Obstetricians' Attitudes on Maternal and Infant Immunization - A survey in USA

Maternal and Child Health Journal

Missed Opportunities

Abstract

The recent reoccurrence of several vaccine-preventable diseases demonstrates the need for new techniques to promote childhood vaccination. Many mothers make decisions regarding vaccination of their children during pregnancy. As a result, obstetricians have a unique opportunity to influence maternal decisions on this crucial component of child health. Our objective was to understand OB/GYNs' attitudes, beliefs, and current practices toward providing vaccinations to pregnant patients and providing information about routine childhood immunizations during standard prenatal care. We surveyed OB/GYNs in the United States about their vaccination practices and perceptions during the 2009 H1N1 outbreak. Most (84%) respondents indicated their practice would be administering H1N1 vaccines to pregnant patients. While a majority (98%) of responding providers felt childhood vaccination is important, relatively few (47%) felt that they could influence mothers' vaccination choices for their children. Discussion of routine childhood immunization between obstetricians and their patients is an area for future improvements in childhood vaccination.

Read the entire article at Medscape

Comments: What I find fascinating is the interplay between Ob/gyn and the Pediatrician that is being increasingly realized in the West. While problems exist, they are taking steps to try to come together in the best interests of the patients. Here in India though, the situation is unfortunately quite different. There is hardly any professional interaction between Pediatricians & Ob/gyn. There are many reasons for this, including problems related to fees sharing (many Ob/gyn still deliver without pediatric support, and only call the pediatrician when the child is born distressed after birth). Other problems include lack of updated knowledge regarding newer recommendations for vaccines like Influenza in pregnancy, or cervical cancer vaccination. Finally, in smaller towns, many Ob/gyn also do the pediatric vaccination & OPD consultations themselves, thus creating further conflict of interest. Of course, I am speaking predominantly from a pediatrician perspective, but I am sure most doctors would agree that further cooperation would be in the best interest of the patients. Perhaps our professional bodies, FOGSI & IAP in India, can take further steps in this regard.

Breast cancer screening evaluated: the verdict - Lancet

Whether breast cancer screening does more harm than good has been debated extensively. The main questions are how large the benefit of screening is in terms of reduced breast cancer mortality and how substantial the harm is in terms of overdiagnosis, which is defined as cancers detected at screening that would not have otherwise become clinically apparent in the woman's lifetime. An independent Panel was convened to reach conclusions about the benefits and harms of breast screening on the basis of a review of published work and oral and written evidence presented by experts in the subject. To provide estimates of the level of benefits and harms, the Panel relied mainly on findings from randomised trials of breast cancer screening that compared women invited to screening with controls not invited, but also reviewed evidence from observational studies. The Panel focused on the UK setting, where women aged 50—70 years are invited to screening every 3 years. In this Review, we provide a summary of the full report on the Panel's findings and conclusions. In a meta-analysis of 11 randomised trials, the relative risk of breast cancer mortality for women invited to screening compared with controls was 0·80 (95% CI 0·73—0·89), which is a relative risk reduction of 20%. The Panel considered the internal biases in the trials and whether these trials, which were done a long time ago, were still relevant; they concluded that 20% was still a reasonable estimate of the relative risk reduction. The more reliable and recent observational studies generally produced larger estimates of benefit, but these studies might be biased. The best estimates of overdiagnosis are from three trials in which women in the control group were not invited to be screened at the end of the active trial period. In a meta-analysis, estimates of the excess incidence were 11% (95% CI 9—12) when expressed as a proportion of cancers diagnosed in the invited group in the long term, and 19% (15—23) when expressed as a proportion of the cancers diagnosed during the active screening period. Results from observational studies support the occurrence of overdiagnosis, but estimates of its magnitude are unreliable. 

The Panel concludes that screening reduces breast cancer mortality but that some overdiagnosis occurs. Since the estimates provided are from studies with many limitations and whose relevance to present-day screening programmes can be questioned, they have substantial uncertainty and should be regarded only as an approximate guide. If these figures are used directly, for every 10 000 UK women aged 50 years invited to screening for the next 20 years, 43 deaths from breast cancer would be prevented and 129 cases of breast cancer, invasive and non-invasive, would be overdiagnosed; that is one breast cancer death prevented for about every three overdiagnosed cases identified and treated. Of the roughly 307 000 women aged 50—52 years who are invited to begin screening every year, just over 1% would have an overdiagnosed cancer in the next 20 years. 

Evidence from a focus group organised by Cancer Research UK and attended by some members of the Panel showed that many women feel that accepting the offer of breast screening is worthwhile, which agrees with the results of previous similar studies. Information should be made available in a transparent and objective way to women invited to screening so that they can make informed decisions.

Independent UK Panel on Breast Cancer Screening. The benefits and harms of breast cancer screening: an independent review. The Lancet. 2012;380:1778-86.

Source 

Cocooning Protects Babies

Everyone in a baby’s life needs to get vaccinated against whooping cough and flu!

What is cocooning?

Babies younger than 6 months old are more likely to develop certain infectious diseases than older children are. Cocooning is a way to protect babies from catching diseases from the people around them – people like their parents, siblings, grandparents, friends, child-care providers,  babysitters, and healthcare providers. Once these people  are vaccinated, they are less likely to spread these contagious diseases to the baby. They surround the baby with a  cocoon of protection against disease until he or she is old enough to get all the doses of vaccine needed to be fully  protected.

Why is cocooning important?

Babies less than 6 months old are too young to have  received all the doses of vaccine that are needed to protect  them from whooping cough (pertussis), flu (influenza),  and other dangerous diseases. To be fully protected, babies need to get all the vaccine doses in a series – not just  the first dose.

Unvaccinated adults and family members, including parents, are often the ones who unknowingly spread dangerous  diseases to babies.

How can we protect babies?

Everyone has the opportunity to protect babies by getting  vaccinated themselves. Cocooning is an easy and effective  way that people can work together to prevent the spread  of whooping cough and flu to babies.

How can we protect babies against  whooping cough?

•        All children should be vaccinated on schedule with  DTaP (the childhood whooping cough vaccine).

•        All teenagers and adults need a one-time dose of Tdap  vaccine (the teen and adult whooping cough vaccine).

•        Unvaccinated women who might become pregnant  should receive a Tdap vaccination.

•        Pregnant women who haven’t been vaccinated with  Tdap should receive a dose in the 2nd or 3rd trimester  of pregnancy. This will protect the pregnant woman as well as her baby!

How can we protect babies against flu?

Everyone age 6 months and older needs to receive flu  vaccine every year.

Source

Commentary: In India, where even routine vaccinations are not completed for many babies, cocooning may seem like an exotic concept! However, there needs to be an awareness regarding this concept among pediatricians, since there are increasing number of parents coming to private practitioners who want to protect their babies from "all" infectious illnesses by vaccinations. In this situation the concept of cocooning should be explained to them in relation to grandparents, the parents & other close care-providers. Given the abysmal lack of adult vaccination, this would end up benefiting the adults too ! As stated above, Pertussis & Flu (influenza) are the two vaccinations which the adults maybe offered to prevent the newborn baby from getting these serious diseases.