Flu jabs during pregnancy: NHS Q&A

Dr Cathy ReadDr Richard Pebody

Dr Cathy Read, flu expert at the Department of Health, and Dr Richard Pebody, influenza lead at the Health Protection Agency, answer Mumsnetters' questions about the flu jab during pregnancy, the whooping cough vaccination for pregnant women and the safety of immunisations offered by the NHS. 

Safety of vaccines | Flu jab while breastfeeding | Flu jabs and immunity | Information about immunisation

 

Q. minipie: I've had the flu jab at 30 weeks pregnant. Can you tell me more about the protection the jab will give to my baby once born - how long will it last?


A. Dr Read and Dr Pebody: The influenza vaccine is recommended for all women who are pregnant during the flu vaccination season. We know that pregnancy itself increases the risk of severe complications of flu in both mothers and their babies.

After your baby is born, he or she will have received protection from the vaccine you received during your pregnancy. Studies show that not only do babies of vaccinated mothers have raised flu antibodies but they also get less flu than babies of unvaccinated mothers. So you are protecting yourself and your baby. This protection probably lasts for the first few months, although your newborn baby may be less likely to catch flu this coming winter.

Q. Alltheflowers: My 15 month old has a neurological disorder and is due to have the flu jab for the first time. Is it really safe for children and are there any risks? I can't get the flu jab myself until end of October (I'm pregnant). Is it safe to wait until then?

A. Dr Read and Dr Pebody: If your doctor has recommended that your 15 month old should have the flu vaccine, then please go ahead and get this done. Sadly, we know that children with neurological disorders are especially vulnerable to the severe effects of flu. It is safe for children to have the flu vaccine.

If you are pregnant, you should also get the flu vaccine (and the whooping cough vaccine). At the moment there is no flu around so it is safe to wait till the end of October. However, you shouldn't delay your whooping cough vaccine if you are between 28 and 38 weeks pregnant.

Q. PrincesspumpkinshoutsBOO: I have been advised by my midwife to have a flu jab but I am only 10 weeks pregnant. Is it too early?

A. Dr Read and Dr Pebody: The influenza vaccine is recommended for all women who are pregnant (at any trimester) during the flu season in the UK. Vaccination during pregnancy will reduce the risk of a pregnant woman catching the flu and protect her baby. You need to have the vaccine at this time of the year so that you are protected against flu before it starts to circulate.

Q. Dizzyhoneybee: Although I am not pregnant, the GP has recommended that I have the flu vaccine. However, she says that I do not meet the NHS criteria for having the vaccine. Surely, if the GP recommends it then I should be able to have it on the NHS?

A. Dr Read and Dr Pebody: If you are not in one of the groups currently recommended to receive the flu vaccine then you will not be able to receive it on the NHS. Flu immunisation can be sourced privately - and a GP can recommend immunisation outside of the national guidance on clinical grounds.

 

Safety of vaccinations for pregnant women and babies

Q. owlface: How is the flu jab tested thoroughly to rule out any longer term side effects if new strains, eg swine flu, are added?

A. Dr Read and Dr Pebody: The safety of the flu vaccine has been established over many years of use and new strains are put into the vaccine almost every year. Changing the strains doesn't have an impact on the safety of the flu vaccine. There are studies of the safety of flu vaccines in pregnant women and the flu vaccine is routinely given to pregnant women in countries like the US and Canada.

Vaccine safety is monitored continuously; any potential problems would be rapidly assessed and prompt action would be taken to minimise any risks to people. Longer term onset side effects have not been reported from the flu vaccine.

Q. PedanticPanda: What kind of testing has been done on the vaccine, what were the sample sizes used and how were the studies carried out? Was it just the immediate effects on the baby that was looked at, or have long-term effects also been examined? Has the jab ever harmed a mother or baby and to what degree?

A. Dr Read and Dr Pebody: Please see the answers to the questions from owlface. There is no evidence that seasonal flu vaccines cause any long-term side effects, and no evidence of harm to pregnancy.

Q. Youmaylogout: How long do the ingredients stay in the body and what are their effects?

A. Dr Read and Dr Pebody: The different ingredients in vaccines do not stay in the body but are broken down and eliminated from the body in much the same way that other medicines are. Before this happens, they stimulate your immune system to produce antibodies that will protect you and your baby from catching flu.

Q. Mimmymouse: I had the flu and the whooping cough jabs at 37 weeks plus 5 days - in order to try to get the immunity across to the baby before delivery. The first thing that was said to me about it by a colleague was: "It'll be thalidomide all over again."

Now I can't sleep from worry that I've poisoned my baby and might have caused it pain or suffering. I'm sure this colleague was speaking from a position of uninformed, though well-intentioned stupidity (she's anti vaccinations), but scaremongering like this really hurts.

I'd love Dr Read and Dr Pebody to let us know that these jabs are thoroughly and expertly researched. Details would be welcome.

A. Dr Read and Dr Pebody: We are really sorry that you have been given this unnecessary anxiety – you haven't poisoned your baby or caused it pain or suffering.

Published studies involving 1,000s of women have been undertaken to assess the safety of the influenza vaccine given in pregnancy. There is no evidence of harm, and there are very clear benefits in protecting you and your baby against the serious complications of flu. It is now common practice in many countries to give the flu vaccination during pregnancy.

The whooping cough vaccine is being offered to pregnant women as a response to the current outbreak of whooping cough amongst infants less than two months old. It has been introduced to protect young infants who are too young to be vaccinated themselves, but are at particularly high risk of complications and hospitalisation from whooping cough. You can find a pdf Q&A on whooping cough vaccine for pregnant women on the Department of Health website.

Q. Growyourown77: Does the flu jab mean flu (if those strains) will be avoided or just that serious risks are minimised? Do you feel flu-y from the jab on the day? I'd like to know about the whooping cough jab, too. It hasn't been mentioned by my midwife.



A. Dr Read and Dr Pebody: The flu vaccine can either completely protect you from flu or make it less severe – it depends a bit on how well the vaccine matches the strains of flu that are circulating. Although it can give you a sore arm or even a mild temperature on the day of the vaccination or the day after, it can't give you flu.

Vaccination against whooping cough is now being recommended for pregnant women between weeks 28 to 38 of pregnancy (the optimal time is between weeks 28 and 32). This is a temporary programme introduced to protect babies against whooping cough in the two months before they have their first vaccinations. This recommendation has been made because of a large rise in whooping cough cases in young babies. Sadly there have been ten babies who have died from whooping cough so far this year.

Q. Shriek: Isn't mercury extremely harmful? Apparently, there are "....25 micrograms in one average flu vaccine, and the EPA safety limit is 5mcg". I think its important to have robust scientific evidence stating that there are absolutely no dangers to injecting mercury into your bloodstream before even considering such a step.

I wonder if people really are aware of the implications for themselves and their babies, and if the NHS have such data and is ready to review it publicly? Is it OK to inject heavy metals into us/babies/children? Can we have independent knowledge, rather than information from anyone with a vested interested (like pharmacy giants who are fighting hard to convince the public that the NHS must spend its vital money on 'blanket' injection programmes, regardless of those at individual risk).

A. Dr Read and Dr Pebody: This information is wrong. Our flu vaccines don't have any mercury in them, apart from one vaccine called Fluvirin that contains miniscule amounts left over from the manufacturing. Your doctor will be able to offer you the flu vaccine with no mercury. There is robust scientific evidence that the mercury in vaccines does not harm recipients, but all our childhood vaccines are mercury free anyway and so are our flu vaccines.

Q. Countrykitty: I'm 24 weeks pregnant and, following NHS advice, I had my flu jab on Friday. I have today read on the BBC website that a company, which supplies approximately 10% of the UK's flu vaccine stock, has withdrawn its supply of the flu vaccine after having safety concerns over two batches. Should we be concerned about this? What in particular are their safety worries? Will we be contacted if we have been given a vaccine supplied by this company?

A. Dr Read and Dr Pebody: The vaccines from the company with the manufacturing problem were never issued for use so there is no need for concern. There are no safety worries. The company you have read about has reported that there were some unexpected test results on two batches of vaccine during standard quality control testing and the vaccines never went into distribution.

 

Flu jab while breastfeeding

NHS flu safe logoQ. Nightfall1983: If a breastfeeding mother has the jab will that pass on protection to her baby, too? Can this be done on the NHS?

A. Dr Read and Dr Pebody: There is no reason why a woman who is breastfeeding cannot be given the flu vaccine. It will help protect her from getting flu and then passing it on to her baby. However, breastfeeding, while important for babies' general health, will not by itself prevent flu infection in your baby, even if you are vaccinated. The flu vaccine can be given to breastfeeding women on the NHS, but only if they are in one of the clinical risk groups.

Q. Bongaloo: I was pregnant last year and had the flu jab - and had a much better winter for it! I've written off a few Xmases with flu and could really do without being ill this year. So (as I don't qualify for a free jab) I'm thinking of paying for it this year. Is there any reason why I can't have it while breastfeeding? (I'd still be breastfeeding if I had the flu anyway).

A. Dr Read and Dr Pebody: I'm glad to hear you had the flu vaccine when you were pregnant last year and you clearly benefitted from it. Breastfeeding women can have the flu vaccine, although only those with risk factors can get it on the NHS.

 

Flu jabs and immunity

Q. Mitchdafish: How is immunity measured in young babies following flu jabs in pregnancy. Is it by blood tests for antibodies? Or by cases of flu in babies? Subsequently, what proportion of babies may be protected if their mothers have the jab?

A. Dr Read and Dr Pebody: Studies on young babies of vaccinated mothers have measured their antibodies and there have also been studies on rates of flu in babies of vaccinated mothers compared with flu in babies of unvaccinated mothers. There were fewer flu cases in the babies of vaccinated mothers.

Q. LeBFG: What's the NHS view on research showing mass vaccination campaigns driving evolution of new strains of flu virus? Although we may be saving individual lives now in the present, are we not storing up problems for future generations in a similar way to antibiotics and development of resistance? What are the NHS's long-term goals vis-a-vis the flu vaccine and mass vaccination campaigns?

A. Dr Read and Dr Pebody: There is no accepted evidence that flu vaccines push the emergence of new flu virus strains. Flu viruses mutate all the time and have done this from long before there were ever flu vaccines. We are indeed saving lives presently with flu vaccination and there is no evidence that we are storing up problems for the future.

We have recently announced that we will be including children for flu vaccination in the future and our real hope is that scientists will develop vaccines that protect against all flu strains and produce long-lasting immunity. This would mean that we wouldn't need to be vaccinated every year.

Q. Shriek: Are we wiping out a whole tranche of immunity development tools for babies/children, leading to worse vulnerabilities in the long term? The immune system can only develop in response to bacterial and viral contact.

Surely there is sense in using safe vaccines only for those at a real risk, rather than the blanket policy of scaring everyone into believe that they, or their babies, could die as a result of not having it. After all, there is no greater chance of getting swine flu or the regular seasonal flu if you are pregnant.

A. Dr Read and Dr Pebody: The problem with your theory - that it is better to get diseases to build your own immunity, is that it is fine as long as you or your baby don't get them seriously and even die. We just can't predict who will get severely ill or die from flu and while there is no greater chance of you getting flu while you are pregnant, there really is a greater chance that you will get seriously ill. The immunity that pregnant women pass to their babies is short-lived and has no bearing on the development of the baby's own immune system.

 

Information about immunisation

Q. Bealos: Why is the information given on the NHS site about immunisation so basic? It simply tells us things are 'safe' and 'have been tested'. Why does it not include links to research and reports from which the NHS has drawn conclusive evidence to tell us that flu jabs and whooping cough jabs (whilst pregnant) are safe?

A. Dr Read and Dr Pebody: The information provided by NHS Choices is written for a general audience. You can find information of a more technical nature in the 'Green Book', which provides the clinical guidance on immunisations. This is the influenza chapter.

Last updated: 24-Sep-2013 at 4:05 PM