Immunization is Crucial for Pregnant Patients and Their Babies

As ob-gyns, we know the important role that vaccination plays in the health of mother and baby. It is one of our best options in reducing their chances of morbidity and mortality from vaccine-preventable diseases. Additionally, vaccination helps prevents the spread of certain infectious diseases.

The fall is usually when we start reminding women to get their annual flu vaccine, especially if they are pregnant. However, recent reports of whooping cough (pertussis) and measles exposure underscore the need to discuss other vaccinations with our patients. August is National Immunization Awareness Month and a great time to talk to your pregnant patients about immunization.

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This International Women’s Day Take the Pledge for Equality

March 8, 2016 marks International Women’s Day and as obstetrician-gynecologist we are dedicated to quality care of women throughout their lives. We know that gender-equality is a great issue for women here in the U.S. and around the world.

As women’s health care providers, we know many of the things that help women to achieve parity. One, of course, is reproductive autonomy. The ability to control if and when to become pregnant helps women to finish their educations, progress in their careers, and pursue their life goals. This cannot be emphasized enough, but unfortunately, millions of women around the world lack reproductive control.

The theme for the 2016 International Women’s Day is #PledgeforParity. I view this theme as making two important statements: one is that women, despite gains, still do not enjoy the equality that they deserve. The other is that we all must actively take a stand, and we can do so by signing the pledge and by joining the discussion on social media.

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It’s Not Too Late to Vaccinate Your Patients Against Influenza

The New Year is upon us. Unfortunately, it also coincides with flu season and we still have a long way to go when it comes to educating our patients on the benefits of the influenza vaccine. A recent poll found that many Americans don’t believe they need the flu shot. Those who haven’t been immunized cited a variety of reasons including the belief that the flu shot is unnecessary, belief that the vaccination is ineffective, concerns about the side effects or risk and worries that the vaccine could infect them with the flu. As clinicians, we know that the flu shot is safe, effective, and the best protection our patients have against influenza. It is our job to communicate these messages to all of our patients, especially pregnant women.

December 6th marked the beginning of National Influenza Vaccination Week, a national campaign to urge everyone to get the flu vaccine. Throughout the entire flu season, I encourage all health care providers to strongly recommend the flu shot to your patients, emphasizing the importance of this simple preventative health action.

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Adults Need Vaccines, Too!

ACOG Celebrates National Immunization Awareness Month

Every year, thousands of adults in the United States suffer serious health problems, are hospitalized, or even die from diseases that could have been prevented by vaccination. To celebrate the importance of immunizations throughout life – and to help remind adults that they need vaccines, too – ACOG is recognizing August as National Immunization Awareness Month. This is the perfect opportunity to make sure adults are protected against diseases like whooping cough, tetanus, shingles and pneumococcal disease. Let’s not forget the flu either, as flu season is right around the corner!

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How to Counsel Patients about Immunizations

In recent years, we’ve made great strides in encouraging vaccination in pregnant women. During the 2009 H1N1 pandemic, influenza vaccination rates in pregnant women increased from 15% to around 47%. Since then, rates have been sustained around 50%, increasing to 53% in the 2013-14 flu season. However, there are still patients who choose not to be vaccinated, possibly due to misinformation about vaccines.

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Improving Women’s Health through Vaccinations

As ob-gyns, we are entrusted with protecting women’s health, including providing preventive health care services. During an annual well-woman visit, each of us has an opportunity to discuss many topics: contraception, reproductive health, cardiovascular risk factors, healthy eating, exercise, smoking cessation, and more. It’s also an important time to discuss and provide necessary immunizations.

The Centers for Disease Control and Prevention and ACOG recommend vaccinations for adults throughout life. However, data from its National Health Interview Survey show that adults are not getting the immunizations they need. Continue reading

Vaccine Safety Facts: Overcoming the Hype

It’s National Influenza Vaccination Week, a time for ob-gyns and health professionals to encourage the annual flu vaccine for everyone 6 months and older, including pregnant women. We’ve all seen the numbers on the many millions of lives that have been saved by the flu vaccine and other vaccinations. Vaccines have been a major public health triumph. In fact, they have been so successful that the average American has fortunately never personally seen a single case of polio or even measles, diseases that were commonplace and often deadly not so long ago. So getting everyone vaccinated should be easy, right?

Yet, we sometimes encounter resistance from our patients who may have heard myths and inaccuracies about vaccines. That’s especially true when vaccine safety has been in the news, as it’s been over the past few weeks, this time related to the HPV vaccine. While this type of sensational media coverage can be frustrating, we must focus on our role as health care providers to be the experts, to dispel the myths, and to provide the facts.

How can we overcome the vaccine hype? By sharing these and other key vaccine facts with our patients, consistently and regularly:

Vaccine Facts

Fact: More than 100 million diseases have been prevented because of vaccinations in the US alone.

Fact: Vaccines are safe. Extensive research has found no link between vaccines and autism or other serious health conditions.

HPV Vaccine Facts

Fact: The HPV vaccine is safe.

Fact: The HPV vaccine is nearly 100% effective in preventing cervical cancer caused by certain HPV strains.

Flu Vaccine Facts

Fact: Getting the flu vaccine does not cause the flu.

Fact: It’s safe for pregnant women to get the flu vaccine.

As ob-gyns, we are in a unique position to educate women about the facts on vaccines. Together with our patients, we can be more effective than the hype of an uninformed or misguided spokespeople who knowingly or unknowingly undermines the value of vaccines. The overwhelming evidence is clear—vaccines are safe and effective, and we need to take every opportunity to communicate these facts to our patients.

For more information on immunizations, go to www.immunizationforwomen.org.

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Talk to Your Pregnant Patients about Immunization

As an ob-gyn, I believe in the importance of vaccines. They are one of our best options for preventing the spread of certain infectious diseases. Usually, this is the time of year that we start reminding women to get their annual flu vaccine, especially during pregnancy. But based on the troubling recent reports of whooping cough (pertussis), measles, and mumps outbreaks across the country, it’s clear that flu isn’t the only vaccine reminder that our patients need.

These recent disease outbreaks are worrisome, especially since pertussis, measles, and mumps had been extremely rare in the US. Because of many years of widespread vaccination against these diseases in the US, the population had developed “herd immunity”—because most of the “herd” was immunized and not susceptible to infection, the few not vaccinated still received protection. But in recent years, anti-vaccine sentiments have grown, and more and more children are skipping important immunizations, leaving many vulnerable to these diseases. Outbreaks often start when an unvaccinated person comes in contact with a disease (usually during a trip abroad) and brings it back to a community where a number of people are unvaccinated.

Pregnant women and infants are hit especially hard by disease outbreaks. Pregnancy causes changes to the immune system that make women more vulnerable to infections like pertussis and flu, and most vaccines cannot be administered to infants until they are about six months old. Vaccination of the mother during pregnancy becomes especially important because it provides protection for both mom and baby. Ob-gyns have a real opportunity to increase vaccination rates during pregnancy, a time when we see our patients more regularly and have repeated opportunities to discuss the benefits of immunization. While the measles, mumps, and rubella vaccine should not be given until after delivery, the tetanus, diphtheria, and pertussis (Tdap) vaccine can be given during pregnancy. The Centers for Disease Control and Prevention now recommends that all pregnant women receive the Tdap vaccine with every pregnancy. ACOG also recently issued updated recommendations on Tdap immunization for pregnant women.

Some women may worry about the safety of vaccines. Research has overwhelmingly shown vaccines are safe and are not linked with autism. Because of all that’s at stake, ethical considerations prohibit extensive scientific and medical research during pregnancy. However, millions of pregnant women have received immunizations over the years with minimal side effects and no serious adverse events linked to the vaccines. Learn more on ACOG’s immunization website: www.immunizationforwomen.org.

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Guest Blog: A Changing Tide—Have New Pap Test Recommendations Taken Hold?

David Chelmow, MD

David Chelmow, MD

If you’ve been following women’s health news, you know that a lot’s changed recently with Pap screening. Over the last decade, health organizations including ACOG, the American Cancer Society (ACS), and the US Preventive Services Task Force (USPSTF), have been reviewing research to determine how we can best prevent cervical cancer without excessive testing and unnecessary medical intervention.

The latest round of recommendations issued by each of these groups in 2012, building on guidance from ACOG in 2009, is generally consistent. All three organizations agree that for most women, cervical cancer screening should:

  • begin at age 21
  • stop after age 65 or following a hysterectomy in which the cervix has been removed
  • be performed every three years (Pap test only) OR every five years in women over 30 who’ve received negative results on a simultaneous Pap and human papillomavirus (HPV) test

The Centers for Disease Control and Prevention (CDC) recently published two studies looking at the use of Pap testing from 2000 to 2010. Much of what they found was good news and strongly suggests that doctors and patients are increasingly following the new recommendations. Fewer women younger than 21 were tested, and there was less Pap screening of women who had hysterectomy.

Unfortunately, there was also disappointing news. Many women continued to receive unnecessary Pap tests, including more than half of women younger than 21. Given the frequency of HPV infection in this age group, these young women are at significant risk for harms of testing without any expected benefit of cancer prevention. A much better strategy for prevention in this age group is HPV vaccination, but data from other sources suggest only a small portion of eligible women are receiving the full three-shot course of the vaccine. Additionally, 60% of women age 30 and older who had a hysterectomy continued to get Pap testing over this timeframe, according to CDC. Only a few of these women will need continued testing.

The studies also found that women age 22 to 30 who have never been screened increased from 6% to 9%—disturbing data considering most cervical cancer occurs in women who have never been screened or have not been screened in more than five years. Women age 30 to 64 who did not have health insurance were also less likely to be up to date with Pap screening in 2010 than in 2000.

For women to get the best protection against cervical cancer, they should get the HPV vaccine and be screened using the Pap and HPV tests according to ACOG recommendations. Let’s hope that the 2010—2020 summary finds that more women are getting screened according to the recommendations.

David Chelmow, MD, is professor and chair of the department of obstetrics and gynecology at Virginia Commonwealth University Medical Center in Richmond. Dr. Chelmow is a member of The American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins–Gynecology.

Guest Blog: Pregnant Women—Avoid the Flu, Get Vaccinated

Laura E. Riley, MD

Preventing flu when you’re pregnant is an essential element of prenatal care, and the best way to do that is to get your annual flu shot. Seasonal influenza is a virus that spreads easily and is most common in the US between October and May, often peaking in February.

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. I offer flu shots to all my pregnant patients and those who are considering becoming pregnant. In fact, ACOG and the Centers for Disease Control and Prevention recommend that everyone older than six months of age receive the flu vaccine every year.

It’s important that pregnant women get the flu shot, not the nose spray version of the vaccine, which contains a live attenuated virus. The flu shot is safe for pregnant women and their unborn child during any trimester; it is also safe after delivery and for breastfeeding women. Flu vaccination will not only protect new mothers but can provide protection to their babies in the first six months of their life. Family members, caregivers, and others who will be around the baby should also be vaccinated.

Ob-gyns should offer the flu shot to all their pregnant patients. During pregnancy, the flu shot is the best protection there is against serious illness from seasonal influenza.

The flu vaccine is now widely available at doctors’ offices, clinics, pharmacies, and health departments. To find a vaccination location near you, see this HealthMap Vaccine Finder.

For more information about the flu vaccine, other vaccine-preventable diseases, and the immunization needs of special populations, visit ACOG’s Immunization for Women website.

Laura E. Riley, MD, is chair of The American College of Obstetricians and Gynecologists’ Immunization Expert Work Group. Dr. Riley is director of Labor and Delivery at Massachusetts General Hospital in Boston.