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Swine flu vaccinations stir concern Pregnant women are among the reluctant

It's likely to be a couple of more weeks until the swine flu vaccine is available, but already there is concern nationwide that those in one of the high-priority groups for the vaccine -- pregnant women -- are among the people least likely to get vaccinated.

Most years, only about one in seven pregnant women gets a flu shot. Federal officials hope to bring those numbers up this year, but they may face an uphill road.

Several factors come into play, experts say.

Generally, pregnant women are more reluctant to take any kind of medicine or get any sort of vaccine, for fear of harming the fetus.

In the case of the swine flu vaccine, those concerns may be heightened.

"There's a public perception that the vaccine is being ramrodded through without adequate testing," said Dr. Bruce D. Rodgers, director of maternal fetal medicine at the University at Buffalo.

The Centers for Disease Control and Prevention in Atlanta has acknowledged that the swine flu vaccine has not been thoroughly tested on pregnant women and children.

Studies of thevaccine in pregnant women were scheduled to begin this month, according to the CDC. In New York State, the first round of the vaccine is expected to be available in mid-October, according to the Department of Health.

Despite the lack of full testing for pregnant women, the federal government is urging them to get the swine flu vaccine, saying it's expected to be as safe as any flu vaccine.

"The 2009 H1N1 influenza vaccine will be made using the same processes and facilities that are used to make seasonal influenza vaccines," the CDC's Web site says.

But even if the government succeeds in convincing a pregnant woman she should get the vaccine, it may not be simple for her to get it.

"The problem is, these women are cared for by multiple caretakers, family doctors and obstetricians. It's not clear which practitioner is responsible to administer the vaccine," Rodgers said.

And in some cases, primary care doctors and obstetricians don't offer vaccinations.

While pediatricians routinely give vaccinations, many physicians who treat adults are not in the business of giving vaccinations, said Dr. Anthony J. Billittier IV, Erie County's health commissioner.

"It's something that's becoming more and more problematic for many practitioners that care for adults," he said.

The up-front cost of purchasing vaccines has turned off many doctors, he said. The shingles vaccination, for example, costs about $200 for a single dose. And some vaccines can be purchased only in packs of 10.

The government is covering the cost of the swine flu vaccines. But if a doctor's office is not set up for giving vaccinations, offering the swine flu vaccine would still involve extra start-up expenses, such as purchasing the equipment to keep the vaccines at the designated temperature.

For a time, there was an additional question of whether insurance companies would reimburse health care providers for the cost of giving the vaccine. A number of companies have decided they will cover those costs -- a move some experts believe may help persuade more doctors to start offering the vaccinations.

"Because most of our plans cover preventive services, including flu vaccines, in full with no co-payment, the H1N1 vaccine will be covered in full for the vast majority of our members," Dr. Thomas Foels, medical director of Independent Health, said in a prepared statement Monday.

BlueCross and BlueShield announced two weeks ago that the company would cover administration costs for the swine flu vaccine.

It remains to be seen what effect those decisions will have on pregnant women, who seem at particular risk for complications with the swine flu. They're at least four times as likely to be hospitalized as other flu sufferers, and they account for a disproportionately high number of swine flu deaths.

Billittier said local primary care physicians and obstetricians have generally been responsive to his appeals for their help in vaccinating the community, including pregnant women.

"It appears that health care providers in Erie County are taking on this challenge in agreeing to partner with public health to protect our community," he said. "This H1N1 is everybody's problem, and everybody needs to be involved in the solution."

At the same time, Billittier tried to put the situation in perspective.

"It really is just yet another influenza virus," he said. "The vaccine made for H1N1 is really just a seasonal flu vaccine that's designed to target the newest virus that's headed our way. Many people basically have no concerns at all about seasonal influenza but have major concerns about H1N1 -- and probably both have similar potential to cause health issues."


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