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.”
The presence of potential listeria in several samples of hummus has prompted a national recall by Virginia-based Sabra Dipping Co. of 30,000 cases of Classic Hummus.
Inspectors with the Michigan Department of Agriculture and Rural Development learned of the possible contamination by Listeria monocytogenes after routine inspections March 30 at a Kroger in Port Huron, according to Jennifer Holton, MDARD spokeswoman.
Samples from the prepackaged product were collected for testing, and the results came back days later. Michigan officials alerted inspectors in Virginia and officials with the U.S. Food and Drug Administration who, in turn, are working with Sabra.
The recall is limited to five stock unit, or SKU, numbers of Classic Hummus. No other Sabra product is affected at this time.
In healthy individuals, listeria monocytogenes may cause short-term symptoms such as high fever, severe headache, stiffness, nausea, abdominal pain and diarrhea,
But it can cause serious and sometimes fatal infections in young children, frail or elderly people, and others with weakened immune systems, and it can cause miscarriages and stillbirths among pregnant women.
Measles is dangerous to the health of both mothers and their unborn children, but can be prevented, says a recent statement from the Society for Maternal-Fetal Medicine (SMFM). Pregnant women who contract measles are at risk for more severe complications of the illness, as well as increased risk for both preterm labor and preterm delivery. Vaccination is contraindicated during pregnancy, and should be given at least 28 days prior to becoming pregnant, or during the postpartum period.* ACOG endorses the 2015 Childhood/Adolescent Immunization Schedule and also recommends that vaccination be offered to women found to be at risk of measles.
See more from the statement in the SMFM Newsroom.
For more information on measles check out the CDC's measles web page and ACOG's Immunization for Women website.
Patients sometimes ask us why we don't have pictures of the babies we deliver on the walls in our office..... this article from NY Times explains it all.
Pictures of smiling babies crowd a bulletin board in a doctor’s office in Midtown Manhattan, in a collage familiar to anyone who has given birth. But the women coming in to have babies of their own cannot see them. They have been moved to a private part of the office, replaced in the corridors with abstract art.
“I’ve had patients ask me, ‘Where’s your baby board?’ ” said Dr. Mark V. Sauer, the director of the office, which is affiliated with Columbia University Medical Center. “We just tell them the truth, which is that we no longer post them because of concerns over privacy.”
For generations, obstetricians and midwives across America have proudly posted photographs of the babies they have delivered on their office walls. But this pre-digital form of social media is gradually going the way of cigars in the waiting room, because of the federal patient privacy law known as Hipaa.
Under the law, the Health Insurance Portability and Accountability Act, baby photos are a type of protected health information, no less than a medical chart, birth date or Social Security number, according to the Department of Health and Human Services. Even if a parent sends in the photo, it is considered private unless the parent also sends written authorization for its posting, which almost no one does.
So doctors — especially those at large institutions with internal compliance officers — have been stripping down the walls or, as Dr. Sauer did at the Center for Women’s Reproductive Care, hiding the photos, often with a bit of sadness. (The babies on the office’s website are models.)
While privacy is a virtue, the doctors say, the law could make more sensitive distinctions.
“For me, the face of a baby, that is really an anonymous face,” said Dr. Pasquale Patrizio, director of the Yale Fertility Center in New Haven. “It was representative of so much happiness, so much comfort, so much reassurance. It is purely a clinical office now.”
Although his center no longer displays the photos, parents insist on sending them in, Dr. Patrizio said. “We are scanning them and leaving them in their own charts — their encrypted charts,” he said, chuckling.
Most people know Hipaa as the law responsible for the “Notice of Privacy Practices,” the blizzard of forms given to patients to sign, informing them of the ways in which their protected health information may be used. The law was enacted in 1996, but the banishment of baby photos has accelerated since 2009, when an economic stimulus bill provided money to promote electronic health records and let the government step up enforcement of the rules.
Rachel Seeger, a spokeswoman for the Office for Civil Rights of the Department of Health and Human Services, confirmed that the displays were illegal. “A patient’s photograph that identifies him/her cannot be posted in public areas” unless there is “specific authorization from the patient or personal representative,” she wrote in an email.
By specific authorization, Ms. Seeger said, she meant an official Hipaa-compliant form, including elements like an expiration date. She was not aware, however, of any medical office that had been fined over the issue.
There are, predictably, degrees of compliance with the law. Fertility centers, where baby walls can be a subtle form of marketing, are the most likely to have abolished them. Though those doctors cite the Hipaa law as the reason, they also worry about a photo accidentally betraying a confidence, especially in an era when Instagram and Facebook can quickly broadcast any photograph.
“A lot of times the baby is being held by a mother,” Dr. Sauer, whose office specializes in infertility cases, said. “Most people do not disclose that they used an egg donor.”
At the University of Southern California’s fertility program, the lab area has photos of embryos next to the babies they produced. But in the public area, art has replaced baby pictures.
At Midwifery of Manhattan, on the other hand, baby photos cover two big walls like wallpaper. “I love this custom,” Sylvie Blaustein, the head midwife, said. “I worry that people are going to be afraid to do it.”
Dr. Jacques Moritz, director of the division of gynecology at Mount Sinai Roosevelt in Manhattan, still displays baby pictures in an exam room. “There’s not a day that goes by that somebody doesn’t come in with a picture of the kid — up until 17, 18, 19 and 20,” he said.
“I think we have to have some common sense with this Hipaa business,” Dr. Moritz continued. “To leave medical records open to the public, to throw lab results in the garbage without shredding them, that makes sense” to prohibit. “But if somebody wants to post a picture of something that’s been going on for a millennium and is a tradition, it seems strange to me not to do that,” he said.
Dr. Moritz said he believed that parents who sent in photos implicitly allowed them to be posted. That may be true, but the law still does not allow it. “Unfortunately, there’s no concept of implied authorization for this type of use,” said Clinton Mikel, chairman of the American Bar Association’s eHealth, Privacy & Security Interest Group.
Other obstetric practices try to thread the needle. Some keep the baby photos in an album that patients can choose to open or not. (Still illegal, said Ms. Seeger of the health department.) Or they separate the waiting areas for obstetric and gynecological patients, though not necessarily with Hipaa in mind: They don’t want women who are not interested in children or who have fertility problems to be bothered.
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“The one thing they want more than anything else is a baby, but one thing they don’t want to look at is someone else’s baby,” said Dr. Randall R. Odem, chief of the division of reproductive endocrinology and infertility at Washington University School of Medicine in St. Louis.
Downtown Women OB/GYN Associates, in SoHo, took down its baby wall several years ago. But staff members were flummoxed when a patient posted a picture of her baby on the office Facebook page. Was that O.K.?
“I think we ultimately did take it down,” Alex Dettmer, the practice manager, said. “One of our compliance companies said, you might as well play it safe.”
A version of this article appears in print on August 10, 2014, on page A1 of the New York edition with the headline: Baby Pictures at Doctor’s? Cute, Sure, but Illegal.
Ebola virus is the cause of a viral hemorrhagic fever disease. Symptoms include: fever, headache, joint and muscle aches, weakness, diarrhea, vomiting, stomach pain, lack of appetite, and abnormal bleeding. Symptoms may appear anywhere from 2 to 21 days after exposure to ebolavirus though 8-10 days is most common.
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Wawona Packing Co. is voluntarily recalling peaches, nectarines, plums and pluots that were packed at its Cutler, California, warehouses between June 1 and July 12. Wawona believes the products may be contaminated with Listeria monocytogenes.
Costco, Trader Joe's, Kroger and the Walmart Corp. -- which operates Walmart and Sam's Club stores, have all posted notices about the fruit recall on their websites. The recall is nationwide, according to the U.S. Food and Drug Administration.
Listeria monocytogenes is a bacterium that can cause Listeriosis. The most common symptoms of Listeriosis are gastrointestinal issues (such as diarrhea), fever and muscle aches. Pregnant women, infants, older adults and people with a weakened immune system are particularly at risk for a more serious infection, according to the Centers for Disease Control and Prevention.
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