Reporting System. Am J Obstet Gynecol 2011;205:473.e1–9.
nant women. Obstet Gynecol 2013;122: 1271–8.
4. Centers for Disease Control and Prevention (CDC). Safety of influenza A (H1N1) 2009 monovalent vaccines - United States, October 1-November 24, 2009. MMWR Morb Mortal Wkly Rep 2009; 58:1351–6.
2. Fiore AE, Shay DK, Broder K, Iskander JK, Uyeki TM, Mootrey G, et al. Prevention and control of seasonal influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP), 2009 [published erratum appears in MMWR Recomm Rep 2009;58:896–7]. MMWR Recomm Rep 2009;58:1–52.
In Reply: We thank Dr. Wiwanitkit for his comments regarding our study.1 It is important to keep in mind that live attenuated influenza vaccines were not recommended in pregnant women.2,3 Ours was a special study that used reports of pregnant women who in most cases appeared to have inadvertently received the live H1N1 influenza vaccine and in whom reports were submitted because this vaccine was not recommended in pregnancy. We were able to prospectively follow the pregnancy outcomes of these women and their infants and were able to calculate incidence rates for certain pregnancy outcomes, which is not possible using only routinely submitted reports to surveillance systems such as the Vaccine Adverse Event Reporting System. In our approach, we were able to avoid some important limitations of passive surveillance systems such as the Vaccine Adverse Event Reporting System, including overreporting or underreporting. The study that Dr. Wiwanitkit references4 is not comparable with our study. It was an assessment of Vaccine Adverse Event Reporting System reports that did not include prospective follow-up and was subject to underreporting, and the rate of adverse events was calculated based on estimated doses of the vaccine administered. Financial Disclosure: The author did not report any potential conflicts of interest.
Pedro L. Moro, MD, MPH Immunization Safety Office, Division Of Healthcare Quality Promotion, NCEZID, Centers for Disease Control and Prevention, Atlanta, Georgia
REFERENCE 1. Moro PL, Museru OI, Broder K, Cragan J, Zheteyeva Y, Tepper N, et al. Safety of Influenza a (H1N1) 2009 live attenuated monovalent vaccine in preg-
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Letters to the Editor
3. National Center for Immunization and Respiratory Diseases, CDC; Centers for Disease Control and Prevention (CDC). Use of influenza A (H1N1) 2009 monovalent vaccine: recommendations of the Advisory Committee on Immunization Practices (ACIP), 2009. MMWR Recomm Rep 2009;58:1–8. 4. Centers for Disease Control and Prevention (CDC). Safety of influenza A (H1N1) 52 2009 monovalent vaccines - United States, October 1-November 24, 2009. MMWR Morb Mortal Wkly Rep 2009; 58:1351–6.
Scope of Global Health Training in U.S. Obstetrics and Gynecology Residency Programs To the Editor: As clearly stated in the article by Hung et al,1 maternal health in low-resource areas is a substantive public health concern. The patient burden overwhelms the number of adequately trained health care providers, which makes timely access to optimal health care almost nonexistent. Global health has become a priority to many individual physicians and residency programs alike. The descriptions provided by Hung et al of various programs were informative, but the list was not comprehensive. If our modestly sized community hospital provides opportunity beyond the scope discussed in this article, how many other programs were excluded that offer their residents global health opportunities? Western Connecticut Health Network and the University of Vermont have established an innovative global health program, which includes weekly tropical medicine lectures, journal clubs focusing on global ethical issues, monthly global health seminars, and community outreach programs. Residents and medical students are funded to do an elective rotation at one of our four international
sites as a complement to the certificate program. Host faculty from our partner institution are invited to participate in an observership program, which is funded by our Global Health department, to give them perspective on the American health care system. Women’s global health is the focus of many medical students interested in obstetrics and gynecology, and the existence of established programs likely will affect their selection in the U.S. National Resident Matching Program. It is imperative that a women’s global health organization be developed that recognizes and brings together all programs committed to such work. This would allow medical students to appropriately choose a program whose objectives coincide with their personal interest as well as allow obstetrics and gynecology residency programs to collaborate and provide more efficient care to the women of the world. Financial Disclosure: The authors did not report any potential conflicts of interest.
Karina Haber, MD Robert Samuelson, MD Shohreh Shahabi, MD Danbury Hospital, Danbury Connecticut
REFERENCE 1. Hung KJ, Tsai AC, Johnson T, Walensky RP, Bangsberg DR, Kerry VB. Scope of global health training in U.S. obstetrics and gynecology residency programs. J Obstet Gynecol 2013;122:1101–9.
In Reply: We thank Haber et al for bringing their global health program to our attention. Their program may benefit from being publicized on the department’s web site. As described in our article,1 we agree with Haber et al that interest in global health among medical students appears to be on the upswing. Providing prospective residency applicants with access to official, up-to-date information2 about their program may help to attract students with specific interests in global health. It is possible that their program would have been included in our analysis if we had employed a study design such as a survey of program directors or of graduating residents. As we described, these alternatives likely would have been limited by unpredictable biases resulting from low response
OBSTETRICS & GYNECOLOGY
nant women. Obstet Gynecol 2013;122: 1271–8.
4. Centers for Disease Control and Prevention (CDC). Safety of influenza A (H1N1) 2009 monovalent vaccines - United States, October 1-November 24, 2009. MMWR Morb Mortal Wkly Rep 2009; 58:1351–6.
2. Fiore AE, Shay DK, Broder K, Iskander JK, Uyeki TM, Mootrey G, et al. Prevention and control of seasonal influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP), 2009 [published erratum appears in MMWR Recomm Rep 2009;58:896–7]. MMWR Recomm Rep 2009;58:1–52.
In Reply: We thank Dr. Wiwanitkit for his comments regarding our study.1 It is important to keep in mind that live attenuated influenza vaccines were not recommended in pregnant women.2,3 Ours was a special study that used reports of pregnant women who in most cases appeared to have inadvertently received the live H1N1 influenza vaccine and in whom reports were submitted because this vaccine was not recommended in pregnancy. We were able to prospectively follow the pregnancy outcomes of these women and their infants and were able to calculate incidence rates for certain pregnancy outcomes, which is not possible using only routinely submitted reports to surveillance systems such as the Vaccine Adverse Event Reporting System. In our approach, we were able to avoid some important limitations of passive surveillance systems such as the Vaccine Adverse Event Reporting System, including overreporting or underreporting. The study that Dr. Wiwanitkit references4 is not comparable with our study. It was an assessment of Vaccine Adverse Event Reporting System reports that did not include prospective follow-up and was subject to underreporting, and the rate of adverse events was calculated based on estimated doses of the vaccine administered. Financial Disclosure: The author did not report any potential conflicts of interest.
Pedro L. Moro, MD, MPH Immunization Safety Office, Division Of Healthcare Quality Promotion, NCEZID, Centers for Disease Control and Prevention, Atlanta, Georgia
REFERENCE 1. Moro PL, Museru OI, Broder K, Cragan J, Zheteyeva Y, Tepper N, et al. Safety of Influenza a (H1N1) 2009 live attenuated monovalent vaccine in preg-
666
Letters to the Editor
3. National Center for Immunization and Respiratory Diseases, CDC; Centers for Disease Control and Prevention (CDC). Use of influenza A (H1N1) 2009 monovalent vaccine: recommendations of the Advisory Committee on Immunization Practices (ACIP), 2009. MMWR Recomm Rep 2009;58:1–8. 4. Centers for Disease Control and Prevention (CDC). Safety of influenza A (H1N1) 52 2009 monovalent vaccines - United States, October 1-November 24, 2009. MMWR Morb Mortal Wkly Rep 2009; 58:1351–6.
Scope of Global Health Training in U.S. Obstetrics and Gynecology Residency Programs To the Editor: As clearly stated in the article by Hung et al,1 maternal health in low-resource areas is a substantive public health concern. The patient burden overwhelms the number of adequately trained health care providers, which makes timely access to optimal health care almost nonexistent. Global health has become a priority to many individual physicians and residency programs alike. The descriptions provided by Hung et al of various programs were informative, but the list was not comprehensive. If our modestly sized community hospital provides opportunity beyond the scope discussed in this article, how many other programs were excluded that offer their residents global health opportunities? Western Connecticut Health Network and the University of Vermont have established an innovative global health program, which includes weekly tropical medicine lectures, journal clubs focusing on global ethical issues, monthly global health seminars, and community outreach programs. Residents and medical students are funded to do an elective rotation at one of our four international
sites as a complement to the certificate program. Host faculty from our partner institution are invited to participate in an observership program, which is funded by our Global Health department, to give them perspective on the American health care system. Women’s global health is the focus of many medical students interested in obstetrics and gynecology, and the existence of established programs likely will affect their selection in the U.S. National Resident Matching Program. It is imperative that a women’s global health organization be developed that recognizes and brings together all programs committed to such work. This would allow medical students to appropriately choose a program whose objectives coincide with their personal interest as well as allow obstetrics and gynecology residency programs to collaborate and provide more efficient care to the women of the world. Financial Disclosure: The authors did not report any potential conflicts of interest.
Karina Haber, MD Robert Samuelson, MD Shohreh Shahabi, MD Danbury Hospital, Danbury Connecticut
REFERENCE 1. Hung KJ, Tsai AC, Johnson T, Walensky RP, Bangsberg DR, Kerry VB. Scope of global health training in U.S. obstetrics and gynecology residency programs. J Obstet Gynecol 2013;122:1101–9.
In Reply: We thank Haber et al for bringing their global health program to our attention. Their program may benefit from being publicized on the department’s web site. As described in our article,1 we agree with Haber et al that interest in global health among medical students appears to be on the upswing. Providing prospective residency applicants with access to official, up-to-date information2 about their program may help to attract students with specific interests in global health. It is possible that their program would have been included in our analysis if we had employed a study design such as a survey of program directors or of graduating residents. As we described, these alternatives likely would have been limited by unpredictable biases resulting from low response
OBSTETRICS & GYNECOLOGY
