- TORONTO - Canada will purchase
supplies of unadjuvanted swine flu vaccine to offer to pregnant women who
might otherwise choose not to be vaccinated, the country's chief public
health officer has revealed.
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- Dr. David Butler-Jones told The Canadian Press that Canada
will buy 1.2 million doses of unadjuvanted pandemic vaccine which will
be reserved for pregnant women, who are at significantly greater risk of
becoming severely ill and dying if they contract the virus.
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- "I'm anticipating for pregnant women we will have
an option," he said in an interview.
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- The vaccine will be supplied by GlaxoSmithKline, Canada's
pandemic vaccine manufacturer, and is expected to be available at the same
time as the country's other supplies of vaccine.
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- Adjuvants are compounds that boost the immune system's
response to vaccine, allowing smaller doses to be used per person. Canada
is buying adjuvanted pandemic vaccine partly in response to a call from
the World Health Organization for affluent countries to use "antigen
(vaccine) sparing" techniques so that limited global supplies can
be stretched as far as possible.
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- While some European countries have used adjuvanted flu
vaccines for a number of years, none of the currently licensed flu vaccines
in Canada contains an adjuvant.
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- And there are no data on the use of adjuvanted flu vaccine
in pregnant women - a fact that may add to the already high degree of reluctance
many pregnant women feel about taking any medication or therapy.
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- "What is absolutely clear is that there is much
more of a safety data base in pregnant woman with non-adjuvanted vaccine,"
said Dr. Marie-Paule Kieny, head of the WHO's vaccine research initiative,
the division overseeing pandemic vaccine issues.
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- "Does it mean that it (adjuvanted vaccine) will
be unsafe? No. It means that there is no hard evidence that it will be
(safe)."
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- The lack of evidence led a panel of experts that advises
the WHO on vaccine issues to recommend unadjuvanted vaccine be offered
to pregnant women if that option is available.
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- Butler-Jones said some pregnant women may prefer an adjuvanted
formulation, because it's likely to protect more broadly against mutated
strains of the virus if and when they arise, and because it can be taken
in smaller doses.
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- Another plus, he said, is that one dose of adjuvanted
vaccine might suffice, meaning pregnant women could be protected faster
than if they had to get two doses of an unadjuvanted vaccine. (Dose requirements
for swine flu vaccines are still being determined.)
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- But the decision to buy unadjuvanted vaccine for pregnant
women - something the Public Health Agency of Canada had earlier said it
would not do - reflects the very real fear of public health officials that
pregnant women may shun this vaccine.
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- "I think that it is possible that a good chunk of
the (pregnant) patients may just say: 'You know what? No thanks.' And that's
obviously a problem," said Dr. Richard Beigi, an academic obstetrician
from Pittsburgh who recently published results of a survey suggesting few
pregnant women would agree to take a pandemic flu shot.
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- "I think it is going to be challenging," Kris
Sheedy, head of the H1N1 vaccine communications team at the U.S. Centers
for Disease Control, said of the effort to convince pregnant women they
should get a pandemic flu shot.
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- It is well known that in previous pandemics pregnant
women were the hardest hit group in terms of deaths. And this time around,
there have been many reports already of miscarriages, emergency deliveries
and deaths in pregnant women who caught swine flu.
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- Pregnant women are also at greater risk of complications
from catching seasonal flu. Yet their willingness to be vaccinated against
it remains low, despite government recommendations that they should get
flu shots.
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- Sheedy said in the U.S., around 15 per cent of pregnant
women get vaccinated most years. Dr. Jeff Kwong, a University of Toronto
researcher who studies flu shot rates, said he doesn't know of a corresponding
national figure for Canada. But a small study in Toronto during the 2003-04
flu season showed 14 per cent of women got a flu shot during their pregnancy.
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- Beigi's survey asked nearly 400 pregnant women if they
would agree to be vaccinated with an avian influenza vaccine during a pandemic
caused by that virus.
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- The survey was conducted before swine flu broke out and
was done in the context of fears that the H5N1 virus - which kills roughly
60 per cent of the people who catch it - might cause the next pandemic.
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- Despite the high fatality rate of the H5 virus, only
15.4 per cent of the pregnant women surveyed said they'd take a shot if
a bird flu pandemic erupted. And half the office staff of the obstetrical
practices where the survey was conducted said they would not recommend
the pregnant women in their care get pandemic vaccine.
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- "I was relatively shocked at the responses,"
said Beigi, who teaches in the department of obstetrics, gynecology and
reproductive sciences at the University of Pittsburgh Medical Center.
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- Sheedy said the CDC plans to work with obstetricians,
hoping to persuade them to make the case for pandemic vaccination to their
patients. Studies have shown, she said, that pregnant women value highly
the advice they get from their obstetricians.
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- "I'm empathetic," she said, noting she has
a two year old and a five year old, and remembers well the concerns of
pregnancy.
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- "I understand that some (pregnant women) are going
to choose not to vaccinate, but I do hope that if we're able to get information
out there about what we're seeing with this virus and its impact on these
women, that many of them will at least ... consider it."
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- Follow Canadian Press Medical Writer Helen Branswell's
flu updates on Twitter at CP-Branswell
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- Copyright © 2009 The Canadian Press. All rights
reserved
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