We approach is an extremely sensitive subject and complex. Sensitive because it is an unborn baby, because the complex immunological status of pregnant women is still very mysterious. What comes to
a pediatrician in this case?
The gynecologist who sees pregnant women, is it not better placed?
No, e follows your gynecologist pregnancy and is trying to deliver the baby the most wonderful, but immunology is not his cup of tea. The immunologist
? Yes it is very hard, but how will you meet?
The pediatrician is at the crossroads between mother, father, child. It can help you sneak.
Anyway I try, to the best of my ability and my knowledge.
What is the status of a pregnant woman an immunological point of view?
A pregnant woman has received the father's sperm, which, combined with an egg, gave an "egg" which will turn into an adorable baby. Therefore welcomes the mother this fetus, future infant. This is similar to a transplant.
When we make a skin graft if the donor is not compatible, that is rejected in 8-10 days. Off the baby is 9 months tolerated. At 9 months, it seems "rejected" and the delivery takes place.
pregnancy was achieved through a process of immune tolerance during which the mechanisms of graft rejection are put to sleep.
same time the baby is tolerated, many other "things" are accepted: Toxoplasma transmitted not undercooked meats, Candida albicans fungus, which gives the B streptococcus and others.
pregnant woman no longer rejects what is foreign.
is also why it is minimally responsive to vaccines. It is not clear how effective are the vaccines. Although the last ten years, advocates vaccination of pregnant women are still quite ignorant of their effects and 10 years is very short.
How effective vaccines for pregnant women?
To my knowledge, there is no serious study on the effectiveness of vaccines in this situation because it is ethically impossible to recruit pregnant women to study the effect of an injection of vaccine. Of course, in the series "Be modern", some vaccinate pregnant women for two reasons apparently laudable, then protect them and their babies . But this is very recent. How many times have we not seen great trials, brutally interrupted? In time pediatrician, I believe that exceptions linked to an individual situation particularly serious, it takes about 20 years back to accept a new treatment for a product on individual growth, but also physical brain. For vaccines in pregnant women, has mostly been limited to study the case by mistake a vaccine was injected, and the only question that holds the attention then is: how is the baby?
frantic lobbying of private health systems, laboratories and insurance in the USA-probably in Europe, but we talk less - not greatly increased our tranquility. (See reference section of the World)
The only publication that I could find on the database in the NEJM (see below) on a limited study done in Bangladesh in 2008 ( why Bangladesh when everything was so simple in the U.S.? probably because this country has an outstanding medical facilities as well as its legal system, which made everything easier ). 340 pregnant women were vaccinated with reduced flu in mothers (but for doing my own research on small series of Parisians in easy to follow, I wonder how we can effectively monitor 340 women in a country as impoverished as Bangladesh.) And it was a Glaxo vaccine , so a study funded by the laboratory. can therefore eliminate this highly suspicious study. Would I be grumpy or bad language at the moment? I no it's not so good character!
Presumably pregnant women the vaccine is less effective. More when it is a new vaccine, nobody knows anything. What
toxicity of vaccines for mom and baby?
In most cases there is no problem (remember that the incidence of Guillain Barre syndrome during the U.S. influenza vaccination in 1976 was 1 in 56 000 vaccinations). But statistics do not count if it's your baby, especially there is no large series. Will you try saying the Bank? Would you take a risk when you do not know whether the vaccine will protect you?
Abstract:
Pregnant women are slightly more at risk but not more than other flus and what they propose is not rated for a company wide scale. I can not decide for you because there is no right answer.
If you do not know what to do, give you 15 days. In 15 days we have to experience some side effects.
References:
Effectiveness of Maternal Influenza Immunization in Mothers and Infants . New England Journal of Medicine (NJEM) 359 :1555-1564 October 9 2008 NUMBER 15 (this study in Bangladesh Glaxo flu vaccine uses a coincidence no doubt) (NB: access to the full article is available to subscribers)
New England Journal of Medicine Vol 361 No 20 12 November 2009 (4 articles on the flu)
A STEP HEHEAD, Infant Protection Through Maternal Immunization.'s Pediatric Clinic of North America 47 No. 2 April 2000 449-463
The Lobby will not disarm. Interview Wendel Porter Former Director of Communication of a giant U.S. health insurance "Le Monde" dated Tuesday, November 24, 2009 (NB access to the full article is available to subscribers)
"Should we vaccinate pregnant women?" I do not think anyone can answer this question. The mother herself will decide ultimately. A poker player must know, but what does he know of immunology, development of fetuses and the affect of mothers? "
Article may be changed.
Updated November 26, 2006 marked
The next topic talk about the flu in the U.S. and Australia and New Zealand in France, Auvergne because the NEJM (always him) of 12 November published a synthesis of these two countries. I have also used data on pregnant women to shape my opinion. Leave me a little time, it is in English very technical stuffed percentage, and I have my awesome to see young patients in consultation and intaglio and life itself! Good day!
0 comments:
Post a Comment