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Pregnancy and Pandemic Influenza A (H1N1) 2009: Information for Programme Managers and Clinicians. Geneva: World Health Organization; 2010 Jul.

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Pregnancy and Pandemic Influenza A (H1N1) 2009: Information for Programme Managers and Clinicians.

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General guidance for pregnant women, mothers, and their newborns during the pandemic

Protection against infection

The main route for transmission of pandemic (H1N1) 2009 influenza virus seems to be similar to seasonal influenza; that is, via droplets that are expelled by speaking, sneezing, or coughing. People can avoid infection by taking the following measures:

  • avoid close contact with people who exhibit symptoms of influenza-like illness (if possible, try to maintain a distance of at least 1 metre);
  • avoid touching mouth and nose;
  • wash hands thoroughly with soap and water or clean them with an alcoholbased hand sanitizer on a regular basis (especially if touching the mouth and nose or surfaces that are potentially contaminated);
  • if possible, reduce the time spent in crowded settings during epidemics in the community; and
  • improve airflow in living spaces by opening windows.

It is advisable to practise additional good health habits, including getting adequate sleep, eating nutritious food, and staying physically active.

Special considerations for pregnant women and new mothers and their babies

  • Pregnant women, new mothers, and newborn infants should avoid crowded public places whenever possible.
  • Pregnant women and new mothers should avoid providing care for those with confirmed, probable, or suspected influenza infection, except for their own newborns.
  • Anyone with respiratory symptoms should not provide care for a pregnant woman or a mother and newborn baby.
  • Mothers should be encouraged to begin breastfeeding within one hour of giving birth and to breastfeed frequently and exclusively including a period of pandemic (H1N1) 2009 circulation. Infants who are not breastfed are more vulnerable to infectious diseases, including severe respiratory tract infection.
  • Inform parents and caretakers about how to protect infants from virus infections that cause respiratory illnesses, including pandemic (H1N1) 2009, by:
    • Washing hands frequently with soap and water and cleaning soiled surfaces to keep the environment free from virus contamination, especially since infants have a tendency to place their hands in their mouths.
    • Adhering to respiratory etiquette—that is, covering their mouth and nose, when coughing or sneezing. If a tissue is used, it should be discarded in a bin with a lid and then hands should be washed.10
    • Keeping newborn infants close to their mothers. In general, this closeness promotes infant survival from various threats.

Specific measures

  • Antivirals for prophylaxis are generally not recommended. This includes pregnant women and newborn infants exposed to pandemic (H1N1) 2009 virus.11
  • When pandemic (H1N1) 2009 vaccines become available in a country, pregnant women should be immunized as a priority group given their increased risk of complications and death.12,13
  • From May 2010 the new seasonal influenza vaccines (e.g. those prepared for the 2010 southern hemisphere influenza season) will include protection against pandemic (H1N1) 2009 and can be given to pregnant women. Older seasonal vaccines not containing a pandemic 2009 strain will not protect against the pandemic (H1N1) 2009 virus.14
  • Pandemic (H1N1) 2009 and seasonal influenza vaccines are not recommended for infants below 6 months of age.
  • Only inactivated influenza vaccine is suitable for pregnant women and children
  • less than 24 months of age. Live attenuated influenza vaccine should not be
  • used in this population.
  • Vaccination is also recommended for all health care workers.13

Health care during and following pregnancy and childbirth in the pandemic

All pregnant women and their babies should be protected against influenza virusinfection.

Provide standard health care during and following pregnancy and childbirth as recommended in national guidelines. In the context of pandemic (H1N1) 2009, additional considerations include the following:

Antenatal care

  • When pandemic (H1N1) influenza transmission is occurring in the community, consider reducing antenatal clinic visits to the minimum required15 and advise women with low-risk pregnancies to postpone clinic visits during early pregnancy for a few weeks.
  • Advise pregnant women to avoid crowded places, whenever possible, during community outbreaks. This includes avoiding long waits in crowded clinic waiting areas or using public transportation when coming for health services and for any other travel.
  • Organize care for asymptomatic pregnant women in separate areas from those for ill women and apply triage criteria, i.e. check quickly for symptoms of influenza, including fever and respiratory symptoms. If a woman has these symptoms, she should be separated from those without symptoms. Mechanisms should be in place (e.g. posters, signs) which would facilitate women with symptoms to self-separate upon arrival at the health facility and to not wait in an area with asymptomatic pregnant women.
  • Provide adequate information on the prevention of influenza and steps to take in case of symptoms that suggest influenza infection.
  • Help pregnant women to develop their birth and emergency preparedness plans and inform them about any relevant reorganization of health services in a pandemic situation.
  • When attending pregnant women, use all preventive measures to avoid transmission of infection. Vaccination is recommended for all healthcare workers.

Childbirth and postnatal care for the mother

  • On admission, check for any symptoms and signs suggesting influenza infection. Apply infection control measures and ensure that during and following childbirth, pregnant women and their newborn infants are not exposed to symptomatic individuals with acute respiratory illness. Have separate areas for labour and delivery for women with pandemic (H1N1) 2009 virus infection (see section on "Infection control and prevention" below).
  • Allow birth companions, but screen them for infection (i.e. take their history, measure body temperature, and look for signs of influenza infection). If infection is a possibility, arrange for an alternative, healthy birth companion. Emphasize to the companion the importance of preventive measures during the mother's and newborn's stay.
  • Develop discharge criteria; reduce the length of stay in the postnatal ward to the minimum required by maternal and newborn conditions, and inform community services of any change.
  • Provide women and their families with adequate information on prevention of infection with pandemic (H1N1) 2009 virus and the steps to take if symptoms suggestive of virus infection develop after discharge.

Newborn care and breastfeeding

  • Do not separate the baby from the mother. Institute rooming-in.
  • Ensure adherence to WHO recommendations on protecting, promoting, and supporting breastfeeding,16 which includes initiating breastfeeding within the first hour of life to establish exclusive breastfeeding.
  • Minimize contact between health-care workers and the mother-baby dyad and minimize the time spent in hospital by mother and baby as much as possible.
  • Implement screening procedures and limit the number of visitors to maternities and newborn care units.

Footnotes

10

Infection prevention and control of epidemic- and pandemic-prone acute respiratory diseases in health care: WHO interim guidelines. World Health Organization, June 2007. Available at: http://www​.who.int/csr​/resources/publications​/swineflu/WHO_CD_EPR_2007_6​/en/index.html. Accessed on 29 March 2010.

11

WHO Guidelines for Pharmacological Management of Pandemic (H1N1) 2009 Influenza and other Influenza Viruses. World Health Organization, February 2010. Available at: http://www​.who.int/csr​/resources/publications​/swineflu/h1n1_use​_antivirals_20090820/en/indx.html. Accessed on 29 March 2010.

12

Safety of pandemic vaccines. Pandemic (H1N1) 2009 briefing note 6. World Health Organization, 6 August 2009. Available at: http://www​.who.int/csr​/disease/swineflu/notes​/h1n1_safety_vaccines_20090805​/en/index.html. Accessed on 29 March 2010.

13

WHO recommendations on pandemic (H1N1) 2009 vaccines. Pandemic (H1N1) 2009 briefing note 2. World Health Organization, 13 July 2009. Available at: http://www​.who.int/csr​/disease/swineflu/notes​/h1n1_vaccine_20090713/en/index​.html. Accessed on 29 March 2010.

14

Serum cross-reactive antibody response to a novel Influenza A (H1N1) virus after vaccination with seasonal influenza vaccine. US Centers for Disease Control and Prevention. Morbidity and Mortality Weekly Report. 2009 May 22;58(19):521–552. [Accessed on 29 March 2010]; Available at http://www​.cdc.gov/mmwr​/preview/mmwrhtml/mm5819a1.htm. [PubMed: 19478718]

15

Pregnancy, childbirth, postpartum and newborn care. A guide for essential practice. World Health Organization, United Nations Population Fund, UNICEF, and the World Bank. Geneva, Switzerland, 2009. Available at: http://www​.who.int/making​_pregnancy_safer​/documents/924159084x/en/index.html. Accessed on 29 March 2010.

16

For WHO recommendations see Breastfeeding. World Health Organization, 2010. Available at: http://www​.who.int/child​_adolescent_health​/topics/prevention_care​/child/nutrition​/breastfeedin/en/index.html. Accessed on 29 March 2010.

Copyright © World Health Organization 2010.
Bookshelf ID: NBK200790

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