Guillain-Barré syndrome

First, a pregnancy update:

Last week I went with Holly to her appointment with the midwife where we heard the baby's heartbeat for the first time. Holly is starting to show a little, and this morning I was able to feel the top of her womb. She'll have another ultrasound in a few weeks. Holly has had some occasional queasiness, but no serious morning sickness. So, everything is going very well!

Guillain-Barré syndrome:

Guillain-Barré syndrome (GBS) is an inflammatory disorder of peripheral nerves, causing muscle weakness and sensory changes (tingling or burning sensation and/or pain). About 70% of cases are preceded by a ‘trigger’ event, usually occurring 1 to 3 weeks before the onset of symptoms. One of the most common trigger events is an upper respiratory infection - including influenza.

The incidence (number of new cases) of GBS is estimated to be 1.8 per 100,000 population per year. In the United States, there around 6,000 new cases of GBS every year.

In 1976, there was an increase in the incidence of GBS among the recipients of the 'swine flu' vaccine of about 1 case per 100,000 vaccine recipients. In 2004 the Institute of Medicine concluded that there was sufficient evidence of a causal relationship between the 1976 'swine flu' vaccine and GBS, but the reason has not been determined.

Since 1976, vaccine production methods have changed, resulting in fewer side effects. Most studies have found no association between GBS and influenza vaccines manufactured after 1976, but a few studies suggest that there may be an additional one case of GBS per one million influenza vaccine recipients. Since influenza is a trigger event for GBS, a protective effect from the vaccine against GBS cannot be ruled out.

When considering the possible side effects of a vaccine, it's important to consider the risk versus the benefits. The attack rate for influenza during flu season is 10% to 40%. In contrast to a possible 1 additional case of GBS per one million vaccine recipients, the hospitalization rate for 2009 H1N1 was 222 per one million and the death rate was 9.7 per one million cases. Pregnant women are at much higher risk for hospitalization and death from influenza than the general population. GBS is a condition from which most people completely recover.

I've never bought a lottery ticket because the probability of winning is low. I don't worry about GBS when I take a flu vaccine because the probability of developing GBS as a result is either nonexistent or extremely low. I'm much more likely to miss work or be hospitalized because of the flu.

References:

Centers for Disease Control and Prevention. (2010). Preliminary results: surveillance for Guillain-Barré syndrome after receipt of influenza A (H1N1) 2009 monovalent vaccine – United States, 2009-2010. Morbidity and Mortality Weekly Report, 59(21), 657-661. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5921a3.htm.

Centers for Disease Control and Prevention. (2011). Guillain-Barré syndrome (GBS): questions & answers. http://www.cdc.gov/flu/protect/vaccine/guillainbarre.htm.

Haber, P., DeStefano, F., F., Angulo, F. J., Iskander, J., Shadomy, S. V., Weintraub, E. et al. (2004). Guillain-Barré syndrome following influenza vaccination. JAMA, 292(20), 2478-2481. http://jama.ama-assn.org/content/292/20/2478.full.

Harati, Y. & Bosch, E. P. (2008) Disorders of peripheral nerves. In W. G. Bradley, R. B. Daroff, G. M. Fenichel, & J. Jankovic (Eds.) Neurology in clinical practice (5^th Ed.) [Electronic version].

Hughes, R. A., Charlton, J., Latinovic, R., & Guilliford, M. C. (2006). No association between immunization and Guillain-Barré syndrome in the United Kingdom 1992 to 2000. Archives of Internal Medicine, 166(12), 1301-1304. http://archinte.ama-assn.org/cgi/content/full/166/12/1301.

Grimaldi-Bensouda, L., Alpérovitch, A. Besson, G.,Vial, C. Cuisset, J. M., Papeix,C. et al. (2011). Guillain-Barré syndrome, influenzalike illness, and influenza vaccination during seasons with and without circulating A/H1N1 viruses. American Journal of Epidemiology, 174(3), 326-335. http://aje.oxfordjournals.org/content/174/3/326.full.

Juurlink, D. N., Stukel, T. A., Kwong, J., Kopp, A., McGeer, A., Upshur, R. E. et al. (2006). Guillain-Barré syndrome after influenza vaccination in adults. Archives of Internal Medicine, 166(20), 2217-2221. http://archinte.ama-assn.org/cgi/content/full/166/20/2217.

Lasky, T., Terracciano, G. J., Magder, L., Koski, C. L., Ballesteros, M., Nash, D. et al. (1998). The Guillain-Barré syndrome and the 1992 – 1993 and 1993 – 1994 influenza vaccines. New England Journal of Medicine, 339(25), 1797-1802. http://www.nejm.org/doi/full/10.1056/NEJM199812173392501.

National Research Council. (2004). Immunization safety review: influenza vaccines and neurological complications. Washington, DC: The National Academies Press. http://www.iom.edu/Reports/2003/Immunization-Safety-Review-Influenza-Vaccines-and-Neurological-Complications.aspx.

Sivadon-Tardy, V., Orlikowski, D., Porcher, R., Sharshar, T., Durand, M-C., Enouf, V. et al. (2009). Guillain-Barré syndrome and influenza virus infection. Clinical Infectious Diseases, 48(1), 48-56. http://cid.oxfordjournals.org/content/48/1/48.full.

Stowe, J., Andrews, N., Wise, L., & Miller, E. (2009). Investigation of the temporal association of Guillain-Barré syndrome with influenza vaccine and influenzalike illness using the United Kingdom General Practice Research Database. American Journal of Epidemiology, 169(3), 382-388. http://aje.oxfordjournals.org/content/169/3/382.full.

Tam, C. C., O'Brien, S. J., Petersen, I., Islam, A., Hayward, A., & Rodrigues, L. C. (2007). Guillain-Barré syndrome and preceding infection with Campylobacter, influenza, and Epstein-Barr virus in the General Practice Research Database. PLoS ONE 2(4), e344. http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0000344.

Vellozzi, C., Burwen, D. R., Dobardzic, A., Ball, R., Walton, K., & Haber, P. (2009). Safety of trivalent inactivated influenza vaccines in adults: background for pandemic influenza vaccine safety monitoring. Vaccine, 27(15), 2114-2120. doi.org/10.1016/j.vaccine.2009.01.125

Everything you need to know about thimerosal

Many parents have concerns about the presence of mercury in vaccines. Because some formulations of influenza vaccines contain thimerosal, I think this would be a good time to introduce the topic.

Thimerosal is a mercury-containing preservative that has been used since the 1930s to prevent contamination of vials that contain more than one dose of vaccine (multi-dose).

Multi-dose vial of flu vaccine
(CDC/Jim Gathany)

The tops of vials are disinfected with alcohol before each use, but alcohol cannot kill all of the microorganisms that might be present, so bacteria or fungi can be introduced into the vial when the stopper is punctured with a needle. Since vaccines contain proteins and other nutrients, bacteria and fungi can multiply inside the vial. Thimerosal kills microorganisms and prevents potentially fatal vaccine reactions.

Because the stopper is punctured only once, single-dose vials do not contain thimerosal. Prefilled syringes of flu vaccine and live attenuated influenza vaccine (LAIV) also do not contain thimerosal.

Other than localized reactions to thimerosal (pain/redness/swelling at the injection site) and rare allergic reactions, no harmful effects from the amount of thimerosal in vaccines has ever been demonstrated. However, in response to public concerns over mercury exposure, the U.S. Public Health Service and American Academy of Pediatrics issued a joint statement in 1999 recommending the removal of thimerosal from all vaccines routinely administered to children (CDC, 1999; Finn & Egan, 2008).

In the United States, all vaccines routinely administered to children do not contain thimerosal or contain only a trace amount of thimerosal. Influenza vaccine is the single exception to that rule. Influenza vaccine formulations in multi-dose vials contain thimerosal, but single-dose vials and prefilled syringes of trivalent inactivated influenza vaccine (TIV; the “flu shot”) do not contain thimerosal. Live attenuated influenza vaccine (LAIV; “nasal spray” flu vaccine) does not contain thimerosal.

Neither CDC’s Advisory Committee on Immunization Practices nor the American College of Obstetricians and Gynecologists express a preference for thimerosal-free influenza vaccines for pregnant women (ACOG, 2010; CDC, 2010). Nevertheless, thimerosal-free influenza vaccines are available for adults and children.

Everything you need to know about thimerosal:

Thimerosal in vaccines is a contentious issue. I’ve included links to information on thimerosal below.

These are my take-home messages:

·       All routine childhood immunizations are thimerosal-free or contain only a trace amount of thimerosal.

·       Influenza vaccines are available in thimerosal free formulations.

·       Some states, including Washington, Oregon, and California have laws restricting the use of thimerosal-containing vaccines.

Thimerosal content of vaccines:

·       Thimerosal Content of Vaccines Routinely Recommended for Children 6 Years of Age and Younger

·       Mercury content of 2011-2012 seasonal influenza vaccines

More information on thimerosal:

·       Centers for Disease Control and Prevention (CDC): Thimerosal

·       Children’s Hospital of Philadelphia: Hot topics: thimerosal

·       Food and Drug Administration (FDA): Thimerosal in vaccines

·       National Network for Immunization Information: Thimerosal-mercury

References:

American College of Obstetricians and Gynecologists. (2010). Influenza vaccination during pregnancy. Committee Opinion No. 468. Obstetrics & Gynecology, 116(4), 1006-1007. http://www.acog.org/Resources_And_Publications/Committee_Opinions/Committee_on_Obstetric_Practice/Influenza_Vaccination_During_Pregnancy.aspx.

Centers for Disease Control and Prevention. (1999). Recommendations regarding the use of vaccines that contain thimerosal as a preservative. Morbidity and Mortality Weekly Report, 48(43), 996-998. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm4843a4.htm.

Centers for Disease Control and Prevention. (1999). Thimerosal in vaccines: a joint statement of the American Academy of Pediatrics and the Public Health Service. Morbidity and Mortality Weekly Report, 48(26), 563-565. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm4826a3.htm.

Centers for Disease Control and Prevention. (2010). Prevention and control of influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices. Morbidity and Mortality Weekly Report, 59(8). http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5908a1.htm.

Finn, T. M. & Egan, W. (2008). Vaccine additives and manufacturing residuals in United States-licensed vaccines. In S. A. Plotkin, W. A. Orenstein, & P. A. Offit (Eds.) Vaccines (5^th Ed.). [Electronic version].

Influenza vaccines

Holly and I went together to get our flu immunizations back in October. She was not pregnant at the time, so we both received the nasal spray flu vaccine.

There are two types of influenza viruses available in the United States: the trivalent inactivated influenza vaccine (TIV) and live attenuated influenza vaccine (LAIV). Both vaccines contain antigens of two influenza A viruses (H1N1 and H3N2) and an influenza B virus. TIV, or the "flu shot," contains antigens from killed influenza viruses; either split viruses or subunits of influenza viruses. LAIV, or "nasal spray" flu vaccine, contains attenuated (weakened) flu viruses that are cold-adapted, which means that the viruses replicate most efficiently at temperatures found in the upper respiratory tract.

The flu shot is recommended for pregnant women by the American College of Obstetricians and Gynecologists, the American Academy of Family Physicians, and the CDC’s Advisory Committee on Immunization Practices (ACIP). Inactivated influenza vaccine has been recommended for pregnant women since the 1960s. Since that time, numerous studies have assessed the safety of the flu shot for both mother and baby and none have found serious adverse effects for either mother or baby (ACOG, 2010; CDC, 2010; MacDonald et al., 2009; Moro et al. 2011; Tamma et al., 2009).

Because LAIV is a live-virus vaccine, there is a theoretical risk of infecting a fetus with the vaccine virus, so LAIV is not recommended for pregnant women. Although LAIV recipients can shed vaccine virus, pregnant women do not need to avoid people who have received the vaccine; in fact, pregnant women can safely administer LAIV (CDC, 2006). Postpartum and breastfeeding women may receive LAIV (CDC, 2010).

Newborn babies are protected from a number of diseases by antibodies that they receive from their mothers through the placenta (maternal antibodies can also interfere with a baby's immune response to vaccines). There is evidence that giving a flu shot to a pregnant woman protects her baby from influenza (Benowitz et al., 2010; Eick et al., 2011; Poehling et al., 2011; Zaman et al., 2008).

Side effects:

The most common side effect of the flu shot is pain at the injection site. Other side effects include headache, muscle aches, and fever. The most common side effects of LAIV are runny nose, cough, and sore throat. Severe allergic reactions to flu vaccine are rare (CDC, 2010). The viruses for both TIV and LAIV are grown on chicken eggs. In general, flu vaccines are not contraindicated for people who can eat eggs. People with severe egg allergies should talk to a health care provider about flu vaccine (CDC, 2011).

There are a few more points I'd like to make about influenza vaccines, but I don't want my posts to run too long. Instead, I'll post a gratuitous picture of Holly's ultrasound from a couple of weeks ago:

References:

American College of Obstetricians and Gynecologists. (2010). Influenza vaccination during pregnancy. Committee Opinion No. 468. Obstetrics & Gynecology, 116(4), 1006-1007. http://www.acog.org/Resources_And_Publications/Committee_Opinions/Committee_on_Obstetric_Practice/Influenza_Vaccination_During_Pregnancy.aspx.

Benowitz, I., Esposito, D. B., Gracey, K. D., Shapiro, E. D., & Vazquez, M. (2010).

Influenza vaccine given to pregnant women reduces hospitalization due to influenza in their infants. Clinical Infectious Diseases, 51(12), 1355-1361. http://cid.oxfordjournals.org/content/51/12/1355.full.

Centers for Disease Control and Prevention. (2006). Prevention and control of influenza: recommendations of the Advisory Committee on Immunization Practices. Morbidity and Mortality Weekly Report, 55(10), 1-42. http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5510a1.htm?s_cid=rr5510a1_e.

Centers for Disease Control and Prevention. (2010). Prevention and control of influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices. Morbidity and Mortality Weekly Report, 59(8) 1-62. http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5908a1.htm.

Centers for Disease Control and Prevention. (2011). Prevention and control of influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP), 2011. Morbidity and Mortality Weekly Report, 60(33), 1128-1132. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6033a3.htm?s_cid=mm6033a3_w.

Eick, A. A., Uyeki, T. M., Klimov, A., Hall, H., Reid, R., Santosham, M. et al. (2011). Maternal influenza vaccination and effect on influenza virus infection in young infants. Archives of Pediatrics & Adolescent Medicine, 165(2), 104-111. doi:10.1001/archpediatrics.2010.192.

MacDonald, N. E., Riley, L. E., & Steinhoff, M. C. (2009). Influenza immunization in pregnancy. Obstetrics & Gynecology, 114(2, Part 1), 365-368. doi:10.1097/AOG.0b013e3181af6ce8.

Moro, P. L., Broder, K., Zheteyeva, Y., Walton, K., Rohan, P., Sutherland, A. et al. (2011). Adverse events in pregnant women following administration of trivalent inactivated influenza vaccine and live attenuated influenza vaccine in the Vaccine Adverse Event Reporting System, 1990-2009. American Journal of Obstetrics and Gynecology, 204(2), 146.e1-146.e7. doi:10.1016/j.ajog.2010.08.050.

Poehling, K.A., Szilagyi,P. G., Staat, M. A., Snively, B. M., Payne, D. C., Bridges, C. B. et al. (2011). Impact of maternal immunization on influenza hospitalizations in infants. American Journal of Obstetrics & Gynecology, 204(6 Supple. 1), S141-S148. http://www.ajog.org/article/S0002-9378(11)00232-8/fulltext.

Tamma, P. D., Ault, K. A., del Rio, C., Steinhoff, M. C., Halsey, N. A. & Omer, S. B. (2009). Safety of influenza vaccination during pregnancy. American Journal of Obstetrics and Gynecology, 201(6), 547-552. http://www.ajog.org/article/S0002-9378(09)01108-9/fulltext.

Zaman, K., Roy, E., Arifeen, S. E., Rahman, M., Raqib, R., Wilson, E. et al. (2008). Effectiveness of maternal influenza immunization in mothers and infants. New England Journal of Medicine, 359(15), 1555-1564. http://www.nejm.org/doi/full/10.1056/NEJMoa0708630.

Influenza: what are H and N?

I changed my mind. I don't feel that I can talk about flu vaccines until I talk a little more about influenza viruses.

Holly told me that my last post was too dry and that I should make it more personal, so here goes:

Influenza fascinates me. Next to malaria, I’ve spent more time reading about flu than any other disease. Like malaria parasites, the surface antigens on influenza viruses change and allow flu viruses to hide from the immune system. This will be important when we talk about flu vaccine efficacy and effectiveness.

I became interested in flu in 2005 when I was involved with avian influenza pandemic preparation at the hospital where I worked at the time. My first direct experience with pandemic influenza was in 2009 when a pregnant woman was admitted to the intensive care unit (ICU) with what was then called “swine flu” by the media. Later that year, I worked for the Louisiana Office of Public Health in 2009 H1N1 pandemic influenza response.

There are three types of flu viruses: influenza A, influenza B, and influenza C.

Influenza C causes mild disease in humans, and that's pretty much all you will ever hear about it. We don't bother vaccinating against it.

Both influenza A and influenza B cause severe disease in humans. Influenza B only infects humans. Influenza A infects humans, other mammals, and birds. In fact, birds are the reservoir for vast number of influenza A viruses.

Dan Higgins/CDC

Viruses are not cells. They do not have the cellular mechanisms required to manufacture proteins. They cannot replicate (make copies of themselves) independently. Viruses infect living cells and take over their "machinery" to replicate. Not surprisingly, influenza viruses kill the cells that they infect.

Influenza viruses have special glycoproteins (large molecules that are made up of sugar and protein) on their surface. Hemagglutinin, the "H" of H1N1, H3N2, and H5N1, allows influenza viruses to attach to and penetrate cells in the respiratory tract. Neuraminidase, the "N" in the virus name, allows newly formed flu viruses to escape from the infected cells.

For influenza A viruses, there are at least 16 different hemagglutinins and 9 different neuraminidases, so there are influenza A permutations from H1N1 to H16N9. Humans are most commonly infected with H1, H2, and H3 and N1 and N2.

The ability of a flu virus to infect humans depends on how well it is adapted to receptors in our respiratory tract. Influenza viruses that are easily transmitted from person-to-person are those that are best adapted to human receptors. Humans can be infected with influenza A viruses that are adapted to other mammals or birds, but usually only through close contact with infected animals.

Hemagglutinin and neuraminidase are two of the antigens targeted by our immune system. When we are infected with a flu virus, our immune system starts producing antibodies that are specific to the hemagglutinin and neuraminidase on that virus.

The genes that code for hemagglutinin and neuraminidase mutate frequently, creating minor changes in those antigens. When enough of these changes accumulate, our antibodies no longer "recognize" that virus. This is called antigenic drift.

Both influenza A and influenza B drift, but only influenza A viruses shift.

That is a subject for another time.

References:

Hayden, F. G. (2011). Influenza. In L. Goldman & A. I. Schafer (Eds.) Goldman's Cecil medicine (24th Ed.) [Electronic version]

Treanor, J. J. (2009). Influenza viruses, including avian influenza and swine flu. In G. L. Mandell, J. E. Bennett, & R. Dolin (Eds.). Mandell, Douglas, and Bennett’s principles and practice of infectious diseases. (7th Ed.) [Electronic version].

Influenza and pregnancy

The first thing that needs to be said is, it’s not too late to get vaccinated against flu! In the U.S., flu season typically peaks around February, sometimes as late as April or May.

The American College of Obstetricians and Gynecologists (ACOG), the American Academy of Family Physicians, the American Academy of Pediatrics and the CDC’s Advisory Committee on Immunization Practices (ACIP) recommend that all pregnant and postpartum women receive a flu vaccine. So, if you’re already pregnant, it’s still not too late to get a flu shot.

You can use the Flu Vaccine Finder to find a provider near you.

Some of the changes that occur during pregnancy place women at higher risk of complications from influenza, especially during the second and third trimesters. A pregnant woman’s body needs more oxygen but she is less able to take a deep breath. There are changes in a woman’s immune system that protect the baby but decrease her ability to fight infection. A woman’s heart also works harder during pregnancy. Pregnant women are four to five times more likely than the general population to become seriously ill and require hospitalization due to influenza.

What is influenza?

In talking to people about flu, it seems that there is some confusion about what flu is. I’ll start by talking about what flu is not:

Influenza is not “stomach flu.” Even though some people may be nauseated and throw up when they have the flu, influenza is a respiratory disease, not a gastrointestinal disease. What people call “stomach flu” (nausea, vomiting, and diarrhea) is usually viral gastroenteritis.

Influenza is not a “bad cold.” There are lots of viruses that cause the common cold. Both influenza and the common cold can cause coughing and runny nose, but the symptoms of flu are usually much more severe. Like the cold, influenza is a respiratory disease, but the systemic symptoms of flu (fever, chills, muscle aches, and headache) are worse than the respiratory symptoms.

To add to the confusion, there are many “influenza-like illnesses” (ILI) that are not influenza. Parainfluenza viruses, respiratory syncytial virus, and adenoviruses can cause illness that is indistinguishable from influenza.

People shed influenza viruses and can infect others for up to a day before the onset of symptoms and continue to shed influenza viruses for up to ten days after symptoms start. Children and people with immune deficiencies can shed influenza viruses much longer than that. A person infected with influenza can transmit flu to other people before knowing that she or he has the flu and can continue to infect other after beginning to feel better.

So, influenza is a viral respiratory disease that causes fever, chills, muscle aches (myalgia), headache, and cough.

Influenza also knocks people off of their feet. Flu usually keeps people in bed and away from work or school for three days and can take a week or more for otherwise healthy people to recover.

Influenza also kills people. A graph of influenza deaths by age shows a U-shaped pattern, with relatively few deaths in the middle, and higher number of deaths in young children and older adults. People with chronic medical conditions are also more likely than healthy adults to develop complications from influenza or die. The most common complication associated with influenza is pneumonia.

Next I’ll talk about influenza vaccines.

References:

American College of Obstetricians and Gynecologists. (2010). Influenza vaccination during pregnancy. Committee Opinion No. 468. Obstetrics & Gynecology, 116(4), 1006-1007. http://www.acog.org/Resources_And_Publications/Committee_Opinions/Committee_on_Obstetric_Practice/Influenza_Vaccination_During_Pregnancy.aspx.

Centers for Disease Control and Prevention. (2010). Prevention and control of influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices. Morbidity and Mortality Weekly Report, 59(8). http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5908a1.htm.

Lee, F. E. & Treanor, J. (2010). Viral infections. In Murray and Nadel’s textbook of respiratory medicine. (5th Ed. pp.). [Electronic version].

MacDonald, N. E., Riley, L. E., & Steinhff, M. C. (2009). Influenza immunization in pregnancy. Obstetrics & Gynecology, 114(2, Part 1), 365-368. doi:10.1097/AOG.0b013e3181af6ce8.

Tamma, P. D., Ault, K. A., del Rio, C., Steinhoff, M. C., Halsey, N. A. & Omer, S. B. (2009). Safety of influenza vaccination during pregnancy. American Journal of Obstetrics and Gynecology, 201(6), 547-552. http://www.ajog.org/article/S0002-9378(09)01108-9/fulltext.

Treanor, J. J. (2009). Influenza viruses, including avian influenza and swine flu. In Mandell, Douglas, and Bennett’s principles and practice of infectious diseases. (7th Ed.). [Electronic version].

Happy New Year!

Happy New Year!

2012 will be a happy new year for my wife and me because Holly is pregnant with our first child. In August of this year, Holly’s parents will be blessed with their first grandchild and my parents with their sixth grandchild. We’re both excited to bring our baby into the world but, like other expectant parents, we also have concerns and fears. For me, some of the responsibilities that come with raising a child are frightening. I worry about my ability to be a good parent and make the right decisions. I am blessed to be married to an amazing woman whose values I share and whose judgment I trust.

For many parents, making decisions about immunizations can be frightening. Even parents who believe that vaccines protect their children from serious diseases also worry about the safety of vaccines. We hear conflicting stories in the news about side effects of vaccines. We hear from parents whose children had serious health problems after receiving a vaccine. We hear about new vaccines and wonder if they are really necessary and if our children are receiving too many immunizations. It can be hard to know what to believe and whom to trust.

Holly and I have decided to immunize our child following the schedule recommended by the CDC’s Advisory Committee on Immunization Practices (ACIP). This is not a decision we’ve made lightly. After considering the benefits and risks of immunization, this is a decision that we have made confidently and without fear or hesitation.

I’ve been a registered nurse for 20 years, but I became interested in vaccines in 2000 while studying tropical medicine at Tulane University in New Orleans. After receiving a Diploma in Clinical Tropical Medicine and Traveler’s Health, I spent a year directing an immunization and public health education outreach program at a health center in rural Ethiopia. As you might imagine, it was hard work, but I loved it! Since then I completed my master’s degree at Tulane and am now working public health in the U.S.

As Holly and I prepare for parenthood, I want to hear from other parents and parents-to-be. I want to hear your concerns and questions about vaccines and your experiences with immunizing your child. If you have experiences with vaccine-preventable diseases, please share them. After our baby is born, we’ll talk about the immunizations that she or he will receive.

Seven months may seem like a long time to talk about immunizations for a child who hasn’t been born yet, but there’s a lot of ground to cover in that time. The risks of adverse events following immunization, the reasons why vaccines are recommended, how effective vaccines are at preventing disease, vaccine ingredients, vaccine safety testing, and, of course, vaccine-preventable diseases are all on the table and open for discussion.

First, let’s talk about vaccines that are recommended for mothers-to-be.

References:

Benin, A. L., Wisler-Scher, D. J., Colson, E., Shapiro, E. D., & Holmboe, E. S. (2005). Qualitative analysis of mothers’ decision-making about vaccines for infants: the importance of trust. Pediatrics, 117(5), 1532-1541. http://pediatrics.aappublications.org/content/117/5/1532.full.

Freed, G. L., Clark, S. J., Butchart, A. T., Singer, D. C., & Davis, M. M. (2010). Parental vaccine safety concerns in 2009. Pediatrics, 125(4), 654-659. http://pediatrics.aappublications.org/content/125/4/654.full.html.

Gust, D. A., Darling, N., Kennedy, A., & Schwartz, B. (2008). Parents with doubts about vaccines: which vaccines and reasons why. Pediatrics, 122(4), 718-725. http://pediatrics.aappublications.org/content/122/4/718.full.html.

Kennedy, A., Basket, M., & Sheedy, K. (2011). Vaccine attitudes, concerns, and information sources reported by parents of young children: results from the 2009 HealthStyles survey. Pediatrics, 127(Supple. 1). S92-S99. http://pediatrics.aappublications.org/content/127/Supplement_1/S92.full.html.