Written by So it’s that time of year again. How much flu vaccine can the manufacturers shift this year? And how much can they get away with charging for it?
This year, there’s a slight shift in the Hughes household’s interaction with the influenza vaccine pushers. This year, Mrs Craigalog is pregnant during flu season. How does pregnancy interact with the evil influenze virus? And are you more or less likely to get the asian bird flu, which in 3 years has infected a whopping 60 people worldwide (but could of course mutate at any moment, any day now, no really, it might even happen before the big west coast earthquake) and could wipe out awhopping 0.1% of the world population according to the most pessimistic estimates if it went pandemic. And of course like in most pandemics, the vaste vaste majority of those who died would be the malnurished and the elderly and the otherwise-frail.
Now I don’t mean to be dismissive of the poor folks who’s contracted this and died (all 30-40 of them in the last 3 years), and nor do I mean to be dismissive of those who would die if this did become a pandemic (if). But the question on the household table is: should Mrs Craigalog get the vaccine now that she’s in her third trimester, or should we exercise our capito-democratic power and *not* have our insurance company buy a dose for her?
We will recall the statistics that I dug up last time this subject arose. But those were talking about the population as a whole. Certainly, I am prepared to consider the hypothesis that pregnancy might affect influenza morbidity. Mrs Craigalog’s obstetrician highly recommended that she get the kickback^H^H^H^H^H^H^H^Hvaccine, because
Pregnant women are just as likely to have serious complications from influenza as the elderly
Ok, now that’s a medical statement which is surely based on hard research, right? Uh, yeah right. Research into how much the flu vaccine company sales rep is going to pay for your steak dinner next time he takes you out. Or maybe research into how much the hospital is going to bonus you up for every vaccine you sell (and you thought the commission-comped sales reps at Circuit City was hard-sell!). Ok, so let’s find some research on this.
The CDC (immune to pressure from politicians/drug companies as they are there), recommends that pregnant women bevaccinated:
Additional Information Regarding Vaccination of Specific Populations
Pregnant Women
Influenza-associated excess deaths among pregnant women were documented during the pandemics of 1918–1919 and 1957–1958 (99–102). Case reports and limited studies also indicate that pregnancy can increase the risk for serious medical complications of influenza as a result of increases in heart rate, stroke volume, and oxygen consumption; decreases in lung capacity; and changes in immunologic function (103–106). A study of the impact of influenza during 17 interpandemic influenza seasons demonstrated that the relative risk for hospitalization for selected cardiorespiratory conditions among pregnant women enrolled in Medicaid increased from 1.4 during weeks 14–20 of gestation to 4.7 during weeks 37–42 in comparison with women who were 1–6 months postpartum (107). Women in their third trimester of pregnancy were hospitalized at a rate (i.e., 250/100,000 pregnant women) comparable with that of nonpregnant women who had high-risk medical conditions. By using data from this study, researchers estimated that an average of 1–2 hospitalizations could be prevented for every 1,000 pregnant women vaccinated.
Because of the increased risk for influenza-related complications, women who will be beyond the first trimester of pregnancy (>14 weeks of gestation) during the influenza season should be vaccinated. Certain providers prefer to administer influenza vaccine during the second trimester to avoid a coincidental association with spontaneous abortion, which is common in the first trimester, and because exposures to vaccines traditionally have been avoided during the first trimester (108). Pregnant women who have medical conditions that increase their risk for complications from influenza should be vaccinated before the influenza season, regardless of the stage of pregnancy. A study of influenza vaccination of >2,000 pregnant women demonstrated no adverse fetal effects associated with influenza vaccine (109). However, additional data are needed to confirm the safety of vaccination during pregnancy.
Let’s, for now, set aside the pandemic years, and consider the Medicaid (ie more likely poor and otherwise less healthy) study, which certainly has extensive data behind it. 4.7 times the risk of hospitalization in weeks 37-42 sure sounds dangerous to me! From the abstract of the report from this study:
Women in their third trimester without other identified risk factors for influenza morbidity had an event rate of 21.7 per 10,000 women-months during influenza season. Approximately half of this morbidity, 10.5 (95% CI 6.7-14.3) events per 10,000 women-months, was attributable to influenza.
Oh. So in the third trimester, 10 hospitalizations occur per 10,000 women-months. So if the influenza season is 3 months long, that equates to about 1 in 333 women being hospitalized during the final 3 weeks of pregnancy, or the 2 weeks past their due date. Women, of course, who are probably exhausted from carrying about 30 pounds or more of excess baby weight, and would be quite likely to think any excuse to sit in bed for a couple weeks until the baby comes would probably be a good idea. Let’s take the cost of a vaccination as $10 for the vaccine, plus $5 for the marginal cost of the slightly-longer office visit (pregnant women who are getting vaccinated are likely already paying for an office visit anyway). That’s $5000 for the vaccination of all 333 women. That’s one expensive hospital-stay avoidance, even if the vaccine completely prevents the hospital admissions (remember that the vaccine is only about 50% effective in an average year at preventing influenza; and that these women are likely in at least some cases choosing hospitalization because they’re 37+ weeks pregnant as much as because they have the flu). So economically, it seems the flu vaccination of 3rd trimester woman is a waste of money. Actually, there is a chance that those women who spend the last couple weeks of their pregnancies in hospital have a higher rate of interventions & complications while they’re subsequently giving birth, so there might be some increased costs there which make the $5k seem less high. But I doubt there’s much data there.
And now I’ve been writing for too long, so I’ll put off till later doing a bit more looking into this. For now though, the indication seems to be that this is yet another case of vaccinating people who really don’t need it, at a cost which is unjustifiable.
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