ACOG updates its recommendations on Influenza Vaccination During Pregnancy

The American College of Obstetricians and Gynecologists (ACOG) updated it committee opinion on influenza vaccination in pregnancy and post-exposure prophylaxis. This was published April 2018 and replaces Committee Opinion Number 608, September 2014.

This updated committee opinion is based on data that showed that only 54% of pregnant women in the USA were vaccinated during the 2016-2017 influenza season. This number needs to be worked on as the U.S. Health and Human Services’ Healthy People 2020 goal is vaccinating 80% of pregnant women against influenza.

Pregnant women are particularly susceptible to influenza infection and its resulting morbidities; therefore, influenza vaccination is an integral element of pre-pregnancy, prenatal, and postpartum care.

ACOG makes the following recommendations:

1) The Centers for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices and ACOG recommend that all adults receive an annual influenza vaccine. In addition, women who are pregnant or will be pregnant during the influenza season receive an inactivated influenza vaccine as soon as it is available.

2) Any of the licensed, recommended, inactivated influenza vaccine is safe during any trimester. Obstetrician-gynecologists and other health care providers should play an active part in counseling all pregnant women about the safety of influenza vaccine in pregnancy and its importance in protecting the newborn against the flu because of passive immunity.

3) It is recommended that every Obstetrician-gynecologist must get a flu vaccine every year and keep a stock of the vaccines in her office. If she is unable to provide the vaccination services, she should refer the patient to other provider, pharmacies or hospitals.

4) Patients who are allergic to egg and have had only hives can receive any licensed and recommended influenza vaccine that is otherwise appropriate for their age and health status.

5) In case the allergy symptoms are more serious than hives, the vaccine should be administered in an inpatient or outpatient medical setting including hospitals, clinics and physician offices.

6) Patients with flu-like illness should be started on antiviral medications, presuming it to be influenza. The provider should start the antiviral treatment based on clinical evaluation and not solely rely on the lab results.

7) All the office and hospital staff should also be encouraged to receive an influenza vaccine every year.

8) All pregnant women and women who are up to 2 weeks postpartum exposed to influenza virus because of close contact with an influenza patient should be started on post-exposure antiviral chemoprophylaxis (75 mg of oseltamivir once daily for 10 days). If oseltamivir is unavailable, zanamivir can be substituted, two inhalations once daily for 10 days.

Committee opinion

 Media courtesy: March of Dimes