This document discusses the importance of influenza vaccination during pregnancy. It notes that pregnant women are at higher risk of severe illness from the flu. The flu can harm both the mother and baby by increasing the risks of complications like premature labor. Vaccination is recommended for all pregnant women during flu season to protect both mother and baby. The flu shot is considered safe during pregnancy and can provide protection to infants for the first 6 months of life through antibodies passed during pregnancy and breastfeeding.

1. Mission --
Use of Flu vaccine
in Pregnancy
Dr. Sharda Jain
Sec General :
Delhi Gynaecology Forum
Founder & Chairman
Dr. Jyoti Agarwal
Dr. Jyoti Bhaskar

2. • Group photo
Our TeamOur Team
Mission Against FLU / Swine flu

3. Aim
• Increasing awareness
about Flu / Swine Flu
• Infection and
PREGNANCY
increased susceptibility
or severity in
pregnancy
• INFLUENZA & its
vaccination

4. Pregnant women more SEVERELY affected
by infections with some organisms
INFECTION INCREASED
SUSCEPTIBILITY
INCREASED
SEVERITY
PREVENTION
STRATEGIES
INFLUENZA No YES Influenza vaccination ;
antiviral prophylactic
medication for selected
patients
HEPATITIS E No YES Sanitation programs
HERPES SIMPLEX No YES Protection from S.T.D
transmitted during pregnancy
MALARIA
(Mainly due to plasmodium
falciparum)
No YES Insecticide – treated bad nets
(for areas where malaria is
endemic appropriate
prophylaxis (for travelers)
STRONG EVIDENCE

5. Infection Increased
Susceptibility
Increased
Severity
Prevention strategies
Measles No Yes Vaccinations
Smallpox No Yes Vaccination
Varicella No Yes Vaccination
HIV
Type - 1
Yes No Consistent and
Correct condom use:
Protection from S.T.D
During pregnancy
Pregnant women more SEVERELY affected
by infections with some organisms (cont.)
MORE LIMITED EVIDENCE

6. Influenza
&
Vaccine

7. Influenza
• Influenza is a highly
contagious acute
respiratory illness caused
by infection with
influenza viruses
• Affects the upper and
lower respiratory tracts
• Mostly seen in winter

8. Influenza
• SYMPTOMS
Cough, sore throat running nose, Sneezing ,
body ache, fever, Leg pain , loose motions
GESTATION PERIOD - May vary but
Testing is recommended if symptoms manifest
for 2 – 3 days

9. Infection Process and Transmission
• Virus attaches to and penetrates respiratory
epithelial cells in trachea and bronchi
• Virus replicates and destroys host cell (4-6hr)
• Symptoms occur but viremia absent
• Virus shed in respiratory secretions for 5-10
days, runs course in 2 weeks
• Person-to-person (aerosols from cough or
sneeze), or surface transmission

10. Clinical presentation
• within 1 to 2 days after infection may reveal basilar
rales.
• Bilateral interstitial infitrates –seen in lungs.
• Gram stains of sputum - bacteria and mononuclear
cells.
• Virus within exfoliated epithelial cells
• Culture -- Nasopharyngeal washings, nasal swabs, and
throat swabs.
• Serum antibody is detectable 2 to 3 weeks after
infection . Paired specimens are needed

11. Often misunderstood
and underestimated,
Influenza is not just
“a bad cold”!

12. JAMA2000; 284 (13): 1740
Often misunderstood and underestimated,
Influenza is not just “a Bad Cold”!

13. Complications Of Influenza
PULMONARY:
Primary influenza viral
pneumonia
Secondary bacterial
pneumonia
Asthma, COPD,
bronchitis, cystic fibrosis
exacerbation
Exacerbation of other
chronic medical conditions
NON-PULMONARY:
Myositis
Cardiac complications
Toxic shock syndrome
Guillian-Barré syndrome
Transverse myelitis
Encephalitis
Reye’s syndrome
Betts RF. Chapter 141: Influenza virus. In: Principles and Practice of Infectious Diseases, 4th ed. Editors: Mandell GL, et al. Churchill Livingstone, New York, 1995, 1556-58

14. PROGNOSIS
Influenza generally is a
self-limited disease,
but serious morbidity and mortality
do occur.
In Children , Pregnant ladies , Elderly people dose
suffering from complex diseases such as cancer ,
HIV , hepatitis or underwent organ transplant , etc

15. How can Flu affect in
pregnancy ?
 Even in healthy pregnant women,
changes in immune, heart, and lung
functions during pregnancy increase the
likelihood of serious flu illness,
hospitalization and even death.
Risk is even higher in presence of
medical conditions.

16. Influenza in Pregnancy
Mother
• Pregnant women are a HIGH-RISK group
during influenza epidemics.
• Increased mortality is caused by viral
pneumonia itself and by superimposed
staphylococcal and gram-negative enteric
pneumonias.
• Rates of spontaneous abortion are as high as
25% to 50 %.

17. High risk conditions
Respiratory disease
• Asthma
• Chronic bronchitis and
emphysema
• Other pulmonary diseases
Cardiac disease
• Atherosclerotic heart disease
• Cardiomyopathy/CCF
• Congenital heart disease
Neurodevelopmental disorders
• Cerebral palsy
• Musculodystrophy
• Cognitive disorders
Metabolic disorders
• Diabetes
Haematological diseases
• Sickle cell anaemia
• Thalassemia major
Immunocompetency disorders
•HIV/AIDS
•Chemotherapy
•Transplant pts on
immunosuppressants
•Chronic corticosteroid therapy
Chronic renal insufficiency on
dialysis
Chronic liver disease, esp. with
cirrhosis
Morbid obesity
Pregnancy
Background Paper on Influenza Vaccines and Immunization. SAGE Working Group: April 2012

18. How can Flue affect in
Baby
Severe illness in pregnancy can also be
dangerous to the baby because it
could lead to serious problems like
premature labour and delivery due
to mother’s illness.

19. Fetus
• Influenza virus can be transmitted
transplacentally to the fetus.
• Many studies of large number of
patients have failed to link influenza
and congenital malformations.
• However, serious maternal illness with
hypoxia can cause premature labor and
abortion.

20. Problems in breathing or shortness of breath
Pain or pressure in the chest or abdomen
Sudden dizziness or confusion
Severe or constant vomiting
Decreased or n o movement of your baby
High fever that is not responding to fever
medicine
When to Hospitalize ?

21. Seasonal Epidemic of
FLU
Peaks in rainy seasion
and mild peak is seen
winter

22. Disease burden: epidemic influenza
• Virus is not a new virus
• Belongs to the family Orthomyxoviridae
• Three types determined by nuclear material
– Influenza A, B and C
• Influenza A subtypes are further described
based on H and N surface glycoproteins
• Virus appears in groups or clusters
• Vaccine usually available
• Post exposure prophylaxis available

23. Seasonal Epidemics
• 5 to 10 % of the world’s population catches
influenza i.e., 500 million people
• Including 3 to 5 million I million = 10 lac
• And 2,50,000 to 5,00,000 deaths each year
• 15 - 45% of children are infected with an influenza
virus each year
• Certain groups are at high risk for complications
(pregnancy & old people)
WHO Public Research Agenda for Influenza 2009.
www.who.int/csr/disease/influenza
serious casesserious cases

24. PANDEMIC Influenza
(World – Wide Outbreak)
• Occurs when:
–new influenza type A virus emerges
(antigenic shift)
–no immunity in population
–virus spreads efficiently between humans

25. Pandemic History (120 years)
2014 –
2015
H1N1
2014 –
2015
H1N1

26. Estimated global mortality association with
the first 12 months of 2009 pandemic
Influnza A H1N1 virus
•18,500 lab-confirmed deaths reported worldwide between
April 2009 and August 2010
• Authors estimate 2,01,200 respiratory deaths and 83,300
cardiovascular deaths due to H1N1
15 times higher than reported lab-confirmed deaths
15 times15 times
Fatimah S Dawood, A Danielle luliano carrireed, mortin I meltzer, David K shay,
Po-yung cheng, Don Bandaranayake, robert F breiman lancet (online)june 26,2012
2014 - 2015
Toll on deaths was less
2014 - 2015
Toll on deaths was less

27. Treatment

28. Anti-viral medicine
oseltamivir is prescribed if
tested positive for H1N1
MEDICINES
AVAILABLE

29. Good Practices
Getting flue vaccine in
pregnancy and elderly
woman is the best
precaution

30. Treatment
• Hospitalzation if FEBRILE or Pulmonary symptoms
due to high rates of pneumonia especially in the
third trimester.
• Antiviral prophylaxis should be initiated as soon as
possible
• OSELTAMIVIR is generally preferred : 75 mg two
times per day for 5 days.
• Bacterial superinfection should be treated
empirically on the basis of presumed pathogens
(third – generation cephalosporin or gentamicin )

31. The CDCrecommends
that all pregnant women receive flu
VACCINEregardless of
Gestational age.

32. Flu vaccine
 Flu vaccination is a safe way to
prevent possible flu-related
complications.

33.  The injectable flu vaccine stimulates body to
develop defense. Decreasing chances of
infection.
 This immunity can also be passed on to the
babies by mothers during pregnancy and
while breast feeding, thus providing some
level of protection in early life.

34.  Vaccines are not 100 %
effective, but can prevent flu,
decrease complications and
hospitalization.

35. Influenza (inactivated)
• Because vaccinating against influenza before
the season begins is critical, and because
predicting exactly when the season will begin
is impossible, routine influenza vaccination is
recommended for all women who are or will
be pregnant (in any trimester) during
influenza season
• Protection to infant lasts for 6 months

36. Influenza Vaccine
• Lack of awareness of benefits and concerns
about vaccine safety in pregnancy are the
common barriers to vaccination
• Pregnant women whose provider
recommended and offered influenza vaccine
were 5 times more likely to be vaccinated
than those who were not offered

37. Is it really safe to take the
vaccine in pregnancy
The injectable flu vaccine is generally
considered to be safe in pregnancy.
There are no significant side effects in
pregnant women and their babies.

38. Vaccines recommended for
all pregnant women in USA
• In the United States, vaccines recommended
in pregnancy include the seasonal influenza
vaccine, tetanus toxoid, and the pertussis
vaccine as a combined tetanus-diphtheria
toxoid and acellular pertussis vaccine (Tdap).
• Influenza vaccination recommended in the
USA for all pregnant women regardless of
trimester since 2004
Munoz FM. Maternal Immunization: An Update for Pediatricians. Pediatric Annals 2013; 42(8): e163-e168

39. Advocacy on influenza vaccine

40. Association of Physicians of India
• Women in 2nd
and 3rd
trimester at
increased risk for influenza requiring
hospitalization
• Vaccination before flu season is critical
• Routine influenza vaccination recommended
for all women who are/will be pregnant in
any trimester just before start of influenza
season
Sharma RK, Ruhela V. Immunization in pregnant women. In: Muruganathan A et al. API. Adult immunization 2014. 2nd Ed. Jaypee
Brothers, 2014.pp.120-27

41. FOGSI
(Nov 2014)
• All pregnant women should receive influenza
vaccination at 26 weeks of pregnancy or
later. Vaccination can be done earlier in case
of a pandemic.
• All non-immunized postnatal mothers should
receive the influenza vaccine.
• In addition, annual influenza vaccination can
be offered to all adults and elderly women.

42. Other bodies recommending
Influenza vaccination in pregnancy
• American College of Obstetricians and
Gynaecologists (ACOG)
• Indian Academy of Pediatrics (IAP)
• Advisory Committee on Immunization
Practices (ACIP)
• American Academy of Pediatrics (AAP)

43. Advisory Committee on
Immunization Practices (ACIP)
Routine Recommendation in
pregnancy
20112011

44. WHAT ARE THE PRECAUTIONS
YOU DOCTORS SHOULD TAKE?
• Maintain good hygiene
• Wash/ sanities hands in regular intervals
• Must wash hands before eating
• Avoid shaking hands
• Avoid close contact with infected people

45. • If you have sore throat, cough or
fever for more than 3 days,
get yourself tested
• Infected people should wear
mask and stay indoors
WHAT ARE THE PRECAUTIONS YOU
DOCTORS SHOULD TAKE?

46. Take Home Message
•It is good practice that
medical fraternity
takes flu vaccine in
January every year
All pregnant women
should also be
Vaccinated for flu
at 26 weeks

47. • With the exception of clean drinking water ,
vaccines are most effective intervention to
reduce and prevent an infectious disease
• Today 28 diseases are vaccine
preventable
• Let us add Flu Vaccineto this list
Presented on 7-10-2015 at Faridabad O / G society

48. Has started routine influenza
vaccination in pregnancy 2014 oct

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CONTACT US
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WEBSITE :
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50. Cherish
by following best practices in Medicare