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

ACOG updates the practice advisory for influenza vaccination during pregnancy

The American congress of obstetrics and gynecologists(ACOG) has issued a recent practice advisory for influenza vaccination during pregnancy.

A recent case -control study published in September issue of journal Vaccines linked spontaneous abortion and receipt of influenza vaccine in first trimester of pregnancy. In this case control study women had nearly twice the odds of experiencing a miscarriage if they were vaccinated in the preceding 28 days period. (OR 2.0; 95% CI 1.1–3.6)

The odds of spontaneous miscarriage were further increased 7 times if the women also received the pH1N1-containing vaccine in the previous influenza season. (OR 7.7; 95% CI 2.2–27.3)

Once the 28 days window is passed, not increased chances of spontaneous pregnancy loss was observed.

The same study also observed no adverse effects or pregnancy loss when vaccination was given either later in the first trimester or in the second or third trimester.

Hence, ACOG reviewed the evidence by evaluating all the scientific information available and concluded that this study had some limitations and does not establishes causality. It also calls for additional studies and clinical trials before the concern is fully addressed.

ACOG still affirms it stand of vaccinating every pregnant woman with a flu shot, irrespective of the trimester she is in.

For many years, ACOG and the CDC have recommended that every pregnant woman receive a flu shot during any trimester.

ACOG practice advisory

Vaccinations before, during and after pregnancy.

ACIP broadens its policy for Influenza vaccination in pregnant women and children

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ACIP broadens its policy for Influenza vaccination in pregnant women and children

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The CDC’s Advisory Committee on Immunization Practices (ACIP) passed new draft recommendations for influenza vaccine in children and pregnant women.

The basic recommendations for Influenza vaccination for 2017-2018 flu season would remain the same.

A major update was allowing of any licensed, recommended and age-appropriate trivalent or quadrivalent inactivated influenza vaccine (IIV) or recombinant influenza vaccine (RIV) for pregnant women as against the previous recommendation which only specified inactivated vaccine (IIV).

Some of the committee members were uncertain about safety of recombinant influenza vaccine (RIV), Flublok.

Lisa Grohskopf, MD, MPH, medical officer of the influenza division of the CDC, did acknowledge that there were more data on the safety of inactivated influenza vaccines, she asserted to the committee that “the general overall safety profile of Flublok in comparison to inactivated vaccines is reassuring.”

In addition, the committee advised against use of quadrivalent live attenuated influenza vaccine (LAIV4), which is given by nasal spray, in the coming season because of its declining efficacy. The vaccine failed to show any statistically significant benefits in pediatric age group during last three seasons.

Also, Afluria, an inactivated influenza vaccine in both trivalent and quadrivalent formulas can now be safely administered to children aged 5 years and above instead of 9 years and above. This is because similar rates for febrile seizures and reactions were observed in both the age range.

The director of the CDC and the U.S. Department of Health and Human Services will look into the approved recommendations.  Once reviewed and approved, the final recommendations will be published in the CDC’s Morbidity and Mortality Weekly Report.

Vaccinations before, during and after pregnancy.