She was seven months pregnant, a Hispanic woman on Medicaid living with her husband and five other children in a cramped apartment. But then she came down with the flu. Suddenly, acutely ill, she was rushed to a hospital, delivered her baby in an emergency surgery and died a few days later without ever having held the child.
The Santa Ana, Calif., woman was among dozens of pregnant women who died during the H1N1 flu pandemic in 2009. Approximately 6 percent of the deaths caused by H1N1 occurred in pregnant women, a rate that far exceeded any other group. Expectant mothers are among several types of people who are much more vulnerable to the influenza virus than the rest of the population, including young children and older people, people with asthma, Native Americans and those with heart disease. Flu can also make chronic health conditions worse, according to the Centers for Disease Control and Prevention.
Instead of the flu being a miserable experience that causes a few days of missed work, the price more susceptible people pay for infection can be significantly higher, such as hospitalization and even death. Curtailing the economic and social costs of flu complications has become a major public-health imperative in recent years. Each year in the United States, flu causes several thousand deaths and more than 200,000 hospitalizations.
Still, only about 20 percent of people who are particularly vulnerable to complications from the flu get vaccinated, Dr. Gregory A. Poland, director of Translational Immunovirology and Biodefense at the Mayo Clinic and Foundation in Rochester, Minn., told TakePart.
People who remain unvaccinated either don't know they are vulnerable or are afraid of the vaccine or need prodding by their physician, says Poland, a spokesperson on flu protection for the Infectious Diseases Society of America. Infants and young children are at higher risk for complications because haven't developed strong enough immune systems to fight flu while people over age 65 have immune systems that aren't as hearty as they used to be.
"People ages 65 and older face a two-edged sword," he says. "At that age, at least in the United States, many Americans have accumulated a variety of medical problems. The second problem is what we call immunosenescence or immune age. That's the ability of the immune system to respond to pathogens or vaccines decreases over time. They are not only vulnerable to the virus, but by the same mechanism, they tend not to respond as well to the vaccine."
A new vaccine for people ages 65 and older that has four times the dose of flu antigen became available last year. Called the Fluzone High Dose, it produces a stronger immune response although, according to the CDC, it's not yet clear whether it offers greater protection from the flu.
Public health officials are trying harder than ever to let vulnerable people know how they can protect themselves against the flu. And, according to one new report, efforts to reach one high-risk group may be working. Research released last month from the CDC found almost half of pregnant women surveyed had received a flu vaccination in the 2011-2012 flu season. That's a significant boost from the estimated vaccination rate of 30% in 2007-2008 and 38% rate in 2010-2011.
The deadly H1N1 flu outbreak of 2009-2010 was a harsh wake-up call on the need to target flu protection measures to the most vulnerable populations, such as pregnant women. According to one study, among 347 pregnant women who became severely ill with H1N1 in 2009, 75 died and 272 were admitted to an intensive-care unit. Of those women who delivered while hospitalized for influenza, 63.6 percent delivered preterm or very preterm and 43.8 percent delivered low birth-weight infants. While H1N1 was particularly dangerous for pregnant women, any type of influenza in pregnant women is risky because they have weakened immune systems and lower respiratory capacity.
The new study, published in the Morbidity and Mortality Weekly Report, was a poll of 1,660 pregnant women. Researchers found black women had lower rates of vaccination than Hispanic and white women. The study also showed that more than 81 percent of the women got the shot when their doctors recommended it.
Women who declined vaccination did so because they thought it might cause the flu or hurt the baby or because they didn't think the vaccine was effective.
"When we can get physicians that take care of a special group, like ob-gyns, on board, we seem to do reasonably well in improving vaccination rates," Poland said.
"The problem with pregnant women has been that they have absorbed a cultural knowledge that you don't take anything when you're pregnant. That narrative has to be turned around to: If you get vaccinated, you protect yourself and your unborn baby."
Here's the CDC's list of groups most vulnerable to flu:Children younger than 5, but especially those younger than 2 Adults ages 65 and older Pregnant women People of American-Indian or Alaskan Native descent People who have asthma People who have neurological and neurodevelopmental conditions (such as cerebral palsy, seizure disorders, mental retardation, epilepsy, muscular dystrophy or spinal cord injury) People with serious, chronic conditions such as chronic obstructive pulmonary disease, cystic fibrosis People with heart disease and coronary artery disease People with blood disorders (such as sickle cell disease) People with endocrine disorders (such as diabetes) or inherited metabolic disorders People with kidney or liver disorders People with weakened immune systems, such as those with HIV or AIDS, cancer or people taking steroids on a regular basis People age 19 and younger who are on long-term aspirin therapy People who are morbidly obese
If you're at higher risk for complications from the flu, you should talk to your doctor about getting a flu shot or other ways to protect yourself from the flu. For example, if you live with young children, it's important that they get the flu shot in order to lower the chances that you would be exposed to the virus.
You can take other precautions to protect yourself from the flu, according to the CDC:Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it. Wash your hands often with soap and water. If soap and water are not available, use an alcohol-based hand sanitizer. Avoid touching your eyes, nose, or mouth. Germs are spread this way. Try to stay at least six feet away from people who appear ill. If you are sick with flu-like illness stay home for at least 24 hours after your fever is gone. Your fever should be gone without the use of a fever-reducing medicine. Keep away from others as much as possible to keep from making them sick. Follow public health advice regarding school closures, avoiding crowds and other social distancing measures. Be prepared in case you get sick with a supply of over-the-counter medicines, alcohol-based hand sanitizer and tissues. Call your doctor if you get sick. Take flu antiviral drugs if your doctor prescribes them.
Are you getting a flu shot this year? Why or why not? Let us know in the comments.
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Shari Roan is an award-winning health writer based in Southern California. She is the author of three books on health and science subjects.
- Public Health