Tag: pregnant

Obstetric Tetanus Is Still a Thing in the United States

Yes, even though we have had a tetanus vaccine for over 80 years, obstetric tetanus is still a thing in the United States.

Obstetric Tetanus in Kentucky

According to a report from the CDC, in July 2016, an unvaccinated Amish woman in Kentucky developed “facial numbness and neck pain, which progressed over 24 hours to stiff neck and jaw and difficulty swallowing and breathing” about nine days after “she delivered a child at home, assisted by an unlicensed community childbirth assistant.”

She  was hospitalized for a month, during which time she had seizures and was on a mechanical ventilator to help her breath for a “prolonged” amount of time.

Fortunately, her baby didn’t also develop tetanus, even though the family refused a recommended dose of tetanus immunoglobulin that could prevent neonatal tetanus from developing.

Surprisingly, after this incident, only 12% of community members agreed to be vaccinated with a tetanus vaccine. One pregnant woman even refused to get vaccinated. This is even less than the response to the Ohio measles outbreak in 2014, when up to 28% of unvaccinated Amish members got vaccinated with an MMR vaccine.

Neonatal Tetanus

An 8-day old baby with neonatal tetanus born to an unvaccinated mother.
An 8-day old baby with neonatal tetanus born to an unvaccinated mother. (CC BY 3.0)

In addition to obstetric tetanus, getting tetanus during or right after a pregnancy, neonatal tetanus is a big concern for unvaccinated mothers. Just like if their mothers don’t get a flu or pertussis containing vaccine, without a tetanus vaccine, newborn babies don’t get any passive immunity and protection against tetanus.

In 2015, 34,019 newborns died from neonatal tetanus worldwide. Amazingly, that is down from 787,000 newborns in 1988 “through immunization of children, mothers, other women of reproductive age (WRA) and promotion of more hygienic deliveries and cord care practices.”

It is not all about hygiene though. Tetanus spores are everywhere. For example, in the Kentucky case, the CDC found no evidence of “birth trauma, unsterile conditions, or other complications.”

In Montana, the baby of an unvaccinated mother developed tetanus that was linked to a non-sterile clay that was given to them by a midwife for home umbilical cord care.

Fortunately, these kinds of cases are rare. There have probably been less than 40 cases of neonatal tetanus since the early 1970s, and only two since 1989, but they should still be a reminder of what could happen if we stop getting vaccinated.

Risky Umbilical Cord Practices

Adding to the risk of getting tetanus, the same moms who aren’t getting vaccinated and protected may be following unsafe umbilical cord care practices.

“…tetanus in neonates can result from umbilical cord colonization, particularly in countries with limited resources. This infection results from contamination of the umbilical separation site by Clostridium tetani acquired from a nonsterile device used to separate the umbilical cord during the peripartum period or from application of unhygienic substances to the cord stump.”

AAP – Umbilical Cord Care in the Newborn Infant – 2016

In countries that are still combating neonatal tetanus, we hear of mothers in rural areas  putting herbs, herbal pastes, chalk, powders, clay, oils, and even butter on their baby’s umbilical cord.

These natural substances are certainly not safer than more standard care, as they can be contaminated with something else that is natural – tetanus spores.

What natural things, and risky, things can you see recommended for umbilical cord care in developed countries? How about honey, goldenseal powder, Frankincense and myrrh oil, and Aztec Healing Clay?

You don’t feed honey to infants because of the risk of botulism spores, but you are supposed to put it directly on their umbilical stump?

Some midwifes even recommend ground rosemary or other dried herbs that you are actually supposed to sprinkle directly on your baby’s umbilical stump. The use of dried herbs is especially problematic. It is well known that these products are not sterile.

“Spore forming bacteria (B. cereus, C. perfringens) that are capable of causing foodborne disease when ingested in large numbers are frequently found in spices and herbs, but usually at low levels.”

Food Microbiology. Volume 26, Issue 1, February 2009, Pages 39–43

If dried herbs are also contaminated with tetanus spores (C. tetani), and you place them on an umbilical cord stump of a child whose mother wasn’t vaccinated against tetanus, then you unnecessarily increase the risk for neonatal tetanus.

Not that you would ever hear about this risk from anyone who pushes these practices or tells these moms to avoid getting vaccinated. What happened to informed consent?

And what happens as Andrew Wakefield‘s kids continue to grow up, move beyond getting measles, and begin to have kids? If they still aren’t vaccinated, they and their babies will be at risk for diseases that we thought we had gotten well controlled, like obstetric tetanus, neonatal tetanus, and congenital rubella syndrome.

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Passive Immunity

In contrast to active immunity, like when you get a vaccine, passive immunity isn’t triggered by your own immune system.

Instead, passive immunity is the protection you can get from “someone” else.

Passive Immunity is Temporary

While the best example of passive immunity is the protection that newborn babies get from their mothers, other examples include:

  • antitoxin serum – often produced in animals, this type of serum can provide antibodies against botulism and diphtheria toxins. Examples include TAT, DAT, and HBAT.
  • immune globulin – either pooled or from a single person with high titers of antibodies, immune globulin is made from donated plasma can provide antibodies against the hepatitis A or B virus, measles, rabies, tetanus, and varicella. They can be used for postexposure prophylaxis, after you have been exposed to one of these diseases and are not already immune. Examples include IGIV, HBIG, VariZIG, RIG, and Baby BIG, etc.
  • palivizumab (Synagis) – a monoclonal antibody that is specific for the RSV product and which is given to high risk premature babies to keep them from getting sick during RSV season.

Again though, the best example of passive immunity is the transfer of a mother’s antibodies to her baby through her placenta, which can include antibodies against measles, pertussis, and hepatitis B, etc., as long as the mother has immunity to these diseases.

Of course, this type of passive immunity doesn’t mean that your baby doesn’t need to get vaccinated, a common argument of those who skip or delay getting their infants vaccinated.

The biggest problem with passive immunity is that it is only temporary. In the case of maternal antibodies, they start to wane after a few months in many cases, even though they might provide protection against many diseases for up to six to twelve months.

Polio and Passive Immunity

Passive immunity likely helped prevent young children from getting more serious cases of polio in the pre-epidemic era. While infants likely got exposed to polio when they were 6 to 12 months old, since they still had partial protection from maternal antibodies, they may have gotten diarrhea (enteric infection), but it wouldn’t progress to the more serious paralytic polio.

With better hygiene and sanitation, eventually fewer young infants got exposed to polio, and we lost this method of getting “active immunity under the cover of passive protection.” Instead, they got exposed when they were older and had lost any protection from passive immunity. This led to the epidemics of polio and paralytic polio with which we are all familiar.

Breast Milk

Breast milk is another source of passive immunity. This comes from a different type of antibody though, in addition to other substances in breastmilk. While the antibodies babies get through the placenta are IgG antibodies and are directed against most vaccine-preventable diseases, breastmilk antibodies are IgA.

IgA is also called the secretory immunoglobulin, as it is found in our saliva, and respiratory tract and intestinal secretions, but don’t enter our bloodstream. While the secretory IgA antibodies children get in breastmilk won’t protect them against most vaccine-preventable diseases, they can protect them from other viruses and bacteria that cause diarrhea and respiratory infections, etc.

For More Information On Passive Immunity:

 

References On Passive Immunity:
Vaccines (Sixth Edition), 2013

 

 

Thimerosal in Vaccines

Although it was never actually linked to any real side effects, thimerosal (mercury) was removed from almost all childhood vaccines in 1999.

Thimerosal, a preservative, only remained in flu vaccines for a few years, but thimerosal free flu vaccines have been available since 2003.

That’s also the year that the remaining non-flu vaccines with thimerosal expired – January 2003.

And this year, at least “120 million doses of thimerosal-free or preservative-free influenza vaccine will be produced.” That means that over 75% of flu shots are thimerosal free, leaving only some multi-dose vials of flu shots to still have thimerosal, but making it easy to avoid if you want to.

Myth of Continued Exposure to Mercury in Vaccines

Although thimerosal was removed from vaccines in 1999, some anti-vax folks still claim that many vaccines contain mercury.
Although thimerosal was removed from vaccines in 1999, some anti-vax folks still claim that many vaccines contain mercury. Photo courtesy of Refutations to Anti-Vaccine Memes

Although most anti-vaccine groups have moved on to other conspiracy theories to scare parents, some still falsely claim that vaccines continue to be made with thimerosal and that thimerosal is dangerous.

Robert F. Kennedy Jr., for example, continues to claim that even though thimerosal has been removed from pediatric vaccines, “thimerosal levels remain virtually unchanged.” This is mostly, he claims, because of flu shots with thimerosal. Also, when a pregnant woman gets a flu shot, Kennedy claims that the fetus gets a bolus of thimerosal “that’s about 800 times the amount of mercury the CDC recommends.”

First, it is important to remember that the original concerns about thimerosal were because children who received a complete set of thimerosal containing vaccines (only hepatitis B, DTaP, and Hib ever had thimerosal) could get up to 187.5 micrograms of ethyl mercury by the time they were six months old, which exceeded the EPA limits for methyl mercury ingestion (but was less than the FDA limits). They aren’t the same type of mercury though, and thimerosal free versions of DTaP and Hib were already available in the late 1990s, so many kids likely got less than 187.5 micrograms of ethyl mercury.

Since thimerosal was removed from almost all vaccines beginning in 1999, that left flu vaccines as the main pediatric vaccine that still used thimerosal as a preservative. So did expanded flu shot recommendations for kids mean that they still got a lot of thimerosal over the years?

It is extremely unlikely that many kids have gotten each and every one of their yearly flu vaccines with thimerosal. It is more likely that they got just a few with thimerosal and the rest without, as thimerosal free flu vaccines became more widely available. After all, a flu vaccine with reduced thimerosal was available as early as 2002.

In 2003, thimerosal free flu shots became available and Flumist, a thimerosal free flu nasal spray vaccine was also approved. The supply of thimerosal free flu vaccines increased each and every year. For the 2014-15 flu season, over 100 million doses of flu vaccine are available that are thimerosal free or preservative free (with only trace amounts of thimerosal).

Even if kids did get flu vaccines with thimerosal each year though, would it matter? A 2008 study in Pediatrics, “Mercury Levels in Newborns and Infants After Receipt of Thimerosal-Containing Vaccines,” found that the half-life of ethyl mercury was about two days, “suggesting that exposure to thimerosal-containing vaccines does not result in an accumulation of mercury in blood.” And the highest blood level they found was less than 5-8 nanograms/ml, which is far less than the 187.5 micrograms that anti-vax groups continue to talk about, even in infants who had already received a cumulative dose of 162.5 micrograms of thimerosal.

What about flu shots in pregnancy?

A 2010 study in Pediatrics, “Prenatal and Infant Exposure to Thimerosal From Vaccines and Immunoglobulins and Risk of Autism,” found that “prenatal and early-life exposure to ethylmercury from thimerosal-containing vaccines and immunoglobulin preparations was not related to increased risk of” autism spectrum disorders. Two other studies have also found that prenatal exposure to thimerosal from immunoglobulin preparations, like Rho(D) immune globulin, during pregnancy were not associated with an increased risk for autism.

And also consider that fewer than 15 to 30% of pregnant women got flu shots before 2009. After 2009 and the H1N1 pandemic, rates did increase, but only to about 38 to 52%.

Although current recommendations don’t state a preference for the type of flu shot for pregnant women, it is likely that at least some of them got thimerosal free flu shots. In California, for example, since the passage of their Mercury Free Act in 2006, pregnant women and children younger than age 3 years have to get vaccines that are ‘mercury free.’

What To Know About Thimerosal in Vaccines

Thimerosal is a preservative that was removed from vaccines beginning in 1999, which means that most teens today got little or no exposure to thimerosal from vaccines.

More Information About Thimerosal in Vaccines:

Updated April 8, 2017