HEALTHY!
Please contact me direct if you have any further questions.
R. Lorenzo, PMD, C-COHC, ACS, NAEMT-M
State Board of Medicine and MQA - Licensed & Practicing Paramedic since 2004; Affiliated Preceptor of Didactic & Clinical Paramedicine Education at a State Dept of Education College, SACS & CoAEMSP Accredited; Administrative Member of Regional Dept of Flight Medicine & Emergent Transfers, Tertiary Hospital; and Contracted Member for a County Fire Rescue Department, a political Division of the State.
Although formally trained as well as Licensed & Certified to practice and instruct advanced pre-hospital medicine by the State Board of Medicine to which I report and various other boards, any answers given here are for information ONLY, they are not to be used to make a diagnosis or as a treatment guideline. ALWAYS seek treatment for conditions that are emergent or symptoms that are unusual for you. Although checked, medicine is ever changing, so you should verify the accuracy of this post with a physician, since most online information isn't verified at all.