WHO, CDC, European experts have identified Pregnant Women as a high risk priority group for influenza A vaccination and antiviral treatment. Clinical studies and CDC data show a relatively high mortality in pregnant women due to 2009 H1N1 infection. Current recommendations call for starting the antiviral therapy in pregnant women as soon as possible and even before waiting for the confirmatory test for 2009 H1N1. CDC/WHO recommend continued breastfeeding during antiviral treatment.
- Influenza A (H1N1) 2009 Monovalent Vaccine (CSL Limited)
- Influenza A (H1N1) 2009 Monovalent Vaccine (Novartis Vaccines and Diagnostics Limited)
- Influenza A (H1N1) 2009 Monovalent Vaccine (Sanofi Pasteur, Inc.)
Information about pandemic influenza vaccines
Informations sur les vaccins contre la grippe pandémiqueInformazioni sui vaccini per l’influenza pandemicaInformācija par gripas pandēmijas vakcīnām
1 – Risks for pregnant women?
- Lung Infection Model pneumonia, this infection poses a significant risk to the mother and also to the fetus.
- Respiratory Distress Syndrome
- Risk of miscarriage
- Risk of premature delivery
The Augusta Chronicle - Tom Corwin - 1 hour ago Less than 65 percent of health care workers and less than half of pregnant women got a flu shot last season, the Centers for Disease Control and Prevention reported Thursday, but both are still good increases over previous rates. Centers for Disease Control calls for H1N1 immunization The State Column
The Augusta Chronicle - Tom Corwin - 1 hour ago
Less than 65 percent of health care workers and less than half of pregnant women got a flu shot last season, the Centers for Disease Control and Prevention reported Thursday, but both are still good increases over previous rates.
Centers for Disease Control calls for H1N1 immunization The State Column
2 – Important Risks for mother and child?
I Never Get The Flu
CDC Video Player.
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3 – Recommendations for pregnant women?
4 – Recommendations for nursing women?
5 - Influenza symptoms:
- Sudden fever (but can not quite too high)
- Sore throat
- Nausea, vomiting and diarrhea may also occur.
6 – Chronic conditions that may increase the risk of influenza complications in pregnant women (non-exhaustive list):
- Cardiac or pulmonary disorders (including bronchopulmonary dysplasia, cystic fibrosis and asthma) …
- Diabetes mellitus or other metabolic diseases …
- Cancer, immunodeficiency, immunosuppression (due to underlying disease or treatment) …
- Kidney …
- Anemia or hemoglobinopathy …
7 – Recommendations for immunizations in pregnant women:
2009 H1N1 Influenza Vaccine and Pregnant Women
CDC Updated Guidelines
CDC recommend that pregnant women receive the 2009 H1N1 influenza vaccine
Pregnant women should get the “flu shot”— an inactivated vaccine (containing fragments of killed influenza virus) that is given with a needle, usually in the arm. The flu shot is approved for use in pregnant women.
It is anticipated that seasonal flu and 2009 H1N1 vaccines may be administered on the same day but given at different sites (e.g. one shot in the left arm and the other shot in the right arm). However, we expect the seasonal vaccine to be available earlier than the 2009 H1N1 influenza vaccine. The usual seasonal influenza viruses are still expected to cause illness this fall and winter. Pregnant women and others at increased risk of complications of influenza are encouraged to get their seasonal flu vaccine as soon as it is available.
Influenza vaccines have not been shown to cause harm to a pregnant woman or her baby. The seasonal flu shot (injection) is proven as safe and already recommended for pregnant women. The 2009 H1N1 influenza vaccine will be made using the same processes and facilities that are used to make seasonal influenza vaccines.
A number of clinical trials which test 2009 H1N1 influenza vaccine in healthy children and adults are underway. These studies are being conducted by the National Institutes of Allergies and Infectious Diseases (NIAID). Studies of 2009 H1N1 influenza vaccine in pregnant women are expected to begin in September.
There is no evidence that thimerosal (used as a preservative in vaccine packaged in multi-dose 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. CDC recommends that pregnant women may receive influenza vaccine with or without thimerosal.
CDC anticipate that 21-28 days will be needed between the first and second doses.
There is no test that can show whether a person had 2009 H1N1 influenza in the past. 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. It is not necessary to test a person who previously had an influenza-like illness. People for whom the 2009 H1N1 influenza vaccine is recommended should receive it, even if they have had an influenza-like illness previously, unless they can be certain they had 2009 H1N1 influenza based on a laboratory test that can specifically detect 2009 H1N1 viruses. CDC recommends that persons who were tested for 2009 H1N1 influenza discuss this issue with a healthcare provider to see if the test they had was either an RT-PCR 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.
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 expected to be mild, such as soreness, redness, tenderness or swelling where the shot was given. Some people might experience headache, muscle aches, fever, nausea and fainting. If these problems occur, they usually begin soon after the shot and may last as long as 1-2 days. Like any medicines, vaccines can cause serious problems like severe allergic reactions. However life-threatening allergic reactions to vaccines are very rare. In 1976, an earlier type of swine flu vaccine was associated with cases of a severe paralytic illness called Guillain-Barre 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 GBS 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. Cell cultured (protein free medium) vaccines are available in Europe as alternative but not in USA. FluMist is approved only in the USA but is not approved for use in pregnant women and is not approved in Europe.
Published 15 September 2009, doi:10.1136/bmj.b3680
Cite this as: BMJ 2009;339:b3680
Recommendations for the administration of influenza vaccine in children allergic to egg
M Erlewyn-Lajeunesse, consultant in paediatric allergy 1, N Brathwaite, consultant in paediatric allergy2, J S A Lucas, honorary consultant in allergy and respiratory paediatrics, senior lecturer in child health1,3, J O Warner, professor of child health4
- Egg-free, mammalian culture based flu vaccines should be given preferentially to individuals allergic to egg
If an egg-free vaccine is not available, only vaccines with a stated maximum egg content <1.2 µg/ml (0.6 µg per dose) should be used in individuals allergic to egg
- If egg based vaccine is administered to individuals with egg allergy, this should be done in a centre experienced in the management of anaphylaxis
- A single dose protocol is recommended for those with less severe egg allergy
- A two dose, split protocol can be used in those with anaphylaxis to egg or those with moderate or uncontrolled asthma
Cite this as: BMJ 2009;339:b3680
Prevalence of influenza A and B antibodies in pregnant women and their offspring Journal of Clinical Virology View PDF
Wutzler et al 2009 in 209 mothers and their neonates in Germany showed and confirmed active placental transport of maternal influenza antibodies during the third trimester. The prevalence of the anti influenza B virus antibodies was significantly higher in neonates than their mothers. New born babies have higher prevalence and concentrations of influenza A and B antibodies than their mothers. Antibodies to measles, mumps, rubella, parainfluenza, varicella zoster, tetanus, pertussis and deptheria are actively transferred to neonates across the placenta during the third ptrimester period.
Passive immunity to influenza in neonates is important since current vaccines are not indicated for babies less than 6 months old. Annual influenza vaccination may improve the protection of pregnant women and their off spring against influenza.
Best Practice topic: 2009 influenza A (H1N1) virus (27 Oct 2009)
2009 H1N1 Mid-Level Range* Estimated Range * * Deaths have been rounded to the nearest ten. Hospitalizations have been rounded to the nearest thousand and cases have been rounded to the nearest million. Exact numbers also are available.
CDC Estimates of 2009 H1N1 Cases and Related Hospitalizations and Deaths from April-November 14, 2009, By Age Group
~12 million to ~23 million
~19 million to ~38 million
65 years and older
~3 million to ~6 million
~34 million to ~67 million
~51,000 to ~101,000
~87,000 to ~172,000
65 years and older
~15,000 to ~29,000
~154,000 to ~303,000
~790 to ~1,550
~5,360 to ~10,570
65 years and older
~920 to ~1,810
~7,070 to ~13,930
Estimated Range *
* Deaths have been rounded to the nearest ten. Hospitalizations have been rounded to the nearest thousand and cases have been rounded to the nearest million. Exact numbers also are available.
Vaccine Safety & Availability
Report adverse events (side effects) related to the administration of U.S. licensed vaccines
FDA Press Release, September 30, 2005
MMWR Weekly Report, Centers for Disease Control, October 20, 2006
Children aged 6 months to 9 years should receive 2 doses of 2009 H1N1 vaccine 4 weeks apart to have sufficient levels of protective antibodies.
- Editorial: The future of influenza vaccines (8 Oct 2009)
- Research: Partial protection of seasonal trivalent inactivated vaccine against novel pandemic influenza A/H1N1 2009 (8 Oct 2009)
- Podcast: Vaccines – Q&A (7 Oct 2009)
H1N1 Flu (Swine Flu): Resources for Pregnant Women
- Webcast: Latest Information for Pregnant Women and New Moms
- Information for Pregnant Women in Education, Child Care, and Health Care
- 2009 H1N1 Influenza Vaccine and Pregnant Women
- General Information About H1N1.
- Resources for Parents and Caregivers.
Should I have an H1N1 flu vaccination after Guillain-Barré syndrome? ( BMJ 9 Sep 2009)
Centers for Disease Control and Prevention (CDC).
MMWR Morb Mortal Wkly Rep. 2009 Oct 9;58(39):1100-1.
PMID: 19816398 [PubMed - in process]
Jain S, Kamimoto L, Bramley AM, Schmitz AM, Benoit SR, Louie J, Sugerman DE, Druckenmiller JK, Ritger KA, Chugh R, Jasuja S, Deutscher M, Chen S, Walker JD, Duchin JS, Lett S, Soliva S, Wells EV, Swerdlow D, Uyeki TM, Fiore AE, Olsen SJ, Fry AM, Bridges CB, Finelli L; the 2009 Pandemic Influenza A (H1N1) Virus Hospitalizations Investigation Team.
N Engl J Med. 2009 Oct 8. [Epub ahead of print]
PMID: 19815859 [PubMed - as supplied by publisher]
Burrel S, Roncin L, Lafon ME, Fleury H.
Euro Surveill. 2009 Sep 24;14(38). pii: 19334.
PMID: 19814958 [PubMed - in process]
- Tamma PD, Ault KA, Del Rio C, Steinhoff MC, Halsey NA, Omer SB. Safety of influenza vaccination during pregnancy. Am J Obstet Gynecol. 2009 Oct 20. [Epub ahead of print] PubMed PMID: 19850275.
- Eisen DP, McBryde ES. Avoiding Guillan-Barré Syndrome following swine origin pandemic H1N1 2009 influenza vaccination. J Infect Dis. 2009 Nov 15;200(10):1627-8. PubMed PMID: 19857155.
- Zhu FC, Wang H, Fang HH, Yang JG, Lin XJ, Liang XF, Zhang XF, Pan HX, Meng FY, Hu YM, Liu WD, Li CG, Li W, Zhang X, Hu JM, Peng WB, Yang BP, Xi P, Wang HQ, Zheng JS. A Novel Influenza A (H1N1) Vaccine in Various Age Groups. N Engl J Med. 2009 Oct 21. [Epub ahead of print] PubMed PMID: 19846844.
- Kramarz P, Ciancio B, Nicoll A. Seasonal and pandemic influenza vaccines for the elderly and other risk groups: a review of available data. Pol Arch Med Wewn. 2009 Oct;119(10):654-9. PubMed PMID: 19847142.
Published at http://www.nejm.org September 10, 2009 (10.1056/NEJMe0908224)Pandemic Influenza Vaccine Policy — Considering the Early Evidence
Kathleen M. Neuzil, M.D., M.P.H.
Safety of neuraminidase inhibitors against novel influenza A (H1N1) in pregnant and breastfeeding women
Can. Med. Assoc. J., Jul 2009; 181: 55 – 58 ; doi:10.1503/cmaj.090866
- Swine Flu News & Influenza Times
- Grippe A (H1N1) v 2009
- |Le Virus A (H1N1) v : Grippe Porcine à variante Humaine
- Peramivir: Swine Flu ( 2009 H1N1 ) Pandemic Emergency Use?
- Swine Flu [Influenza A ( 2009 H1N1) ] Pandemic Review
- Swine Flu (2009 H1N1) Pandemic Scientific & Medical Resources
- I Tamiflu & Relenza Influenza ( 2009 H1N1 ) MarketI
- Influenza ( 2009 H1N1 ) Vaccine Market
First US H1N1 vaccines will be nasal spray – CDC
….”Some of the other vaccines contain thimerosal, a preservative that scientists say is safe but which worries some people, and the state of Washington, for instance, says infants and pregnant women may not be given thimerosal-containing vaccines ”
19th Septemeber—-TIMES OF INDIA US
Important Contact Numbers:
Outbreak Monitoring Cell (Control Room,
NICD): 011-23921401 EMR Control room (Ministry of Health and
family Welfare: 011- 23061469
Medical professionals : If you see Influenza like illness (ILI) , please inform 1075 (Toll free or call 1800-11-4377)
Please see website : htpp://www.mohf.h1n1.nic.in
health and family welfare ministry :India
Summary of 2009 H1N1 Risk for pregnant women
Your risk of getting infected with H1N1 4 out of 100 ( vs 1 out of 100 in normal population)
Risk of death from H1N1 infection 6 out of 1000 (vs 1.5 out of 1000 in normals)
Risk of GBS due to vaccine 1 out of 1 million
CDC data: Out of 700 cases of 2009 H1N1 in pregnant women, 100 patients were hospitalized and 28 patients died (both mother and fetus).
It is your choice what type of risk you are willing to choose.
Added on November 3, 2009 New links and CDC Data KM ( Salim & Minoo)
What Pregnant Women Should Know About H1N1 Virus
If you are pregnant, you should get vaccinated against H1N1 as soon as possible. Your vaccination can potentially protect your unborn child from infection. The Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP)has recommended that H1N1 vaccination efforts focus on five groups. One of those groups is pregnant women and recently pregnant women. Use our Flu Shot Locator to get vaccinated where you live. Note that pregnant women should not receive the nasal-spray flu vaccine LAIV (FluMist®)
- Severe illnesses among pregnant woman and infants have been reported in the current H1N1 outbreak. Severe illness in the mother can be stressful to the fetus.
- Changes to a pregnant woman’s immune system can make her more sensitive to the flu and result in serious complications if she is infected with H1N1.
- A diagnosis of infection in the fetus or infant can be challenging. The effects of the flu on a fetus are also difficult to predict.
Anecdotal reports suggest that women who have given birth, similar to pregnant women, might be at increased risk for severe complications and death from 2009 H1N1 influenza.
- Based on these reports, women should be considered to be at increased risk of influenza-related complications up to 2 weeks after giving birth (including following pregnancy loss).
- Women who are up to 2 weeks postpartum (including following pregnancy loss), and who are suspected or confirmed to have 2009 H1N1 influenza, should receive antiviral treatment as soon as possible. See CDC’s Updated Interim Recommendations for the Use of Antiviral Medications in the Treatment and Prevention of Influenza for the 2009-2010 Season.
There are separate vaccines for seasonal flu and H1N1 flu viruses. You should get vaccinated against both viruses.
- Pregnant women and recently pregnant women are one of the priority vaccination groups recognized by the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP).
- You should get the seasonal flu shot and the H1N1 flu shots as soon as possible. Use our Flu Shot Locator to get vaccinated where you live. Note that pregnant women should not receive the nasal-spray flu vaccine LAIV (FluMist®)
- Flu vaccines are available in different settings, such as vaccination clinics organized by local health departments, healthcare provider offices, and schools, and other private settings, such as pharmacies and workplaces.
Flu vaccine has not been approved for use in babies under 6 months old. However, there are some things you can do to help protect your baby:
- Keep your infant out of crowded areas and away from people who are sick.
- Avoid sharing of toys and other items that have been in infants’ mouths.
- Wash thoroughly with soap and water any items that have been in infants’ mouths.
Don’t panic. If you have flu-like symptoms, contact your doctor. Doctors are getting guidance on the proper medications and treatment to use with pregnant women that will not harm your baby.
- If you are sick, stay home (except to get medical care) and limit contact with others.
- Treat a fever right away with acetaminophen (Tylenol®). It is the best over-the-counter treatment of fever in pregnancy.
- Drink plenty of fluids to replace those you lose when you are sick.
- If you are not sick but have close contact with someone who has H1N1 flu or is being treated for exposure to H1N1 flu, ask your doctor whether you need treatment with antivirals to reduce your chances of getting the flu.
Differences in Recommendations
Talk about organic content!
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tool on the topic of Swine Flu.
Very COOL timeline, too.
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