Fears about the impact of swine flu upon pregnant women are generating alarm and some confusion. And not only in Australia. In Britain, various health and medical sources have been giving the public conflicting advice, according to this report in the British Medical Journal.

Meanwhile, Professor Peter McIntyre, Director, National Centre for Immunisation Research and Surveillance of Vaccine-Preventable Diseases, is concerned that the focus upon swine flu and pregnancy may be distracting attention from the risks of influenza generally for pregnant women. He writes:

“Pregnant women are at risk – not just from swine  influenza, as highlighted in the media in recent days, but from influenza of  any kind.

“Ordinary” seasonal influenza is also still circulating. Both vaccines and antiviral drugs are important.

With respect to vaccines, influenza vaccine has been recommended by  the National Health and Medical Research Council for women in pregnancy for  almost 10 years – but few receive it.

This is  probably related to both lack of familiarity with the whole notion of  vaccines in pregnancy by practitioners caring for pregnant women, as well as reluctance on the part of many, if not most, women to receive any treatment  in pregnancy, either vaccine or drug.

Therefore  it is important to emphasise that there is no theoretical or data-based  reason to expect any adverse effects from vaccines which do not contain  live organisms in pregnancy. In partcular, influenza vaccines are safe in pregnancy. The primary rationale  is to provide protection for the mother but there is accumulating evidence that some protection is probably also afforded to the baby after birth.

Once a swine influenza vaccine is available, pregnant women will be a priority risk group, something which has been emphasised by recent publicity concerning severe cases in pregnant women.

It is important to remember that  vaccines for “ordinary” influenza are available now  and are  recommended for pregnant women, who are especially at risk in the later stages of pregnancy, and that professional and public attitudes to using influenza  vaccines in pregnancy need to change now.

With respect to antiviral drugs, it is important that pregnant women  see their doctor early if influenza is a possibility as anti viral treatment  is most beneficial early. Pregnant women also need to see their doctor if it  is possible that their children have influenza, as this may be an opportunity  for even earlier treatment. Given the potential severity of influenza in  pregnancy, the benefits of treatment clearly exceed the risks.

Regarding risks for Indigenous communities, we know that influenza  rates generally are much higher in Indigenous children and adults, with  hospitalisations for influenza and pneumonia 3.5 times higher than in  non-Indigenous Australians.

The biggest  difference is in 25-49 year olds, where the rates are 8  times higher. This younger adult group is the very group now coming to light  with swine flu but has been evident as an important  risk group in earlier data.  This is  reflected in the recent announcement by the Commonwealth that free influenza vaccine will be provided under the National Immunsation Program for all  Indigenous adults from 15 years of age as well as for all persons from 6  months of age who have conditions placing them at increased of severe  influenza.

This group at increased risk, as mentioned above, includes pregnant women. This is especially so for pregnant Indigenous women, where we know that there are high rates of respiratory and ear disease in babies very early  and that mothers themselves are significantly more likely to have health problems. The  increased risk relates not only to medical conditions, but to general living conditions, and other risk factors such as high rates of  cigarette smoking.

Indigenous people should be a priority  group for access to both antivirals and to vaccine for the swine flu, when it  becomes available. For the whole  community, communication about risks and benefits will be crucial.”