Office of the President
Gerald F. Joseph, Jr., MD, FACOG
October 20, 2009
Dear Colleague,
More pregnant women are dying from H1N1 (formerly “swine flu”) as compared to the general population. The best strategy to prevent this is to vaccinate pregnant women for both 2009 H1N1 influenza and seasonal flu. I strongly encourage you to vaccinate your pregnant patients. But most importantly, immediately treat pregnant patients who have influenza-like illness. For pregnant patients with influenza-like illness, do not wait for test results to initiate treatment, if testing is performed. See updated CDC information for health care providers on treatment at http://www.cdc.gov/H1N1flu/pregnancy/antiviral_messages.htm and use of diagnostic tests at http://www.cdc.gov/H1N1flu/diagnostic_testing_clinicians_qa.htm.
ACOG has developed new materials to help ob-gyns and their pregnant patients from contracting 2009 H1N1 and seasonal influenza and to keep their illness from worsening. Specifically:
These new ACOG materials can be reproduced and can be printed from ACOG’s website at http://www.acog.org/departments/dept_notice.cfm?recno=20&bulletin=4866. ACOG, AAFP, AMA, and CDC issued a letter to physicians urging them to vaccinate their pregnant patients http://www.acog.org/departments/resourceCenter/2009H1N1JointDearColleagueLtr.pdf. Fellows will also be receiving a copy of these materials in the mail. CDC has posted a triage algorithm for adults > 18 years old with influenza-like illness at http://www.cdc.gov/h1n1flu/clinicians/pdf/adultalgorithm.pdfand for children < 18 years old at http://www.cdc.gov/h1n1flu/clinicians/pdf/childalgorithm2.pdf.
There are concerns being voiced by pregnant women about 2009 H1N1 and seasonal flu immunization as well as many myths and misperceptions. Ob-gyns need to advocate strongly to their pregnant patients that they be vaccinated for both H1N1 and seasonal flu and counter these myths.
- There is no evidence that thimerosal (a mercury preservative in the multi-dose vaccine) is harmful to a pregnant woman or her fetus or is linked to autism. Although the 2009 H1N1 influenza virus is new, the vaccine has been made and tested the same way as the seasonal flu vaccine. Millions of pregnant women have received the flu vaccine for more than 45 years. Flu vaccine has not been shown to cause harm to pregnant women or their babies.
- The risk of Guillain-Barré Syndrome is estimated to be no more than 1 case per 1 million persons vaccinated. Pregnant women should tell the person giving the shots if they have ever had Guillain-Barré Syndrome.
- It is important that you assure your pregnant patients of the safety of the vaccines and the very real risk from influenza during pregnancy. In addition to ACOG’s new fact sheet for pregnant patients (see above), CDC has Q & As on H1N1 vaccine and pregnant women at http://www.cdc.gov/h1n1flu/vaccination/pregnant_qa.htm as well as for obstetric providers at http://www.cdc.gov/h1n1flu/vaccination/clinicians_qa.htmand at http://www.cdc.gov/h1n1flu/vaccination/providers_qa.htm.
The following is a SUGGESTED SCRIPT TO USE WITH PREGNANT AND POSTPARTUM PATIENTS:
Safety of 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 breast feeding. This will help prevent you and your baby from getting the flu.
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Pregnant women should receive the “flu shot” for both H1N1 and seasonal flu and should NOT receive the nasal spray. Postpartum and breastfeeding women should also be immunized for both H1N1 and seasonal flu and can receive either the “flu shot” or the nasal spray. Both H1N1 and seasonal flu vaccinations can be administered at the same time but in different injection sites. Both immunizations can be given at any time during pregnancy.
There are some people who should not get any flu vaccine without first consulting a physician. These include:
- People who have a severe allergy to chicken eggs.
- People who have had a severe reaction to an influenza vaccination.
- People who developed Guillain-Barré syndrome within 6 weeks of getting an influenza vaccine previously.
- Children younger than 6 months of age (influenza vaccine is not approved for this age group).
- People who have a moderate-to-severe illness with a fever (they should wait until they recover to get vaccinated).
See CDC information on 2009 H1N1 vaccination for clinicians at http://www.cdc.gov/h1n1flu/vaccination/professional.htm.
Thank you for joining ACOG in this effort.
Sincerely,
Gerald F. Joseph, Jr., MD FACOG
President, ACOG
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