Pregnant in November? Get your Influenza vaccine 

It is November and we are right in the middle of influenza season—so it is a great time to get vaccinated, especially if you are pregnant, elderly or have underlying chronic conditions. 

These groups of people are more vulnerable: Children, because they haven't had a well-developed immune system but also because they interact with elderly grandparents, so they're more likely to transmit as well. 

Pregnant women are in a kind of immuno-compromised state. By giving the vaccine to the mother, you are also protecting the fetus at least for six months of life till the antibodies last. When mothers are vaccinated, antibodies are passed to the babies and protect them for the first 6 months of life. These viruses and bacteria (Influenza, RSV, Group B Streptococcus) are the ones that cause neonatal deaths and in fact, Pakistan has the highest neonatal mortality rate in the world—even more than Afghanistan (45 out of 1000 live births). 

Influenza is an acute respiratory infection caused by viruses. Symptoms vary with some people getting mildly sick, others severely ill and some requiring hospitalization. People can die of influenza as well.

Influenza is thus a serious disease and not the common cold. The common cold is caused by a variety of viruses (Coronaviruses are one of them, like SARS-CoV-2).

Approximately one in seven people is the rate of influenza infection (globally one billion people get it). Anywhere between 3 million to 5 million people get severe influenza, which is close to the population of Karachi’s District East.

In Pakistan, influenza season runs from October to April and can be contracted by anyone. 

Some vaccines are given in the Expanded Program of Immunization (EPI) in Pakistan. So, in childhood, everyone gets them, along with booster doses at intervals. But then you are done for life and you never need to get those vaccines again. But this is not the case for influenza. 

You have to be vaccinated against influenza each year because the virus is constantly mutating. Novel influenza viruses are the ones that can cause pandemics. The deadliest one was the Spanish Flu in 1918, caused by the H1N1 strain, that led to more deaths than those in the two world wars combined.

In response to pandemics, the global health authorities started surveillance to keep track. Pakistan is part of the WHO Global Influenza Surveillance Network and has its own National Influenza Surveillance System of which certain national hospitals are a part.

Modes of transmission or how influenza spreads:

  • A droplet infection can travel six feet.
  • The aerosol can travel a very long distance.
  • Fomites (objects or materials) can also spread it. Fomites are anything that you carry, your mobile, or you touch, door knobs. 

The WHO recommends annual influenza vaccination prior to the beginning of the influenza season.​

(Front row, L-R): AKU Vice Chair of Research at Paediatrics and speaker Dr Imran Nisar, Chair of Paediatrics Dr Fyezah Jehan, ​Dr. Hooma Ourooj representing the director-general of Health, Dr Shafi Kolhoro​, speaker and researcher Shahira Shahid and the people who attended the first influenza vaccine dissemination seminar on Friday, November 10, 2023 at AKU, Karachi. ​​

​​​Our study

Healthcare workers can successfully persuade pregnant women to get the vaccine. In fact, we found that pregnant women vaccination rates improved 10 to 12 times if their healthcare worker recommended it. And healthcare workers were more likely to recommend the vaccine if they took it themselves. Immunization training also gives them more confidence to advise p​regnant women.

Unfortunately, however, in Pakistan the challenge is that our vaccine coverage is suboptimal. We have no national influenza immunization policy, vaccines are not available in government facilities (only in private) and people don’t generally understand complications associated with influenza during pregnancy.

We did a study to document what enables or acts as a barrier to the uptake of the influenza vaccine among two priority groups: pregnant women and healthcare workers in Pakistan.

We went to Karachi, Islamabad, Quetta, and Peshawar from September to December 2021 and recruited participants from several hospitals. We enrolled 420 healthcare workers, whose average age was 33 years, and half of them were women. Half of them were doctors and one third were employed in the medicine department. Almost all of them (96.4%) had received two doses of the COVID-19 vaccine.

We found that many of them did not have enough knowledge about influenza and its risks. They were aware that we have lower vaccine coverage in Pakistan compared to that of high-income countries. They acknowledged the importance of vaccinations for patients and health personnel. Some barriers to vaccination included a lack of confidence in it, worry about side-effects, the vaccine’s effectiveness. Misinformation on social media affordability, and accessibility also hindered vaccination.

Healthcare workers recognized th​e importance of reliable media sources to share information on vaccines. They tended to trust the WHO, government health departments, healthcare providers, and spiritual leaders. They saw themselves as playing a role in vaccine uptake within communities. And they gave us feedback that there should be regular public service reminders, standardized surveillance, improved affordability, non-injectable options, and concise communication.

Material taken from Influenza KAP Survey Dissemination Workshop 2023 November 10, 2023 at AKU, Karachi, Pakistan conducted by Dr Imran Nisar and Shahira Shahid of the Department of Paediatrics & Child Health.