Influenza vaccination: an essential element of prenatal care
All women who will be
pregnant through the influenza season (October - May in the United States)
vaccinated against influenza, according to recommendations made by the
Centers for Disease Control and Prevention's Advisory Committee on Immunization
Practice (ACIP) and supported by the COP.
(The above has been published in October issue of Obstetrics and
Influenza, commonly called "the flu," is an illness caused by RNA viruses
that infect the respiratory tract of many animals, birds, and humans. In most
people, the infection results in the person getting fever, cough,
and malaise (tired, no energy); some people also may develop a sore throat,
nausea, vomiting, and diarrhea. The majority of individuals has symptoms for
about one to two weeks and then recovers with no problems. However, compared
with most other viral respiratory infections, such as the common cold, influenza
(flu) infection can cause a more severe illness with a mortality rate (death
rate) of about 0.1% of people who are infected with the virus.
Typical clinical features of influenza include
fever (usually 100 F-103 F in adults and often even higher in children),
respiratory symptoms such as
runny or stuffy nose,
fatigue, sometimes extreme.
Most candidates who get the flu recover completely in one to two weeks, but
some develop serious and potentially life-threatening medical
complications, such as pneumonia.
Much of the illness and death caused by influenza can be prevented by annual
influenza vaccination. Flu vaccine (influenza vaccine made from inactivated and
sometimes attenuated [non-infective] virus) is specifically recommended for
those who are at high risk for developing serious complications as a result of
influenza infection. The CDC has listed these groups listed below as being at
high risk and should obtain the novel H1N1 vaccine as soon as it is available to
people who live with or care for children younger than 6 months of age,
health-care and emergency-services personnel,
Studies of healthy young adults have shown influenza vaccine to be 70%-90%
effective in preventing illness. Studies show the vaccine reduces
hospitalization by about 70% and death by about 85% among the elderly who are
not in nursing homes. Among nursing-home residents, vaccine can reduce the risk
of hospitalization by about 50%, the risk of pneumonia by about 60%, and the
risk of death by 75%-80%.
Pregnancy and immunization
Pregnant women are vulnerable to the risks from seasonal influenza and
also had excess mortality during the influenza pandemics of 1918 to 1919, 1957
to 1958, and the 2009 pandemic ó supporting the need for vaccination in this
group. All women who will be pregnant through the influenza season
(November- March) should be vaccinated against influenza, according to
recommendations made by the Centers for Disease Control and Prevention's
Advisory Committee on Immunization Practice (ACIP) and supported by the COP.
As long as there is a sufficient supply of vaccination, unvaccinated pregnant
women should be immunized at any time during influenza season, using inactivated
influenza vaccine. It is preferable, though, to vaccinate pregnant women early
in the influenza season, regardless of gestational age. Live attenuated
influenza vaccine is contraindicated during
Research suggests that pregnancy increases the risk for complications from
the flu, including pneumonia and symptoms severe enough to require
hospitalization. Since pregnancy alters an expectant motherís
immune system, impacting
the functions of both the
and lungs, a case of the flu can become problematic. Influenza during
pregnancy can increase the risk of
miscarriage, and the high,
sustained fever some women experience with the flu increase the risk of the
birth defect spina bifida.
Live vaccines are NOT recommended for pregnant women.
In addition, maternal immunity achieved through vaccination is the only
effective strategy for
because the influenza vaccine is not approved for use in infants younger than 6
months. A prospective, blinded, randomized controlled trial showed fewer cases
of laboratory-confirmed influenza and of respiratory illness with fever among
infants of immunized mothers.
Note: If you have an
sensitivity to eggs, or any previous negative affect from an influenza
vaccination, let your health care provider know. The flu vaccination is probably
not appropriate for you in this case. In addition to getting vaccinated Ė or if
you have an egg allergy and canít get the shot --you can reduce your chance of
getting influenza by washing your hands frequently with a mild soap and warm
water and avoiding close contact with anyone who has the illness.
If youíre pregnant and you think you have the flu, contact your midwife or
doctor without delay. Do not take any over-the-counter products, including
herbal remedies, until cleared by your health care provider. Some
over-the-counter flu remedies, dietary supplements, and herbals are dangerous