HomeWomen's HealthStatements & GuidelinesNew & Revised Statements and Guidelines

Influenza Vaccination for Pregnant Women (C-Obs 45)


NEW College Statement
C-Obs 45
1st Endorsed: November 2011
Current: November 2011
Review: November 2014

 

Influenza vaccination during pregnancy should be routine: safety is well established and both maternal and infant benefit is now proven with only 5 vaccination doses estimated to prevent one case of serious maternal or infant respiratory illness 1.

Preventing influenza during pregnancy is an essential part of antenatal care because pregnant women are at an increased risk of serious illness due to influenza 2. Excess morbidity and mortality for pregnant women infected with influenza compared with non-pregnant women of similar age who are infected with influenza has been noted during pandemics as long ago as 1918 3 but drew public and professional attention most recently during 2009 4,5.

  • The most effective strategy for preventing influenza in pregnant women is annual immunisation. Influenza vaccination is estimated to prevent 1 to 2 hospitalisations per 1000 women vaccinated during the second or third trimester 6.
  • Influenza vaccination is recommended for all pregnant women regardless of gestation.
  • Inactivated influenza vaccine is usually available from February each year in the Southern Hemisphere. Live attenuated influenza vaccination has not been licensed in Australia6.
  • Vaccination early in the season and regardless of gestational age is optimal, but unvaccinated pregnant women should be immunized at any time during influenza season as long as the vaccine supply lasts. Some maternal benefit is might accrue as early as 2 weeks after vaccination with research in pregnant women demonstrating seroconversion by 4 to 6 weeks after vaccination7. Infection in the 3rd trimester of pregnancy appears to be the most dangerous for the pregnant woman5.
  • No study to date has shown an adverse consequence of inactivated influenza vaccine in pregnant women or their offspring8,9,10.
  • Active placental transfer of maternal antibodies makes influenza vaccine during pregnancy a highly effective measure to protect infants from influenza during the first 6 months of life 1,11,12.
  • The Australian Government Department of Health and Aging strongly recommends vaccination for pregnant women (http://immunise.health.gov.au)
  • The Royal Australian and New Zealand College of Obstetricians strongly endorses routine vaccination of pregnant women against influenza
  • The Royal Australian and New Zealand College of Obstetricians strongly endorse routine vaccination of obstetric and midwifery staff, both to protect these individuals as well as their families, closes contacts and patients.

 

References

  1. Zaman, K. Eliza Roy, Shams E. Arifeen et al. Effectiveness of Maternal Influenza Immunization in Mothers and Infants; N Engl J Med 2008; 359: 1555-1564.
  2. Rothberg MB, Haessler SD, Brown RB. Complications of viral influenza; Am J Med. 2008 Apr; 121(4): 258 -64.
  3. Naleway AL, Smith WJ, Mullooly JP. Delivering influenza vaccine to pregnant women. Epidemiol Rev. 2006; 28:47-53. Epub 2006 May 26.
  4. ANZIC Influenza Investigators, Webb SA, Pettilä V, Seppelt I, Bellomo R et al. Critical care services and 2009 H1N1 influenza in Australia and New Zealand. N Engl J Med. 2009 Nov 12;361(20):1925-34. Epub 2009 Oct 8
  5. Hewagama S, Walker SP, Stuart RL, Gordon C, Johnson PD, Friedman ND, O’Reily M, Cheng AC, Giles ML. 2009 H1N1 influenza A and pregnancy outcomes in Victoria, Australia. Clin Infect Dis. 2010 Mar 1;50(5):686-9
  6. Australian Dept. Health and Aging, NHMRC. The Australian Immunisation Handbook 9th Edition. Available online at http://www.health.gov.au/internet/immunise/publishing.nsf/Content/Handbook-influenza
  7. Mak TK, Mangtani P, Leese J, Watson JM, Pfeifer D. Influenza vaccination in pregnancy: current evidence and selected national policies. Lancet Infect Dis. 2008 Jan;8(1):44-52.
  8. Tamma PD, Ault KA, del Rio C, Steinhoff MC, Halsey NA, Omer SB. Safety in influenza vaccination during pregnancy. Am J Obstet Gynecol. 2009 Dec;201(6):547-52. Epub 2009 Oct 21.
  9. Lacroix I, Damase-Michel C, Kreft-Jais C, Castot A, Montastruc JL; French Association of Regional Pharmacovigilance Centres 2009 H1N1 influenza vaccines in pregnant women: the French Pharmacovigilance survey. Vaccine. 2011 Feb 4;29(7):1357-8. Epub 2010 Dec 23.
  10. Moro, P.L., Border K, Zheteyeva Y, et al. Adverse events in pregnant women following administration of trivalent inactivated influenza vaccine and live attenuated influenza vaccine in the Vaccine Adverse Event Reporting System, 1990-2009. American Journal of Obstetrics & Gynecology Volume 204, Issue 2 , Pages 146.e1-146.e7, February 2011
  11. Benowitz I, Esposito DB, Gracey KD, Shapiro ED, Vázquez M. Influenza vaccine given to pregnant women reduces hospitalization due to influenza in their infants. Clin Infect Dis. 2010 Dec 15;51(12):1355-61. Epub 2010 Nov 8.
  12. Eick, A.A., Timothy M. Uyeki, MD, MPH, MPP; Alexander Klimov, PhD; Henrietta Hall, MS; Raymond Reid, MD; Mathuram Santosham, MD; Katherine L. O’Brien. Maternal Influenza Vaccination and Effect on Influenza Virus Infection in Young Infants. Arch Pediatr Adolesc Med. 2011;165(2):104-111

 

Disclaimer

This College Statement is intended to provide general advice to Practitioners. The statement should never be relied on as a substitute for proper assessment with respect to the particular circumstances of each case and the needs of each patient.

The statement has been prepared having regard to general circumstances. It is the responsibility of each Practitioner to have regard to the particular circumstances of each case, and the application of this statement in each case. In particular, clinical management must always be responsive to the needs of the individual patient and the particular circumstances of each case.

This College statement has been prepared having regard to the information available at the time of its preparation, and each Practitioner must have regard to relevant information, research or material which may have been published or become available subsequently.

Whilst the College endeavours to ensure that College statements are accurate and current at the time of their preparation, it takes no responsibility for matters arising from changed circumstances or information or material that may have become available after the date of the statements.

 
Go to top

Copyright © 2011 Royal Australian and New Zealand College of Obstetricians and Gynaecologists. ABN: 34 100 268 969