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Influenza and Pregnancy

Resource material and packages for patients and healthcare workers

Two pregnant women died from influenza in the 2015/16 season and one near miss in that season and in 2016/17.

Reminder that all staff should get vaccinated to ensure that they are protected to reduce the chance of becoming infected, getting ill (healthcare workers have died in the Caribbean in the last outbreak), bringing the flu back to their families and cross infecting other patients in the hospital.

The vaccine is safe.The vaccine is an international best practice recommendation. It offers additional protection to the newborn.

Please share to all CEO’s, Medical Directors and Chiefs of Staff, Maternity Units, CMOsH, RHA GMs Nursing to get Nursing personnel on board, Primary Care Managers, A&E, ICU staff. Private Sector. These senior personnel are responsible for dissemination of the material to other staff under their purview.

Immunization to be administered at all Primary and Secondary Care Antenatal clinics at any stage of pregnancy, Postnatal clinics, Well women clinics, Family planning clinics, Health care workers and all other at risk groups as communicated by the Ministry of Health. The vaccine should be available for all patients (public and private) in November 2017.

Resources

http://immunizationforwomen.org/2017-2018-influenza-season
https://www.cdc.gov/Features/PregnancyAndFlu/

NHS UK Guideline
Principles for Care in the Clinical Areas
– Pregnant women who are suspected of having influenza should be kept in a side room.
– Triage staff must alert the labour suite coordinator of an impending admission with suspected influenza as soon as possible.
– Ensure masks, tissues and hand gel are available at all times.
– Wherever possible the number of staff caring for a woman should be kept to a minimum, utilising staff that are already known to have had H1N1v. On admission of a woman suspected of having Influenza a referral to the Infection Prevention and Control Service is necessary. These referrals can be made electronically via NOTIS
– Linen soiled with body fluids including respiratory secretions should be classified as infected and placed in red linen bags. Other waste should be disposed of as usual for clinical and non-clinical waste. Double bagging is not required for clinical waste unless staff feel that there is a risk of leakage if liquid or heavy waste may leak from or break a single bag.
– No special precautions are needed for the disposal of waste and linen (follow usual Trust practices and policies).
– Environmental cleaning should be with detergent and hot water. Frequently touched surfaces such as medical equipment and door handles, should be cleaned twice daily and when known to be contaminated with secretions, excretions or body fluids. Ward housekeepers can perform environmental cleaning.
– When a patient has been discharged there should be terminal cleaning. Ward housekeepers can perform environmental cleaning.
– No special precautions are required for crockery and utensils. There is no need for disposable plates and cutlery.
– Relatives and visitors with flu-like symptoms should not visit the hospital
– Visitors must observe the hand hygiene code

Direct Patient Care
– When providing direct care for the woman; staff must wear surgical face masks, plastic aprons and gloves, remembering to clean hands before and after. Add eye protection if there is a risk of eye contamination from respiratory secretions.
– Assess and manage obstetric complications as normal.
– For aerosol generating procedures (which should be avoided when possible) staff should wear a long sleeved, fluid repellent, disposable gown, gloves, goggles and an FFP3 mask. This enhanced precaution is referred to as PPE, personal, protective equipment. Staff must be fitted for and trained in the use of the FFP3 mask; the Infection Prevention and Control team will provide this service.
– The use of the birthing pool is not recommended for women who are presenting with Flu like symptoms

Breastfeeding
• Breastfeeding is important for providing maximum protection to the baby against several infections through the maternal antibodies. Antivirals are not contraindicated, and so it can be
continued while the mother is receiving antiviral treatment or prophylaxis.
• Demand feeding should be encouraged, and where possible additional formula should not be used so that the infant receives as many of the maternal antibodies as possible. If a mother is
too ill to feed, feeding expressed milk should be considered.

Guidance for the care of the newborn
National guidance recommends keeping mother and baby together whenever possible.
• The best way of reducing the risk of transmission is by hand washing and using and disposing of tissues. Mothers and other carers should take particular care to wash their hands before
handling the baby.
• Mothers and infants need not be separated unless the neonate is premature or has other co-morbidities, and the clinician’s risk assessment indicates the benefit of separation to be greater
than the risks to the neonate.
• Consider use of appropriate measures to minimize exposure to infectious materials, e.g., placing the baby in a cot, and reducing exposure to possible environmental contamination.
• Use of surgical masks by the mother while handling her baby could be considered in the first week of illness.
• Mothers and babies with uncomplicated flu should be transferred home as soon as possible.

Monitoring Baby
• Newborn babies are especially vulnerable to respiratory infections that are commonly prevalent at this time of the year. Hence health care workers and relatives caring for the baby
should be alert for any signs or symptoms of respiratory infection, so that early referral and appropriate treatment can be started.

ACOG Guidance for Patients
The Flu Vaccine and Pregnancy

Everyone aged 6 months or older should get a yearly influenza (flu) shot—especially pregnant women. Seasonal flu is caused by a virus that spreads easily among people. It is most common between October and May. If you are pregnant, the flu can be serious or even life- threatening. Getting a vaccine is the best way to prevent the flu. It also helps protect your baby until he or she can be vaccinated at age 6 months.

The flu is more than a bad cold. It usually comes on suddenly. Signs and symptoms may include fever, headache, fatigue, muscle aches, coughing, and sore throat. It can lead to complications, such as pneumonia. Some complications can be life-threatening.

Certain people have an increased risk of developing flu complications. These include the following groups:

People aged 65 years and older
Children younger than 5 years
People who have illnesses or conditions like asthma, heart disease, or cancer
Pregnant women
Risks for Pregnant Women

Even if you are in good health, being pregnant increases your risk of serious illness and complications from the flu. This increased risk is linked to changes in the immune system and in other body systems that normally occur during pregnancy. You also have a higher risk of pregnancy complications, such as preterm labor and preterm birth, if you get the flu. You are more likely to be hospitalized if you get the flu while you are pregnant than when you are not pregnant. Your risk of dying from the flu is increased as well.

Vaccination Recommendations

The Centers for Disease Control and Prevention (CDC) recommend that everyone 6 months of age and older—including pregnant women and women who are breastfeeding—get the flu vaccine each year. If you are pregnant, it is best to get the vaccine early in the flu season (October through May), as soon as the vaccine is available. You can get the shot at any time during your pregnancy. If you are not vaccinated early in the flu season, you still can get the vaccine later in the flu season. If you have a medical condition that further increases the risk of flu complications, such as asthma or heart disease, you should think about getting the vaccine before the flu season starts.

There are two types of flu vaccines: 1) a shot and 2) a nasal mist. The flu shot contains a form of the flu virus that is inactivated. It cannot cause disease. The shot can be given to pregnant women at any time during pregnancy. A live, attenuated influenza vaccine is available as a nose spray. The nose spray vaccine is not recommended for pregnant women. However, it is safe for women after they have given birth, including those who are breastfeeding.
How the Flu Vaccine Works

How the Flu Vaccine Protects You and Your Baby

Flu vaccine is injected.
Antibodies are made.
Antibodies are transferred to the baby.
How the Flu Vaccine Protect You and Your Baby

The flu vaccine triggers your immune system to make antibodies against the flu virus. Antibodies circulate in the bloodstream. If they encounter a flu virus, they “tag” it for destruction by other parts of the immune system. It takes about 2 weeks for the body to build up protective antibodies after you get the flu shot.

With some types of vaccines, the antibodies that are made remain active for many years. But the types of viruses that cause the flu can change every year. The antibodies made in response to one year’s flu vaccine may not work against the next year’s flu viruses. For this reason, the flu vaccine is updated each year. To be fully protected, you need to get the flu vaccine yearly.

The flu vaccine does “double duty” by protecting both you and your baby. Babies cannot get the flu vaccine until they are 6 months old. When you get a flu shot during pregnancy, the protective antibodies made in your body are transferred to your baby. These antibodies will protect your baby against the flu until he or she can get the vaccine at 6 months of age.

Children younger than 5 years of age also are among those who have a high risk of getting serious flu complications. It is recommended that anyone who comes in contact with your child get a flu shot. This includes babysitters, members of the same household, and family members.

Safety

Vaccines are developed with the highest safety standards. The U.S. Food and Drug Administration approves all vaccines. The CDC continues to monitor all vaccines after they are approved. They have been used for many years in millions of pregnant women and are not known to cause pregnancy problems or birth defects.

There is no scientific evidence that vaccines made with thimerosal, a mercury-containing preservative, can cause autism or other health problems in babies. Thimerosal-containing vaccines do not cause autism in children born to women who received these vaccines. It is possible to get the flu vaccine made without thimerosal, but experts have not said that the thimerosal-free version is better for any particular group—including children and pregnant women.

Most side effects of vaccines are mild, such as a sore arm or a low fever, and go away within a day or two. Severe side effects and reactions are rare. The CDC keeps track of side effects of and reactions to all vaccines given in the United States. When you receive a vaccine, you should receive a Vaccine Information Statement. This statement lists the possible side effects of and reactions to that vaccine. If you have concerns about vaccine side effects, talk to your obstetrician or other member of your health care team.

If You Get the Flu

If you think you have the flu and you are pregnant (or you have had a baby within the past 2 weeks), contact your obstetrician or other health care professional right away. Taking an antiviral medication as soon as possible is recommended. Flu symptoms may include the following:

Fever or feeling feverish
Chills
Body aches
Headache
Fatigue
Cough or sore throat
Runny or stuffy nose

Antiviral medication is available by prescription. It is most effective when taken within 48 hours of the onset of flu symptoms, but there still is some benefit to taking it up to 4–5 days after symptoms start. An antiviral drug does not cure the flu, but it can shorten how long it lasts and how severe it is. Even if you just think you have the flu, it is best to be on the safe side and contact your obstetrician or other member of your health care team. You also should call your obstetrician or other health care professional if you are pregnant and come in close contact with someone who has the flu. This includes living with, caring for, or talking face-to-face with someone who may have the flu. You may be prescribed an antiviral drug to reduce the risk that you will get the flu.

Finally…

Getting the flu vaccine is an important part of prenatal care. Protect your baby, yourself, and others from the flu by getting the vaccine while you are pregnant. If you think you are getting the flu or have been around anyone with the flu, contact your obstetrician or other member of your health care team as soon as you can. Antiviral medication may make the flu less severe.

Influenza Vaccination During Pregnancy (14 downloads) FAQs for Patients Vaccine Safety (12 downloads) FAQs for Patients Flu (12 downloads)