Vaccination decisions

This is a contentious area at the moment and I, by no means, am an expert. The information in this post is a culmination of what I’ve discerned as legitimate information on the internet and therefore subject to error and misjudgement.

This week I will be offered a vaccination against Whooping cough (Pertussis) because there was a sustained outbreak of it in 2012, and whilst cases are now falling, they are still unusually high. Thousands of people a year in the UK have been taken ill, including tiny babies who are hit by it the hardest. Some have died and there are heartbreaking accounts from parents on the internet that tapped into my deepest fears as I read them over the weekend. It’s highly contagious and caught through droplets and vapour in the air from people sneezing and coughing. It doesn’t seem like there is a very effective way of treating it and the administration of antibiotics just prevents contagion from the sufferer, other than that you just have to hope their tiny lungs have what it takes it battle it.

The danger zone is the period before the baby is 8 weeks old. By 8 weeks they will be given their own primary vaccination, but before that they are vulnerable. So the NHS have decided to give pregnant mothers a whooping cough booster. This way the antibodies transfer to the foetus transplacentally, giving her the defence she needs for the first few weeks of her life. So far so good.

The vaccine the NHS are administering is called Repevax – from what I can gauge, Repevax is the copyrighted brand name for the vaccine ‘DTaP’. DTaP is a vaccine against Diptheria, Tetanus, Pertussis and Polio.

All of this sounded fine-ish to me, because growing up I had every vaccine going. Although I am still confused about why you need to sling an extra three vaccinations in there, if Pertussis is the only significant threat at the moment. Feels a bit like they had some left over in the warehouse and made do, or maybe they got a good deal on it?

Understandably I feel nervous about going from policing every chemical I put on or in my body (including using an organic deodorant made from exotic fruit and jojoba extract that cost me a very cheeky 15 quid) to blindly putting my faith in the NHS, holding out my arm and allowing it to be injected with agents and chemicals that I don’t understand. I’d never really cared much about looking into vaccines I’d been given before, but now I’m carrying a passenger without a voice I wanted to extend her the courtesy of doing some homework first.

In addition to this, Jake is cynical about the ethics of the drugs industry and his inclination is to refuse all of them unless absolutely required. I don’t necessarily disagree with him. It seems widely acknowledged that successfully peddling drugs to large medical organisations is a dirty, corporate world. There isn’t some divine board of ethics selecting our drugs with only our best interests at heart. The final selection is probably down to drug company tactics motivated by profit and slick drug reps thinking only of their commission. Less cynically, it’s down to what the NHS can afford. We don’t have a bottomless pot of money to give the whole population the best healthcare money can buy, all of the time. I’m sure the NHS have to make pragmatic decisions all time about who gets which vaccine and when and maybe sometimes, it’s not the most perfect solution.

We both also believe in being socially responsible. We’re aware there are some people who are allergic to vaccines and therefore rely on herd immunity – people like us – to have them.

All things considered, we realised we needed to know more about Repevax to feel comfortable. A quick Google search did not provide us with that comfort. The Summary of Product Characteristics says:

“The use of this combined vaccine is not recommended during pregnancy”.

This is because pregnant women are routinely left out of clinical trials, and therefore they can’t say categorically what the effects of the drug are on a foetus.

The NHS have responded and said although the drug is not ‘recommended’ it is not ‘not recommended’ or ‘cointraindicated’ as they call it in the world of drugs. Repevax is given to three years olds as a whooping cough booster, so it has been tested in that capacity, but has only been administered to pregnant women (apparently 60% have taken up the offer) since 2012, so it’s still early in the game. We can’t even learn from The States because, despite the fact they have been administering DTaP to pregnant women longer, they don’t give them Repevax – they give them some other brand.

It really weighed on me researching this, because invariably you come across stories of babies that died of whooping cough, and for every one of those there are heartbroken parents whose babies were stillborn who are utterly convinced it is down to this vaccine – as they maintain the deterioration started around 32 weeks – the time it was administered. The NHS say this would have happened anyway and that there is no link, but it still leaves an uneasy feeling.

The situation isn’t ideal. I either a) just take it and worry about consequences b) don’t take it and spend the first eight weeks of the baby’s life as a paranoid wreck worrying she will catch Pertussis or c) do a combination of what they call ‘cacooning’ and quarantine: Jake and I have the vaccine after the birth and then she and I stay inside for two months until she’s ready for her jab and receive no visitors.

After debating these three, frankly shit, options I came across some more research that has been done recently. In reaction to the concern, the manufacturers of TDaP have rallied around and collected birth registries from all the births by mothers that were vaccinated. The results showed that there was no ‘elevated frequency or unusual patterns of averse effects’ in women that received TDaP, which gives me an element of comfort.

The other important thing to acknowledge is that, at 32 weeks, the baby is completely physically developed. I think there is still some reinforcement going on the lung area, but the baby is pretty much just getting fatter until her due date from weeks 32 onwards.

It must also be mentioned that the other three components of TDaP (Tetanus, Diptheria and Polio vaccines) have been given to pregnant women for decades, it’s just the Pertussis element that is new.

The last three points cited have helped me decide to have the vaccination, but I don’t feel comfortable with the situation, or with the lack of information from a recognised and trusted authority addressing the fact there have not been clinical trials of this vaccine for use on pregnant women.

I found an article by the BBC quoting the Chief Medical Officer Prof Dame Sally Davies as saying the vaccine was a ‘no brainer’ during pregnancy. I welcome the reassurance, but with no clinical trials under our belt to show us the long term effects of giving babies a pertussis vaccination in utero, should it be?

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