Influenza ( 2009 H1N1 ) & Pregnancy: Vaccination and Treatment

Swine Flu, Influenza A, H1N1 v, Pregnancy, High Risk, WHO, CDC, EMEA, FDA, Vaccination, 3rd Trimester, Antiviral,Tamiflu, Relenza, Breastfeeding

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Abstract

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.

 


 

WARNINGS AND RECOMMENDATIONS
WHO, CDC
 
From Sanofi Aventis Image Library
 
Digital image model of 2009 H1N1 Virus

 

 
This is for information only. 
 
You are responsible for your own health and all decisions about your own health must be taken in consultation with your treating medical doctor/specialist and in accordance with national guidelines. 
A pregnant woman is highly susceptible to H1N1 infection and must take extra precautions (hand wash, soap, mask, minimize contact with infected persons) in minimizing the risk of exposure to the virus

Influenza A/2009 H1N1.
International (WHO, European) and National (CDC, UK, Swiss, Canada, Belgium French) recommendations are summarized here and links, RSS feeds and video links are provided for your information.
 
 
 

Injectable Vaccines

Intranasal Vaccine

EMEA Approval
http://www.emea.europa.eu/pdfs/human/pandemicinfluenza/60825909en.pdf

Information about pandemic influenza vaccines

Informations sur les vaccins contre la grippe pandémiqueInformazioni sui vaccini per l’influenza pandemicaInformācija par gripas pandēmijas vakcīnām

Celvapan
 

Visit the Agency’s new Pandemic influenza (H1N1) website

 

  • Asthma Information for Patients and Parents of Patients (CDC, 15 Sep 2009)
  • Use of Influenza A (H1N1) 2009 Monovalent Influenza Vaccine in Pregnant Women
  •  
    FDA and EMEA have approved the emergency use of Tamiflu in pregnant women and babies less than 1 year old during Pandemic 2009 H1N1 outbreak and extended the shelf life of Tamiflu by 2 years (from earlier 5 to 7 years). Relenza can be used in patients not responding to Tamiflu. 



    [Ways to produce a flu vaccine chart]


    1 – Risks for pregnant women?

        The pregnant woman is more likely that another person getting the flu, but it is more likely to develop certain complications and particularly: 


    • 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

     Chest infection symptoms may appear late in the 2nd quarter and during the 3rd quarter, but they can also worsen during late pregnancy. 

            The risks of miscarriage are possible during the first months of pregnancy may be the complication of pulmonary infection. 

        According to some studies, contact the influenza A in late pregnancy may increase the risk through 4, see 5 of the emergence of cardiovascular complications for mother and cardiac events for the fetus. 

        In newborns, the infection of influenza A can be fatal.


        It should be noted however that these infections are very rare and do not pose particular risks.

    Flu shot gains among health care workers, pregnant women

    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

    Half of pregnant U.S. women get flu shot UPI.com



    2 – Important Risks for mother and child?


        Above 2nd, 3rd month of pregnancy and late pregnancy.

    2 months pregnancy
    cours.fse.ulaval.ca
    3 months pregnancy
    web.libre.or

    I Never Get The Flu

    Source: National Center for Immunization and Respiratory Diseases 
    Running Time: (1:01)Release Date: 12/15/2009http://www.cdc.gov/CDCTV/INever/index.html

    CDC Video Player.  Flash Player 9 is required.
    CDC Video Player.
    Flash Player 9 is required.

    3 – Recommendations for pregnant women?


        a / pursue a completely normal life, whether family or social 

        In the case of symptoms, better stay home. 


        b / on hygiene, the same recommendations should be implemented, to recall: 


        Wash hands carefully with soap and water (at home it is best to use warm water and hand sanitizer). 

        Wash hands in all possible situations (sneezing, blowing your nose, back home …) 

        A bottle containing disinfectant can find a place in a handbag, like any cosmetic product (perfume and other). 

        

        c / social behavior: coughing and sneezing or in the elbow, either inside the arm, rather than doing it in the interior of the hands. 

        Pay particular attention to items shared with others: work area, office furniture, computer …. 

    In case of contact the suspect, a visit to the doctor is required (for review and possible absorption). 


    4 – Recommendations for nursing women?


    Breastfeeding: Women who contacted the virus while they are breastfeeding “may” continue breastfeeding during their antiviral therapy.
     
    Wash hand before touching your baby
     
    Wear mask during breastfeeding and never cough or sneeze directly or in the direction of your baby.


    5 - Influenza symptoms:


    • Sudden fever (but can not quite too high)
    • Cough
    • Sore throat
    • Wheezing
    • Stiffness
    • Fatigue
    • Nausea, vomiting and diarrhea may also occur.


        If symptoms, consult a physician preference. 




    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 …
     
    Text: Beware of H1N1 Fraudulent Products: More

     

    7 – Recommendations for immunizations in pregnant women:

        Should one or not vaccinate pregnant women, nursing women ?

        See the various recommendations by major countries on vaccination




    USA-CDC

    RECOMMENDATIONS CONCERNING THE ANTI-INFLUENZA VACCINATION AMONG P

    SWITZERLAND

    RECOMMENDATIONS FOR INFLUENZA VACCINATION AMONG PREGNANT WOMEN IN


    FRENCH

    RECOMMENDATIONS FOR INFLUENZA VACCINATION AMONG PREGNANT WOMEN IN

    Vaccine Facts  

    2009 H1N1 Influenza Vaccine and Pregnant Women 

    CDC Updated Guidelines

    CDC recommend that pregnant women receive the 2009 H1N1 influenza vaccine

    A pregnant woman who gets any type of flu is at risk for serious complications and hospitalization. Pregnant women who are otherwise healthy have been severely impacted by the 2009 H1N1 influenza virus. In comparison to the general population, a greater proportion of pregnant women infected with the 2009 H1N1 influenza virus have been hospitalized. In addition, severe illness and death has occurred in pregnant women. Six percent of confirmed fatal 2009 H1N1 flu cases thus far have been in pregnant women while only about 1% of the general population is pregnant.
     
    While hand washing, staying away from ill people, and other steps can help to protect pregnant women from influenza, vaccination is the single best way to protect against the flu.

    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.

     
    People should always inform their immunization provider if they have any severe allergies, if they’ve ever had a severe allergic reaction following flu vaccination, or if they have ever had GBS.

    Clinical review: Recommendations for the administration of influenza vaccine in children allergic to egg (15 Sep 2009)  BMJ

     

    Published 15 September 2009, doi:10.1136/bmj.b3680
    Cite this as: BMJ 2009;339:b3680

    Clinical Review

    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

    Summary points

    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


     

    Tips for non-specialists
    • Celvapan (Baxter), a pandemic A/H1N1 vaccine, and Optiflu (Novartis), a seasonal influenza vaccine are grown in a mammalian cell culture system and are egg-free
    • Other flu vaccines are prepared in hens’ eggs and may contain small amounts of egg protein
    • Individuals with severe egg allergy face a risk of anaphylaxis with flu vaccines that contain egg


    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.

    BMJ

     BMJ Learning module: Swine flu vaccination – your questions answered (3) (22 Oct

    Best Practice topic: 2009 influenza A (H1N1) virus (27 Oct 2009)

     

    CDC

     

    Vaccine Safety & Availability

    -


    CDC Releases 2009 H1N1 Vaccine Schedules

    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.

     

     

     

    References and Links :
    • H1N1 Flu (Swine Flu): Resources for Pregnant Women


    See also

    The Lancet

  • First published trials of specific pandemic vaccines with ECDC comment – Immune responses after one or two doses of monovalent unadjuvanted and adjuvanted influenza A (H1N1) 2009 vaccines (ECDC, 15 Sep 2009)
  • Get Seasonal Flu Vaccinations Now, Health Officials Urge Americans
  • U.S. Vaccination Coverage of 70% Could Curb Pandemic H1N1
  • H1N1 Trials Begin for Pregnant Women
  • New England Journal of Medicine Influenza Center

    1. Update on Influenza A (H1N1) 2009 Monovalent Vaccines.

      Centers for Disease Control and Prevention (CDC).

      MMWR Morb Mortal Wkly Rep. 2009 Oct 9;58(39):1100-1.

      PMID: 19816398 [PubMed - in process]

    2. Hospitalized Patients with 2009 H1N1 Influenza in the United States, April-June 2009.

      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]

    3. Oseltamivir susceptibility in south-western France during the 2007-8 and 2008-9 influenza epidemics and the ongoing influenza pandemic 2009.

      Burrel S, Roncin L, Lafon ME, Fleury H.

      Euro Surveill. 2009 Sep 24;14(38). pii: 19334.

      PMID: 19814958 [PubMed - in process]

    4. 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.
    5. 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.
    6. 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.
    7. 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.


    [1][2][3][4][5][6][7][8][1][9]

    1. Editorial
      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.

    Experience with traditional seasonal vaccines tells us that the immune responses in older children, pregnant women, and immunocompetent adults with chronic conditions are roughly similar to those of healthy nonpregnant adults.  Immunogenicity data in young children are critical to guide policy decisions.
     
    In our current global situation, in which demand for influenza vaccine greatly exceeds supply, dose-sparing strategies are needed.Fewer or partial doses and the use of adjuvants can all contribute to increased global vaccine supply.
     
    Both vaccines tested have generally acceptable side-effect and adverse-event profiles, with pain or tenderness at the injection site being the most common adverse event observed. It is reassuring that the manufacturing process for these vaccines is identical to that used for seasonal vaccines, which have a strong record of safety.
     
    Although concerns linger about the association of the 1976 swine influenza vaccine with the Guillain–Barré syndrome, the syndrome was rare, with approximately 1 case for every 100,000 persons vaccinated. A plan for robust and comprehensive safety surveillance should be in place to detect uncommon events rapidly during the upcoming vaccination campaigns, so that risk–benefit ratios can be reassessed.
     
    Additional studies are ongoing that will address the immunogenicity of live-attenuated vaccines, and additional inactivated vaccines, in various age groups and on various schedules and in combination with seasonal influenza vaccines. The desire to see all the available data must be balanced with the need to deploy vaccine quickly to reduce morbidity associated with the pandemic. Likewise, the need to make timely decisions must be balanced with thoughtful, transparent debate and openness to changing direction as new data emerge.
     
     
    In a recent paper published in CMAJ, Tanake et al state that the use of the two antivirals Tamiflu and relenza is compatible with breast feeding. Limited data show that Tamiflu is not a teratogen and thus it can be used during pregnancy as the information about Relenza is not available.
     
    Toshihiro Tanaka, Ken Nakajima, Atsuko Murashima, Facundo Garcia-Bournissen, Gideon Koren, and Shinya Ito
    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


    Other items recommended to read:

     

    Health News

    Israeli woman in 39th week of pregnancy dies of swine flu

    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

    21st September…. 

    latimes.com  
    ” Each year, influenza results in thousands of deaths in our community, and the H1N1 flu has demonstrated that it affects children, young adults and pregnant women more severely than the general population.”
    Vaccines in general are well-accepted by the majority of parents, children and adults because they have an exemplary safety record and have played an important role in eliminating diseases that were once common. Despite the strong opinions of a small minority, it is important to remember that vaccines are required to meet high safety standards, and there are no data to support that they cause harm.”

    INDIA

    Important Contact Numbers:

    Outbreak Monitoring Cell (Control Room,

    NICD): 011-23921401 EMR Control room (Ministry of Health and

    family Welfare: 011- 23061469

    Important Websites:

    http://www.mohfw.nic.inhttp://www.nicd.in


    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)

    CDC Recommendations


    What Pregnant Women Should Know About H1N1 Virus

    Flu Vaccination Locator. People at risk should get the H1N1 vaccine as soon as possible. Click here for more info.

    • Pregnant women and recently pregnant women are a priority group for the H1N1 (Swine) flu vaccineMore…

    • You should get vaccinated against both seasonal and H1N1 flu. More…
    • There are some steps you can do to protect children under 6 months old. More…
    • If you have H1N1 flu, you should stay home, follow your doctor’s orders, and watch for signs that you need immediate medical attention. More…
    • Antiviral medications can be given to pregnant women. Take direction from your doctor regarding medications and treatment. More…
    • Breastfeed your infant because breast milk passes on antibodies from the mother to a baby.More…
    • Follow available guidance if you are pregnant and work in schools and healthcare settings. More…
    • If you are a health care worker, pregnant, and must continue to work, follow these guidelines. More…
    • Emergency medical care may become necessary. Know the signs. More…
    • Antiviral dosage recommendations have been issued for post-exposure prevention and treatment of H1N1 flu. More…

     


    Protect Your Unborn Child

    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®)

     

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    After Pregnancy

    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.

     

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    Vaccinations: Seasonal and H1N1

    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.

    Initial Results Show Pregnant Women Mount Strong Immune Response to One Dose of 2009 H1N1 Flu Vaccine

    CDC Advisors Make Recommendations for Use of Vaccine Against Novel H1N1.  

     

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    Protect Your Newborn

    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.

     

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    What To Do If You Get Sick

    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 

    WHO

    WHO expert panel recommends a single dose of 2009 H1N1 vaccine for all subjects including children. WHO endorses use of already approved adjuvents in pandemic vaccines and has recommended the use of nasal spray live attenuated vaccine FluMist 2009 H1N1 for pregnant women.

    CDC/FDA

    Although adjuvents are considered safe, the adjuvent containing pandemic vaccines were not approved in the US. Recommends 2 dose schedule for children 6 months to 9 years old. The live virus containg nasal spray FluMist is not recommended for pregnant women and children less than 2 years of age.

    ECDC/EMEA

    Has not approved the use of live attenuated virus containing nasal spray FluMist in Europe. Adjuvents containing vaccines (As04 and MF059) are approved. Recommends 2 dose schedule of the pandemic flu vaccine for all inspite of clinical studies showing immuno protection with one dose of vaccine. This may be a way to cover European experts and politicians who ordered 2 dose of vaccine per person?
    The NIAID sponsored trial of pandemic flu vaccine in 50 pregnant women showed robust immune response after a 15 mcg dose of the 2009 H1N1 vaccine. There were no serious adverse events linked to the vaccine. 


    Talk about organic content!
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