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Vaccination against influenza during pregnancy
Vaccination means establishing controlled contact between a pathogen and the immune system. This stimulates the immune system to develop a natural defense against the pathogen. In order to control this contact, the pathogen is first grown and multiplied and then rendered harmless.
Influenza viruses are usually grown on chicken eggs because cultivation in other brood variants does not currently work. However, many vaccine manufacturers are working hard to replace the reproduction on hen's eggs with other, animal-free methods.
Then the influenza viruses are rendered harmless, whereby care must be taken that they contain enough properties to be able to trigger a reaction of the immune system later. To inactivate the viruses, surfactants (a type of detergent) or formaldehyde or similar chemicals are added, which are then rinsed out again after this step.
Since the flu viruses are constantly mutating, the World Health Organization (WHO) determines each year which virus strains were primarily involved in the regional and global flu waves. From these strains the four virus strains are then selected from which the vaccination for the following year is developed.
In addition to the destroyed virus residues, the vaccine also contains distilled water, salts and buffers so that the inoculation liquid is as similar to human serum as possible, and minimal residues from the manufacture of the vaccines.
The vaccination therefore helps the body to build up its own immune defense against the influenza viruses from last year. The vaccination does not detect new mutations. It can therefore happen that people who have been vaccinated also develop influenza.
People who have had a weakened immune system - due to illness, medication or pregnancy - are often unable to develop complete immunity to the flu virus after vaccination. It can therefore happen that you still get the flu. However, it is usually milder than without the vaccination.
The same applies to pregnant women: large studies have shown that around 50 percent of all pregnant women cannot build up complete immune protection against the infection after vaccination.
Effectiveness of the flu vaccination
Again and again people fall ill with influenza who got vaccinated against the flu in autumn. Is the vaccination ineffective and therefore pointless?
The flu vaccination is developed from the virus strains that have been most frequently involved in serious flu illnesses in the past year. So it helps the body to build up its own immune defense against the influenza viruses from last year.
But it happens again and again that some of the flu viruses change over the course of the summer. Such new mutations are not detected by the vaccination. If an important mutation has taken place in the flu viruses between the development of the vaccine, the vaccination and the occurrence of the new flu wave, it can happen that the immune system no longer "recognizes" the changed virus.
So far, the vaccines consisted of only three different strains. From 2017, for the first time, vaccinations with four virus strains will also be available for those insured by statutory health insurances. This greatly increases the likelihood that the immune system will actually develop defenses against the current flu viruses through a vaccination.
People with a weakened immune system are often unable to develop a powerful immunity to the flu virus after vaccination. This includes people with an immune deficiency due to an illness, due to medication - especially long-term use of cortisone - and the elderly. It can therefore happen that you get the flu despite the vaccination. However, it is usually milder than without the vaccination.
The same applies to pregnant women, in whom the immune system is dampened in order to protect the mother and embryo from a rejection reaction: Large studies have shown that around 50 percent of all pregnant women cannot develop a complete immune protection against the infection after the vaccination. Conversely, this also means that 50 percent of vaccinated pregnant women are protected from infection with this dangerous disease.
In addition, these studies were conducted when vaccines containing three strains of the virus were still in use. If the four-stem vaccine is used, this number will certainly decrease.
The vaccination also does not protect against colds caused by other viruses: rhinoviruses, adenoviruses, coronaviruses, respiratory syncytial viruses have a completely different structure than influenza viruses. An infection with these viruses can therefore not be prevented by the influenza vaccination.
Concerns about the flu vaccination during pregnancy?
The ingredients of the vaccinations and their maximum permissible quantities are strictly regulated in the European Pharmacopoeia. But many pregnant women would prefer not to be vaccinated because they fear harming themselves and especially their baby. We list all the ingredients of flu vaccinations, their concentrations and their possible effects in the body.
The flu vaccination does not contain any aluminum or mercury. It contains virus particles that do not reach the unborn baby. Very large studies that followed up the children of vaccinated pregnant women up to school age have shown that the children do not differ in any way from unvaccinated children, apart from the fact that the children of unvaccinated mothers are more likely to develop severe infections in their first few weeks and months of life Respiratory disease.
There is only one reason to refrain from a flu vaccination during pregnancy and that is if the pregnant woman has a severe allergy to chicken protein. Because at the moment you need chicken eggs for the cultivation and reproduction of the influenza viruses. There is therefore no vaccine that is completely free from chicken protein.
- Virus particles
- Leftovers of the chicken egg
- Salts and buffers
- Disinfectants and preservatives
1. Virus particles
For the production of the vaccines, special, germ-free chicken eggs are first inoculated with the viruses and then stored in an incubator at 37 degrees for a few days. Antibiotics are also used to prevent germs from spreading on the eggs and viruses during this time. The viruses multiply in the egg white. The eggs are then killed by a cold treatment, the viruses are extracted from the egg, isolated and inactivated by formaldehyde or similar disinfecting substances.
Through further production steps, the viruses are broken down into their individual components to such an extent that, as far as possible, only the protein structures remain, to which the human immune system reacts and builds up immune protection. All other virus components are washed out.
The technical term for these purified virus particles is "hemagglutinin". Each vaccine therefore initially consists of three or four hemagglutinin components washed out from different virus strains (15 micrograms each).
2. Leftovers of chicken protein
Despite numerous cleaning steps, the flu vaccine may contain minimal residues of chicken protein. For this reason, pregnant women who are known to have a severe allergy to egg white are not currently allowed to be vaccinated against the flu. Some manufacturers are trying to get away from vaccine production with chicken eggs, not only to avoid allergies, but also because one aseptic chicken egg is consumed per vaccine dose, which is expensive and delays the production of the vaccine.
Each vaccine contains 1 ml of highly purified, distilled water.
4. Salts and Buffers
So that the purified virus particles do not dissolve or clump in the vaccine, and so that the vaccine liquid is as similar as possible to human blood, salts and buffers are added in amounts that also correspond to the natural conditions. These salts and buffers include - in different quantities from different manufacturers - NaCl (table salt), KaCl (potassium salt, which is also permitted as a food additive without quantity restrictions), and sodium and potassium hydrogen phosphates as buffers so that the pH value of the inoculation solution remains stable. Both phosphates are used as standard buffers in the manufacture of liquid pharmaceuticals and also in food production.
All salts and buffers are completely harmless in the amounts used.
5. Disinfectants and preservatives
Different manufacturers use different substances for cleaning, disinfection and preservation. These include:
Formaldehyde, cetrimonium bromide, sodium deoxycholate, polysorbate 80, octoxinol, squalene.
Numerous purification steps mean that the vaccines only contain traces of these substances. The maximum permissible levels are defined in the European Pharmacopoeia.
Here is an example: Formaldehyde: The maximum amount allowed in vaccines is 0.2 grams per liter. Since a vaccination only contains 1 ml of liquid, the maximum amount of formaldehyde that can be ingested is 0.0002 grams. An adult in Germany ingests 1 to 15 milligrams of formaldehyde daily through food, corresponding to 0.001 to 0.015 grams. The vaccination contains a maximum of one fifth of the amount of formaldehyde that is consumed with food every day, even with a very health-conscious diet. In contrast, the one-off, additional amount of formaldehyde with which the body is exposed to a vaccination is irrelevant, neither as a possible trigger of an allergy nor as a possible toxin.
To prevent germs from colonizing and multiplying in the incubators on and in the chicken eggs in which the viruses are grown, the chicken eggs are treated with antibiotics. Different manufacturers use different substances for this. They include: neomycin, polymyxin, kanamycin, gentamycin
The antibiotics used are also washed out of the vaccines in numerous cleaning steps, so that the finished vaccine serum - if at all - only contains traces of them.
Here are two examples: The antibiotic gentamycin is used for severe pneumonia and other infectious diseases in a dose of up to 300 micrograms per day for one to two weeks. The unborn baby is not harmed by these amounts; medical studies have shown this. A maximum amount of less than 30 micrograms (0.03 milligrams) per milliliter is permitted in vaccines. For a pregnant woman weighing 60 kg, this results in a load of half a microgram per kilogram of body weight, with the antibiotic having a half-life of around two hours. So after four hours there is only 0.125 micrograms of the antibiotic in the body. In this concentration, gentamycin has no effect, neither on germs nor on the health of mother and child.
For the antibiotic neomycin, the limit value that is permitted in vaccines is less than 30 micrograms per milliliter.
Since the antibiotics used in the vaccine manufacturing process are rarely prescribed in humans, the risk that a pregnant woman will be allergic to any of the antibiotics is very small. However, if such an allergy is present, the situation should be discussed with the gynecologist, because the positive effects of the vaccination must then be weighed against a possible allergic vaccination incident. On the other hand, it is completely excluded that the antibiotics in the Vaccination multi-resistant germs could be generated. Because the antibiotics - if they are present at all - are present in such small traces and are excreted in such a short time that a positive or negative effect on germs is excluded.
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