Protecting Yourself Against the Flu During Pregnancy
Seasonal influenza or the “flu” is caused by a virus that produces symptoms of fever, cough, sore throat, nasal congestion or runny eyes. Influenza typically occurs in the winter months and causes infection in the elderly, adults with medical problems or the very young. This year, a new strain of influenza called 2009 H1N1 or “swine flu” has been causing infections worldwide.
Although the influenza virus can change slightly each year, many people have some immunity to it and the spread of infection from person to person is limited. This year, the new H1N1 influenza virus has changed enough so that very few people have immunity, and the infection has spread rapidly in some parts of the world including the United States.
The new H1N1 influenza is spread from person to person the way many infections are spread. When an infected person coughs or sneezes, germs become airborne. That is why it is important to cover your cough and stay a safe distance from infected people. One may also become infected from touching surfaces or objects where the virus was deposited, and that is why frequent hand washing is also important. People with influenza can be contagious from one day before they show signs of being sick until seven days afterward.
While many cases of influenza may be mild, some groups of people, such as pregnant women, young children, and those people with medical problems, may get sicker if they are infected.
The U.S. Centers for Disease Control (CDC) recommends a three-step program to help keep pregnant women safe during this influenza season. The so-called “Take 3” approach is:
- Get vaccinated. The CDC recommends that pregnant women get vaccinated with the seasonal flu vaccine. This will protect them from other strains of influenza that may be circulating this winter. The influenza vaccine is made from an inactive form of virus that is safe for use in pregnancy and does not cause influenza. This year, there is also a second inactivated vaccine, the 2009 H1N1 vaccine that will specifically protect against this new form of influenza. It is recommended that pregnant women get both vaccines. Fathers and grandparents who will be taking care of newborns are also advised to get vaccinated to help prevent the newborn from getting exposed to influenza. In pregnant women, only the injectable, inactivated form of the vaccine, and not the nasal spray vaccine (live weakened), is recommended.
- Take preventive action to avoid getting influenza. People should cover their cough and use a tissue when they cough or sneeze to help prevent the spread of influenza to others. Keep a safe distance (the CDC recommends at least six feet) from people or are sick with a fever, cough, sore throat. Wash your hands frequently and avoid touching your eyes, nose or mouth.
- If you get sick, call your doctor immediately. Certain anti-flu medications (Tamiflu, Relenza) can keep flu symptoms mild and you recover more quickly. These medications are considered safe to use in pregnancy, and taking them is much safer than getting sick from influenza. If you have been exposed to the influenza virus because you were in close contact to someone with influenza (the CDC defines close contact as living with or caring for an individual sick with influenza, sharing utensils or exposure to respiratory droplets), your doctor may offer medication (prophylaxis) to prevent influenza. This should be started within the first two days of exposure. Lastly, high fevers should be treated with acetaminophen (Tylenol).
In adults, emergency warning signs that need urgent medical attention include:
- Difficulty breathing or shortness of breath
- Pain or pressure in the chest or abdomen
- Sudden dizziness
- Confusion
- Severe or persistent vomiting
- Flu-like symptoms that improve but then return with fever and a worse cough
In children, emergency warning signs that need urgent medical attention include:
- Fast breathing or trouble breathing
- Bluish or gray skin color
- Not drinking enough fluids
- Severe or persistent vomiting
- Not waking up or not interacting
- Being so irritable that he or she does not want to be held
- Flu-like symptoms that improve but then return with fever and a worse cough
Common questions:
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Is it safe to get the influenza vaccine at any point during pregnancy?
Answer: Yes, the inactive injectable influenza vaccine is safe to take during any stage in pregnancy. The live or nasal spray vaccine should not be used during pregnancy. Studies begun in September to test the safety of the vaccine have not shown an increased risk of complications from the flu shot in pregnant women or children. Getting influenza itself is potentially very dangerous for pregnant women. Not only will the vaccine protect the mother, but the newborn will also receive protective antibodies from the mother through the placenta.
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I’ve heard that the vaccine may contain thimerosal and that isn’t safe in pregnancy.
Answer: Thimerosal is a preservative which contains a small amount of mercury. The influenza vaccine comes in multiple dose and single dose sizes. Multiple dose vaccine bottles require thimerosal, but single dose vials or syringes don’t. The CDC and the Federal Drug Administration (FDA) say that the small amount of thimerosal in the vaccine is safe in pregnancy and has not been shown to cause diseases in children, such as autism. However, pregnant women may choose the preservative-free vaccine if available.
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I just delivered my baby and am breastfeeding. Should I take the vaccine?
Answer: Yes, caring for a newborn keeps you in a group that needs extra protection during this influenza epidemic. Both vaccines, the inactivated influenza shot and the live, weakened influenza nasal vaccine, are safe for use in breastfeeding women and will protect mothers and infants. Infants less than 6 months are too young to receive the influenza vaccine themselves, so vaccinating mothers will provide the newborn with the mother’s antibodies if breastfeeding.
