Michelle Fiscus, MD, FAAP from the Association of Immunization Managers (AIM) joins host Chris Stallman, CGC to discuss respiratory virus season and what pregnant people can do to help protect their babies against RSV, COVID-19, Seasonal Influenza (flu) and whooping cough (pertussis).
Resources mentioned in this episode:
Association of Immunization Managers:
BOOSTRIX Tdap Vaccine – MotherToBaby Pregnancy Study
Ep. 78 Transcript
You’re listening to the Mother 2 Baby podcast, medications and more during pregnancy and breastfeeding. Ask the experts with your host, genetic counselor and mama for Chris Stallman.
This episode contains evidence-based information that’s current as of the day recorded and may change as more data becomes available. To get the very latest information about this topic or other topics in pregnancy and breastfeeding, Please contact a mother to baby specialist at 866 626 6847, by text at 855 999 3525, or through our website at mothertobaby.org.
Welcome to another episode of the MotherToBaby podcast. My name is Chris Stallman, and I’m a genetic counselor, a mom of four, and a teratogen information specialist. So what that means is that I talk to people, so patients, family members, healthcare providers, and the general public about exposures that can happen before pregnancy, during pregnancy, while breastfeeding, or in cases of adoption.
And an exposure can be anything. So it could be a chemical at your job. It could be a medication that you take, or it could be a vaccine. Our guest today is here to talk with us about respiratory virus season and vaccines. Dr. Michelle Fiscus is a board-certified pediatrician and chief medical officer at the Association of Immunization Managers, or AIM, which helps to support the CDC funded immunization programs across the country.
Dr. Fiscus, welcome to the show. Great to be here. Thanks, Chris. So can you tell us a little bit about the AIM organization? Sure, we are a small but mighty 501c3 nonprofit that works nationally, as you said, to support the CDC funded immunization program. So every state in the United States has an immunization program, usually housed at their state department of health.
And then there are some cities, some major cities like Washington, D. C. or New York City or Philadelphia, Philadelphia. That have their own immunization programs within their states. And then we also support the immunization programs in the U. S. territories and freely associated states like Guam and Micronesia and the U.
S. Virgin Islands and Puerto Rico. And so we help. Those program managers, um, make their jobs a little easier. They have a lot that they have to do to make sure that vaccines are available in their jurisdictions to make sure that, um, every person that’s, that’s there has the ability to get vaccinated and to make sure that the information that they’re getting about vaccines is correct.
Very, very critical. I feel like it had always been, but I think in the last few years, especially we we’ve learned collectively, you know how important that correct and timely information is so. Speaking of that, what are respiratory viruses and when is respiratory virus season? Respiratory viruses are, are those, um, illnesses that circulate in fall.
Um, sometimes they’re common colds, which can be caused by thousands of different kinds of viruses. But the ones that we really think about with respiratory season are seasonal influenza or the flu, um, something called respiratory syncytial virus, which may be a little less. We call that RSV because respiratory syncytial virus is really kind of hard to say.
And then, um, we also see, um, COVID 19, of course, SARS CoV 2, which is the virus that causes COVID 19, which really hasn’t settled into a season yet, but Because of the number of hospitalizations and sick people that we get from COVID 19, when you layer that on top of the fall flu cases and the fall RSV cases, it really starts to strain the U.
S. health system. Um, and so we’re going to lump COVID 19 into this too for the purpose of this discussion. Okay. Why is vaccination important? Well, vaccination is really our best, uh, defense against any of these viruses. Viruses are super smart. They’re really good at mixing up their, their genetics and finding ways to get around.
Um, defenses that we have to fight them off and some of those viruses, like for instance, influenza or SARS CoV 2 that causes COVID, they change constantly from season to season and sometimes even within seasons. And so our bodies may have experienced those viruses before and they created this great immune protection against those viruses.
But then that virus goes out and puts on like a big nose and glasses and a mustache and it comes back and it looks completely different from the virus that your body saw the last time. And so these are vaccines that we really have to get over and over again. We’re talking about influenza or COVID 19 because those viruses keep trying to outsmart the defenses that we have in place to keep us from getting super sick.
So when you’re pregnant, You, um, you’re a little bit, what we call immunosuppressed. You’re, you’re, it’s a little easier for you to get sick. You’re a little run down. Sometimes you’re a little anemic because of pregnancy. And it’s easier for those viruses to get in and cause problems that make pregnant people super sick.
And sometimes put them at, at much higher risk of being hospitalized or even dying from infections that maybe wouldn’t be as serious had they not been pregnant. Okay. Absolutely. And what about risks to the newborn for things like RSV or whooping cough and pertussis? Well, those little babies come out pretty defenseless, too.
They get some antibodies from their mom from either transfer across the placenta. So if you get vaccinated with, say, a vaccine that protects against pertussis or whooping cough while you’re pregnant, then that antibody can pass to your baby. Because when the baby comes out, they’re not old enough. get vaccinated.
So we really rely on those antibodies that mom can give to protect and we all want to protect our babies the best possible way. So, um, so being vaccinated while you’re pregnant, breastfeeding, these are all things that help protect the baby and help develop their immune system so that they can fight off a virus if they come into contact with it.
The other thing that we can do is, Make sure that if we’re vaccinated, we’re not bringing those viruses and those bacterial illnesses like pertussis into our house where then we’re face to face with our babies and putting them at higher risk of getting them super sick. Those little babies, um, have to work really hard if they get a respiratory virus.
They’ve got little tiny lungs and not a lot of capacity. And so if we start to stress them, Um, then they have a really hard time eating. They have a hard time sleeping. They have a hard time growing. They might be super fussy. And sometimes we have to put them in the hospital just because they get dehydrated and need some oxygen to try to help, um, manage them until their bodies can fight off whatever illness we’re dealing with.
So the vaccine certainly, as you said, can protect babies. family members, but also the person who is pregnant or newly delivered or breastfeeding as well. Because as you say, you know, we are absolutely worried about those around us, but we also need that person who was pregnant or who is breastfeeding. We need them to be healthy too, not only for their own well being, but for, you know, taking care of themselves and the people around them.
That’s exactly right. And you know, when you get vaccinated, when you’re pregnant, you kind of get to double dip a little bit because that vaccine. against flu or, or COVID is helping you not get seriously ill from flu and COVID. But then you’re also giving those antibodies to your baby. So if they come into contact with it when they’re really young and before they can get vaccinated, then that’s also helping to protect them.
Remember, babies can’t be vaccinated against COVID until they’re six months old. So they have a really long window of exposure. exposure, where if we can get mom to give them some antibodies, they can really help protect them. And they also can’t get vaccinated against influenza until they’re six months old.
And then it has to be in the season when we’re actually vaccinated against influenza. So some babies might be closer to a year. Before they get their first flu vaccine and um, and you know, having moms help give them a good healthy start with that protection is really important in those early days. I didn’t even think of that, but I’m so glad that you mentioned it.
So my last two were both born in January. Um, and obviously we had to wait six months for these vaccinations and it, it did, you know, we’ve just waited until the next cold and flu season, you know, it was a bit more than six months for us and honestly, I never would have put that together. So I think that’s a great reminder that sure, six months is, is where it can start.
if you’re in that particular season for flu. I know you had mentioned that COVID doesn’t really have a season, but for flu, you know, there are some, some clear guidelines and they’re not available everywhere throughout the entire year. Right. And the same goes for RSV. We, we only, um, vaccinate pregnant people right now when it’s RSV season, when we’re, when we’re looking at having a baby during RSV season, which generally runs October to March or so, November to March.
Um, So, you know, if you’re pregnant and it’s April, you may not be able to get an RSV vaccine right now, and your baby may be born without the ability to protect them. So we do have kind of a safety net or a second chance with RSV, something called nircivumab, which needs an acronym. But yeah. But that is a, what’s called a passive antibody that we can give newborns that come into their first RSV season.
It’s not really a vaccine. The vaccine teaches your body how to make antibodies. This is actually giving the baby antibodies. Our to what the mom would give if the mom had been vaccinated, and we can give that one shot to a newborn baby who was born during our RSD season to help protect them. So if the mom didn’t have an opportunity to protect their baby because of these vaccines, the timing of their pregnancy in the RSD season, there is an opportunity to protect the baby directly when the baby’s born.
What vaccines are recommended during pregnancy that can protect against respiratory viruses? And is there a specific time in pregnancy where people should get them? Great question. So, for your time. Every person needs to get a flu vaccine and that can happen at any point in a pregnancy. So, um, if, you know, if you’re getting into October and you’re pregnant, that is a perfect time to get vaccinated against influenza.
You can even get vaccinated a little earlier in the season if you’re due to deliver your baby in like September or October. You might even be able to get vaccinated against influenza as early as August in some cases. So, if you If you’re pregnant right now, you should go get a flu vaccine. Um, I’m a pediatrician.
We like to say flu before boo. So we want to get everybody vaccinated against influenza before Halloween. Yeah, that’s awesome. That’s the ideal time. But if you miss that, you can get vaccinated against influenza anytime during the season. But, but really the idea is you want to get that vaccine in before we really start seeing the virus.
Thankfully right now in the U. S. influenza is still pretty quiet. CDC does a lot of careful watching to see what’s happening with these viruses and we’re not really seeing much in the way of flu. So you’ve got some time, but really ideally before the end of October. you want to try to get a flu vaccine.
You should also get what’s called a Tdap vaccine, which is not against a virus but protects your baby against whooping cough or pertussis. That’s a bacterial infection that babies can get when they’re very young. They themselves can’t start getting vaccinated against it until they’re two months old and even then that’s just the first of a series of shots.
So they have a period of time in their early months. where they’re vulnerable to whooping cough, and that’s a bacterial infection that can be fatal in newborn babies. And so, giving mom the Tdap vaccine helps to give those antibodies to the baby before they’re able to get vaccinated themselves, and helps to protect them.
From whooping cough, which is really, really important. And then, um, the RSV vaccine, if you’re pregnant, coming into RSV season. So, um, beginning now, September, October, until, um, January or so of this year. It was between 32 and 36 weeks gestation is when you should get your RSV vaccine against respiratory syncytial virus.
Again, that is mainly to protect the baby, although moms can get serious RSV illness as well. But really what we’re trying to do is protect that baby who was born during RSV season. So if you’re between 32 and 36 weeks of your pregnancy, that’s the window where we want to get you vaccinated against RSV to help the baby.
And then COVID vaccines can happen at any time. And so just recently in August, we had new updated COVID 19 vaccines approved. And if you are pregnant, you Or even if you’re not pregnant, if you have not had that new updated 24 25 COVID 19 vaccine, you really need to go get that. You can get it at any time during your pregnancy to help protect you from serious COVID disease, but also help to pass some of those antibodies to, to your baby, who again can’t get vaccinated until they’re six months old.
Um, a lot of people think, you know, well, I’ve had COVID, so I don’t need to worry about getting COVID vaccine. And the way I like to think about this is, you know, if you’ve got a kid and, um, let’s say they’re five years old and you go into the closet and get out last year’s winter coat and put it on your now six year old, it’s going to be way too small for them in most cases.
And that coat might give them a little bit of protection against the cold in the winter, but if it gets really bad, it is not going to be enough. And that’s kind of how I think about COVID vaccines. Last year’s COVID vaccine, yeah, might cover you a little bit, but the new viral variants that keep evolving and changing and putting on new disguises are looking a lot more like a blue flannel coat than last year’s pink puffy coat, and your immune system might not know what to look for.
So you really need to go get that updated vaccine, so if you have not had a COVID vaccine since September, you’re behind, and you really need to go get that updated one, especially if you’re pregnant. And are there other vaccines that might be recommended for some people during pregnancy? I’m going to give the very, um, scientific response of independent.
If, if you are someone who might be at high risk for something like Hepatitis B, um, it might be recommended that you get a Hepatitis B vaccine, again, to protect yourself and also to protect your baby from Hepatitis B. Hepatitis B is one of those viruses that down the road can cause cancer. Um, liver cancer is what we see with hepatitis B.
So that’s one that we really want to prevent in everyone. Um, so you could get a recommendation for that if you’ve not had those vaccines. Hepatitis A is another one. If you’re someone who maybe has liver disease or is at high risk of having trouble from a hepatitis infection, it might be recommended that you get a hepatitis A vaccine.
And if you’re planning on traveling internationally while you’re pregnant, there may be certain travel vaccines that are recommended. So make sure you check with your doctor to make sure that if there are any travel vaccines that might be recommended that you’re getting those too far in advance of you going on those international trips.
So as you said, you know, it’s going to depend and I’m going to add a very mother to baby answer to that, which is. Also, something you’ve already mentioned, talk with your health care provider and they can let you know what vaccines are recommended for you. Absolutely. The best place to get information. Dr.
Fiscus, thank you so much for being on the show today. But before you go, what is the final thought you would like to leave the audience with? The one. The best thing that you can do this respiratory season to help protect you and your baby the best is to receive vaccines against RSV, COVID 19, and influenza, and also the Tdap vaccine to prevent whooping cough in your baby.
We all as moms want to do the absolute best thing we can do to protect our babies and these are the absolute best things that you can do to make sure that your baby gets off to a healthy start and to protect you for the rest of your pregnancy to make sure that you don’t suffer any serious consequences from any of these diseases that we can so easily prevent with a vaccine.
So true. Thank you again. Um, and in our show notes, we’ll put some information about the mother to baby vaccination fact sheets that we have. And of course, some information about AIM. Perfect. So you can find out more about AIM at immunizationmanagers. org. We do have a lot of resources there that might be helpful, but also look at places like March of Dimes, the Centers for Disease Control and Prevention, and healthychildren.
org, which is the American Academy of Pediatrics. parent facing website. All of those are great resources for factual information about the immunizations that you and your baby need. Excellent. Thank you so much. Thanks for having me. Oh, you said the magic words. That means we would like to have you back for a future show.
Absolutely. Anytime. That would be wonderful. Thank you. And that’s going to do it for this episode of the Mother2Baby podcast. On the next episode, we’re going to be joined by a special guest from our partners at an organization called Vaccinate Your Family. She is currently pregnant and we’ll talk about some of the myths she’s been hearing among her circle of friends surrounding vaccination during pregnancy.
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