2009-2010 Influenza Season Update #7
Information for Healthcare Providers Regarding Pregnant & Postpartum Women
Planning for 2nd Dose of H1N1 Vaccine for Children Age 6 Months to 9 Years
November 06, 2009
To: Obstetric Health care Providers, Vermont Healthcare Providers
From: Wendy Davis, MD, Commissioner of Health
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The Centers for Disease & Control (CDC) has provided updated and additional guidance for obstetric health care providers caring for pregnant and postpartum women. Pregnant women are at higher risk for severe complications and death from influenza, including both 2009 H1N1 influenza and seasonal influenza. Postpartum women, who are in transition to normal immune, cardiac, and respiratory function, should be considered to be at increased risk of influenza-related complications up to 2 weeks postpartum (including following pregnancy loss).
Surveillance of Severe Illness in Pregnant and Postpartum Women
Pregnant women represent 6 percent of confirmed 2009 H1N1 influenza deaths in the United States, while only about 1 percent of the general population is pregnant at any given time. The Vermont Department of Health is working closely with CDC to monitor pregnant and postpartum women (up to 6 weeks postpartum) with severe influenza that have been hospitalized or who have died. Hospitals have been asked to report all laboratory-confirmed influenza hospitalizations. The Health Department may be in touch with providers for additional information. Providers may also reach the Health Department’s Epidemiology Section by calling 802-863-7240.
CDC Pregnancy Flu Line for Providers
Providers may also report information on hospitalized or deceased pregnant or postpartum women (up to 6 weeks postpartum) directly to CDC by calling 404-368-2133. Providers with specific questions about critical or clinically complicated influenza cases involving pregnant or postpartum women can reach a board-certified obstetric provider (24/7) through this CDC flu line.
Current Guidance for Providers
2009 H1N1 Influenza Vaccine and Pregnant Women: Information for Healthcare Providers: http://www.cdc.gov/h1n1flu/vaccination/providers_qa.htm
- The Advisory Committee on Immunization Practices (ACIP) recommends that pregnant women receive inactivated 2009 H1N1 monovalent and seasonal influenza vaccines, which can be given to pregnant women in any trimester and can be given at the same time but in different injection sites.
- Pregnant women should receive inactivated vaccine (flu shot) but should not receive the live attenuated vaccine (nasal spray).
- Caregivers of newborns are potential sources of transmission of H1N1 influenza. Women who were not vaccinated during pregnancy should receive the vaccine postpartum to prevent the mothers from getting influenza and passing it to their infants.
Updated Interim Recommendations for Obstetric Healthcare Providers Related to Use of Antiviral Medications in the Treatment and Prevention of Influenza for the 2009-2010 Season: http://www.cdc.gov/H1N1flu/pregnancy/antiviral_messages.htm
- Treatment with antiviral medications is recommended for pregnant women or women who are up to 2 weeks postpartum (including following pregnancy loss) with suspected or confirmed influenza, and can be taken during any trimester of pregnancy.
- Pregnancy should not be considered a contraindication to oseltamivir or zanamivir use. These medications are Pregnancy Category C medications, indicating that no clinical studies have been conducted to assess the safety of these medications for pregnant women. However, the available risk-benefit data indicate pregnant women with suspected or confirmed influenza should receive prompt antiviral therapy.
- Post-exposure antiviral chemoprophylaxis can be considered for pregnant women and women who are up to 2 weeks postpartum who have had close contact with someone likely to have been infectious with influenza. Close contact, in this instance, is defined as having cared for or lived with a person who has confirmed, probable, or suspected influenza, or having been in a setting where there was a high likelihood of contact with respiratory droplets and/or body fluids of such a person. Clinical judgment is an important factor in treatment decisions.
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NOTE: Planning for Second Dose of H1N1 Vaccine for Children (6 months to 9 years of age)
- CDC recommends that clinicians should administer two doses of 2009 H1N1 monovalent vaccine to children 6 months through 9 years of age; the two doses of 2009 H1N1 monovalent vaccine should be separated by 4 weeks.
- Health care providers should plan for ensuring vaccine 2nd dose administration for 6 month to 9 year olds when requesting H1N1 vaccine supplies to meet the needs of their practice.
Vaccine that is readily available at practices should be used for administering the second dose of vaccination for patients in this age group.