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 and postpartum women, and updates this regularly.
CDC's message is that the highest priorities are to immunize and treat pregnant and postpartum women with influenza-like illness with oseltamivir 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."
NEW INFORMATION ON H1N1 INFLUENZA VIRUS See the CDC's update and lessons learned about pregnant women and H1N1. April 21, 2010 Centers for Disease Control and Prevention (CDC). Preliminary results: surveillance for Guillain-Barré syndrome after receipt of influenza A (H1N1) 2009 monovalent vaccine - United States, 2009-2010. MMWR Morb Mortal Wkly Rep. 2010 Jun 4;59(21):657-61. Available at: http://www.cdc.gov/mmwr/pdf/wk/mm5921.pdf. Retrieved June 15, 2010. NEW!
Siston AM, Rasmussen SA, Honein MA, Fry AM, Seib K, Callaghan WM, et al. Pandemic 2009 influenza A(H1N1) virus illness among pregnant women in the United States. Pandemic H1N1 Influenza in Pregnancy Working Group. JAMA 2010 Apr 21;303(15):1517-25. Available at: http://jama.ama-assn.org/cgi/reprint/303/15/1517. Retrieved April 23, 2010. May require payment. Creanga AA, Johnson TF, Graitcer SB, Hartman LK, Al-Samarrai T, Schwarz AG, et al. Severity of 2009 pandemic influenza A (H1N1) virus infection in pregnant women. Obstet Gynecol 2010;115:717-26. Available at: http://www.acog.org/departments/resourceCenter/ongV115N4.pdf. Retrieved April 5, 2010.
H1N1 Influenza Resources for Clinicians
The College's assessment and treatment flow chart for pregnant women with influenza-like illness (published online only!) November 9, 2009
The CDC's H1N1 Flu Resources for Obstetric Health Care Providers April 13, 2010
The College and other leading physician groups urge physicians to vaccinate their pregnant patients for the 2009 H1N1 influenza and seasonal flu. October 22, 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. updated January 14, 2010. 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. 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. College Updates on 2009 H1N1 Influenza Virus College President Dr. Gerald F. Joseph Jr. issued an important update about H1N1 ("swine flu") to Fellows. April 5, 2010 College President Dr. Gerald F. Joseph Jr issues an important update about H1N1 ("swine flu") update to Fellows. November 19, 2009
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
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 See the CDC's H1N1 Influenza Diagnosis and Lab Testing Recommendations for guidance. 2009 H1N1 Influenza Virus information for Pregnant Women
See the CDC's resources for pregnant women about H1N1 influenza.
Use the joint College and AMA 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. A Spanish version of the patient fact sheet for pregnant women is also available. (published online only!) November 9, 2009
The College and other health organizations released a joint information message for pregnant women concerning influenza. September 23, 2009
Considerations for pregnant women who are more likely to be exposed to Novel H1N1 Flu (Swine Flu) at work: Information for women in education, child care, and health care. Updated November 9, 2009 Treatment Information Information on Vaccines for 2009 H1N1 Influenza The U.S. Department of Health and Human Services has authorized tort liability immunity for the H1N1 vaccine to healthcare professionals who are authorized under state law to prescribe, administer, and dispense vaccines. CDC Information on Seasonal Influenza Information for Persons with Disabilities
The CDC has posted information about 2009 H1N1 Flu for people with disabilities and their caregivers on it Website. A pdf version of this document can be printed at: http://www.cdc.gov/h1n1flu/pdf/people_with_disabilities.pdf. December 1, 2009
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 6/15/2010
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