CDC Guidelines on the Prevention and Control of Influenza in Pregnancy
The CDC has released guidance for managing pregnant women who have suspected or confirmed flu. Of note, pregnant women are considered to be in the high-risk category. The following recommendations are current for the 2019-2020 flu season.
If patient is hospitalized, continue Droplet Precautions for 7 days after illness onset or until 24 hours after the resolution of fever and respiratory symptoms, whichever is longer
Discharge patient from medical care when clinically appropriate, not based on the period of potential virus shedding or recommended duration of Droplet Precautions
Instruct patient to follow respiratory hygiene and cough etiquette, including wearing a facemask, if being transported outside of her room
Health care personnel entering rooms of pregnant women with suspected or confirmed influenza should adhere to Standard and Droplet Precautions, which include
Donning a facemask upon entry into the room
Performing hand hygiene
Wearing gloves for any contact with potentially infectious materials
Wearing gowns for any patient-care activity where contact with body fluids may occur
Patient and visitor education
Inform regarding the risks of influenza virus transmission
Instruct about adherence to respiratory hygiene and cough etiquette, hand hygiene, and use of personal protective equipment (PPE) according to current facility policy
Suspected or confirmed influenza, on labor & delivery floor
Patient should remain on Droplet Precautions
Health care personnel on labor & delivery should adhere to Standard and Droplet Precautions, including practicing hand hygiene before and after handling the newborn
To reduce the risk of influenza virus transmission to the newborn
Consider temporarily separating the mother who is ill with suspected or confirmed influenza from her baby following delivery during the hospital stay
Discuss the risks and benefits of temporary separation with the mother
Ideal setting for care of a healthy term newborn while in the hospital is within the mother’s room
Newborns infected with influenza virus are at increased risk for severe complications
Decisions about temporary separation should be made in accordance with the mother’s wishes
Throughout the course of temporary separation
Feedings should be provided by a healthy caregiver if possible
Mothers should be encouraged to express their milk to establish and maintain milk supply
Expressed breastmilk should be fed to the newborn
Because the ideal length of temporary separation in the hospital is not yet established, assess on a case-by-case basis and consider the following in the decision process
If the mother has been afebrile without antipyretics for >24 hours
Whether the mother can control her cough and respiratory secretions
If co-location (“rooming in”) of the newborn with his/her ill mother in the same hospital room, limit influenza-virus exposure of the newborn using the following strategies
Use engineering controls like physical barriers (e.g., a curtain between the mother and newborn)
Keep the newborn ≥6 feet away from the ill mother
Ensure a healthy adult is present to care for the newborn
If no other healthy adult is present in the room to care for the newborn
Instruct the mother to put on a facemask and practice hand hygiene before each feeding or other close contact with her newborn
Retain use of facemask during contact with the newborn
Continue these practices while on Droplet Precautions in the hospital
Once contact between mother and newborn is resumed
Droplet Precautions for influenza should continue to be observed in the hospital until at least 7 days after maternal illness onset
If a newborn of a mother with suspected or confirmed influenza is in the nursery
Newborn care can be provided by a non-ill person using Standard Precautions and the newborn should be closely observed for signs of infection
Symptomatic mothers, care givers, and family members should not enter the nursery
If a newborn develops signs of the flu, place on Droplet Precautions and have the newborn examined by a physician
Test for influenza
Consider oseltamivir treatment
CDC considers women who are pregnant or postpartum (within 2 weeks after delivery) to be at high-risk
CDC recommends starting oseltamivir treatment as soon as possible for
Hospitalized patients with suspected or confirmed influenza
High-risk outpatients with suspected or confirmed influenza
Administer antiviral treatment as early as possible
Ideally, within 48 hours of symptom onset
Do not delay treatment even for a few hours while awaiting test results
Treatment initiation even after 48 hours can still be beneficial
Adult dose for oseltamivir is 75 mg twice daily for 5 days
Visitors should be limited to persons who are necessary for patient’s care/wellbeing
Visitors who have been in contact with an infected patient before and during her hospitalization are a possible source of influenza for other patients, visitors, and staff
Screen all visitors for acute respiratory illness
Only allow asymptomatic individuals to visit
Instruct visitors to limit their movement within the facility
Facilities should provide instruction, before visitors enter patients’ rooms, on proper hygiene and procedures
Before Hospital Discharge
Strongly encourage and, if possible, provide the flu vaccination to
Any unvaccinated family members aged 6 months and older
Caregivers in contact with the newborn
Advise caregivers that they should
Contact their health care provider promptly if the newborn develops signs that suggest a flu infection
Isolate any individuals in the home who become ill to protect the newborn
Ensure that the ill postpartum woman follows hand hygiene and respiratory hygiene and cough etiquette when having contact with her newborn
Caregivers, if possible, should be limited to vaccinated non-ill adults until the mother’s flu resolves
How Flu Spreads
The CDC provides the following information on contagiousness of the flu
Person to Person
People with flu can spread it to others up to about 6 feet away. Most experts think that flu viruses spread mainly by droplets made when people with flu cough, sneeze or talk. These droplets can land in the mouths or noses of people who are nearby or possibly be inhaled into the lungs. Less often, a person might get flu by touching a surface or object that has flu virus on it and then touching their own mouth, nose, or possibly their eyes.
When Flu Spreads
People with flu are most contagious in the first three to four days after their illness begins. Most healthy adults may be able to infect others beginning 1 day before symptoms develop and up to 5 to 7 days after becoming sick. Children and some people with weakened immune systems may pass the virus for longer than 7 days.
Symptoms can begin about 2 days (but can range from 1 to 4 days) after the virus enters the body. That means that you may be able to pass on the flu to someone else before you know you are sick, as well as while you are sick. Some people can be infected with the flu virus but have no symptoms. During this time, those people may still spread the virus to others.
Period of Contagiousness
You may be able to pass on flu to someone else before you know you are sick, as well as while you are sick.
People with flu are most contagious in the first 3-4 days after their illness begins.
Some otherwise healthy adults may be able to infect others beginning 1 day before symptoms develop and up to 5 to 7 days after becoming sick.
Some people, especially young children and people with weakened immune systems, might be able to infect others with flu viruses for an even longer time.
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This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
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presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
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