Gerald F. Joseph, Jr., MD, FACOG

September 22, 2009

Dear Colleague:

Healthy pregnant women have been severely impacted by the 2009 H1N1 influenza virus (formerly called "novel H1N1 flu" or "swine flu"). Pregnant women are 4 times as likely as the general population to be hospitalized for the 2009 H1N1 influenza virus. Six percent of confirmed deaths due to H1N1 flu have been in pregnant women while only 1% of the general population is pregnant. Obstetrician-gynecologists can play a pivotal role in helping to prevent these adverse outcomes. 

 Vaccination for H1N1

1.  Make a plan now for vaccinating your pregnant patients for 2009 H1N1 influenza virus and for seasonal influenza. If you don't plan to vaccinate your pregnant patients in your office, you should instruct them where they can go to be vaccinated.  

2. Advocate that your pregnant patients be vaccinated for 2009 H1N1 and seasonal influenza. Dispel any myths and misperceptions about immunizing for influenza during pregnancy.  Document these conversations and your patients' vaccination status. On September 3 the Centers for Disease Control and Prevention (CDC) posted information that   addresses 2009 H1N1 influenza vaccine in pregnancy with Qs and As for women and clinicians at  http://www.cdc.gov/h1n1flu/pregnancy.

3. State pre-registration is key for physicians administering H1N1 vaccine.   In anticipation of the availability of the H1N1 vaccine, many states have established a pre-registration process that will allow physicians and health care providers who are authorized to administer vaccinations to pre-register for receipt of the H1N1 vaccine.  Visit  http://www.cdc.gov/h1n1flu/vaccination/statecontacts.htm for state/jurisdiction contact information for providers interested in supplying the H1N1 vaccine.  If your state contact information is not yet listed, contact your local health department.  CDC is updating the list as states develop their plans.

 4. To get help with your immunization plans and to be aware of your community's plan,  contact your local health department or state/jurisdiction public health contact at  http://www.cdc.gov/h1n1flu/vaccination/statecontacts.htm.  If your state contact information is not yet listed, contact your local health department.  CDC is updating the list as states develop their plans.

Updated antiviral information

Since rapid access to antiviral medications is essential, health care providers who care for pregnant women should develop methods to ensure that treatment can be started quickly after symptom onset. More information regarding antiviral treatment can be found on the CDC website at  http://www.cdc.gov/H1N1flu/pregnancy/antiviral_messages.htm. Actions that will support initiation of early treatment include:

·         Informing pregnant women of signs and symptoms of influenza and need for early treatment after onset of symptoms of influenza.

·        Ensuring rapid access to telephone consultation and clinical evaluation for these patients as well as patients who report severe illness. 

·         Considering empiric treatment of pregnant women based on telephone contact if hospitalization is not indicated and if this will substantially reduce delay before treatment is initiated.

In selected circumstances, providers might also choose to provide pregnant women with prescriptions that can be filled at the onset of symptoms after telephone consultation with the provider.   This strategy could substantially reduce delay before treatment in pregnant patients with comorbidities.

MASH 9/22/09