Influenza Season Recommendations for Pregnant and Breastfeeding Mothers

Vaccines

Pregnant Patients: The American College of Gynecology (ACOG) and the Centers for Disease Control and Prevention (CDC) recommend that all pregnant women be vaccinated against the seasonal flu.  Pregnant women may receive the injectable vaccine during any trimester of pregnancy.  However, the live attenuated vaccine known as FluMist is not recommended in any stage of pregnancy. Thimersol is contained in small amounts in the multi-dose vials, but the single dose vials do not contain thimersol. Further, despite certain internet stories, there is no squalene present in any of the influenza vaccines used in the USA.  The seasonal flu vaccine has be administered without major complications to millions of pregnant women throughout the years

Breastfeeding Patients: The CDC and the Food and Drug Administration (FDA) recommend that all breastfeeding women be immunized against the flu.  This will further protect the breastfed infant as these antibodies will pass into milk and help protect the newborn from infection.  Again,  the multi-dose vials contain a small amount of mercury, but there is no evidence that this would even pass to a breastfeeding infant.  The live attenuated vaccine,  FluMist,  is not recommended for breastfeeding women,  although we know the risks are low. 

Treatments

Oseltamivir (Tamiflu) or zanamivir (Relenza) are both quite active against seasonal flu.  These antivirals only work if used early in the illness.  They are not indicated if fever and illness has been present for more than 48 hours.

However, patients should first be evaluated by a physician to see if their fever is due to influenza or perhaps some other infectious agent (bacterial) prior to receiving a prescription for these antiviral agents. 

Pregnant Patients: The antivirals oseltamivir (Tamiflu) and zanamivir (Relenza) can be used in pregnant patients, regardless of trimester of pregnancy, as the risks of influenza are much higher than the risk of these medications.   There are no indications that these drugs harm a fetus.

Breastfeeding Patients: Oseltamivir (Tamiflu) is probably compatible with breastfeeding.  Levels of  oseltamivir in milk (39 ng/mL) are very low and would be subclinical to an infant. The infant would receive only about 0.5% of the mothers dose.  The CDC considers oseltamivir safe to use in breastfeeding mothers.  At present, we do not have breastfeeding data on zanamivir (Relenza).  While it is probably safe to use,  physicians are advised to use oseltamivir (Tamiflu) instead of  zanamivir (Relenza) in breastfeeding mothers.

 

References

http://www.cdc.gov/flu/protect/vaccine/pregnant.htm

http://www.acog.org/departments/dept_notice.cfm?recno=20&bulletin=5377

Wentges-Van HN, Van EM, Van der Laan JW. Oseltamivir and breastfeeding. Int J Infect Dis. 2008

 

       Antiviral medication dosing recommendations for treatment or chemoprophylaxis                                               

 Medication

Treatment

(5 days)

Chemoprophylaxis

(10 days)

Oseltamivir

Adults

 

75-mg capsule twice per day

75-mg capsule once per day

 

Children ≥ 12 months

Body Weight (kg)

Body Weight (lbs)

 

 

≤15 kg

≤33lbs

30 mg twice daily

30 mg once per day

> 15 kg to 23 kg

>33 lbs to 51 lbs

45 mg twice daily

45 mg once per day

>23 kg to 40 kg

>51 lbs to 88 lbs

60 mg twice daily

60 mg once per day

>40 kg

>88 lbs

75 mg twice daily

75 mg once per day

Zanamivir

Adults

 

10 mg (two 5-mg inhalations) twice daily

10 mg (two 5-mg inhalations) once daily

Children (≥7 years or older for treatment, ≥5 years for chemoprophylaxis)

 

10 mg (two 5-mg inhalations) twice daily

 10 mg (two 5-mg inhalations) once daily  

From:  http://www.cdc.gov/h1n1flu/recommendations.htm

 

       Dosing recommendations for antiviral treatment or chemoprophylaxis of children

                                            younger than 1 year using oseltamivir.

Age

Recommended treatment dose for 5 days

Recommended prophylaxis dose for 10 days

Younger than 3 months

12 mg twice daily

Not recommended unless situation judged critical due to limited data on use in this age group

3-5 months

20 mg twice daily

20 mg once daily

6-11 months

25 mg twice daily

25 mg once daily

 

 

 

 

 

 

 

 

From :  http://www.cdc.gov/h1n1flu/recommendations.htm

 

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