Q: Why does CDC recommend that pregnant women receive the
2009 H1N1 influenza vaccine?
A. It is important for a pregnant woman to receive the 2009
H1N1 influenza vaccine as well as a seasonal influenza vaccine.
A pregnant woman who gets any type of flu is at risk for serious
complications and hospitalization. Pregnant women who are
otherwise healthy have been severely impacted by the 2009 H1N1 influenza
virus (formerly called “novel H1N1 flu” or “swine flu”). In comparison
to the general population, a greater proportion of pregnant women
infected with the 2009 H1N1 influenza virus have been hospitalized.
In addition, severe illness and death has occurred in pregnant women.
Six percent of confirmed fatal 2009 H1N1 flu cases thus far have
been in pregnant women while only about 1% of the general population
is pregnant. While hand washing, staying away from ill people, and
other steps can help to protect pregnant women from influenza, vaccination
is the single best way to protect against the flu.
Q: Is there a particular kind of flu vaccine that pregnant
women should get? Are there flu vaccines that pregnant women
should not get?
A. There are two type of flu vaccine. Pregnant women
should get the "flu shot"— an inactivated vaccine (containing fragments
of killed influenza virus) that is given with a needle, usually
in the arm. The flu shot is approved for use in pregnant women.
The other type of flu vaccine — nasal-spray flu vaccine (sometimes
called LAIV for “live attenuated influenza vaccine)—is not currently
approved for use in pregnant women. This vaccine is made with
live, weakened flu viruses that do not cause the flu). LAIV (FluMist®)
is approved for use in healthy* people 2-49 years of age who are
not pregnant.
Q. Will the seasonal flu vaccine also protect against the
2009 H1N1 flu?
A. The seasonal flu vaccine is not expected to protect against
the 2009 H1N1 flu. Similarly, the 2009 H1N1 influenza vaccine will
not protect against seasonal influenza.
Q. Can the seasonal influenza vaccine and the 2009 H1N1
influenza vaccine be given at the same time?
A. It is anticipated that seasonal flu and 2009 H1N1 vaccines
may be administered on the same day but given at different sites
(e.g. one shot in the left arm and the other shot in the right arm).
However, we expect the seasonal vaccine to be available earlier
than the 2009 H1N1 influenza vaccine. The usual seasonal influenza
viruses are still expected to cause illness this fall and winter.
Pregnant women and others at increased risk of complications of
influenza are encouraged to get their seasonal flu vaccine as soon
as it is available.
Q: Is the 2009 H1N1 influenza vaccine safe for pregnant
women?
A: Influenza vaccines have not been shown to cause harm to
a pregnant woman or her baby. The seasonal flu shot (injection)
is proven as safe and already recommended for pregnant women. The
2009 H1N1 influenza vaccine will be made using the same processes
and facilities that are used to make seasonal influenza vaccines.
Q: What safety studies have been done on the 2009
H1N1 influenza vaccine and have any been done in pregnant women?
A: A number of clinical trials which test 2009 H1N1 influenza
vaccine in healthy children and adults are underway. These
studies are being conducted by the National Institutes of Allergies
and Infectious Diseases (NIAID). Studies of 2009 H1N1 influenza
vaccine in pregnant women are expected to begin in September.
Q: Does the 2009 H1N1 influenza vaccine have preservative
in it?
A: There is no evidence that thimerosal (used as a preservative
in vaccine packaged in multi-dose vials) is harmful to a pregnant
woman or a fetus. However, because some women are concerned about
exposure to preservatives during pregnancy, manufacturers will produce
preservative-free seasonal and 2009 H1N1 influenza vaccines in single
dose syringes for pregnant women and small children. CDC recommends
that pregnant women may receive influenza vaccine with or without
thimerosal.
Q: How many 2009 H1N1 influenza vaccine shots will
be needed?
A: Some people, including pregnant women, may need two doses.
We will know more about the number of doses once data from the clinical
trials are available.
Q. What will be the recommended interval between the first
and second dose if two doses are needed?
A. This will not be known until clinical trial data are available.
We anticipate that 21-28 days will be needed between the first
and second doses.
Q: Should the 2009 H1N1 influenza vaccine be given
to someone who has had an influenza- like illness since between
April and now? Do I need a test to know if I need the vaccine
or not?
A. There is no test that can show whether a person had 2009 H1N1
influenza in the past. Many different infections, including influenza,
can cause influenza-like symptoms such as cough, sore throat and
fever. In addition, infection with one strain of influenza virus
will not provide protection against other strains. People for whom
influenza vaccine is recommended should receive the 2009 H1N1 vaccine,
even if they had an influenza-like illness previously. It is not
necessary to test a person who previously had an influenza-like
illness. People for whom the 2009 H1N1 influenza vaccine is recommended
should receive it, even if they have had an influenza-like illness
previously, unless they can be certain they had 2009 H1N1 influenza
based on a laboratory test that can specifically detect 2009 H1N1
viruses. CDC recommends that persons who were tested for 2009 H1N1
influenza discuss this issue with a healthcare provider to see if
the test they had was either an RT-PCR or a viral culture that showed
2009 H1N1 influenza. There is no harm in being vaccinated if you
had 2009 H1N1 influenza in the past.
Q: What are the possible side effects of the 2009
H1N1 influenza vaccine?
A. The side effects from 2009 H1N1 influenza vaccine are expected
to be similar to those from seasonal flu vaccines. The most
common side effects following vaccination are expected to be mild,
such as soreness, redness, tenderness or swelling where the shot
was given. Some people might experience headache, muscle aches,
fever, nausea and fainting. If these problems occur, they
usually begin soon after the shot and may last as long as 1-2 days.
Like any medicines, vaccines can cause serious problems like severe
allergic reactions. However life-threatening allergic reactions
to vaccines are very rare. In 1976, an earlier type of swine
flu vaccine was associated with cases of a severe paralytic illness
called Guillain-Barre Syndrome (GBS) at a rate of approximately
1 case of GBS per 100,000 persons vaccinated. Some studies
done since 1976 have shown a small risk of GBS in persons who received
the seasonal influenza vaccine. This risk is estimated to be no
more than 1 case of GBS per 1 million persons vaccinated. Since
then, flu vaccines have not been clearly linked to GBS. GBS has
a number of different causes, and GBS can occur in a person who
has never received an influenza vaccine. The potential benefits
of influenza vaccination in preventing serious illness, hospitalization,
and death substantially outweigh these estimates of risk for vaccine-associated
GBS.
Anyone who has a severe (life-threatening) allergy to eggs or to
any other substance in the vaccine should not get the vaccine.
People should always inform their immunization provider if they
have any severe allergies, if they’ve ever had a severe allergic
reaction following flu vaccination, or if they have ever had GBS.
Q. Can the family members of a pregnant woman receive the
nasal spray vaccine?
A. Pregnant women should not receive the live nasal spray influenza
vaccine but family and household members and other close contacts
of pregnant women (including healthcare personnel) who are 2 through
49 years old, healthy* and not pregnant may receive live nasal spray
vaccine.
Q. Can a pregnant healthcare worker administer the live
nasal influenza vaccine?
A. Yes. No special precautions are (such as gloves) are necessary.
Hands should be washed or cleaned with waterless hand sanitizer
before and after administering the vaccine or having any direct
contact with patients in a health care setting.
Healthcare Providers
Q. Where can healthcare providers obtain 2009 H1N1
influenza vaccine?
A. The CDC will be distributing the 2009 H1N1 influenza vaccine
to each state. If healthcare providers want to provide H1N1 vaccine
directly to their patients, they can contact their local health
department to obtain H1N1 vaccine. Information to direct providers
interested in obtaining vaccine to appropriate public
health contacts in their state is available.
Q. How will healthcare providers obtain other supplies
necessary for vaccination?
A. The vaccine will be distributed with a kit which will
contain needles, syringes, sharps containers and alcohol swabs.
Q. How much does the vaccine cost?
A. The vaccine will be provided free; however, healthcare
providers may bill for vaccine administration.
Q. If a pregnant woman delivers before receiving
her second dose of vaccine, should she still receive the second
dose?
A. Yes. In addition to protecting her from infection, infants
less than 6 months old will not be able to be vaccinated so it is
recommended that everyone who lives with or provides care for infants
less than 6 months of age receive both the seasonal influenza vaccine
and 2009 H1N1 influenza monovalent vaccine to provide protection
for the infant.
One recent study conducted in Bangladesh, assessed the effectiveness
of influenza immunization for mothers and their young infants. Inactivated
influenza vaccine reduced proven influenza illness by 63% in infants
up to 6 months of age. This study confirmed that maternal influenza
immunization is a strategy with substantial benefits for both mothers
and infants.
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