Zika virus is a mosquito-transmitted virus that generally causes no symptoms or mild illness, but is associated with microcephaly in infants whose mothers contract it during pregnancy. In January 2016, the US Centers for Disease Control and Prevention (CDC) issued a health advisory, travel alert and MMWR urging women who are pregnant to avoid countries where Zika virus transmission is ongoing. Women trying to become pregnant should consult with their healthcare providers before traveling to these areas and strictly follow steps to avoid mosquito bites during the trip. While cases of Zika have been reported in the United States, as of January 2016 these are limited to patients who recently traveled to countries with Zika transmission. Transmission is not occurring in the US.
Zika virus can be spread from a pregnant woman to her fetus. There have been reports of a serious birth defect of the brain called microcephaly and other poor pregnancy outcomes in babies of mothers who were infected with Zika virus while pregnant. Knowledge of the link between Zika and these outcomes is evolving, but until more is known, CDC recommends special precautions for the following groups:
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How dangerous is influenza (the flu) in pregnant women?
Pregnant women who get the flu can become much sicker than women who get the flu when they are not pregnant. Studies have shown that pregnant women with a respiratory illness from the flu have more medical visits, more hospitalizations, and longer hospital stays.
I am pregnant. Should I get the influenza vaccine (flu shot)?
Yes. Flu shots are an effective and safe way to protect you and your baby from serious illness and complications of the flu. Pregnant women and their babies are at an increased risk of serious complications from the flu. The flu shot given during pregnancy helps protect infants younger than 6 months who are too young to get the flu vaccine and have no other way of getting flu antibodies. The flu shot has been given to millions of pregnant women over many years. It has been shown to be safe for pregnant women and their babies. Pregnant women can get the flu shot at any point during the flu season (typically October through May).
During which trimester is it safe to have a flu shot?
The flu shot can be given at any time during pregnancy. Pregnant women are advised to get the shot as soon as possible when it becomes available and to speak to their obstetrician–gynecologists or other providers about being immunized.
Which flu vaccine should pregnant women get?
Pregnant women should get the inactivated influenza vaccine (“flu shot”) that is given with a needle, usually in the arm. Currently, there are two types of flu shots you can get:
1) the trivalent shot or 2) the quadrivalent shot. The trivalent shot covers three flu strains, and the quadrivalent shot covers four. The Advisory Committee on Immunization Practices (ACIP) and the American College of Obstetricians and Gynecologists do not recommend one type over the other.
Will the flu shot give me the flu?
No, you cannot get the flu from receiving the flu shot. However, you may still get cold symptoms because the flu shot does not protect against the common cold.
Is there a flu vaccine that pregnant women should not get?
Yes. Pregnant women should not get the nasal spray vaccine, which is made with the live flu virus. The nasal spray vaccine is safe for women after they have given birth, even if they are nursing, and for family members.
Are preservatives in flu vaccines safe for my baby?
Yes. Thimerosal is a mercury-containing preservative used in very small amounts in the flu vaccine. It is safe for pregnant women and their babies. There is no scientific evidence that thimerosal causes problems for pregnant women or children born to women who received thimerosal-containing vaccines during pregnancy. Although thimerosal-free types of the vaccine also are available, ACIP does not indicate a preference for thimerosal-containing or thimerosal-free vaccines for any group, including pregnant women. Pregnant women can get the flu shot with or without thimerosal.
What else can I do to protect my baby against the flu?
Getting your flu shot while you are pregnant is the most important step in protecting yourself and your baby against the flu. After birth, breastfeeding your baby and making sure other family members and caregivers get the flu vaccine will further protect your baby.
I am breastfeeding my baby. Is it safe to get the flu shot?
Yes. Flu vaccines can be given to women who are breastfeeding if they did not get the shot when they were pregnant. Women who are breastfeeding can get either the flu shot or the nasal spray. A woman who breastfeeds passes antibodies through her breast milk, which also may reduce the baby’s chances of getting sick with the flu.
Is it safe to get a flu shot at my local pharmacy?
Yes. Pharmacists are well equipped to give immunizations, and most pharmacies will vaccinate pregnant women. If your obstetrician–gynecologist or other provider’s office does not offer the flu shot, ask about your options. Be sure to let your obstetrician–gynecologist or other provider know when you have gotten the flu shot so that your medical record can be updated.
What should I do if I think I have the flu?
If you think you have flu symptoms, such as fever or chills and exhaustion, contact your obstetrician–gynecologist or other provider’s office right away. Be sure to tell the nurse, obstetrician–gynecologist, or other provider that you are pregnant. If you have severe symptoms, such as fever higher than 100.0°F along with trouble breathing, dizziness when standing, or pain in your chest, go to the nearest emergency department. You will likely be given an antiviral medication that is safe to use during pregnancy.
Can I get the tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) shot and flu shot at the same time?
Yes. You can get more than one vaccine in the same visit.
Copyright 2015 by the American College of Obstetricians and Gynecologists, 409 12th Street SW, PO Box 96920, Washington, DC 20090-6920 12345/98765 AA572A
This information is designed to aid practitioners in assessing their patients’ immunization needs. This guidance should not be construed as dictating an exclusive course of treatment or procedure. Variations in practice may be warranted based on the needs of the individual patient, resources, and limitations unique to the institution or type of practice. Please be advised that this guidance may become out-of-date as new information becomes available from the Centers for Disease Control and Prevention.
American College of Obstetricians and Gynecologists
Immunization for Women: Influenza Overview for Patients. Available at http://immunizationforwomen.org/patients/diseases-vaccines/influenza/influenza.php. Retrieved May 26, 2015.
Immunization for Women www.immunizationforwomen.org
Centers for Disease Control and Prevention. Seasonal influenza: pregnant women and influenza (flu).
Available at: http://www.cdc.gov/flu/protect/vaccine/pregnant.htm. Retrieved May 15, 2015.
Department of Health and Human Services. Pregnant Women. Available at: http://www.flu.gov/atrisk/pregnant/index.html. Retrieved May 15, 2015.
For more information visit CDC's section concerning Seasonal Flu Vaccine Safety and Pregnant Women
The CBS Evening News (9/17, story 12, 1:45, Pelley) reported that this year’s influenza vaccine may be more effective than last year’s. According to Dr. Jon Lapook, “Last year, the vaccine was only 23 percent effective because the predominant strain mutated after the vaccine had already been manufactured.” CDC “officials say this year’s flu vaccine is well-matched right now to circulating viruses.”
The Los Angeles Times (9/18, Kaplan) reports that this year, “flu watchdogs at the CDC have scrutinized 199 flu specimens collected in the United States and elsewhere between May 24 and Sept. 5.” They found that “the majority of those specimens – 118 of them – were H3N2 viruses, and all of them were built in a way that should make them vulnerable to this year’s vaccines.”
McClatchy (9/18, Mueller) reports that “by including components of H3N2 in this season’s flu vaccine, health care professionals hope to raise vaccine effectiveness against predominant strains back up to the 50 to 60 percent range.”
The AP (9/18, Neergaard) reports that, “all told, at least 171 million doses of flu vaccine are expected this year.”