2009 H1N1 Influenza Virus and Seasonal Influenza Virus
In the wake of the 2009 H1N1 influenza virus (formerly known as Swine Flu) outbreak, the College has compiled pertinent clinician guidance and resources, including information for pregnant women, and updates this regularly.
NEW INFORMATION ON H1N1 INFLUENZA VIRUS The College issued new assessment and treatment flow chart for pregnant women with influenza-like illness (published online only!) November 9, 2009 UPDATED!
http://www.acog.org/departments/resourceCenter/2009H1N1TriageTreatment.pdf
Use the new patient fact sheet for pregnant women on the flu produced by the College and the AMA to inform patients about the safety of flu vaccines and what to do if a pregnant woman thinks she has the flu. (published online only!) http://www.acog.org/departments/resourceCenter/2009H1N1FactSheet.pdf November 9, 2009 UPDATED!
Spanish version available at:
http://www.acog.org/departments/resourceCenter/2009H1N1FactSheet-sp.pdf November 9, 2009 UPDATED!
See the CDC's influenza triage algorithm for adults 18 years and older with influenza-like illness. October 2, 2009 NEW! See the Department of Health and Human Services Press Release on the initial results of the National Institute of Allergy and Infectious Diseases (NIAID) study showing pregnant women mount a strong immune response to one dose of 2009 H1N1 Flu Vaccine. http://www.hhs.gov/news/press/2009pres/11/20091102a.html. November 1, 2009 New! For resources on H1N1 Influenza in other languages see the Office of Minority Health at: See the HHS' Healthcare Providers and Facilities - Decision Tree for 2009 H1N1 Vaccination to assist providers in their decision making. October 5, 2009 Important Information about the Safety of the H1N1 Flu and Seasonal Flu Vaccines! Some pregnant women are concerned about the safety of 2009 H1N1 flu and seasonal flu vaccines. Both flu vaccines are safe. Vaccination is one of the most important things that you can do for yourself and your baby. Vaccination is safe for you and your baby. Both shots protect your baby from getting the flu. Your baby cannot get the flu shot until 6 months of age. The seasonal flu vaccine has been given safely to millions of pregnant women over the past 45 years. Flu shots have not been shown to cause harm to pregnant women or their babies. The 2009 H1N1 flu vaccine is made the same way as the seasonal flu vaccine. The type of mercury used in some vaccines has not been shown to be harmful to a pregnant woman or her unborn baby. Mercury has not been found to cause autism. However, if you are still concerned, there is an H1N1 shot without mercury [may or may not be available in your area]. The risk for a pregnant woman and her unborn baby of getting sick with the flu is far greater than being vaccinated. If you did not get the flu vaccines during pregnancy, you should still get them even if you are breastfeeding. This will help prevent you and your baby from getting the flu.
The College and the CDC recommend that pregnant women receive the 2009 H1N1 and seasonal influenza vaccines. Pregnant women should receive the "flu shot" for both H1N1 and seasonal flu and should NOT receive the nasal spray. Both flu shots can be given DURING ANY TRIMESTER in pregnancy. The CDC guidance can be found at: http://www.cdc.gov/flu/professionals/acip/persons.htm (seasonal flu) and http://www.cdc.gov/h1n1flu/vaccination/providers_qa.htm (H1N1 flu). Seasonal Influenza guidance from the College can be found in the following Committee Opinion: Influenza vaccination during pregnancy. ACOG Committee Opinion No. 305. American College of Obstetricians and Gynecologists. Obstet Gynecol 2004;104:1125-6. Available from the Resource Center (resources@acog.org) or the members' side of the College Website. <  Pregnant women who have been vaccinated for H1N1 and/or seasonal influenza are being asked to participate in a study on vaccine safety at http://www.vaccinesafety.edu/myflushot-R-info.htm. Ob-gyns that are providing influenza vaccines to pregnant women who would like to contribute to the study can send an e-mail to flustudy@jhsph.edu with the subject “ACOG H1N1” or call Howard Choi or Mari Griffioen at 410-955-6964 for more information. Ob-Gyns and their health care staff should be vaccinated for both 2009 H1N1 influenza and seasonal influenza to protect themselves as well as their pregnant patients. Health care providers were designated by ACIP as a target group to receive the H1N1 vaccine. See also the following ACOG Committee Opinion: Primary and preventive care: periodic assessments. ACOG Committee Opinion No. 357. American College of Obstetricians and Gynecologists. Obstet Gynecol 2006;108:1615–22. Available from the Resource Center (resources@acog.org) or the members' side of the College Website. CDC's message is that the highest priority 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." CDC states that "case reports of adverse pregnancy outcomes and maternal deaths have been associated with severe illness." College Updates on 2009 H1N1 Influenza Virus College President Gerald F. Joseph, Jr., MD FACOG issued another important update about H1N1 ("swine flu") to Fellows. October 20, 2009 College President Gerald F. Joseph, Jr., MD FACOG issued an important update about H1N1 ("swine flu") to Fellows. October 5, 2009 College President Gerald F. Joseph, Jr., MD FACOG issued an e-mail blast to Fellows with important information about H1N1 and pregnant women. September 22, 2009 College President Gerald F. Joseph, Jr., MD FACOG issued important information about H1N1 and seasonal influenza to Fellows. August 27, 2009
Available at: http://www.acog.org/departments/dept_notice.cfm?recno=30&bulletin=4902.
The College Resource Center has compiled a list (WebTreats) of resources on H1N1 and updates this information regularly. 2009 H1N1 Influenza CDC Diagnostic Testing Recommendations The CDC's Interim Recommendations for Clinical Use of Influenza Diagnostic Tests (September 29, 2009) During the 2009-10 Influenza Season, for Health Care Providers (September 29, 2009), and information for the public (September 25, 2009). 2009 H1N1 Influenza Virus information for Pregnant Women The College and other health organizations released a joint information message for pregnant women concerning influenza. September 23, 2009 Treatment Information The CDC has issued recommendations on Antiviral Treatment Options, including Intravenous Peramivir, for Treatment of Influenza in Hospitalized Patients for the 2009-2010 Season. These recommendations are available here: http://www.cdc.gov/h1n1flu/eua/peramivir_recommendations.htm. October 26, 2009 NEW!
PostmarketDrugSafetyInformationforPatientsandProviders/UCM187811.pdf. October 23, 2009 NEW! H1N1 Influenza in Pregnancy: Cause for Concern appears in the October 2009 edition of Obstetrics & Gynecology. H1N1 influenza during pregnancy presents with a wide spectrum of severity, and an increased index of suspicion and early treatment are warranted. October 1, 2009 See the CDC's Updated Interim Recommendations for the Use of Antiviral Medications in the Treatment and Prevention of Influenza for the 2009-2010 Season. The text can be found here: Questions and Answers for the 2009-2010 Influenza Season including the 2009 H1N1 Influenza Monitoring Influenza Activity, Including 2009 H1N1 - Questions and Answers 2009 H1N1 Influenza Vaccination Distribution - Questions and Answers Information on Vaccines for 2009 H1N1 Influenza See the FDA's Questions about vaccnes: Use of Influenza A (H1N1) 2009 Monovalent Influenza Vaccine in Pregnant Women at: October 27, 2009 NEW! The Medical Letter on Drugs and Therapeutics article on the H1N1 vaccine: H1N1 vaccine for prevention of pandemic influenza. Med Lett Drugs Ther 2009;51:77-8. Avaialble at: http://medlet-best.securesites.com/index.html. Access is by subscription only. October 5, 2009 CDC Information on Seasonal Influenza
On September 11th the CDC released information that recent national data show that pregnant women have the lowest rates of coverage among all adult populations recommended to receive influenza vaccination. See http://www.cdc.gov/mmwr/PDF/wk/mm5835.pdf p.972.
Seasonal Flu Vaccine Availability (September 2009) Webcasts Webcast for Pregnant Women and New Moms These resources are provided for information only. Referral to these sites does not imply the endorsement of The American College of Obstetricians and Gynecologists of either the organization or their contents, expressed views, programs, or political activities. Further, the College does not endorse any commercial products that may be advertised or available from these organizations or on these websites. This list is not meant to be comprehensive; the exclusion of a site does not reflect the quality of that site. Please note that sites and URLs are subject to change without warning.
DH/MASH 11/20/2009
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