Fall is certainly here! The weather’s cooler, leaves are falling, and it seems as if everyone has the sniffles that inevitably come with the change of seasons. That first sneezing and coughing cold (yup, it already got me) can also be a not-so-gentle reminder of nastier bugs that lurk around the corner, especially the flu.

The influenza virus is most active from November to April and is the reason why we get bombarded in October with flu shot reminders nearly everywhere we go. Inevitably, my patients who are either pregnant or trying to get pregnant ask me whether or not they should get the flu vaccine. The short answer is yes!

Everyone older than 6 months should get the flu shot, even women who are trying to get pregnant and especially if you are pregnant. I find patients are very savvy, so generally that answer is not enough. Well, how about because the Center for Disease Control and Prevention (CDC) says so?

“How can we trust what the CDC has to say when the government is shutdown?” (I initially was joking about this, but the CDC’s website does actually have a disclaimer that says their website might not be up to date).

The main reason to get the flu shot is because the disease can be more serious than you think. How serious? Worldwide, 250,000 – 500,000 people die from influenza complications each year. Sometimes that number can reach the millions when the disease is severe. In the United States, approximately 41,000 people die annually from the flu.

There are groups of people who are particularly vulnerable for developing complications from the infection that include:

• Children aged 6 through 59 months
• Persons aged ≥50 years
• Adults and children who have chronic pulmonary (including asthma) or cardiovascular (except isolated hypertension), renal, hepatic, neurologic, hematologic, or metabolic disorders (including diabetes mellitus).
• Persons who have immunosuppression (including immunosuppression caused by medications or by HIV infection).
• Children and adolescents (aged 6 months through 18 years) who are receiving long-term aspirin therapy and might be at risk for experiencing Reye’s syndrome after influenza virus infection.
• Residents of nursing homes and other long-term care facilities.
• American Indians/Alaska Natives
• Persons who are morbidly obese (BMI ≥40)
• Women who are or will be pregnant during the influenza season

The last bullet is most important. Pregnancy drastically changes a women’s immune system and lung capacity. These physiological changes can cause a substantial amount of severe symptoms and complications from the flu. Additionally, all people that are in contact with the above groups (including all healthcare workers like myself) should get vaccinated to prevent infecting others.

The flu vaccine is not perfect. Each year the World Health Organization’s Global Influenza Surveillance Network makes an educated guess on which strains of influenza are most likely to be active that year.

Sometimes other strains do manage to circulate. Because of this, you might be able to get the flu after receiving the vaccine, but you can expect at least a 70% reduction in your chances.

Generally, the flu shot side effects are mild. You can expect some pain and soreness at the injection site. Runny noses and sore throats have been reported. Very rarely (1 in 10 million chance) a serious condition known as Guillain-Barré syndrome can occur.

Some flu shots are made with eggs so if you have severe allergic reaction to eggs, there is a new recombinant formula that is egg-free and approved for adults 18-49 years old.

If you are terrified of needles, there are two alternative options.

The first option is the live-attenuated vaccine that is given through a nasal spray for people 2 – 49 years old. It works well but it has not been approved for people with asthma, weakened immune systems, or women who are or will soon be pregnant.

The second option is also a new intradermal system that uses a tiny (90% smaller) needle that delivers medication into the skin rather than into the muscle, making it practically pain free. This option has been approved for people ages 18 – 64.

A mercury based preservative called Thiomersal is only found in multi-dose vials. Although there is no association between thiomersal and vaccine safety, single-dose, mercury-free vaccines are the norm and highly recommended for pregnant women.

In addition to the CDC and the World Health Organization, the American Society of Reproductive Medicine and the American Congress of Obstetricians and Gynecologists (both made up of doctors like myself) strongly recommend that you receive the flu shot.

Although it literally can be a pain, in the end it can make a big difference in having the safest pregnancy possible. So if you haven’t done so already, go to your local pharmacy and get the flu shot to protect yourself and your loved ones!