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Pandemic 2009 H1N1 Influenza (Swine Flu) With Pregnancy Dr


Pandemic 2009 H1N1 Influenza (Swine Flu) With Pregnancy Dr. Mohamed El Sherbiny MD Ob.& Gyn. Senior Consultant Damietta, Egypt Has Thiomerosal A Future Risk of Autism ... – PowerPoint PPT presentation

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Title: Pandemic 2009 H1N1 Influenza (Swine Flu) With Pregnancy Dr

Pandemic 2009 H1N1 Influenza(Swine Flu) With
Dr. Mohamed El SherbinyMD Ob. Gyn. Senior
Consultant Damietta, Egypt
  • Epidemiology
  • Clinical picture
  • Diagnosis
  • Complications
  • Treatment
  • Prevention

Part 4 Treatment
  • General Measures

General Measures
  • Antipyretics
  • Antibacterial thereby
  • Oral fluids
  • Nutrition
  • Bed rest

Hazard of Hyperthermia
  • First trimester has been associated with neural
    tube defects and other birth defects
  • During labor Neonatal seizures, encephalopathy,
    cerebral palsy, and neonatal death
  • Acetaminophen is the drug of choice

CDC November 3, 2009
Throner UpToDateJanuary 14, 2010
Antibacterial Therapy
  • Recommended for secondary bacterial pneumonia
  • It is suspected when
  • Secondary fever after a period of defervescence
  • Sputum gram stain and/or culture showing a
    predominant organism (e.g. Streptococcus
    pneumoniae, Staphylococcus aureus, )
  • Lobar consolidation on chest imaging rather than
    the diffuse pattern
  • Leucocytosis
  • Onset of respiratory compromise occurring 4 -7
    days after initial symptoms rather than 1-2 days

Chan-Tack et al . N Engl J Med 2009 3611713.
Throner UpToDateJanuary 14, 2010
Antibacterial Thereby
  • For secondary bacterial pneumonia .
  • Azithromycin  
  • Azithromycin Ceftriaxon (severe cases)
  • Penicillins beta-lactams
  • Clindamycin aminoglycosides.

Throner UpToDateJanuary 14, 2010
Clinical Triage Algorithms For ILI In
Resource-poor Settings
Uncomplicated ILI
Any deterioration or failure to improve within 72
No risk factors
At-risk groups
  • Symptomatic care at home
  • Instruction on
  • infection prevention
  • to return for care
  • Antiviral
  • Close observation
  • Instruction to return for care.
  • Antiviral
  • Hospitalization

November 2009
CDC Guidance Peripartum Care
  • Management of Pregnant women who enter the
    hospital setting with suspected or confirmed 2009
    H1N1 influenza Virus
  • Antepartum Care
  • Intrapartum Care
  • Postpartum Care
  • Newborn Care

CDC November 2009
Antepartum Care
  • Pregnant women who enter the hospital setting
    with suspected or confirmed 2009 H1N1 influenza
  • Placed in a private room (Single room when
  • Cared for using current infection control
    guidance throughout hospitalization
  • Use facemask when outside of the room
  • Underwent diagnostic testing immediately
  • Receive empiric antiviral therapy (oseltamivir or

CDC November 2009
Intrapartum Care
  • In order to protect the infant from exposure, the
    following guidance is provided
  • The mother should use a face mask throughout
    labor, as tolerated.
  • Adhere to current infection control guidance.
  • During delivery, all persons should wear a
    surgical mask with face shield, gloves and gown.
  • Upon delivery of the newborn, immediately
    separate the newborn to an open warmer by a
    distance of gt 6 feet
  • If stable, the newborn may remain in the delivery
    room prior to transition to newborn/postpartum
  • Bathe the infant as soon as the temperature is

CDC November 2009
Postpartum Care
  • Step 1 Consider temporarily separating the
    infected mother from the newborn until met ALL of
    the following criteria
  • The mother has received antiviral medications for
    at least 48 hours
  • The mother is without fever for 24 hours without
    antipyretics and
  • The mother can control cough and respiratory
  • (Criteria for close contact)

CDC November 2009
Newborn Care
  • The mother should be fully
  • supported for breastfeed as it is the best way
    to protect the Infant
  • Immediately following delivery, the mother should
    be assisted and supported to express her

CDC November 2009
Newborn Care
  • The mothers milk should be fed to the newborn by
    a healthy caregiver until criteria are met for
    close contact
  • Milk from an infected mother is
  • not considered infectious.
  • Anti-viral medication use by the mother is not a
    contraindication to breastfeeding.

CDC November 2009
Newborn Care
  • Step 2 Once the criteria for close contact,
    the following guidance is offered prior to
    feeding handling the infant
  • The mother should wash her hands with soap and
  • The mother should put on a face mask
  • The mother should observe all respiratory hygiene

CDC November 2009
  • 1- Immunize persons before exposure
  • 2-Antiviral prophylaxis after exposure
  • 3-Infection control in healthcare settings 
  • 4-Community social distancing measures

Vaccination of Pregnant Women
Centers for Disease Control and Prevention
Case 2
  • A schoolteacher at 26 weeks gestation has been
    informed that one of her first row pupils has
    admitted to the hospital and diagnosed as
    pandemic H1N1

Case 2
  • She is extremely worried
  • How can I prevent The disease? . She asked
  • I has heard a conflicting debates in the mass
  • Can Tamiflu protect me ? Is it safe ?
  • What is the safety of the vaccine to my fetus ?
  • Does it contain toxic mercuric compound ?
  • Has it a future risk of autism to my baby?
  • 4. Does vaccine lead to Paralysis ?

When Is Antiviral Prophylaxis indicated?
  • Close contact with a confirmed or suspected case
    meet one of the following criteria
  • At high risk for complications of influenza
  • Pregnant women and women who are up to two weeks
  • Children who are lt2 years of age or who are at
    high risk of complications of influenza
  • Health care workers and emergency medical

November 2009
What About Safety For Pregnant Women?
  • In view of the elevated risk for severe illness
    for pregnant women, pregnant women are a group
    that should be vaccinated against infection, as
    supplies allow.
  • The benefits of vaccination far outweigh the

WHO 30 October 2009
Are Pandemic Vaccines Safe?
  • Outcomes of studies completed to date suggest
    that pandemic vaccines are as safe as seasonal
    influenza vaccines.
  • Side effects seen so far are similar to those
    observed with seasonal influenza vaccines.

November 2009
What About Safety For Pregnant Women?
  • To date No harmful effects from the pandemic
    influenza vaccine with respect to
  • Pregnancy
  • Fertility
  • Developing embryo or fetus
  • Birthing or post-natal development.

WHO 30 October 2009 November 2009
  • Dear Colleague
  • The American Academy of Family Physicians
  • (AAFP), the American College of Obstetricians
  • And Gynecologists (ACOG), the American
  • Medical Association (AMA), and the Centers
  • for Disease Control and Prevention (CDC) are
  • asking for your Help in urging your pregnant
  • patients to get vaccinated Gainst 2009 H1N1
  • and seasonal influenza.

ACOG Message November -2009
Why pregnant women should receive 2009 H1N1
monovalent and seasonal influenza vaccines
  • Vaccination during pregnancy reduced febrile
    respiratory illness both in the mothers and
    infants and reduced lab-confirmed influenza in
    the infants.
  • Caregivers of newborns are potential sources of
    transmission of H1N1 influenza.
  • Women who were not vaccinated during pregnancy
    should receive the vaccine postpartum to prevent
    the mothers to infants transmission.

ACOG Message November -2009
  • Vaccinating everyone who lives with or cares for
    infants aged lt6 months (too young to
    vaccination) is the best way to prevent these
    children from getting influenza.
  • 2009 H1N1 monovalent and seasonal influenza
    vaccines can be given to pregnant women in any
    trimester and can be given at the same time but
    in different injection sites.
  • Pregnant women should receive inactivated
    vaccine but should NOT receive the live
    attenuated vaccine (nasal spray).

ACOG Message November -2009
  • Postpartum women, even if they are
  • breastfeeding, can receive either inactivated
  • vaccine or live attenuated vaccine (nasal spray).
  • As healthcare providers, physicians and their
    healthcare staff are also a target group
    designated by the ACIP to receive 2009 H1N1
    monovalent and seasonal influenza vaccines to
    protect themselves as well as their pregnant

ACOG Message November -2009
  • Please help to protect your pregnant
  • patients against influenza by encouraging
  • them to get the 2009 H1N1 monovalent and
  • seasonal influenza vaccines and addressing their
  • You are playing a crucial role in helping to
  • prevent influenza in your patients, which can
    save their lives.

ACOG Message November -2009
ACOG Message November -2009
Priority of Vaccination( If vaccine supply is
  •  Pregnant women
  • Household contacts and caregivers of children lt 6
    months of age
  • Healthcare and emergency medical services
    personnel who have direct contact with patients
    or infectious material
  • Children aged 6 months to 4 years
  • Those aged 5 to 18 years who have medical
    conditions that put them at increased risk of

National Center for Immunization and Respiratory
Diseases, CDC. (ACIP), 2009. MMWR 2009 581.
What Is The Efficacy of The 2009 H1N1 Vaccine?
  • No vaccines, including pandemic influenza
    vaccines, provide 100 protection against disease
    (approximately 95 with pregnancy).
  • Also, influenza vaccines only become effective
    about 14 days after vaccination.
  • Those infected shortly before (1 to 3 days) or
    shortly after immunization can still get the

WHO 30 October 2009
Is Getting The Flu Vaccine Safer Than Getting The
Flu ?
  • Severe illness and possible death can be
    associated with influenza for the following
    priority groups
  • Healthy young people from birth through age 24
  • Pregnant women
  • Adults 25 to 64 who have certain underlying
    medical conditions
  • Vaccination is the best way to prevent influenza
    infection and its complications.

CDC January 14, 2010
Has The Preservative Thiomersal A Risk To
  • Thiomersal is a used as vaccine preservative to
    prevent contamination in multi-dose vials.
  • Thiomersal does not contain methyl mercury, which
    is toxic.
  • Thiomersal contains ethyl mercury Nontoxic
  • No evidence of toxicity in infants, children or
    adults, including pregnant women, exposed to
    thiomersal in vaccines.

WHO 30 October 2009
Has Thiomerosal A Future Risk of Autism To The
  • Research shows no link between thimerosal and the
    neurodevelopmental disorder Autism
  • In fact, sadly, autism rates have actually gone
    up since thimerosal was taken out of childhood
    vaccines in 2001, providing further evidence that
    thimerosal-containing vaccines are not related to

WHO 30 October 2009
Is There A Possibility Of Guillain-Barré Syndrome
(GBS) Cases Following The 2009 H1N1 Vaccine?
  • GBS in which the body damages its own nerve
    cells, causing muscle weakness and sometimes
    paralysis is very rare
  • GBS occurs at a rate of 10-20 cases per 1 million
    adults, per year, regardless of vaccination.
  • One additional person out of 1 million
    vaccinated people may be at risk for GBS
    associated with the 1976 influenza vaccine

CDC January 14, 2009
Vaccine Types
  • A-Live attenuated vaccine Nasal spray (not
    licensed for use in pregnant women)
  • B- Inactivated vaccine Intramuscular
  • Multidose inactivated vaccine
  • Prefilled single dose inactivated vaccine
  • 1- Monovalent Used with pregnancy
  • 2-with adjuvants (such as squalene)

Does the 2009 H1N1 monovalent flue vaccine have
an adjuvant or squalene in it?
  • Adjuvants are agents that are sometimes added to
    a vaccine to increase its effectiveness.
  • There are no adjuvants (such as squalene) in
    either the 2009 H1N1 monovalent or seasonal flu

CDC January 14, 2010
Thank You