As autumn approaches my thoughts turn, not to the new school term or autumn leaves but to the subject of vaccination. Perhaps not what you thought I would say but, as midwives, we have access to a simple public health intervention to improve our own health and that of the mothers and babies for whom we care.
Why is flu such a risk for in pregnancy? Pregnant women especially in the third trimester are at significantly greater risk from flu than the wider population. A US study of the 2009 H1N1 outbreak showed a four-fold increase in serious illness and five-fold in hospital admission. (Oxford vaccine knowledge project, 2019). MBRRACE (2014) showed that in that same outbreak in the UK there were 36 deaths during or shortly after pregnancy. There are also risks for the baby with four times more the number of preterm births and increases in both stillbirth and neonatal death. For pregnant women and their unborn babies, flu is not a minor illness. Midwives play a key role in encouraging women to have the flu vaccine. It has been shown to be safe if the circulating strains are correctly identified.
With reports of a serious flu strain currently circulating in Australia with a high level of notifications (Australian Broadcasting Corporation, 2019), it might be, if the northern hemisphere has similar experiences to Australia, that we will see the end of the milder strains experienced since the H1N1 outbreak in 2009.
The focus of encouraging flu vaccination take-up had been on the elderly and those with pre-existing conditions; pregnant women were added more than a decade ago. Recent years has seen a strong push to vaccinate children who form a reservoir for the virus and can be regarded as super spreaders. Children aged from 2 to 10 years (at 31.08.19) are eligible to receive a live attenuated vaccine by intranasal administration. Given that many pregnant women mix regularly with young children, the ongoing year on year extension of eligibility is to be welcomed.
There are concerns though that the current negative view of vaccinations (in particular for measles, mumps and rubella), in certain communities might undermine the push for flu vaccine take up. It is important that all those eligible are encouraged to access vaccination. The ultimate aim is to achieve 75% of all groups including pregnant women receiving vaccination with an interim target of 55%. There is still some way to go with uptake at 47% in 2016/17 and falling to 45.2% in 2018/19 (PHE 2019).
In addition to promoting vaccination to pregnant women, midwives as well as all frontline NHS and social care staff will be encouraged to be vaccinated.
Being vaccinated prevents transmission to anyone who is vulnerable including family members but also avoids exacerbating staff shortages due to illness. However, there are responsibilities on employers to make being vaccinated easy for staff to access especially those working unsocial hours or based in the community. The vaccine is inactivated so there is no risk of getting flu from the vaccine. 2019 saw staff vaccination levels at 70%, double the level in 2010/11 (NHS Employers 2019) but more can be done to increase take-up.
Although the autumn focus is on increasing the levels of flu vaccination, there are two other things to consider. First, pertussis vaccination can be discussed with women at the same time and second the importance of forming good public health habits and laying foundation for childhood vaccination. Midwives have a big role, time to get on with it.