Claire Harlin’s article titled “local doctors respond to aggressive flu season with differing views on the vaccine” (Jan. 17, 2013) suggests that there is a balanced debate over the usefulness of annual influenza vaccines in pregnancy, starting with the anti-vaccine viewpoint of Dr. Timothy Bilash. Before I address the importance of vaccination, I find it confusing that the article suggests Dr. Bilash “recently opened a women’s health practice in Solana Beach.” The first Google entry for Dr. Bilash is a Del Mar Times story from July 15, 2011 announcing “Dr. Timothy Bilash is planting his professional roots in Solana Beach” and lists the same address as the “recently opened” practice.
San Diego County has seen a rapid rise in influenza cases since the start of 2013. We are seeing both influenza A and B in our community. The Center for Disease Control (CDC) has determined this year’s influenza vaccine to be 62 percent effective in preventing influenza. This means that, though not everybody who receives the vaccine will avoid the flu, the likelihood of contracting influenza is reduced by more than half with the vaccination.
Dr. Bilash’s suggestion that influenza vaccination “with pregnant women, it doesn’t seem to make sense” puts women, their unborn children, and their family members directly in harm’s way. His suggestion runs contrary to opinions from the Infectious Disease Society of America, the CDC, and his own national specialty organization, the American College of Obstetricians and Gynecologists (ACOG). ACOG’s bulletin titled “Pregnant? Your Flu Vaccine Due Date Is Now,” (Dec. 4, 2012) recommends influenza vaccination, in part stating “An essential element of prenatal care, the flu vaccination is recommended for all pregnant women, regardless of trimester.” The ACOG President’s blog (Nov. 16, 2012) includes, “It is especially important for pregnant women to be vaccinated because they can become sick enough from the flu that it can lead to severe lung infections requiring hospitalization and preterm delivery.” Per the CDC, “Pregnant women who get the flu are at higher risk of hospitalization, and even death, than non-pregnant women.” Studies have shown the risk of premature delivery is increased in women who get influenza while pregnant.
We’re all aware that vaccinations carry some degree of risk, usually minimal and outweighed by benefit. When addressing potential risk vs. benefit for any treatment with my patients, I try to make them aware that everyday life carries real risks. Drive to the grocery store or movie theatre, and you risk injury or worse from a car accident. Go for a run and risk a fall, a sprained ankle, a head injury. Studies from the United States and Europe looking specifically at influenza vaccine safety show no unique risks for pregnant women, their fetuses, or infants. Pregnant women should not receive live, attenuated vaccine (nasal spray), which is approved only for healthy nonpregnant persons aged 2 to 49 women.
I encourage everybody to look to legitimate websites for guidance on influenza prevention and treatment, such as Mayoclinic.com, Flu.gov, and CDC.gov. We can all practice simple, effective and common-sense precautions to reduce the chances of getting or spreading the flu (as well as the myriad other viral respiratory infections in our schools and community). These measures include getting adequate sleep, eating a balanced diet, staying physically active, covering your mouth when coughing, and washing hands before eating or touching your face.
Matthew Perl, MD
Fellow, American Board of Emergency Medicine Carmel Valley Resident
Fellow, American Board of Emergency Medicine
Carmel Valley Resident