Advertisement

Influenza in Pregnancy: The Case for Prevention

  • Shelly McNeil
  • Beth Halperin
  • Noni MacDonald
Chapter
Part of the Advances in Experimental Medicine and Biology book series (AEMB, volume 634)

Introduction

Influenza viruses are the most common cause of serious respiratory morbidity throughout the world with annual attack rates of 10–40% during each 5–6-week winter outbreak in temperate climates. In tropical climes, the outbreaks have a less distinct and more variable seasonal pattern but the attack rates are similar. Certain populations are well recognized to be at higher risk for serious disease with influenza (Table 1) either due to age (<2 years or >65 years) or to underlying medical conditions or pregnancy (CDC, 2007a; NACI, 2007). Influenza immunization is recommended for all these high-risk groups in North America (CDC, 2007a; NACI, 2007).
Table 1

People at high risk of influenza-related complications (CDC, 2007; NACI, 2007)

Adults and children with chronic health conditions requiring medical follow-up or hospital care:

 • Cardiac or pulmonary disorders (including asthma, cystic fibrosis,   and bronchopulmonary dysplasia)

 • Diabetes mellitus and other metabolic...

Keywords

Pregnant Woman Avian Influenza Influenza Vaccine Influenza Vaccination Influenza Season 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. Acs N, Banhidy F, Puho E, Czeizel AE (2005). Maternal influenza during pregnancy and risk of congenital abnormalities in offspring. Birth Defects Res A Clin Mol Teratol, 73: 989–996.PubMedCrossRefGoogle Scholar
  2. American Lung Association Asthma Clinical Research Centers (2001). The safety of inactivated influenza vaccine in adults and children with asthma. N Engl J Med, 345: 1529–1536.CrossRefGoogle Scholar
  3. Aro T, Haapakoski J, Heinonen OP (1984). A multivariate analysis of the risk indicators of reduction limb defects. Int J Epidemiol, 13: 459–464.PubMedCrossRefGoogle Scholar
  4. Black SB, Shinefield HR, France EK, Fireman BH, Platt ST, Shay D (2004). Vaccine Safety Datalink Workgroup: Effectiveness of influenza vaccine during pregnancy in preventing hospitalizations and outpatient visits for respiratory illness in pregnant women and their infants. Am J Perinatol, 21: 333–339.PubMedCrossRefGoogle Scholar
  5. Bland PB (1919). Influenza in its relation to pregnancy and labor. Am J Obstet Dis Women Child, 79: 184–197.Google Scholar
  6. Brown A (2006). Prenatal infection as a risk factor for schizophrenia. Schizophr Bull, 32: 200–202.PubMedCrossRefGoogle Scholar
  7. Busby A, Dolk H, Armstrong B (2005). Eye anomalies. Seasonal variation and maternal viral infections. Epidemiology, 16: 317–322.PubMedCrossRefGoogle Scholar
  8. Centers for Disease Control and Prevention (2007a). Prevention and control of influenza: recommendations of the advisory committee on immunization practices. MMWR, 56 (RR-6): 1–25.Google Scholar
  9. Centers for Disease Control and Prevention (2007b). Guidance for prevention and control of influenza in the peri- and postpartum settings. www.cdc.gov/flu/professionals/infectioncontrol/peri-post-settings.htm.
  10. Cox S, Posner SS., McPheeters M, Jamieson DJ, Kourtis AP, Meikle S (2006). Hospitalizations with respiratory illness among pregnant women during influenza season. Obstet Gynecol, 107: 1315–1322.PubMedCrossRefGoogle Scholar
  11. Cox S, Posner SF, McPheeters M, Jamieson DJ, Kourtis AP, Meikle S (2006). Influenza and pregnant women: hospitalization burden, 1998–2002. J Womens Health, 15: 891–893.CrossRefGoogle Scholar
  12. Czeizel AE, Puho EH, Acs N, Banhidy F (2007). High fever-related maternal diseases as possible causes of multiple congenital abnormalities: a population-based case-control study. Birth Defects Res A Clin Mol Teratol, 79: 544–551.PubMedCrossRefGoogle Scholar
  13. Davis D, O’Brien MAT, Wolf FM, Freemantle N, Mazmanian P, Taylor-Vaisey A (1999). Impact of formal continuing medical education. Do conferences, workshops, rounds and other traditional continuing education activities change physician behaviour or health care outcomes? JAMA, 282: 867–874.PubMedCrossRefGoogle Scholar
  14. Department of Health, United Kingdom (2006). Immunization against infectious disease- the Green Book. Chapter 19. Influenza, ed. R.M. Salisbury D, Noakes K. 2006, London, UK: TSO (The Stationery Office) www.dh.gov.uk/en/Policyandguidance/Healthandsocialcaretopics/Greenbook/index.htm.
  15. Dodds L, McNeil SA, Fell DB, Allen VM, Coombs A, Scott J, MacDonald N (2007). Impact of influenza exposure on rates of hospital admissions and physician visits because of respiratory illness among pregnant women. CMAJ, 176: 463–468.PubMedCrossRefGoogle Scholar
  16. Edwards MJ (2006). Review: hyperthermia and fever during pregnancy. Birth Defects Res A Clin Mol Teratol, 76: 507–516.PubMedCrossRefGoogle Scholar
  17. Englund J (2003). Maternal immunization with inactivated influenza vaccine: rationale and experience. Vaccine, 21: 3460–3464.PubMedCrossRefGoogle Scholar
  18. Englund JA, Mbawuike IN, Hammill H, Holleman MC, Baxter BD, Glezen WP (1993). Maternal immunization with influenza or tetanus toxoid vaccine for passive antibody protection in young infants. J Infect Dis, 168: 647–656.PubMedCrossRefGoogle Scholar
  19. Erickson LJ, De Wals P., Farand L (2005). An analytical framework for immunization programs in Canada. Vaccine, 23: 2470–2476.PubMedCrossRefGoogle Scholar
  20. Fatemi SH, Pearce DA, Brooks AI, Sidwell RW (2005). Prenatal viral infection in mouse causes differential expression of genes in brains of mouse progeny: a potential animal model for schizophrenia and autism. Synapse, 57: 91–99.PubMedCrossRefGoogle Scholar
  21. France EK, Smith-Ray R, McClure D, Hambidge S, Xu S, Yamasaki K, Shay D, Weintraub E, Fry AM, Black SB, Shinefeld HR, Mullooly JP, Jackson LA, and the Vaccine Safety Datalink Team (2006). Impact of maternal influenza vaccination during pregnancy on the incidence of acute respiratory illness visits among infants. Arch Pediatr Adolesc Med, 160: 1277–1283.PubMedCrossRefGoogle Scholar
  22. Freeman DW, Barno A (1959). Deaths from Asian Influenza Associated with Pregnancy. Amer J Obst Gynec, 78: 1172–1175.Google Scholar
  23. Glezen WP, Couch RB (1978). Interpandemic influenza in the Houston area, 1974–1976. N Engl J Med, 298: 587–592.PubMedCrossRefGoogle Scholar
  24. Glezen WP, Keitel WA, Taber LH, Piedra PA, Clover RD, Couch RB (1919). Age distribution of patients with medically-attended illnesses caused by sequential variants of influenza A/H1N1: comparison to age-specific infection rates, 1978–1989. Am J Epidemiol, 133 (3): 296–304.Google Scholar
  25. Greenberg M, Jacobziner H, Pakter J, Weisl BA(1958). Maternal mortality in the epidemic of Asian influenza, New York City 1957. Amer J Obst and Gynec, 76: 897–902.Google Scholar
  26. Grimshaw JM, Thomas RE, MacLennan G, Fraser C, Ramsay CR, Vale L, Whitty P, Eccles MP, Matowe L, Shirran L, Wensing M, Dijkstra R, Donaldson C (2004). Effectiveness and efficiency of guideline dissemination and implementation strategies. Health Technol Assess, 8 (6): iii–iv, 1–72. PubMedGoogle Scholar
  27. Halperin BA, MacKinnon-Cameron D, McNeil S (2006). Survey of knowledge, attitudes, and behaviour regarding influenza vaccination in pregnancy and childhood. International Conference on Women and Infectious Diseases (ICWID). Atlanta, USA March 17–19, 2006 (Abstract #38). www.womenshealthconf.org
  28. Harris JW (1919). Influenza occurring in pregnant women. A statistical study of thirteen hundred and fifty cases. Jour A.M.A, 72: 978–980.CrossRefGoogle Scholar
  29. Hartert TV, Neuzil KM, Shintani AK, Mitchel EF Jr., Snowden MS, Wood LB, Dittus RS, Griffin MR (2003). Maternal morbidity and perinatal outcomes among pregnant women with respiratory hospitalizations for influenza season. Am J Obstet Gynecol, 189: 1705–1712.PubMedCrossRefGoogle Scholar
  30. Heinonen OP, Shapiro S, Monson RR, Hartz SC, Rosenberg L, Slone D (1973). Immunization during pregnancy against poliomyelitis and influenza in relation to childhood malignancy. Int J Epidemiol, 2: 229–235.PubMedCrossRefGoogle Scholar
  31. Irving WL, James DK, Stephenson T, Laing P, Jameson C, Oxford JS, Chakraverty P, Brown DWG, Boon ACM, Zambon MC (2000). Influenza virus infection in the second and third trimesters of pregnancy: a clinical and seroepidemiological study. BJOG, 107: 1282–1289.PubMedCrossRefGoogle Scholar
  32. Izurieta HS, Thompson WW, Kramarz P, Shay DK, Davis RL, DeStefano F, Black S, Shinefield H, Fukuda K (2000). Influenza and the rates of hospitalization for respiratory disease among infants and young children. N Engl J Med, 342: 232–239.PubMedCrossRefGoogle Scholar
  33. Kilbourne E (2006). Influenza pandemics of the 20th century. Emerg Iinfect Dis, 12: 9–14.CrossRefGoogle Scholar
  34. Kort BA, Cefalo RC, Baker VV(1986). Fatal influenza in pregnancy. Am J Perinatol, 2: 179–182.CrossRefGoogle Scholar
  35. Kwan ML, Metayer C, Crouse V, Buffler PA (2007). Maternal illness and drug/medication use during the period surrounding pregnancy and risk of childhood leukemia among offspring. Am J Epidemiol, 165: 27–35.PubMedCrossRefGoogle Scholar
  36. Kwong JC, Sambell C, Johansen H, Stukel TA, Manuel DG (2006). The effect of universal influenza immunization on vaccination rates in Ontario. Health Rep, 17: 31–40.PubMedGoogle Scholar
  37. Laibl VR, Sheffield JS (2005). Influenza and pneumonia in pregnancy. Clin Perinatol, 32: 727–738.PubMedCrossRefGoogle Scholar
  38. Leck I (1971). Further tests of the hypothesis that influenza in pregnancy causes malformations. HSMHA Health Rep, 86: 265–269.PubMedCrossRefGoogle Scholar
  39. Li Z, Ren A, Liu J, Pei L, Zhang L, Guo Z, Li Z (2007). Maternal flu or fever, medication use and neural tube defects: a population based case control study in northern China. Birth Defects Res A Clin Mol Teratol, 79: 295–300.PubMedCrossRefGoogle Scholar
  40. Local Government Board (1919). 48th Annual Report 1918–1919. Supplement containing the report of the medical department. Section 2. Influenza. London: Her Majesty’s Stationery Office; 7–32.Google Scholar
  41. Lynberg MC, Muin JK, Lu X, Cocian T (1994). Maternal flu, fever and the risk of neural tube defects: a population-based case control study. Am J Epidemiol, 140: 244–255.PubMedGoogle Scholar
  42. MacDonald NE, McNeil S, Allen VM, Scott J, Dodds L (2004). Influenza vaccine programs and pregnancy: a need for more evidence. J Obstet Gynaecol Can, 26: 961–963.PubMedGoogle Scholar
  43. Mazmanian PE, Davis DA (2002). Continuing medical education and the physician as learner: guide to the evidence. JAMA, 288: 1057–1060.PubMedCrossRefGoogle Scholar
  44. McGregor JA, Burns JC, Levin MJ, Burlington B, Meiklejohn G (1984). Transplacental passage of influenza A/Bangkok (H3N2) mimicking amniotic fluid infection syndrome. Am J Obstet Gynecol, 149: 856–859.PubMedGoogle Scholar
  45. McKinney WP, Volkert P, Kaufman J (1990). Fatal swine influenza pneumonia during late pregnancy. Arch Intern Med, 150: 213–215.PubMedCrossRefGoogle Scholar
  46. McNeil S, Dodds L, Fell D, Coombs A, Scott J, Allen V, Halperin B, MacDonald N (2006). Impact of influenza on respiratory-related hospitalizations and pre-term births in pregnant women: from evidence to public health practice in Canada, 83rd Canadian Pediatric Society Annual Meeting, June 13–17, 2006, St. John’s, NL Paediatr Child Health, 11 Suppl B: Abstract# 19B.Google Scholar
  47. McNeil SA, Dodds L, Allen VM, Scott J, Halperin B, MacDonald N (2007). Influenza vaccine programs and pregnancy: new Canadian evidence for immunization. JOGC, 29: 674–676.PubMedGoogle Scholar
  48. Meyer U, Schwendener S, Feldon J, Yee B (2006). Prenatal and postnatal maternal contributions in the infection model of schizophrenia. Exp Brain Res 173: 243–257.PubMedCrossRefGoogle Scholar
  49. Mortimer P (2006). Influenza-related death rates for pregnant women. Emerging infectious diseases. Emerg Infect Dis, 12: 1805–1806.PubMedCrossRefGoogle Scholar
  50. Muennig PA, Khan K (2001). Cost-effectiveness of vaccination versus treatment of influenza in healthy adolescents and adults. CID, 33: 1879–1885.CrossRefGoogle Scholar
  51. Mullooly JP, Barker W, Nolan TF (1986). Risk of acute respiratory disease among pregnant women during influenza A epidemics. Public Health Rep, 101: 205–211.PubMedGoogle Scholar
  52. Mullooly JP, Bridges CB, Thompson WW, Chen J, Weintaub E, Jackson LA, Black S, Shay DK, Vaccine Data Safety Adult Working Group (2007). Influenza- and RSV-associated hospitalizations among adults. Vaccine, 25: 846–855.PubMedCrossRefGoogle Scholar
  53. Munoz FM, Greisinger AJ, Wehmanen OA, Mouzoon ME, Hoyle JC, Smith FA, Glezen WP (2005). Safety of influenza vaccination during pregnancy. Am J Obstet Gynecol, 192: 1098–1106.PubMedCrossRefGoogle Scholar
  54. Murray DL, Imagawa DT, Okada DM, St. Geme JW Jr. (1979). Antibody response to monovalent A/New Jersey/8/76 influenza vaccine in pregnant women. J Clin Microbiol, 10: 184–187.PubMedGoogle Scholar
  55. Naleway AL, Smith WJ, Mullooly JP (2006). Delivering influenza vaccine to pregnant women. Epidemiol Rev, 28: 47–53.PubMedCrossRefGoogle Scholar
  56. National Advisory Committee on Immunization (2004), Statement on influenza vaccination for the 2004–2005 season. CCDR,30 (ACS-3): 1–32.Google Scholar
  57. National Advisory Committee on Immunization (2007). Statement on influenza vaccination for the 2007–2008 season. CCDR, 33 (ACS-7): 1–38.Google Scholar
  58. Neuzil KM, Reed GW, Mitchel EF, Simonsen L, Griffin MR (1998). Impact of influenza on cardiopulmonary hospitalizations in pregnant women. Am J Epidemiol, 148: 1094–1102.PubMedGoogle Scholar
  59. Neuzil KM, Mellen BG, Wright PF, Mitchel EF Jr, Griffin MR (2000). The effect of influenza on hospitalizations, outpatient visits, and courses of antibiotics. N Engl Med, 324: 225–231.CrossRefGoogle Scholar
  60. Poland GA, Jacobson RM, Targonski PV (2007). Avian and pandemic influenza: an overview. Vaccine, 25: 3057–3061.PubMedCrossRefGoogle Scholar
  61. Pool V, Iskander J (2006). Safety of influenza vaccination during pregnancy. Am J Obstet Gynec, 194: 1200–1201.PubMedCrossRefGoogle Scholar
  62. Previc FH (2007). Prenatal influences on brain dopamine and their relevance to the rising incidence of autism. Med Hypotheses, 68: 46–60.PubMedCrossRefGoogle Scholar
  63. Ramphal R, Donnelly WH, Small PA Jr (1980). Fatal influenzal pneumonia in pregnancy: failure to demonstrate transplacental transmission of influenza virus. Am J Obstet Gynecol, 138: 347–348.PubMedGoogle Scholar
  64. Rastogi D, Wang C., Mao X, Lendor C, Rothman PB, Miller RL (2007). Antigen-specific immune responses to influenza vaccine in utero. J Clin Invest, 117: 1637–1646.PubMedCrossRefGoogle Scholar
  65. Registrar General’s Report 1918/1919 (1919). Eighty-second annual report of the registrar-general of births, deaths, and marriages in England and Wales (1919). Her Majesty's Stationery Office. p. xxviii.Google Scholar
  66. Roberts S, Hollier LM, Sheffield J, Laibl V, Wendel GD Jr (2006). Cost-effectiveness of universal influenza vaccination in a pregnant population. Obstet Gynecol, 107: 1323–1329.PubMedCrossRefGoogle Scholar
  67. Saxen L, Holmberg PC, Kurpa K, Kuosma E, Pyhala R (1990). Influenza epidemics and anencephaly. AJPH 80: 473–475.CrossRefGoogle Scholar
  68. Schanzer DL, Langley JM, Tam TWS (2007). Influenza-attributed hospitalization rates among pregnant women in Canada 1994–2000. JOGC, 29: 622–629.PubMedGoogle Scholar
  69. Schoenbaum SC, Weinstein L (1979). Respiratory infection in pregnancy. Clin Obstet Gynecol, 22: 293–300.PubMedCrossRefGoogle Scholar
  70. Shu Y, Yu H, Li D (2006). Lethal avian influenza A (H5N1) infection in a pregnant woman in Anhui Province, China. N Engl J Med, 354: 1421–1422.PubMedCrossRefGoogle Scholar
  71. Silverman NS, Greif A (2001). Influenza vaccination during pregnancy: patients’ and physicians’ attitudes. J Reprod Med, 46: 989–994.PubMedGoogle Scholar
  72. Simonsen L, Fukuda K, Schonberger LB, Cox NJ (2000). The impact of influenza epidemics on hospitalizations. J Infect Dis, 181: 831–837.PubMedCrossRefGoogle Scholar
  73. Simonsen L, Reichert TA, Viboud C, Blackwelder WC, Taylor RJ, Miller MA (2005). Impact of influenza vaccination on seasonal mortality in the US elderly population. Arch Intern Med, 165: 265–272.PubMedCrossRefGoogle Scholar
  74. Stanwell-Smith R, Parker AM, Chakraverty P, Soltanpoor N, Simpson CN (1994). Possible association of influenza A with fetal loss: investigation of a cluster of spontaneous abortions and stillbirths. Commun Dis Rep CDR Review, 4: R28–R32.Google Scholar
  75. Steinhoff MC, Zaman K, Roy E, Arifeen SE, Rahman M, Raqib R, Shahid N (2006). Incidence of vaccine preventable influenza illness in 0–5 month-old infants. Infectious Disease Society of America. Toronto Canada. October 2006: Abstract LB-6.Google Scholar
  76. Sumaya CV, Gibbs RS (1979). Immunization of pregnant women with influenza A/New Jersey/76 virus vaccine: reactogenicity and immunogenicity. J Infect Dis, 140: 141–146.PubMedCrossRefGoogle Scholar
  77. Taubenberger JK, Morens DM (2006). 1918 Influenza: the mother of all pandemics. Emerg Infect Dis, 12: 15–22.PubMedCrossRefGoogle Scholar
  78. Tuyishime J-de-D, DeWals P, Moutquin J-M, Frost E (2003). Influenza-like illness during pregnancy: results from a study in the Eastern Townships, Province of Quebec. JOGC, 25: 1020–1025.PubMedGoogle Scholar
  79. Viboud C, Tam T, Fleming D, Miller MA, Simonsen L (2006). 1951 influenza epidemic, England and Wales, Canada, and the United States. Emerg Infect Dis, 12: 661–668.PubMedCrossRefGoogle Scholar
  80. Voldsgaard P, Schiffman J, Mednick S, Rodgers B, Christensen H, Bredkjaer S, Schulsinger F (2002). Accuracy of retrospective reports of infections during pregnancy. Int J Methods Psychiatr Res, 11: 184–186.PubMedCrossRefGoogle Scholar
  81. Wallis DH, Chin JL, Sur DKC (2004). Influenza vaccination in pregnancy: current practices in a suburban community. J Am Board Fam Pract, 17: 287–291.PubMedCrossRefGoogle Scholar
  82. Widelock D, Csizmas L, Klein S (1963). Influenza, pregnancy and fetal outcome. Public Health Rep, 78 (1): 1–11.PubMedGoogle Scholar
  83. Wong CM, Yang L, Chan KP, Leung GM, Chan KH, Guan Y, Lam TH, Hedley AJ, Peiris JSM (2006). Influenza-associated hospitalization in a subtropical city. PLOS Medicine, 3: 485–492.CrossRefGoogle Scholar
  84. World Health Organization (2007). Cumulative number of confirmed human cases of Avian Influenza A/(H5N1) Reported to WHO: July 11, 2007. www.who.int/csr/disease/avian_influenza/country/cases_table_2007_07_11/en/index.html.
  85. Yawn DH, Pyeatte JC, Joseph JM, Eichler SL, Garcia-Bunuel R (1971). Transplacental transfer of influenza virus. JAMA, 216: 1022–1023.PubMedCrossRefGoogle Scholar
  86. Yeager DP, Toy EC, Baker B III (1999). Influenza vaccination in pregnancy. Am J Perinatol, 16: 283–286.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Shelly McNeil
    • 1
  • Beth Halperin
  • Noni MacDonald
  1. 1.Canadian Centre for Vaccinology, Dalhousie University, IWK Health CentreHalifaxCanada

Personalised recommendations