Information on Pregnancy, Breastfeeding and H1N1 Flu Virus

Updated: June 22, 2010

• Pregnant Women – Which H1N1 Flu Vaccine is Right For You?
• Know what to look for
• Signs of Severe Illness
• Protect Yourself and Your Baby
• H1N1 Flu Vaccine
• Antivirals for Treatment of the Flu
• Considering the Options – Getting the Flu versus Vaccines and Antivirals

Pregnant women are not more likely to get the H1N1 flu, but if they do catch it, they are more likely to suffer complications, like pneumonia and severe respiratory distress. This puts both the mother and the baby's health at risk. Severe complications from the flu could lead to early delivery or miscarriage.

H1N1 Flu Virus: Know What To Look For

Like the seasonal flu, some people who get the H1N1 flu will have a mild illness while other people may become very sick. To date in Canada, most cases of the H1N1 flu (especially in children) have been mild, and sick individuals have recovered quickly.

An average flu sickness (either H1N1 or seasonal) may show the following symptoms:

Almost Always:	Common:	Sometimes:
Sudden onset of: Fever Cough	Fatigue Sore throat Decreased appetite Muscle aches Headache Runny nose	Nausea Diarrhea Vomiting

For pregnant women, the risk of complications from the H1N1 flu is greater in the second and third trimesters of pregnancy and for new mothers, within the six weeks after delivery. Early treatment can help to reduce the risk of complications from the flu. If a pregnant or breastfeeding woman develops flu symptoms, she should speak to a health care provider as quickly as possible.

H1N1 Flu Virus: Signs of Severe Illness

If you develop the following symptoms, seek immediate medical attention:
Shortness of breath, rapid or difficulty breathing Chest pain Bluish or grey skin colour Bloody or coloured sputum (spit)	Severe or persistent vomiting Sudden dizziness or confusion  High fever (over 39.5C) lasting longer than three days  Low blood pressure

Protect Yourself and Your Baby

• Wash your hands often with soap and warm water for at least 20 seconds. Alternatively, if your hands are not visibly dirty you can also clean them with a hand sanitizer with an alcohol content of at least 60-90%. If you are sick, always wash your hands or use a hand-sanitizer before touching your child.
• Breast feed your baby. Breastfeeding is the best way to protect your baby from all illnesses because of the antibodies passed from mother to child. Women who become ill can safely continue to breastfeed their babies. While it isn't known if the flu virus can be passed through breast milk, the benefits of the antibodies in breast milk means that it continues to be the best way to keep your baby healthy.
• Cough and sneeze in your arm, not your hand.
• Know the symptoms of the flu.
• Get immunized with the H1N1 flu vaccine and the seasonal flu vaccine. Both the seasonal flu vaccine and the H1N1 flu vaccine are recommended for pregnant and breastfeeding women.
• Speak to your health care professional as soon as you develop flu symptoms. 
• If you get sick, stay home.
• If you are well, it's important for you to continue to go about your daily activities during the H1N1 flu pandemic. You should continue normal activities such as going to work, community events or worship services.
• Take caution in crowds where you have little control over personal contact. Be vigilant about hand washing and carry a hand sanitizer to reduce the risk of picking up a virus in these types of settings.
• Keep common surfaces and items clean and disinfected.
• Stay healthy by eating healthy foods and keeping active.

For more information about the H1N1 flu and the seasonal flu, such as information about how to take care of someone at home with the flu, please visit www.fightflu.ca or call 1-800-O-CANADA, TTY 1-800-926-9105.

H1N1 Flu Vaccine – Adjuvanted and Unadjuvanted

Getting an H1N1 flu vaccine is the single best way to protect yourself from the H1N1 flu virus. A vaccine produces immunity to a disease by stimulating the production of antibodies (proteins in our bodies that fight diseases).

This year, there will be two flu vaccines – the regular seasonal flu vaccine and the H1N1 flu vaccine. Speak to your healthcare provider for advice on whether to get either or both flu vaccines.

There will be two types of H1N1 flu vaccine available: adjuvanted and unadjuvanted.  An adjuvanted vaccine includes a substance that boosts an individual's immune system and increases their response to a vaccine.  Adjuvants are included in common vaccines such as tetanus and hepatitis B. The adjuvant in Canada's H1N1 flu vaccine is made up of natural ingredients such as water, squalene oil and vitamin E. An unadjuvanted vaccine has no "booster" element.

• The unadjuvanted vaccine is recommended for all pregnant women at any stage of their pregnancy.

However if the unadjuvanted vaccine is not easily available, some pregnant women should consider getting the adjuvanted vaccine.

• If you are more than 20 weeks pregnant, OR if you have a chronic disease (like asthma or diabetes), you are at greater risk for severe complications from the H1N1 flu. You should consider getting the adjuvanted vaccine that is available now.

The potential benefit of early immunity to the H1N1 flu virus (from getting the vaccine) is greater than the possible risk of receiving the adjuvanted flu vaccine.

• If you are less than 20 weeks pregnant, and are healthy, you can wait to get the unadjuvanted vaccine. You are less likely than women in late stages of pregnancy or women with severe chronic disease to develop complications from influenza. Get the unadjuvanted vaccine as soon as it becomes available to you. If you want immunization with the adjuvanted vaccine, that is an option for you.
  

Women who are breastfeeding should receive the adjuvanted H1N1 flu vaccine in order to protect their health and the health of their infant.

Antivirals for Treatment of the Flu

If you develop the flu while you are pregnant or breastfeeding, your health care provider may prescribe antivirals for treatment of the flu.

Antivirals are prescription medications used to treat the flu. While they do not make you immune to the virus, if taken shortly after getting sick (within the first 48 hours), they can reduce flu symptoms, shorten the length of illness and may reduce serious complications.

Antivirals may not be suitable for everyone.  You should talk to your physician.

Women can safely take antiviral medications while breastfeeding. Only low amounts of antiviral medication are passed through breast milk and breast milk continues to be a baby's first line of defense against all illnesses.

Considering the Options – Getting the flu versus getting a vaccine or taking an antiviral

When considering your options about vaccination there are a number of factors that you need to think about. This chart explains the risk of getting the flu versus the benefits and risks of getting an H1N1 flu vaccine and/or taking antiviral medication if you do get the flu.

If you catch the H1N1 Flu

If you are pregnant and become sick with the H1N1 flu there is a chance you could develop severe flu symptoms and be hospitalized.

There is a chance of early delivery or miscarriage.

Knowledge is your best defence. Take steps to protect yourself.

	Getting the H1N1 Flu Vaccine	Taking antivirals after getting the H1N1 flu.
Benefits/Facts	Vaccines have proven benefits. Getting the H1N1 flu vaccine is the single best way to protect yourself and those around you from the H1N1 flu virus.	Antivirals may decrease the severity of sickness.
	You cannot get the flu from the flu vaccine.	Antivirals MUST be taken within the first 48 hours of the onset of symptoms.
	Vaccines are safe. The dangers from vaccine-preventable diseases (like the flu) are many times greater than the risk of a serious reaction to the vaccine.	Very little of the medication is passed through the placenta or through breast milk.
	The H1N1flu vaccine is safe for pregnant and breastfeeding women. Most people have no side effects from flu vaccines.	Recently Health Canada approved the use of antivirals for H1N1(oseltamivir, known as Tamiflu) for children less than one year of age.
	After receiving the H1N1 flu vaccine you will have some immunity to the current strain of the H1N1 flu virus within 10 days.	If you have the flu, talk to your health care provider about treatment options. Antivirals may be one of the treatment options that they recommend.
Risks	Vaccines can have side effects but they are usually mild. You need to weigh the risks of side effects with the risks of serious health problems if you catch the flu.	There is a risk of side effects with any medication including antivirals. The most common side effects of the antiviral oseltamivir include nausea, vomiting, diarrhea, abdominal pain and headaches.
	The most common side effects of flu vaccines are soreness in the arm where the vaccine was given, sore or red eyes, itchiness and for some a mild fever. Most people experience no serious side effects from flu vaccines.	The H1N1 flu virus can adapt and develop resistance to a specific antiviral drug – this means that the drug would no longer be effective in treating the H1N1 flu.
	About one person for every 100,000 doses of vaccine distributed will have a severe reaction to a flu vaccine, including anaphylaxis or Guillain-Barré Syndrome (GBS).	Rare cases of anaphylaxis and serious skin reactions, including toxic epidermal necrolysis, Stevens-Johnson syndrome and erythema multiform, have been reported with the antiviral oseltamivir.
Myth Busting	Thimerosal is a form of mercury used in the H1N1 flu vaccine to stabilize it and maintain its quality during storage. Thimerosal is a different form of mercury than the mercury known to cause health problems. The amount in flu vaccines is much less than the daily limit recommended – for example a can of tuna fish has four times the amount of mercury as the thimerosal in the H1N1 flu vaccine.	Antivirals are not appropriate for everyone. Talk to your health care provider about whether taking antivirals to treat the flu is appropriate for you.
	If you receive the H1N1 flu vaccine you are at no greater risk of acquiring Guillain-Barré syndrome (GBS), a neurological condition that occurs in approximately two in 100,000 people per year and is most often associated with foodborne infections. The possible risk of acquiring GBS from the flu or the flu vaccine is very small.	Antivirals are usually taken in pill form (Tamiflu) or as an inhaled medication (zanamivir).
	An adjuvanted vaccine is a vaccine that includes a substance that boosts an individual's immune system and increases their response to a vaccine. An unadjuvanted vaccine has no "booster" element. Adjuvants are included in common vaccines such as tetanus and hepatitis B. The adjuvant in Canada's H1N1 flu vaccine is made up of natural ingredients such as water, squalene oil and vitamin E. Unadjuvanted vaccines are preferred for pregnant women when the flu virus is not yet in the community. This is because there are less safety data available on adjuvanted vaccine use during pregnancy.	Antiviral drugs given for treatment of the flu usually need to be taken for five days.