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The H1N1 Vaccine & Pregnant Women

by Sue Hubbard, M.D.

I had an e-mail question from a pregnant woman & @blossominvites (via twitter) asking my thoughts about H1N1 vaccine and adjuvants and mercury.  She knew that pregnant women were being prioritized to receive H1N1 (swine flu) vaccine, as there have been a disproportionate number of hospitalizations and deaths in pregnant women who were diagnosed with “swine flu”.  Her concern was the safety of the vaccine during pregnancy.

As with so many other issues while you are pregnant, getting sick, especially with influenza can be more serious for pregnant women. It has been recommended for at least the last three to four years that ALL pregnant women receive seasonal influenza vaccine. This is both to protect the expectant mother, as well as the newborn that derives some immunity from trans-placental antibodies. This year as everyone knows, is quite unusual, in that H1N1 flu vaccines are being recommended in conjunction with seasonal flu vaccines.

The H1N1 vaccine being used in the United States does not have adjuvant. Adjuvants are chemicals that are used when making some vaccines, and the adjuvant seems to boost the body’s antibody response. If this translates into the need for a smaller dose of vaccine per person, then more vaccine is available. Some other countries are using adjuvanted H1N1 vaccines.

The other issue surrounds the preservative thimerasol. Thimerasol has been used for many years to keep multi-dose vials of vaccine from being contaminated with bacteria and fungus, which in theory might enter the vial as different syringes are used to draw up each dose of vaccine. Thimerasol is ultimately broken down into metabolites one of which is ethyl mercury.

There has been concern surrounding the issue of mercury toxicity secondary to cumulative doses of vaccines, and since 2001 thimerasol free vaccines have been used for immunizing infants and children. There continues to be a minimal amount of thimerasol in multi-dose vials of flu vaccine. Typically, a flu vaccine will contain 0.01% thimerasol as a preservative, which translates into about 50 micrograms of thimerasol per 0.5 ml dose of vaccine. This is equivalent to about 25 micrograms of mercury per 0.5 ml dose of vaccine.

We are all exposed to mercury in our daily lives, by way of food that has been contaminated by mercury (including fish, like swordfish, shark and tuna) as well as our dental fillings, batteries and a multitude of other means. Limiting one’s exposure by decreasing consumption of these fish seems more prudent to me, everything in moderation right?

Looking at the miniscule amount of thimerasol/mercury found in a single vaccine given once yearly, and weighing that minimal and theoretical risk against the benefit of being immunized against influenza during pregnancy, I would not hesitate to be vaccinated. I feel that you would have a greater chance of developing influenza and having a serious complication or death by foregoing vaccination. The ACIP, NIH, and Institute of Medicine have all looked at the safety surrounding thimerasol and there is no data to show a link between this preservative and developmental issues in either the fetus or child. This topic has been very well researched, in studies worldwide.

There are preservative free flu vaccines, but they may be more difficult to find as there are not as many produced. Each year companies are improving on getting more of this vaccine to market. If you cannot find preservative free vaccine, I would not wait to be vaccinated. The time is now!

So, get your vaccine as soon as you can. It would take over 420 doses of flu vaccine to even approach the maximum safe dosage of mercury, and you only need two (seasonal and H1N1).

That’s your daily dose, we’ll chat again tomorrow.

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