“The doctor said, ‘It’s absolutely not from the flu shot. You can’t get sick from the flu shot,’” Tyler remembers. “‘You were probably just sick before.’”
It is now standard practice to inoculate expectant women in America against influenza between October and May, the period considered to be “flu season” by the American College of Obstetricians and Gynecologists (ACOG) and the Centers for Disease Control and Prevention (CDC).2,3 (The CDC also recommends that all children over six months of age be vaccinated against influenza every year.4) ACOG, reiterating recommendations from the CDC’s Advisory Committee on Immunization Practice (ACIP), claims that “preventing influenza during pregnancy is an essential element of prenatal care, and the most effective strategy for preventing influenza is annual immunization.”5
When I was pregnant in the fall of 2009, there was a media blitz on the dangers of both the H1N1 (aka swine flu) strain of influenza and other forms of the flu virus. The news articles created so much fear among friends and family members that several relatives, including my father-in-law, kept anxiously calling to make sure the baby was OK and that I hadn’t come down with the flu. The headlines about the dangers, especially to pregnant women, of a number of different influenza viruses commonly lumped together and referred to as “the flu,” were worrisome: “Pregnant Women More at Risk from Swine Flu,” proclaimed an MSNBC article from May 2009. The article was accompanied by an ominous picture of five bleary-eyed Asian travelers wearing surgical facemasks at the Los Angeles International Airport, where, the photo seemed to imply, contagion was rampantly spreading.6 “CDC Reports 28 Swine Flu Deaths Among Pregnant Women,” warned a Washington Post article in October 2009.7
“I recommend the flu vaccine to anybody contemplating pregnancy, any woman in the first, second, or third trimester of pregnancy,” says Allan S. Emery, MD, Section Chief of Gynecology at Providence Hospital in Southfield, Michigan, who has been practicing medicine for over 30 years.8
“Pregnant women get much sicker when they have respiratory diseases than people who are not pregnant,” Emery continues. “That has to do with the physiological changes during pregnancy. They have compromised breathing just from the size of the fetus. Pregnant women are much more likely to have medical visits. If they go to the hospital, they stay there longer. And they run the very real chance of ending up on a respirator.” Because of these dangers, Emery’s group was “very very aggressive with the flu vaccine and quick to treat women symptomatically.”
Like Dr. Emery, Cynthia Fahey, RN, Executive Director of the Perinatal Advisory Council (PAC/LAC), a nonprofit maternal- and child-health organization based in Tarzana, California, believes the flu vaccine is essential. “The complications of flu during pregnancy include bacterial pneumonia and dehydration, which can impact the health of both mother and baby,” Fahey wrote to me. “Pregnant women with the flu are more likely to be hospitalized than women of the same age who are not pregnant. We strongly recommend that all pregnant women receive the flu shot if they are pregnant during flu season. . . . The only exception is women who are allergic to eggs, as egg products are used to create the vaccine.”9
But despite the media clamor and the clear recommendations from ACOG and the CDC, pregnant women are quietly declining the vaccine. “We never even considered it,” my friend Pam McMahon, 28 weeks pregnant with her fourth child, confided, shaking her head disapprovingly as she layered on two winter coats to protect herself from the frigid December air of western Massachusetts. “It just seems totally unnecessary.”10 The only time McMahon’s husband, Jason, remembers getting really sick from the flu was the day after he had a flu shot.
Nonetheless, the vaccination of pregnant women appears to be on the rise. In 2005, only 16 percent of pregnant women in the US received a flu shot.11 Four years later, in 2009, that number had jumped to approximately 50 percent.12 The latter figure may be inflated; according to a National Public Radio report on CDC data from 2009, it appeared that less than 15 percent of pregnant women were accepting the shot.13 By whatever reckoning, at least half the pregnant women in America still forgo the shot, as Pam and I have.
Why are pregnant women declining the flu shot, and why are so many doctors ignoring14 CDC guidelines15 and not recommending the influenza vaccine to their pregnant patients?
Even people who consider themselves generally pro-vaccination have become wary of the flu vaccine. They point out that scientific studies do not show that pregnant women are at any more risk from the flu than anyone else. They also question the efficacy of the vaccine itself, not only because of the imperfect way it is manufactured, but also because they see from their own experience—and the experience of others—that the vaccine does not work. There is an erosion of trust because health authorities—such as Katie Tyler’s doctor, who insisted that the vaccine could not have made her sick—are not candid about possible side effects of the vaccine. Furthermore, they argue that, despite the denial from the CDC, there is clear evidence that the vaccine can and does sometimes cause harm to pregnant women and their fetuses. Finally, the healthcare practitioners and pregnant women who are taking a cautious approach to the influenza vaccine believe that, during pregnancy, less is more: that it is better to risk being naturally exposed to and becoming sick from a wild virus than to risk possible harm by injecting a manufactured, chemical-laden pharmaceutical product into a pregnant woman’s body.
Are Pregnant Women Really at More Risk?
No one enjoys getting the flu, which often feels like a severe cold and is characterized by fever, aches and pains, general malaise, headache, and exhaustion. Influenza symptoms can also include coughing, sore throat, and runny nose.16
When you’re pregnant and feeling more vulnerable than usual, to say nothing of having trouble sleeping and feeling tired, being sick is even more of a strain than usual.
Melissa Yoches’s bout with what might have been the flu was so awful she blocked it out of her memory. “Not sure if it was just a cold or the flu or what, but I was praying to the porcelain god big time, and it was devastating,” Yoches remembers. She lives in Oakland, California, and was 40 years old when her second son was born. “I cannot even express to you the level of uncomfortableness I felt. . . . In my mind, there’s nothing worse than being pregnant and hunkering down over the toilet.”17
But while it’s awful to be sick while you’re pregnant, there’s actually very little evidence to show that pregnant women are at greater risk than anyone else from the flu. And despite fear-inducing headlines, otherwise healthy people have almost nothing to fear from the flu.
As Robert W. Sears, MD, explains in The Vaccine Book: Making the Right Decision for Your Child, our estimates of how many people have serious complications from the flu are both inaccurate and inflated. Though millions of people come down with the flu every year, Sears explains that “virtually all cases of the flu pass without consequence.”18 In reality, the flu poses a real risk mostly to the elderly, many of whom have a host of other health problems.
Sears says that the common misperception of how dangerous the flu is due in part to the source of data about flu deaths that most doctors consult: the database of the CDC’s Morbidity and Mortality Weekly Report (MMWR), which lumps together deaths from the flu and from pneumonia, making it impossible to assess the actual risk of influenza.19 If you comb through statistics compiled by the National Center for Health Statistics of deaths from the flu of people of childbearing age—a database that, Sears says, doctors don’t commonly read—you’ll find that such deaths are rare. For example, in 2006, the actual number of deaths from flu among all men and women in America ages 15–44 was 29.20 In other words, if you’re in that age range, your chance of dying from any disease whose symptoms resemble those of the flu is less than one in 10 million. And even this minuscule number may be inflated; when a patient presents flu-like symptoms, doctors rarely test for the influenza virus.
Anecdotal (and terrifying) stories aside, the scientific evidence that pregnant women are actually dying from influenza is all but nonexistent, even when pneumonia and influenza are lumped together. The largest scientific study to date, the results of which were published in the American Journal of Perinatology in 2004, examined 49,585 pregnant women who were part of the Kaiser Permanente healthcare organization in Northern California over five flu seasons, as well as 48,639 live births among the same client pool during the same time period.
“Hospital admission with a principal diagnosis of influenza or pneumonia was an extremely rare event for the women in the study population,” wrote the study’s six authors. Only nine women (out of almost 50,000) were admitted, which is 0.018 percent, or less than one in 5,000; and of those nine women, all had pneumonia. All nine women recovered with no complications.21
In other words, although everyone agrees that the flu can make you sick and unhappy (“I remember yelling out, ‘Oh God, why me!?!’ while sobbing uncontrollably,” Yoches told me), to the best of our knowledge it actually poses very little threat of complications to pregnant women, and an even smaller threat of death.
After conducting an extensive review of all the available scientific literature, David M. Ayoub, MD, and F. Edward Yazbak, MD, came to the same conclusion. Writing in the Journal of American Physicians and Surgeons, they stated: “The [CDC’s Advisory Committee on Immunization Practices’s] citations and the current literature indicate that influenza infection is rarely a threat to a normal pregnancy.”22
There is another complicating factor in assessing the real risk of influenza to pregnant women: When a pregnant woman suffers from “flu-like symptoms,” there is no way of knowing if she has actually been infected by an influenza virus—again, because doctors in private practice rarely test for the flu. Illnesses caused by the influenza virus are impossible to distinguish from illnesses caused by other viruses or pathogens. If you’re sick, you might have influenza—or you might have a cold or other infection. In the absence of laboratory testing, it’s impossible to know if you have the flu.
“What people don’t understand is that most illnesses that are flu-like in humans are not documented to be caused by the influenza virus,” explained Lawrence B. Palevsky, MD, a physician in private practice on Long Island, New York, who has some 500 families in his practice. “When human adults have a flu-like illness in the winter, there’s no significant documentation that the major cause is influenza virus. It’s just assumed that if someone has a flu-like illness, it’s most likely caused by the influenza virus.”23 The estimates of the numbers of flu cases given yearly by the CDC are not for tested and confirmed cases of influenza, but for all reported flu-like symptoms.
Palevsky’s observation is confirmed by the scientific literature. For example, when British researchers tested pregnant women who had flu-like symptoms, none had detectable evidence of influenza.24 When Canada’s Centre for Infectious Disease Prevention and Control tested over 46,000 people presenting flu-like symptoms in the winter season of 2002–2003, they found that 92.9 percent of those symptoms were caused by viruses other than influenza.25
The Vaccine Itself Is Not Effective
Ritu Ahuja, a 33-year-old mom who lives in Walnut Creek, California, got the flu vaccine, including the H1N1 vaccine, in October 2009, in the first trimester of her pregnancy. Two months later, Ahuja, an attorney for the US Department of Agriculture, became sick with a high fever and chills. The advice nurse diagnosed her over the phone with H1N1 and told Ahuja to come in and get Tamiflu, the antiviral drug commonly used to treat it.
“I told them I’d already had the vaccine, and was simply told that it doesn’t always work,” Ahuja remembers. “They weren’t even going to screen for H1N1 or any other influenza, they were just assuming that’s what it was and giving out Tamiflu.”26
Despite being vaccinated, Ahuja continued to get sick throughout her pregnancy. “One recurring symptom I had with my many colds and other bugs during my pregnancy was an awful, hacking cough. I would cough so hard and for so long that I couldn’t catch my breath. There were times when the baby was definitely affected, and would start to shake and tremble inside of me while I was having a coughing fit. It was pretty scary.”
A reading of the scientific literature reveals that Ahuja’s experience of being sick with upper-respiratory infection throughout her pregnancy despite being vaccinated should not, unfortunately, be surprising. As pointed out by Ayoub and Yazbak, the Kaiser Permanente study of almost 50,000 pregnant women—the largest study to date—found no difference in the incidence of flu or even flu-like illness in those who received the flu vaccine compared to those who did not. This study also found no benefit to the infants of women who had been vaccinated. Nor did vaccination have a positive impact on women with asthma,27 a subgroup that the CDC continually claims is at higher risk from influenza.28 Another study of vaccine safety during pregnancy, published in the American Journal of Obstetrics & Gynecology in 2005, actually found that there were four times as many hospitalizations related to flu-like illness of women who were vaccinated than of women who weren’t,29 echoing findings from an earlier study published in 1998 in the American Journal of Epidemiology.30
Part of the reason the flu vaccine is so ineffective is the imperfect way it is manufactured. Influenza is caused by different strains of the influenza virus.31 If you remember your high school biology, a virus is a microscopic piece of genetic material that can replicate itself only inside the living cell of another organism. In one sense, a virus is “dead”—a piece of nucleic acid coated with protein. At any given time, an inestimable number of different viruses enter and leave our bodies,32 causing no damage. Evolutionary biologists explain that humans have actually evolved to live symbiotically with many different viruses and bacteria.33 When they do replicate themselves, these microscopic creatures change rapidly, which is why the dominant strains of the influenza virus are different in each flu season.
Manufacturing the flu vaccine is a bit like forecasting the weather: vaccine manufacturers and researchers try to predict which strains of influenza will be dominant in the coming flu season. Based on their best guesses, they choose three strains to include in the vaccine.
“The CDC is essentially taking a guess,” explains Heather Zwickey, PhD, Dean of Research, Associate Professor of Immunology at the National College of Natural Medicine, in Portland, Oregon. Zwickey earned her PhD in immunology and microbiology at the University of Colorado, has herself worked on vaccine design, and went on to a postdoctoral research fellowship at Yale University. Although she is pro-vaccine, Zwickey does not believe that universal vaccination for influenza is in the best interests of individual health. “The CDC’s been wrong several times in the past five years,” she says.34
In the literature made available to doctors and other healthcare professionals, the CDC admits that there are several challenges to creating an effective influenza vaccine, and that vaccine effectiveness is greatly lowered when the strains of influenza in the vaccine are not “well matched” to the strains of influenza in circulation in the population—which is what occurred in the 2003–2004 flu season.35
The information the CDC provides to doctors about the inefficacy and imperfect nature of the flu vaccine is surprisingly candid. Their website states: “[I]n some years when vaccine and circulating strains were not well-matched, no vaccine effectiveness may be able to be demonstrated.” (My italics.) “It is not possible in advance of the influenza season to predict how well the vaccine and circulating strains will be matched, and how that may affect vaccine effectiveness.”36
Evidence of Harm
Like any immunization, the flu shot has been associated with adverse reactions. These reactions include relatively benign aches and pains (myalgia), swelling at the site of the injection, and fever. More worrisome is the paralyzing condition known as Guillain-Barré syndrome, which, each year, 20 to 40 people report developing after receiving the flu shot.37 Women with a history of Guillain-Barré syndrome should not get the shot. The combined flu shots seem to have even worse side effects. On April 22, 2010, one month after Australia began vaccinating children with Fluvax, an Australian-made vaccine that contains inactivated fragments of the H1N1 virus as well as of the H3N2 and B strains, the government recalled the vaccine and temporarily suspended the vaccination program.38,39More than 60 children had reported having adverse reactions brought on by the vaccine, including high fevers, vomiting, and febrile convulsions. Australian newspapers reported that one baby in Perth went into a coma after receiving the vaccine.40 Four months later, Finland banned an influenza vaccine that combined H1N1 and other strains after 750 people who had received the vaccine reported adverse outcomes, including a marked increase in narcolepsy.41
But it’s not only immediate side effects of the vaccine that concern pregnant women. When Jennifer Haude, 41, was seven months pregnant with her now three-year-old son, the health department was offering free flu shots at the fairgrounds. There were two lines: one for infants and older adults, and a second line for everyone else. The shot slated for infants and the elderly did not contain thimerosal, a mercury-based preservative that is no longer used in other childhood vaccines because mercury is a known neurotoxin, and there is concern that the preservative may be damaging.42 Haude, who works as a communications coordinator for a faith-based nonprofit in Canton, Ohio, stood in the line for the thimerosal-free shot. She was surprised when a health worker approached her to pull her out of the line.
“I thought that was really weird. . . . If you’re being cautious enough to keep mercury from babies who are sensitive to things, why wouldn’t you keep it away from fetuses, who are really sensitive to things?” Haude says.43
Even though she asked to speak to a supervisor and argued with the health authorities for 10 minutes, they wouldn’t agree to let her have the thimerosal-free vaccine.
Haude was very careful during her pregnancy to do nothing that might harm her fetus: she didn’t drink alcohol or eat cold cuts. Haude left the fairgrounds that windy autumn afternoon without getting a flu shot (and, incidentally, remained healthy until the end of her pregnancy).
“I would have rather suffered the flu than get that shot and hurt my kid,” Haude says. “I’m not going to go there and let them shoot me up with mercury. It’s just not going to happen.”
Although the CDC maintains that there is “no convincing evidence of harm”44 caused by the low doses of mercury in thimerosal-containing vaccines, the scientific studies that have been done to date have had serious design flaws. None of these studies has been done with a control group of unvaccinated children.
Back to Biology 101: We all know that, without an unvaccinated control group, conclusions about the potential safety or toxicity of vaccine additives cannot be made.
We also know that the negative effects of mercury are cumulative. That is, mercury accumulates in the human body over time, and pregnant women are already exposed to potentially toxic levels of mercury, ingesting and inhaling mercury from a variety of sources, including mercury-amalgam dental fillings, the emissions of coal-burning power plants, and fish.
Pregnant women like Haude are not the only ones who are worried. Five years ago, the American Nurses Association (ANA), an organization based in Silver Spring, Maryland, that represents 3.1 million registered nurses, called on pharmaceutical companies to develop seasonal flu vaccines without mercury. In their position statement, the ANA called mercury a “neurotoxicant” and “insist[ed] that pharmaceutical companies develop technology to produce seasonal influenza vaccine without using thimerosal as a preservative and cease using thimerosal as a preservative in vaccines immediately.”45
Many of the flu vaccines produced today contain the mercury-based preservative thimerosal, according to Lyn Redwood, a registered nurse and the cofounder and board member of SafeMinds, a nonprofit organization dedicated to raising awareness about mercury-induced neurological disorders in children.46 “Mercury is highly neurotoxic, and the fetus accumulates mercury at a higher rate than the mother,” she says.
Redwood points out that the Environmental Protection Agency (EPA) estimates that approximately one in every six women already has elevated levels of mercury that could cause harm to her unborn child. The EPA has recently reported finding that mercury cord-blood levels in newborns are approximately 70 percent higher than maternal levels at the time of delivery.47
“It’s illogical and dangerous to expose unborn children to even more mercury,” Redwood insists.48
In the package inserts that accompany the flu vaccines being used in 2011,49 the vaccine manufacturers (CSL Limited, Novartis, GlaxoSmithKline, MedImmune, and Sanofi Pasteur) state that safety studies have not been conducted on pregnant women and nursing mothers. The insert for the Afluria vaccine, manufactured by the Australian company CSL Limited and distributed in the US by Merck, reads: “Pregnancy Category C: Animal reproduction studies have not been conducted with Afluria. It is also not known whether Afluria can cause fetal harm when administered to a pregnant woman or can affect reproduction capacity. Afluria should be given to a pregnant woman only if clearly needed.”50
Pregnancy Category C is a Food and Drug Administration classification indicating that no adequate and well-controlled tests of the drug’s effects during pregnancy have been conducted, but that the potential benefits may outweigh the potential risks to a pregnant mother and her fetus.51
The package insert for the Fluarix vaccine (manufactured by GlaxoSmithKline), which has been tested on pregnant rats, reads: “Safety and effectiveness have not been established in pregnant women or nursing mothers.”52
The insert for the FluMist vaccine (manufactured by MedImmune LLC and administered as a nasal spray) reads: “Safety and effectiveness of FluMist have not been studied in pregnant women or nursing mothers.”53
Agriflu (manufactured by Novartis) has been tested for safety in female rabbits. Though the testing did not result in known harm to the animals, Novartis acknowledges the limits of these data: “There are, however, no adequate and well-controlled studies in pregnant women. Because animal reproduction studies are not always predictive of human response, Agriflu should be given to a pregnant woman only if clearly needed.”54
Because it has been tested on rabbits, Agriflu’s vaccine has been upgraded to a Category B drug, as have Fluarix and FluLaval (both manufactured by GlaxoSmithKline).
Is this enough evidence that these vaccines are safe? Many doctors don’t think so. “In my opinion, animal research is not enough, and more human research needs to be done to verify the flu vaccine’s safety during pregnancy,” insists Dr. Robert W. Sears.55
In addition to potentially toxic vaccine additives and the lack of an established safety record, the flu vaccine may be dangerous for pregnant women for another reason. As Lyn Redwood explains, we know that certain immune responses in pregnant women can cause harm to the fetus. It is not always clear if the harm is caused by the disease agent itself or by the mother’s immune response to the disease, but certain illnesses—including toxoplasmosis and cytomegalovirus (CMV)—put the fetus at risk, for both immediate problems and problems later in life. A growing body of evidence suggests that the mother’s immune response to influenza—the very response that is stimulated when an influenza vaccine is given—may harm the fetus’s growing brain.
According to an article by Melinda Wenner in Scientific American, studies have repeatedly linked adult-onset mental illness to prenatal infections with influenza virus and other microbes, suggesting that the children of mothers who make antibodies to these infections during pregnancy are more likely to be diagnosed with schizophrenia later in life.56
This concerns scientists such as Paul H. Patterson, PhD, a biologist at the California Institute of Technology who studies the interaction between the nervous system and the immune system, and whom Wenner quotes in her article: “I don’t think [the CDC has] considered this risk. In fact, I know they haven’t considered this risk,” Patterson said.
Wenner adds: “Researchers cannot yet predict how often a prenatal immune response might lead to fetal brain damage, but even if it happens less than 1 percent of the time, vaccinating an entire population of pregnant women could affect thousands of children.”57
In Pregnancy, Less Is More
Healthcare providers who push pregnant women to get the flu vaccine are quick to dismiss the idea that the mercury in thimerosal may be a component causing neurological damage in young children. They reject concerns that the flu vaccine has not been adequately tested on pregnant women and their fetuses, and that exposure in utero to the vaccine may cause a problem such as schizophrenia later in life.
Unfortunately, obstetricians and medical scientists have repeatedly denied that harm can come to the offspring of women from medical intervention done during pregnancy.
As Marsden Wagner, MD, points out in his book Born in the USA, beginning in the second half of the 1930s, pregnant women’s bellies were routinely X-rayed, until a report in 1956 showed that X-ray exposure in utero can cause cancer later in life.58 In 1947, the FDA approved the drug diethylstilbestrol (DES) for use during pregnancy. Despite the strong suspicion among some that a drug that mimics the body’s endocrine system (DES acts like naturally occurring estrogen) could be harmful to the human fetus, the majority of the medical community believed DES could prevent miscarriage. Nineteen years later, in 1966, a young woman was admitted to Massachusetts General Hospital because she was bleeding from her vagina.59 She was diagnosed with a fast, extremely rare, and invasive form of cancer. Over the next several years, more teenagers came to Mass General with the same cancer, and a quarter of them died. The others had to have radical surgery—including vaginectomy and hysterectomy—to save their lives.
The drug that Harvard researchers had touted as safe and effective, DES, was finally found to be the cause. But even before DES was approved for use during pregnancy, there had been serious concerns about its potential harmful effects, including a dozen published animal studies providing evidence that it was teratogenic—that is, that it caused developmental malformations. But it wasn’t until 1971 that the FDA withdrew the drug from use in pregnancy.60 DES continued to be used in pregnancy in European countries, including France and the Netherlands, into the early 1980s.61
My point is that the medical establishment and government agencies, despite having the best intentions, sometimes make recommendations that are based on neither good science nor good common sense. We have clear evidence that the flu is usually not dangerous to pregnant women, but we have no clear evidence that the flu shot is safe. What we do know is that the less we interfere with a pregnant woman’s bodily integrity, the better the outcome.
“The flu vaccine in pregnancy makes no sense to me medically,” says Dr. Lawrence B. Palevsky. “I don’t feel there’s any good scientific support to substantiate the recommendation. I don’t think it’s safe, and I don’t think its safety has ever been proven.” In an interview on National Public Radio, Ruth Faden, MD, disagreed. She argued that pregnant women should get the flu shot, but acknowledged that, because of the reluctance to do testing on pregnant women, “medicine is flying blind” in administering drugs, including the vaccine, to pregnant women. “It’s a terribly unsatisfying and arguably utterly unethical situation that we’re in,” Faden admitted.62
When you look at the scientific data showing that pregnant women are not more at risk from the flu than nonpregnant women, and that the flu vaccine is not effective and may actually cause harm, it is difficult to understand how the government could recommend that pregnant women or young children be vaccinated against influenza.
“Our flu-vaccine policy isn’t supported by the science,” Lyn Redwood says. “We have a policy that’s not evidence-based.”
Although Katie Tyler is no longer as angry as she was about getting sick from the flu vaccine, she’s still worried that there might be other negative consequences from the vaccine that her doctor didn’t tell her about, or is unaware of. She won’t accept the vaccine again.
Was it, after all, the flu vaccine that made Tyler sick?
“If a person gets the flu shot and gets sick within three days, the medical community will tell that person that it has nothing to do with the vaccine because you don’t get the flu from the vaccine,” says Dr. Palevsky. “One of the ways the body tries to get rid of the material that it sees as foreign is to get sick. It’s true you don’t get the flu from the vaccine. You get poisoned.”
Jennifer Margulis is writing a book, The Business of Baby, about how corporations and private interests skew the way we parent in America (forthcoming from Scribner, 2013). A Senior Fellow at the Schuster Institute for Investigative Journalism at Brandeis University, she is a former contributing editor to Mothering magazine and a mother of four. You can read more about her at her website (http://www.jennifermargulis.net) and read more of her writing at her popular blog, http://jennifermargulis.net/blog/.
1. Personal communication (2 December 2010).
2. American College of Obstetricians and Gynecologists, Committee Opinion No. 468, “Influenza Vaccination During Pregnancy,” Obstetrics & Gynecology 116, no. 4 (October 2010): 1006–1007.
3. Department of Health and Human Services, Centers for Disease Control and Prevention, “2011–2012 Influenza Season: Disease Activity”: http://www.cdc.gov/flu/about/season/flu-season-2011-2012.htm
4. Department of Health and Human Services, Centers for Disease Control and Prevention, “Recommended Immunization Schedule for Persons Aged 0 Through 6 Years—United States: 2011”: http://www.cdc.gov/vaccines/recs/schedules/downloads/child/0-6yrs-schedule-pr.pdf.
5. See Note 2.
6. MSNBC.com Staff and news service reports, “Pregnant Women More at Risk from Swine Flu,” MSNBC.com (14 May 2009): http://www.msnbc.msn.com/id/30398682/ns/health-cold_and_flu/.
7. David Brown, “CDC Reports 28 Swine Flu Deaths Among Pregnant Women” (2 October 2009): http://www.washingtonpost.com/wp-dyn/content/article/2009 /10/01/AR2009100104308.html?sid=ST2009100104325.
8. This and subsequent quotations: personal communication (21 October 2010).
9. E-mail communication (22 November 2010).
10. Personal communication (4 January 2011).
11. Tippi K. Mak et al., “Influenza Vaccination in Pregnancy: Current Evidence and Selected National Policies,” The Lancet: Infectious Diseases 8, no. 1 (January 2008): 50.
12. “Seasonal Influenza and 2009 H1N1 Influenza Vaccination Coverage Among Pregnant Women—10 States, 2009–10 Influenza Season,” Morbidity and Mortality Weekly Report 59, no. 47 (3 December 2010): 1541–1545; http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5947a1.htm.
13. Richard Knox, “CDC to Urge Swine Flu Vaccine for Pregnant Women,” National Public Radio, All Things Considered (29 July 2009): www.npr.org/templates/story/story.php?storyId=111320170
14. See Note 8.
15. Health and Human Services, Centers for Disease Control and Prevention, “2011–12 Influenza Vaccine and Vaccination Information,” http://www.cdc.gov/flu/flu_vaccine_updates.htm
16. David M. Ayoub, MD, and F. Edward Yazbak, MD, “Influenza Vaccination During Pregnancy: A Critical Assessment of the Recommendations of the Advisory Committee on Immunization Practices (ACIP),” Journal of American Physicians and Surgeons 11, no. 2 (Summer 2006): 41.
17. Personal communication (30 January 2011). According to the CDC, the influenza virus usually manifests as an upper-respiratory infection, but vomiting, diarrhea, and nausea can “sometimes be related to the flu”: http://www.cdc.gov/flu/about/qa/disease.htm.
18. Robert W. Sears, The Vaccine Book: Making the Right Decision for Your Child (New York: Little, Brown, 2007): 121.
19. Ibid.: 121–122.
20. Ibid,: 122
21. Steven B. Black, MD, et al., “Effectiveness of Influenza Vaccine during Pregnancy in Preventing Hospitalizations and Outpatient Visits for Respiratory Illness in Pregnant Women and Their Infants,” American Journal of Perinatology 21, no. 6 (August 2004): 333–339.
22. See Note 16.
23. This and subsequent quotations: personal communication (1 December 2010).
24. W. L. Irving et al., “Influenza Virus Infection in the Second and Third Trimesters of Pregnancy: A Clinical and Seroepidemiological Study,” British Journal of Obstetrics and Gynaecology 107, no. 10 (October 2000): 1282–1289.
25. Public Health Agency of Canada, “Statement on Influenza Vaccination for the 2003–2004 Season,” Canada Communicable Disease Report 29, ACS-4 (15 August 2003): http://www.collectionscanada.gc.ca/webarchives/20071116033200/ http://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/03vol29/acs-dcc-4/index.html.
26. E-mail communication (31 January 2011).
27. See Note 16.
28. See, for example, Department of Health and Human Services, Centers for Disease Control and Prevention, “Flu Shots—Get Vaccinated” (23 August 2010): http://www.cdc.gov/asthma/flu.html.
29. F. M. Munoz et al., “Safety of Influenza Vaccination During Pregnancy,” American Journal of Obstetrics & Gynecology 192, no. 4 (April 2005): 1098–1106.
30. K. M. Neuzil et al., “Impact of Influenza on Acute Cardiopulmonary Hospitalizations in Pregnant Women,” American Journal of Epidemiology 148, no. 11 (1 December 1998): 1094–1102.
31. See Note 18: 119.
32. There are 100,000,000 viruses in one teaspoon of sea water. The viruses and viral particles present in a single human body at any given time number in the millions, but because we don’t know how many of the same kind there are or how many different kinds there are, we can’t give a precise number. See this explanation from Dr. Leo Grady, Laboratories for Viral Diseases/Zoonotic Diseases, Wadsworth Center, New York State Department of Health: http://library.thinkquest.org/10607/gradyres.htm
33. Personal communication with Lynn Margulis, PhD, Distinguished University Professor, Microbial Evolution and Organelle Heredity, Department of Geosciences, University of Massachusetts at Amherst (1 February 2011).
34. Personal communication (11 November 2010).
35. Department of Health and Human Services, Centers for Disease Control and Prevention, “Flu Vaccine Effectiveness: Questions and Answers for Health Professionals” (1 July 2009): http://www.cdc.gov/flu/professionals/vaccination/effectivenessqa.htm.
36. Department of Health and Human Services, Centers for Disease Control and Prevention, “Selecting the Viruses in the Seasonal Influenza (Flu) Vaccine” (9 March 2011): http://www.cdc.gov/flu/professionals/vaccination/virusqa.htm.
37. See Note 18: 130.
38. Reuters, U.S. Edition, “Australia’s CSL Says Recall Child Flu Vaccine” (2 June 2010): http://www.reuters.com/article/2010/06/03/csl-australia -idUSSGE65200H20100603.
39. Debora MacKenzie, “Australia Blames a Flu Vaccine for Child Convulsions,” NewScientist (4 October 2010): http://www.newscientist.com/article/dn19539-australia-blames-a- flu-vaccine-for-child-convulsions.html.
40. Chris Thomson, “Flu Vaccination Ban Goes National After Fever, Convulsions in Children,” WA Today (23 April 2010): http://www.watoday.com.au/wa-news/flu-vaccination-ban-goes-national-after-fever-convulsions-in- children-20100423-tglp.html?from=age_ft.
41. “THL Stops Swine Flu Vaccinations,” Helsinki Times (24 August 2010):
42. “Recommendations Regarding the Use of Vaccines that Contain Thimerosal as a Preservative,” Morbidity and Mortality Weekly Report 48, no. 43 (5 November 1999): 996–998; http://www.cdc.gov/mmwr/preview/mmwrhtml/mm4843a4.htm.
43. Personal communication (12 December 2010).
44. Department of Health and Human Services, Centers for Disease Control and Prevention, “Thimerosal” (8 February 2011): http://www.cdc.gov/vaccinesafety/concerns/thimerosal/index.html.
45. American Nurses Association, “Position Statement on Mercury in Vaccines” (21 June 2006): http://www.nursingworld.org/MainMenuCategories/ANAPoliticalPower/ State/StateLegislativeAgenda/EliminatingMercury/Thimerosal.aspx.
46. This and subsequent quotations: personal communication (1 February 2011).
47. US Environmental Protection Agency, “Methylmercury: Epidemiology Update,” presentation by Kathryn R. Mahaffey, PhD, at National Forum on Contaminants in Fish,
San Diego, CA (25–28 January 2004): http://www.safeminds.org/protect-yourself/fludocuments/mahaffey%5B1%5D.pdf.
48. E-mail communication (19 November 2010).
49. The Johns Hopkins Bloomberg School of Public Health Institute for Vaccine Safety publishes a table of the thimerosal content of most current influenza vaccines (11 October 2010): http://www.vaccinesafety.edu/thi-table.htm.
50. Package insert copy: http://www.merck.com/product/usa/pi_circulars/a/afluria/afluria_pi.pdf.
51. “FDA Pregnancy Risk Categories,” Tulane University School of Medicine, http://tmedweb.tulane.edu/pharmwiki/doku.php/fda_pregnancy_risk_factors
52. Package insert copy: http://us.gsk.com/products/assets/us_fluarix.pdf.
53. Package insert copy: http://www.medimmune.com/pdf/products/flumist_pi.pdf.
54. Package insert copy: http://www.fda.gov/downloads/BiologicsBloodVaccines/Vaccines/ ApprovedProducts/UCM192127.pdf.
55. E-mail communication (2 February 2011).
56. Melinda Wenner, “Infected with Insanity: Could Microbes Cause Mental Illness?,” Scientific American (April 2008): http://www.scientificamerican.com/article.cfm?id=infected-with-insanity.
57. Ibid.: 47.
58. Marsden Wagner, Born in the USA: How a Broken Maternity System Must Be Fixed to Put Women and Children First (Berkeley: University of California Press, 2006): 59.
59. Jennifer Margulis, “Hormonally Charged: An Estrogen Exposé,” Brain, Child (Fall 2003).
60. For an extended discussion of how DES disrupts the human endocrine system and is harmful to human fetuses, see Theo Colborn, Dianne Dumanoski, and John Peterson Myers, Our Stolen Future: Are We Threatening Our Fertility, Intelligence, and Survival? A Scientific Detective Story (New York: Plume, 1997).
61. Sarina Schrager and Beth E. Potter, “Diethylstilbestrol Exposure,” American Family Physician 69, no. 10 (15 May 2004): 2395–2400; http://www.aafp.org/afp/2004/0515/p2395.html.
62. Guy Raz, “Pregnant Women Weigh Risks of H1N1 Vaccine,” National Public Radio, All Things Considered (9 August 2009): http://www.npr.org/templates/story/story.php?storyId=111714561.