Pregnant Women
Q. Am I at a high risk of severe or fatal illness if I am pregnant?
A. Yes. Pregnant women who are otherwise healthy have been severely affected by the 2009 H1N1 influenza virus. In comparison to the general population, a greater proportion of pregnant women infected with the 2009 H1N1 influenza virus have been hospitalized.
In addition, severe illness and death have occurred in pregnant women. Six percent of confirmed fatal 2009 H1N1 flu cases thus far have been in pregnant women while only about 1% of the general population is pregnant.
Q. Should pregnant women have the H1N1 vaccine when it is available?
A. Yes. Handwashing, staying away from ill people, and other steps can help to protect pregnant women from influenza, but vaccination is the single best way to protect against the flu. The Centers for Disease Control (CDC) recommends pregnant women receive the 2009 H1N1 influenza vaccine as well as a seasonal influenza vaccine.
Be sure to have the flu shot, not the nasal spray. The flu shot has inactive virus and cannot make you sick. The nasal spray has weakened amounts of live virus, and some people may get sick.
Q. What safety studies have been done on the 2009 H1N1 influenza vaccine in pregnant women?
A. The National Institutes of Allergies and Infectious Diseases launched the first study of 2009 H1N1 influenza vaccine in pregnant women in mid September. The trial is taking place at six sites nationwide and enrolling a maximum of 120 pregnant women ages 18 to 39 in their second or third trimester of pregnancy. Study investigators and an independent monitoring committee will continuously track the health and safety of participants.
Q. Does the 2009 H1N1 influenza vaccine have preservative in it?
A. Yes, it contains thimerosal. There is no evidence that thimerosal (used as a preservative in vaccine packaged in multidose vials) is harmful to a pregnant woman or a fetus. However, because some women are concerned about exposure to preservatives during pregnancy, manufacturers will produce preservative-free seasonal and 2009 H1N1 influenza vaccines in single dose syringes for pregnant women and small children. The CDC says it is safe for pregnant women to receive influenza vaccine with or without thimerosal.
Q. Should the 2009 H1N1 influenza vaccine be given to someone who has had an influenza-like illness since April of this year and now? Do I need a test to know if I need the vaccine or not?
A. There is no test that can show whether a person had 2009 H1N1 influenza in the past, and it is not necessary to test a person who previously had an influenza-like illness. Many different infections, including influenza, can cause influenza-like symptoms such as cough, sore throat and fever. In addition, infection with one strain of influenza virus will not provide protection against other strains. People for whom influenza vaccine is recommended should receive the 2009 H1N1 vaccine, even if they had an influenza-like illness previously.
If you have had 2009 influenza H1N1, based on a laboratory test that specifically detected the virus, the CDC recommends you discuss this issue with a health care provider to see if the test you had was either a real-time reverse transcription, polymerase chain reaction or a viral culture that showed 2009 H1N1 influenza. There is no harm in being vaccinated if you had 2009 H1N1 influenza in the past.
Q. What are the possible side effects of the 2009 H1N1 influenza vaccine?
A. The side effects from 2009 H1N1 influenza vaccine are expected to be similar to those from seasonal flu vaccines. The most common side effects following vaccination are mild, such as soreness, redness, tenderness, or swelling where the shot was given. Some people might experience headache, muscle aches, fever, nausea, or fainting. If these problems occur, they usually begin soon after the shot and may last as long as 1 to 2 days.
Like any medicines, vaccines can cause serious problems such as severe allergic reactions. Life-threatening allergic reactions to vaccines are rare. In 1976, an earlier type of swine flu vaccine was associated with cases of a severe paralytic illness called Guillain-Barré Syndrome (GBS) at a rate of approximately 1 case of GBS per 100,000 persons vaccinated. Some studies done since 1976 have shown a small risk of GBS in persons who received the seasonal influenza vaccine. This risk is estimated to be no more than 1 case of GBS per 1 million persons vaccinated. Since then, flu vaccines have not been clearly linked to GBS. GBS has a number of different causes and can occur in a person who has never received an influenza vaccine. The potential benefits of influenza vaccination in preventing serious illness, hospitalization, and death substantially outweigh these estimates of risk for vaccine-associated GBS.
Anyone who has a severe (life-threatening) allergy to eggs or to any other substance in the vaccine should not get the vaccine. Always inform your immunization provider if you have any severe allergies, if you’ve ever had a severe allergic reaction following flu vaccination, or if you have ever had GBS.
Q. If I am pregnant woman and I have flulike symptoms, what should I do?
A. If you are sick you should immediately go to your doctor. The doctor will decide if testing or treatment is necessary. Cover your coughs and sneezes with a tissue, or use your sleeve if tissues are unavailable.
Q. How is H1N1 treated?
A. It is treated with the antiviral drugs such as oseltamivir (Tamiflu) and zanamivir (Relenza). These work best when taken within 48 hours of the start of symptoms. If you have a fever you should take acetaminophen to reduce it. High fever has been associated with some fetal defects. As with any flu, drink plenty of water and get plenty of rest.
Q. If a mother contracts H1N1 are there any effects to the unborn baby?
A. The unborn baby is not affected by the virus. However, the virus can make the mother very sick which may in turn cause problems for the baby.
Q. Is it all right to take antiviral medication while pregnant?
A. Yes. It is all right to take antiviral medication while pregnant. No side effects have been reported in pregnant women who have used the drugs.
FAQs About Breastfeeding
Q. Is it all right to keep breastfeeding if I contract H1N1?
A. Yes, keep breastfeeding the baby. Breast milk passes on antibodies from the mother to the baby, and these antibodies helps fight infection. Be careful not to cough or sneeze on the baby’s face. You should wash your hands often. Your doctor might recommend that you wear a mask as added protection for your baby. If you become too sick to breastfeed you may consider pumping your milk and having someone else feed the baby the expressed milk.
Q. Is it all right to breastfeed while taking antiviral medications?
A. Yes. A mother can continue to breastfeed while being treated for the flu.
Information for Health Professionals
Face masks and Infection Control
UAB Guidance on Use of N-95 Respiratory Masks: Clinical staff are asked to use N-95 respiratory masks only when strictly indicated in order to have a sufficient supply if H1N1 influenza reaches pandemic proportions in Alabama. The masks are indicated for protection from both tuberculosis and H1N1 influenza.
Assistant Vice President Robert A. Taylor says the UAB Health System’s vendor has placed all its clients on an allocation until production levels meet the demand for the masks.
UAB Hospital routinely consumes more than its allocation, and the hospital’s needs are met only with supplements from other institutions that do not use all of their allocation. Supplements will likely not be available if demand strains or exhausts supplies.
A scarce-resource process has been implemented to ensure availability and appropriate use of N-95 masks. The Central Support Services Department (CSSD) will track mask issues and replenishments of the mask by patient room to ensure proper usage.
Conservation steps:
- Masks used for tuberculosis, but not H1N1, can be placed in a bag and reused by the same staff member until they no longer function (zip lock bags are available for mask storage).
- The number of students or other people who enter the rooms of infected patients might be limited.
- N-95 masks are no longer kept on carts. An order to move a patient to a negative pressure room will initiate mask acquisition from CSSD.
Questions about the process should be directed to Taylor at bataylor@uabmc.edu.
CDC Guidance on Use of Face masks: The CDC provides guidance on using face masks and respirators for decreasing the exposure to 2009 influenza A (H1N1) here.
These interim recommendations replace other CDC guidance on mask and/or respirator use that may be included in other CDC documents about the 2009 H1N1 virus. No change has been made to guidance on the use of face masks and respirators for health care settings.
This document includes guidance on face mask and respirator use for a wider range of settings than was included in previous documents and includes recommendations for those who are at increased risk of severe illness from infection with the 2009 H1N1 virus compared with those who are at lower risk of severe illness from influenza infection.
CDC Guidance on Infection Control: The CDC provides guidance for infection control for care of patients with confirmed or suspected novel influenza A H1N1 virus infection in a healthcare setting here. This document provides interim guidance for healthcare facilities (eg, hospitals, long-term care and outpatient facilities, and other settings where healthcare is provided) and is being updated as needed.
Treatment Recommendations From CDC (Antivirals)
On September 22, 2009 CDC updated its recommendations for the use of influenza antiviral medicines to provide additional guidance for clinicians in prescribing antiviral medicines for treatment and prevention of influenza during the 2009-2010 flu season. These recommendations are intended to help clinicians prioritize use of antiviral drugs for treatment and prevention of influenza.
As in earlier antiviral recommendations posted on May 6, 2009 and updated on September 8, 2009, the priority for use of antiviral medications this season continues to be in people with more severe illness, such as people hospitalized with influenza, and people at increased risk of influenza-related complications. This document has been updated to provide additional clarification on several issues, including the increased risk for complications in young children, particularly children younger than 2 years of age.
Q. How is the new guidance different from the guidance that was issued on September 8, 2009?
A. The priority use for antiviral medications during the upcoming influenza season remains generally the same as outlined in the antiviral recommendations first posted on May 6, 2009 and updated on September 8, 2009; that is to prioritize use of these drugs for those patients who are severely ill (such as those who are hospitalized) and those patients who are ill with influenza-like illness and who are at higher risk for influenza related complications.
New information in the updated guidance dated September 22, 2009 includes:
1. Additional context and guidance for clinicians regarding the risk for complications and treatment considerations for young and very young children.
2. Information regarding the oral dosing dispenser included in the Tamiflu for Oral Suspension packaging and instructions to insure the units of measure on the prescription instructions match the dosing device are also included.
3. More information about the possible underlying physiological conditions that may be associated with neuromuscular and neurocognitive disorders that might contribute to the increased risk for influenza complications in persons with these types of disorders.
The updated recommendations continue to balance between providing clinicians the information and guidance needed to reach those at greatest risk with appropriate and timely treatment; to reduce the chances of antiviral resistance through inappropriate or unnecessary chemoprophylaxis; and yet to still recognize the overarching importance of clinical judgment in making treatment and chemoprophylaxis decisions.
Antiviral Treatment in Pregnant Women
The CDC provides interim guidance on use of influenza antiviral treatment of pregnant women who are sick with novel influenza A (H1N1) here.
The highest priority message is to treat pregnant women with influenza-like illness as soon as possible; treatment should not be withheld pending results of testing for influenza, if testing is done.
Influenza antiviral chemoprophylaxis recommendations have been updated to be consistent with CDC recommendations for chemoprophylaxis for high risk groups.
Infant feeding recommendations have been updated to reflect current mask use guidance and the need for a cautious approach to preventing infection in infants, even though clinical data are lacking. Recommendations are interim, based on current knowledge of the H1N1 outbreak in the United States, and may be revised as more information becomes available.
Updated Flu Treatment Recommendations From the American Academy of Pediatrics
The American Academy of Pediatrics (AAP) has updated current recommendations for routine use of trivalent seasonal influenza vaccine and antiviral medications for the prevention and treatment of influenza in children. The updated guidelines are published in the September issue of Pediatrics.
Information about the CDC’s U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet)
Alabama has enrolled over one hundred physician practices to report the number of patients with ILI by age group and the total number of patients seen for the week. These practices are located in every public health area and almost every county. To follow these reports in Alabama, click here.
Recommendations of the Advisory Committee on Immunization Practices (ACIP)
CDC's Weekly Influenza Activity and Surveillance Report
Packaging and Shipping of Biological Substances (ADPH Training Webcast)