Wednesday 18 July 2018

Dear Dr Nina: Do I really need all these vaccines while pregnant?

Many vaccines are safe to give during pregnancy
Many vaccines are safe to give during pregnancy

Nina Byrnes

I am pregnant and about to have my vaccination for pertussis.My GP recommended that I have the flu vaccine also while I am there. I am not afraid of vaccines but before I do, I have a couple of questions. Firstly, is it true that the flu vaccine is not very accurate as there are so many different strains of flu? Secondly, if there are different vaccines, can I be assured that all of them are safe? Thirdly, can you explain briefly what pertussis is, and how common is the virus - if I don't get it, will my baby be at a real risk?

Dr Nina replies: Many vaccines are safe to give in pregnancy and some are actually recommended. You specifically asked about the flu and pertussis (whooping cough) vaccines. These are both recommend in pregnancy. Flu can be especially serious in pregnancy. Complications for mom and baby include pre-term labour, small for gestational age, hospitalisation and, rarely, death. Flu vaccination has been given to pregnant women around the world for many years and is considered safe at any stage of pregnancy.

Flu is estimated to kill from 250,000 to 500,000 people worldwide every year. Getting vaccinated is the best way to prevent infection. The vaccine is very safe, has been used for over 60 years and given to millions of people worldwide. Contrary to popular myth, you cannot get the flu from the flu vaccine.

Different strains of influenza circulate in different years. More than 100 national influenza centres in over 100 countries conduct year-round surveillance of circulating viruses. This involves receiving and testing thousands of influenza virus samples from patients.

Twice a year, the World Health Organization (WHO) organises a consultation with those who collate the data. They review the results of surveillance, laboratory, and clinical studies, and the availability of vaccine viruses and make recommendations on the composition of the influenza vaccine. This amalgamation of data makes it unlikely that a circulating strain will be missed.

Also, the annual vaccine contains between two and three strains of flu thus covering several possible virus outbreaks. Flu vaccination has been shown to reduce flu complications by 70pc to 90pc in healthy people. In the elderly, it reduced the risk of serious illness by 60pc, and death by 80pc. Babies born to moms who were vaccinated are 50pc less likely to be hospitalised with flu. It is an accurate and effective vaccine. Once you have received the vaccine, it takes up to two weeks to have full effect.

Whooping cough (pertussis) is a bacterial respiratory infection. Infections have increased in recent years. It is thought that our immunity to pertussis wanes after several years, and so many adults are no longer immune. Babies under six months of age are especially at risk of serious complications of whooping cough infection. The illness can be very severe in young children leading to vomiting, reduced feeding and dehydration. Pneumonia can be a complication.

Whooping cough vaccine is included in the 6:1 vaccination given at two, four and six months of age, but your baby is especially vulnerable in the first few months of life. Expectant mothers are advised vaccination between 16 and 32 weeks of pregnancy. Immunity takes about two weeks to kick in. Vaccination at this stage allows time for mom's immunity to pass to her baby. This vaccine is again considered safe in pregnancy.

Expectant parents spend a lot of time preparing a safe car and home environment for their newborn children. Considering protection from within is also important. The best way to avoid infection is ensure that you and your children's vaccines are up to date.

Q. My daughter got a note home saying that some of the kids in her class have threadworms.

What are these and what symptoms should I look out for?

Dr Nina replies: Threadworm or pinworm is a small white worm that measures between five and 13 millimetres in length and lives in the human intestine. They are found most commonly in children. Threadworm infection occurs when the eggs are ingested through contact with infected hands, surfaces or food. The eggs hatch in the small intestine and then mature and travel as adult worms to the large intestine, where they mate. One to two months later, the female adults travel to the anal area where they lay their eggs mainly at night and then die.

Symptoms commonly occur due to the eggs irritating the anal area causing itching, especially at night. This leads to scratching. Eggs then transfer to hands and nails and can be ingested again, leading to further worm infection. Eggs can also live on any surface such as underwear, clothes, beds or any surface for up to 20 days. Up to a third of people who have threadworm infection may have no symptoms at all. Infection is often diagnosed based on the symptoms people have. You may, however, also be able to see the worms in the anal area at night (usually about two to three hours after going to bed), on underwear, or in the stool.

Threadworm doesn’t usually cause any problems but can be uncomfortable, so treatment is normally given. The main treatment is mebendazole, which can be bought over the counter in any pharmacy. All members of the household should take a dose of 100mg. This treats live worms. The treatment should be repeated two weeks later in order to kill any new worms that have hatched in that time. Surfaces, bedding and clothing should be washed. If you have a high suspicion that your daughter may have worms, it may be worth treating her and the family.

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