Download Get flu vaccine to protect yourself, your family and your

Flu vaccination in pregnancy: information for midwives 2014-15
Pregnant women are now well recognised as being at significantly increased risk of
complications from influenza infection, including death. Their child is also at serious risk,
before and after they are born, if they or their mother catches flu. Therefore all pregnant
women, at any stage of pregnancy, should be actively offered free flu vaccination. Flu
vaccination is safe at all stages of pregnancy.
Twelve pregnant women have died from flu infection and its complications in England and
Wales in the last few years1. The risk is greatest in the last three months of pregnancy2. If a
woman catches flu during pregnancy she is:
 four to five times more likely than non-pregnant individuals to get severe disease3
 at increased risk of admission to intensive care3,4,
 seven times more likely to die from flu than non pregnant women 5,6
 at increased risk of experiencing spontaneous abortion, pre-term birth, and foetal
distress4,5,6
Since the introduction of flu vaccination for all pregnant women in Wales the uptake rate has
been improving, the target is 75%. Based on general practice data in 2013 – 14 uptake was
43.7%, and in a separate point of delivery five day survey of women giving birth during
January 2014, 70.5% of women questioned recalled having received influenza immunisation.7
Midwives have a key role in promoting flu vaccination to their clients. A study of 800
practices found that those where the community midwives were active in administering flu
vaccinations to pregnant patients achieved significantly higher rates of uptake in that at-risk
group (p = 0.023).8
Flu vaccination is safe in all stages of pregnancy
Pregnant women should receive inactivated flu vaccine. There is no evidence of risk during
pregnancy with inactivated viral, bacterial or toxoid vaccines.9,10 Hundreds of thousands of pregnant
women have had a flu vaccine. Data from worldwide use of inactivated influenza vaccines do not
indicate any adverse foetal and maternal outcomes attributable to the vaccine. Animal studies do not
indicate reproductive toxicity.11
There are very few contraindications to the flu vaccine. The only absolute contraindication is
women who have a confirmed history of an anaphylactic reaction to a previous flu vaccine or
any components of the vaccine (except ovalbumin).
Women with confirmed anaphylaxis to egg or egg allergy with uncontrolled asthma can
receive an egg free vaccine in primary care or one with very low albumin content
under supervision in hospital.
© 2014 Public Health Wales NHS Trust.
Material contained in this document may be reproduced without prior permission provided it is done so
accurately and is not used in a misleading context.
Acknowledgement to Public Health Wales NHS Trust to be stated.
Flu vaccine offers good protection to the woman and her unborn baby
Vaccination of pregnant women provides protection for the woman and her baby during the
pregnancy.13 It also protects the baby against flu in the first 4-6 months of life when infection
can be very serious; it is 91.5% effective in preventing hospitalisation of infants in the
first six months of life.14 Seasonal flu vaccination provides around 70% protection in healthy
people in seasons where vaccine is well matched to circulating strains. This protection is
expected to last for one flu season. Longer lasting protection is uncertain so annual flu
immunisation is recommended for those at risk.12 Flu vaccine is available each year usually from
the end of September. The vaccine is best administered in early autumn before the flu season
begins. However, near the end of flu season clinicians should apply clinical judgement to assess
the needs of an individual woman taking into account the level of flu like illness in their
community and the fact that the immune response following vaccination takes about two weeks
to develop fully.
Flu vaccination for midwives
All healthcare professionals working in maternity services should also be actively encouraged
to accept vaccination against seasonal flu, offered through their employer’s Occupational
Health Service. This will both protect staff from infection and pregnant women from exposure
to infected staff.
Get flu vaccine to protect yourself, your family and your patients.
More information including leaflets, training resources etc are available from:
http://howis.wales.nhs.uk/sites3/page.cfm?orgid=474&pid=58686
© 2014 Public Health Wales NHS Trust.
Material contained in this document may be reproduced without prior permission provided it is done so
accurately and is not used in a misleading context.
Acknowledgement to Public Health Wales NHS Trust to be stated.
References
1. CMACE Emergent Theme Briefing December 2010. Available at;
https://www.rcm.org.uk/sites/default/files/Review-of-Maternal-Deaths~he-United-Kingdomre.pdf. Accessed 20/8/14
2. Health Protection Agency. Surveillance of influenza and other respiratory viruses in the UK,
annual reports. 2012 - 13 available at
http://www.hpa.org.uk/webc/HPAwebFile/HPAweb_C/1317139321787. Accessed 21/8/14
3. NHS choices. http://www.nhs.uk/Conditions/pregnancy-and-baby/Pages/flu-jab-vaccinepregnant.aspx.Accessed 21/8/14.
4. Salisbury D, Ramsay M, Noakes K, editors. Immunisation against Infectious Disease. 3rd edition.
London. Stationery Office; 2006 [updated August 2014. Available from:
https://www.gov.uk/government/collections/immunisation-against-infectious-disease-thegreen-book.Accessed 21/8/14
5. Jamieson DJ, Honein MA, Rasmussen SA, et al. H1N1 2009 influenza virus infection during pregnancy
in USA. The Lancet. 2009. August 08;374:451-458
6. Pebody RG, McClean E, Zhao H et al. Influenza A (H1N1) 2009 and mortality in the United
Kingdom: risk factors for death, April 2009 to March 2010. Eurosurveillance
2010;15(20):pii=19571.Accessed21/8/14
7. McGowan A, Lewis R, Cottrell S, Roberts R (2014 )Uptake of pertussis and influenza vaccination
in pregnant women in Wales 2013-14. Public Health Wales available at:
http://howis.wales.nhs.uk/sites3/page.cfm?orgid=474&pid=54871 Accessed 20/8/14
8. Dexter L, Dexter M, Read RJ, et al. Increasing Influenza Immunisation. Report to the Secretary
of State for Health. Sheffield: University of Sheffield, 2012. Online:
http://www.sheffield.ac.uk/polopoly_fs/1.180289!/file/III-FullReportt.pdf.Accessed21/8/14
9. Plotkin SA, Orenstein WA, Offitt P. Vaccines (5th Edition). 2008. Philadelphia. WB
Saunders Company
10. Tamma PD, Ault KA, del Rio C et al. Safety of influenza vaccination during pregnancy.
American Journal of Obstetrics and Gynecology. 2009. December;201(6):547–
552.Available at www.AJOG.org.Accessed 21/8/14
11. Munoz FM, Greisinger AJ, Wehmanen MS, et al. Safety of influenza vaccination during
pregnancy. American Journal of Obstetrics and Gynecology. 2006. April;194(4):1200 and
FAQ 11 http://howis.wales.nhs.uk/sites3/page.cfm?orgid=474&pid=21350.Accessed
20/8/14
12. Pebody R, Hardelid P, Fleming DM, et al Effectiveness of seasonal 2010/11 and pandemic
influenza (H1N1)2009 vaccines in preventing influenza infection in the United Kingdom:
mid season analysis 2010/11. Eurosurveillance. Volume 16, Issue 6, 10Feb 201. Available
at http://www.eurosurveillance.org/images/dynamic/EE/V16N06/V16N06.pdf.Accessed
21/8/14
13. Eick AE, Uyeki TM, Klimov A et al. Maternal Influenza Vaccination and Effect on Influenza
Virus Infection in Young Infants. Archives of Pediatric and Adolescent Medicine. 2011;
165(2):104-111. Available at
http://archpedi.jamanetwork.com/article.aspx?articleid=384298. Accessed 21/8/14
14. Benowitz I, Esposito DB, Gracey KD, et al. Clinical Infectious Diseases. 2010; 51:135561. Available at http://cid.oxfordjournals.org/content/51/12/1355.full. Accessed 20/8/14
© 2014 Public Health Wales NHS Trust.
Material contained in this document may be reproduced without prior permission provided it is done so
accurately and is not used in a misleading context.
Acknowledgement to Public Health Wales NHS Trust to be stated.