Novel Influenza A (H1N1) Outbreak and Vaccination:
What Pregnant and Parenting Women Need to Know
For the most up-to-date information, please consult
the U.S. Centers for Disease Control and Prevention and the LA County Department of Public Health:

http://www.publichealth.lacounty.gov/acd/h1n1public.htm
http://www.cdc.gov/swineflu/

http://www.cdc.gov/h1n1flu/guidance/pregnant.htm
http://www.flu.gov/individualfamily/parents/pregnant/

More resources are listed at the end of this article.

UPDATED APRIL 8, 2010:

Public Health H1N1 Vaccination Clinics
En Español

Additional H1N1 vaccine has arrived in LA County, which means vaccine is now available for everyone! If you have been waiting to receive H1N1 vaccine, go now. Protect yourself and your loved ones from the flu.    Find a clinic

Who Is Eligible?
Anyone over 6 months of age for whom the vaccine is not medically contraindicated, and who has no other usual source of medical care.

Some individuals are at greater risk of flu infection and should make a special effort to get vaccinated. If you fit into the following categories and have not yet been vaccinated, it is important that you protect yourself from the flu and from complications that can result from having the flu. These categories are

• Pregnant women

• People who live with or care for infants under 6 months old

• People who work in health care or emergency medical services

• People aged 6 months through 24 years

• People aged 25 through 64 years who have chronic health problems or a compromised immune system.

H1N1 flu and seasonal flu continue to circulate in the U.S. CDC continues to recommend influenza vaccination for all persons 6 months of age and older. Vaccination is especially important for people at higher risk of serious complications from 2009 H1N1, including pregnant women, people with certain health conditions, the very young, and those people 65 years and older. The majority of 2009 H1N1 deaths have occurred in people between the ages of 50 and 64 years of age; 80% of whom have had an underlying health condition. Health conditions that increase the risk of being hospitalized from 2009 H1N1 include lung disease like asthma or chronic obstructive pulmonary disease (COPD), diabetes, heart, or neurologic disease, and pregnancy.
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As of April 3, 2010 there were 578 reported deaths as a result of H1N1 virus in California, including 148 in L A County.

Studies unveiled at the 47th Annual Meeting of the Infectious Diseases Society of America showed that maternal influenza vaccination reduced rates of prematurity, low birthweight, and flu-related hospitalization of infants, including those younger than 6 months of age. The shot is also safe for breastfeeding mothers.

The H1N1 vaccine is also available in FluMist® nasal spray form. Because FluMist® is a "live" virus, it is not recommended for pregnant women. To find a flu shot provider, see: http://www.findaflushot.com/ or call 211.

The Philadelphia Inquirer reported on November 12 that many people who became sick with influenza-like illness last fall, and presented to the Children’s Hospital of Pennsylvania, were in fact infected with an unusually severe strain of rhinovirus (the cause of the common cold) and not with H1N1. Symptoms included wheezing, pneumonia, fever, and lower respiratory tract infections. These findings suggest that many people who believe that they had H1N1 may have actually had rhinovirus. People who believe they may have contracted H1N1 earlier in the year and thus acquired immunity may want to rethink any decision to forego the H1N1 vaccine.

On June 11, 2009, the World Health Organization (WHO) raised the worldwide pandemic alert level to Phase 6 in response to the ongoing global spread of the novel influenza A (H1N1) virus. A Phase 6 designation indicates that a global pandemic is underway. The U.S. Department of Health and Human Services has declared a public health emergency for swine flu. Young children and pregnant women are two groups of people who are at high risk of serious complications from seasonal influenza, not just the current strain of swine flu.

A Centers for Disease Control study published July 29, 2009, found that pregnant women are four times more likely to be hospitalized as a result of H1N1 infection than the general population. According to the study, of the 45 deaths reported to the agency during the first two months of the outbreak, 6 were pregnant women. This rate is 13 times higher than the proportion of pregnant women in the total population. Experts expect swine flu infections to rise this fall and winter. The CDC recommends that pregnant women begin taking antiviral medication within 48 hours of the onset of symptoms, even before a conclusive diagnosis. The CDC has recommended that pregnant women be given priority for H1N1 vaccine

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Risks to pregnant women
Pregnant women who suspect they may have contracted influenza should contact their health care provider immediately.

According to the CDC, many pregnant women will have a typical, uncomplicated course of influenza, but pregnant women have been shown to be at increased risk for more rapidly progressing and severe illness from influenza, as well as complications with secondary bacterial infections, including pneumonia. Pregnant women with severe influenza are at increased risk for adverse pregnancy outcomes, including increased rates of spontaneous abortion and preterm birth, fetal distress, and delivery complications. Several studies have shown that fever early in pregnancy is associated with an increased risk of birth defects and other adverse outcomes. Maternal fever during labor has been shown to be a risk factor for adverse neonatal and developmental outcomes.

Symptoms
When people catch swine flu they may have a fever, cough, sore throat, body aches, headache, chills and fatigue just like the regular flu. Some people may also have vomiting and diarrhea.

Young children are less likely to have typical influenza symptoms such as fever and cough, and infants may present fever and lethargy, and may not have cough or other respiratory symptoms or signs.

How to avoid Becoming sick
Pregnant women should receive the H1N1 vaccination shot as soon as it is available to them.

Treatment recommendations are being updated daily by the Centers for Disease Control, but pregnant women should follow the same preventive measures as the general population:

• Avoid people with the flu.
• Wash your hands often, for at least 20 seconds, with soap and warm water, or an alcohol-based hand cleaner, like Purell.
• Wash your hands before eating or touching your face, after touching surfaces that someone might have coughed or sneezed on, after going out into the community, and after caring for someone who has the flu or touching something that someone who is sick may have touched.
• Don’t share objects like remote controls, telephones, keyboards, iPods, or pens.
• If these objects must be shared, wipe them down with alcohol wipes between users.
• Those with flu should use separate eating utensils that are washed in hot soapy water after each meal.
• Those with flu should cough and sneeze into disposable tissues. These tissues should be thrown away into a plastic bag. Limit your exposure to the dirty tissues.

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Pregnant women with suspected swine influenza infection
As in all cases of flu, pregnant women with symptoms should contact their health care provider as soon as possible. Treatment is available, but its benefits are greatest if given within 48 hours of the onset of symptoms. Pregnant women who have been in close contact with people with suspected, probable, or confirmed cases of swine flu should also contact their health care provider as soon as possible to see if prophylactic (preventive) treatment is advised.

Breastfeeding considerations
Infants who are not breastfeeding are especially vulnerable to infection and hospitalization for severe respiratory illness. New mothers are encouraged to initiate breastfeeding early and feed frequently. Eliminate unnecessary formula supplementation, so the infant can receive as much maternal antibodies as possible.

Women who are ill with swine influenza should take steps to reduce the risk to their infants, such as frequent hand washing and possibly wearing a surgical mask The risk for swine influenza transmission through breast milk is unknown, but such transmission is believed be very rare.

If a woman is ill, she should continue breastfeeding and increase feeding frequency. If maternal illness prevents safe feeding at the breast, she is encouraged to pump breast milk. Expressed milk should also be used for infants too ill to feed at the breast. In certain situations, infants may be able to use donor human milk from a HMBANA-certified milk bank.

Parents and caretakers should protect their infant from the spread of germs that cause respiratory illnesses like swine flu:

• Wash adults’ and infants’ hands frequently with soap and water for at least 20 seconds, especially after infants place their hands in their mouths.
• Infants and mothers should be kept as close together as possible with early and frequent skin-to-skin contact between mothers and their infants.
• Limit sharing of toys and other items that have been in infants' mouths. Wash thoroughly with soap and warm water any items that have been in infants' mouths.
• Keep pacifiers (including the pacifier ring/handle) and other items out of adults' or other infants' mouths prior to giving to the infant.
• Do not cough or sneeze near the baby.

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Stay current
Pregnant women and mothers are urged to stay up-to-date through the various available sources, some of which are listed below.

Los Angeles County Department of Public health
http://www.lapublichealth.org/

California Department of Public Health
http://www.publichealth.lacounty.gov/acd/h1n1.htm

Centers for Disease Control and Prevention
http://www.cdc.gov/h1n1flu/

Pregnant Women and New Moms - Know What to Do About the Flu
US Dept. of Health & Human Services video
http://www.youtube.com/watch?v=6CdeuNhyQbM

2009 H1N1 Influenza Vaccine and Pregnant Women
http://www.cdc.gov/H1N1flu/vaccination/pregnant_qa.htm

Call 211
http://www.infoline-la.org/
211 is a three-digit dialing code that enables a caller to access over 28,000 health and human service programs throughout Los Angeles County 24 hours per day, 7 days per week and is TTY accessible.

Informaciones en español
http://www.cdc.gov/h1n1flu/espanol/info-general.htm

National Women's Health Center--advice for pregnant women
Flu-Free and a Mom-to-Be: Protect Yourself, Protect Your Baby, Get a Flu Shot!

CDC - What Pregnant Women Should Know About H1N1 (formerly called swine flu) Virus
http://www.cdc.gov/h1n1flu/guidance/pregnant.htm

CDC - Influenza (Flu) | Interim Guidance Pregnant Women and Swine Influenza: Considerations for Clinicians
http://www.cdc.gov/swineflu/clinician_pregnant.htm

CDC - H1N1 Flu (Swine Flu) and Feeding your Baby: What Parents Should Know
http://www.cdc.gov/h1n1flu/breastfeeding.htm

CDC Travelers’ Health Web Site:
http://wwwn.cdc.gov/travel/default.aspx

World Health Organization:
http://www.who.int/csr/disease/swineflu/en/index.html

CDC-Hotline
800-CDC-INFO (800-232-4636)
TTY: 888-232-6348
English, Spanish
24 hours a day, 7 days a week
Email: cdcinfo@cdc.gov

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