*Note- All clinical recommendations/guidance are from the CDC
Pregnant and Laboring Women
Pregnant women, even in women without other health conditions, are especially vulnerable to the H1N1 flu, and have a much higher rate of hospitalization and death than the general population. In fact, about 6% of all H1N1 deaths have been in pregnant women, even though they only make up 1% of the total population. This is a very alarming trend, and speaks to the heightened need for pregnant women to be wash their hands often, avoid close contact (if possible) with anyone that is ill and be vaccinated for H1N1. The Advisory Committee on Immunization Practices has identified pregnant women as a target group for primary vaccination with an H1N1 pandemic flu vaccine, to protect her and her baby.
Treatment : Early treatment with antivirals (5-day course, oseltamivir recommended) is urged for pregnant women with suspected, probable, or confirmed cases of H1N1. Clinicians do not need to wait for confirmed test results to begin treatment. Pregnancy should not be considered a contraindication to antiviral use, as pregnant women appear to be at higher risk for severe complications from H1N1 and the benefits outweigh the theoretical risks of antiviral use.
Ill women in labor: Laboring women wth suspected or confirmed H1N1 should be isolated from well women and wear a surgical mask to prevent transmission to the infant and birth attendants. A mother with influenza-like illness is recommended to be kept separate from her baby until she has had 48 hours of antiviral therapy, is afebrile, and can control her cough and secretions. She should still be encouraged to express her breastmilk for the baby, and to breastfeed as soon as possible.
Newborns of ill mothers: The babies should be closely monitored for signs and symptoms of influenza illness. Treatment with antivirals should be considered if the infant is thought be ill, however, prophylaxis is not routinely recommended due to very limited safety data.
Antivirals as prophylaxis: Pregnant women that have had close contact with a suspected, probable or confirmed case of H1N1 should be given antivirals as prophylaxis (10-day course) right away. The risks of influenza illness are thought to outweigh the theoretical risks of antiviral use.
See the links below for specialty groups in maternal-newborn nursing and medicine.
Special Guidance for Nurses Who Are Pregnant
Pregnant women who will likely be in direct contact with patients with confirmed, probable, or suspected H1N1 (e.g., a nurse, physician, or respiratory therapist caring for hospitalized patients), should consider reassignment to lower-risk activities, such as telephone triage. If reassignment is not possible, pregnant women should avoid participating in procedures that may generate increased small-particle aerosols of respiratory secretions in patients with known or suspected influenza.
Pediatrics
Children are especially susceptible to influenza. Treatment for suspected or confirmed cases of H1N1 should begin as soon as possible. Oseltamivir is approved for children 1 year and older, however the Federal Drug Administration has issued an Emergency Use Authorization (EUA) for the use of oseltamivir for treatment and prophylaxis in children under the age of 1. Zanamivir (Relenza ®) is approved for children 7 years and older (there is no EUA for zanamivir). Specific dosing instructions are on the Antivirals Usage and Dosing link below.
Severly Immunosuppressed Patients
While some severely immunosuppressed patients may develop typical signs and symptoms of influenza, fever may not always be present. Therefore, clinicians should suspect influenza in any severely immunosuppressed patient with acute respiratory symptoms, with or without fever, and initiate empiric antiviral treatment as soon as possible and send respiratory specimens for real-time reverse-transcriptase polymerase chain reaction.
Although influenza vaccination is the best way to prevent influenza, influenza vaccination may be poorly immunogenic in severely immunosuppressed patients6. Therefore, antiviral chemoprophylaxis of influenza can be considered for severely immunosuppressed patients. Immunosuppressed persons aged 6 months and older are recommended to receive both inactivated seasonal influenza vaccine and inactivated 2009 H1N1 monovalent influenza vaccine.
Antiviral therapy with a neuraminidase inhibitor (oseltamivir, zanamivir) should be initiated empiricallyas early as possible for severely immunosuppressed patients with suspected influenza.
Schools
Schools are seen a primary place where the virus will spread, putting school nurses at the forefront for surveillance and control of the flu. The CDC has released new guidance to help school officials in the decision to close a school due to H1N1 outbreaks. School closures, while they seem to be a good way to control the spread of the disease in children, are not as simple as they seem. Closing a school can have significant negative impact on children, their parents, employers, and the school system in general. See the Guidance on School Closures below, as well as a link to the National School Nurses Association website.
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