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Influenza and Pregnancy

Please review this information. We have included the information on our website to help keep our PREGNANT PATIENTS updated on information related to the seasonal flu and the swine flu (H1N1)

WE CURRENTLY HAVE THE H1N1 VACCINE IN STOCK  X COME IN AND RECEIVE THIS VACCINE IF YOU ARE CURRENTLY PREGNANT.

WE CURRENTLY HAVE THE SEASONAL FLU VACCINE IN STOCK  COME IN AND RECEIVE THIS VACCINE IF YOU ARE CURRENTLY PREGNANT.

IF THERE IS A RED X, WE HAVE THE VACCINE IN STOCK. IF IT IS NOT CHECKED, PLEASE CHECK BACK IN ONE WEEK. WE WILL UPDATE THIS SITE AS CHANGES OCCUR IN OUR SUPPLY.

Swine Flu (H1N1)

Swine flu (H1N1) was first reported and identified in April of 2009. Since that time there have been 5,500 reported hospitalizations and 353 reported deaths (2 deaths in Contra Costa County) and an unreported number of confirmed cases. The median age of the confirmed cases to date has been 12 years of age with the highest infection incidence in the 5-24 year old age group (the reproductive population). The median age of people who died from H1N1 was 37 years.

Risk factors for severe infection are similar to those for seasonal influenza – old and young age, people who live with or provide care to the young or old, pregnant women, health care providers, and people with chronic medical conditions (such as asthma, COPD, diabetes, renal or hepatic disease and immunosuppressed conditions – medically induced or infectious). Breast feeding is not a contraindication to immunization.

The signs and symptoms of swine flu are similar to that of seasonal influenza (runny nose, muscle aches, fever, cough, headache and vomiting). 

While there is a rapid influenza diagnostic tests for seasonal flu that may detect H1N1, the sensitivity (detection rate) is only 40%. That means that 60% of patients infected with H1N1 would screen negative. The definitive diagnostic tests are real time reverse transcriptase PCR or viral culture.

The CDC’s Advisory Committee on Immunization Practices (AICP) has made recommendations regarding who should be offered vaccination against H1N1. They include pregnant women, people who live with or provide care for infants <6 months of age, health care providers, children and young adults age 6 months to 24 years of age and persons age 24-64 who have chronic medical conditions (see above) that put them at risk for severe influenza related complications.

Vaccination to seasonal influenza results in a cross-reactive antibody to H1N1 in only 6-9% of people so immunization specifically targeting H1N1 is suggested. Both live, attenuated and inactivated influenza A (H1N1) monovalent vaccines will be available (reportedly by mid October 2009) and should be available for purchase through similar vendors providing vaccinations for seasonal influenza. Alternatively, the California Department of Public Health is providing vaccines to health care providers free of charge. 

OUR OFFICE HAS APPLIED FOR AND EXPECTS TO RECEIVE THE INTRAMUSCULAR, INACTIVATED MONOVALENT, THIMEROSAL-FREE H1N1 VACCINE FOR OUR PREGNANT PATIENTS.

Additional information regarding swine flu vaccination recommendations may be found at: http://www.cdc.gov/h1n1flu/

Seasonal Influenza

Seasonal influenza affects between 5-20% of the population annually. More than 200,000 people are hospitalized from influenza related illnesses with approximately 36,000 people dying annually from influenza related complications. 

As with H1N1 (swine flu) risk factors for severe infection are young age, people who live with or provide care to the young or old, pregnant women, health care providers, and people with chronic medical conditions (such as asthma, COPD, diabetes, renal or hepatic disease and immunosuppressed conditions – medically induced or infectious). 

The signs and symptoms of seasonal influenza include runny nose, muscle aches, fever, dry cough, sore throat and headache. 

Complications from seasonal influenza include super infection with bacterial pneumonia (which is why high risk groups should also receive 23-valent pneumococcal polysaccharide vaccine -- PPSV-23).

Pregnancy increases the risk for influenza complications for the mother and increases number of medical visits for respiratory illnesses during influenza season compared with non-pregnant women. Fortunately, pregnant women with respiratory hospitalizations do not have an increase in adverse perinatal outcomes or delivery complications nor is there an increase in delivery complications, including fetal distress, preterm labor, and cesarean delivery. Furthermore, infants born to women with laboratory-confirmed influenza during pregnancy do not have higher rates of low birth weight, congenital abnormalities, or lower Apgar scores compared with infants born to uninfected women.

Influenza vaccines, aka “the flu shot,” are manufactured in several preparations - trivalent inactivated influenza vaccine (TIV) and live, attenuated influenza vaccine (LAIV). Trivalent inactivated influenza vaccine should be used for pregnant women. Live attenuated influenza vaccine may be used for all non-pregnant women up to 49 years of age. TIV is contraindicated and should not be administered to persons known to have anaphylactic hypersensitivity to eggs or to other components of the influenza vaccine unless the patient has been desensitized.

Vaccination against seasonal influenza should begin in September and continue through January or February since peak influenza activity is generally seen between December and January. 

OUR OFFICE HAS BEEN DISTRIBUTING THIS VACCINE TO OUR PATIENTS AND WILL CONTINUE TO DO SO FOR AS LONG AS SUPPLIES LAST.

Simultaneous administration of inactivated vaccines against seasonal influenza and swine flu (H1N1) may be done if different injection sites are used.

Additional information regarding seasonal influenza vaccination recommendations may be found at:  http://www.cdc.gov/flu/

Treatment / Prophylaxis of Seasonal Influenza and Swine Flu (H1N1):

Because rapid influenza testing has a poor sensitivity at detecting H1N1, and the turn-around time for definitive testing by PCR or culture results may take days (if possible or available at all) - most treatment in the coming months will be based on clinical judgment and identification of risk factors for severe disease.

As of September 2009, 99% of the circulating influenza virus identified in the United States was H1N1. Fortunately, H1N1 viruses are susceptible to oseltamivir and zanamivir, but resistant to amantadine and rimantadine. 

Most people who present with a febrile illness consistent with influenza do not need empiric treatment with antiviral therapy unless they are in a high risk group. However, all pregnant women are in a high risk group. As such, based on clinical judgment, antiviral therapy should be started if a patient presents with signs and symptoms of influenza. The current treatment recommendations are for Tamiflu (oseltamivir) 75 mg orally twice daily for 5 days. In the event that there is a high risk exposure, consideration of chemoprophylaxis should be discussed with your doctor. Chemoprophylaxis dosing is: Tamiflu 75 mg po daily for 10 days. If in the event, treatment is empirically started and diagnostic testing results (either PCR or viral culture – not a negative rapid influenza test) return negative, the treatment regimen may be discontinued.

IF YOU FEEL YOU HAVE HAD A SIGNIFICANT EXPOSURE TO A PERSON DIAGNOSED WITH H1N1 FLU, AND YOU ARE CURRENTLY PREGNANT. THIS WOULD INCLUDE SPENDING CLOSE ONE-ON-ONE TIME WITH AN INFECTED PERSON, WITH LIKELY CONTACT WITH RESPIRATORY DROPLETS FROM THAT PERSON, NOT SIMPLY WALKING BY SOMEONE OR BEING IN THE SAME ROOM WITH AN INFECTED INDIVIDUAL. IF YOU THINK YOU MAY HAVE THE H1N1 (swine flu), PLEASE CALL YOUR PRIMARY CARE PHYSICIAN FIRST. IF THEY ARE UNWILLING / UNABLE TO SEE YOU, THEN COME SEE US.

For more information, visit http://www.cdc.gov/H1N1flu/recommendations.htm

Thanks to the physicians at the John Muir Perinatal Group for putting this information together

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