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Pregnant women to be included in routine flu vaccination



By Lilian Anekwe

Exclusive: Pregnant women are to be routinely vaccinated against seasonal flu, after health secretary Andrew Lansley accepted the recommendation of Government advisors to include them in the list of at-risk groups for flu from next year.

Andrew Lansley made the announcement after the latest minutes from the Joint Committee for Vaccination and Immunisation (JCVI), the expert advisory panel to the Department of Health, showed the committee believes that the evidence was strong enough to include the group permanently in the vaccination process.

At the meeting in October, the experts considered an analysis from researchers at the Health Protection Agency, published earlier this month in the journal Vaccine, which indicated that vaccinating pregnant women against flu in the second or third trimester is likely to fall below cost-effectiveness threshold of £30,000 per QALY.

Lead study author Dr Mark Jit, a health economist at the HPA centre of infections concluded: ‘Vaccination between September and December was found to have an incremental cost-effectiveness ratio of £23,000 per QALY if it is assumed that infants are partially protected through their mothers, and of £28,000 per QALY gained if infants are not protected.’

The minutes of the meeting show the committee had some doubts about the wide confidence intervals around the estimates in the model, but evidence published last month, which showed maternal influenza vaccination also offered protection in young infants, prompted the committee to make a formal recommendation.

‘There are clear health gains to pregnant women from influenza vaccination as pregnancy is an established risk factor for complications from influenza, particularly from the H1N1v strain that may continue to be a major circulating strain.

‘Furthermore, there is now good evidence for a health benefit to infants in the first few months of their life as a result of passive immunity passed to them from their mothers. This could provide some protection to infants in clinical risk groups who cannot receive influenza vaccine before they are six months of age.

‘Given these benefits, the committee advised that pregnant women should be vaccinated routinely against seasonal influenza.’

A Department of Health spokesperson said: ‘The Secretary of State has accepted the recommendation of the JCVI that all pregnant women should be vaccinated against seasonal flu on a routine basis.’

The chief medical officer will write to all GPs in March, to instruct them to offer flu vaccination to all pregnant women from the beginning of the 2011/12 season onwards.

Pregnant women are in the at-risk groups for this year’s flu vaccination campaign, which uses a jab that includes the H1N1 swine flu strain, as it is thought to offer additional protection to pregnant women.

But Speaking earlier this year, Professor David Salisbury, the DH director of immunisation, called on the JCVI to make a ‘quick and definitive’ recommendation on the long term routine vaccination of pregnant women.

The Government has now decided to widen the vaccination programme to all pregnant women, estimated at 500,000 every year.

DH advisors have recommended all pregnant women are vaccinated against flu JCVI minutes 6 Oct 2010 Jit et al Vaccine 2010 Benefits of vaccinating pregnant women

– Pregnancy is an established risk factor for complications from influenza
– Additional protection from the H1N1v strain that may continue to be a major circulating strain
– Other clinical risk groups are offered seasonal influenza vaccines based on clinical judgement rather than an assessment of cost effectiveness
– There is now good evidence for a health benefit to infants in the first few months of their life as a result of passive immunity passed to them from their mothers
– Could provide some protection to infants in clinical
risk groups who cannot receive influenza vaccine before they are six months of age
– There is good evidence that the vaccine can be given safely to pregnant women
– Offering influenza vaccine routinely to all pregnant women could lead to increased uptake of the vaccine by pregnant women with additional risk factors who may be
avoiding vaccination because of their pregnancy

Source: Minutes of JCVI meeting, 6 October