The vaccine is not recommended or pregnant women or or vaccine dose. That said, a registry of more than 1000 vaccine exposed pregnancies reports no cases of congenital varicella syn drome or other associated congenital malformations (Marin, 2014; Wilson, 2008). he attenuated vaccine virus is not secreted in breast milk. hus, postpartum vaccination should not be delayed because of breastfeeding (American College of
Obstetricians and Gynecologists, 2016c).
hese respiratory infections are caused by members of the family Orthomyxoviridae. Inluenza A and B form one genus of these RNA viruses, and both cause epidemic human disease (Cohen, 2015b). Inluenza A viruses are subclassiied further by hemagglutinin (H) and neuraminidase (N) surface antigens. Inluenza outbreaks occur annually, and the most recent epidemic was in 2016 to 2017 caused by an inluenza A/H3N2 strain (Shang, 2016).
Fever, dry cough, and systemic symptoms characterize this infection, which usually is not life-threatening in otherwise healthy adults. However, pregnant women appear to be more susceptible to serious complications, particularly pulmonary involvement (Cohen, 2015b; Mertz, 2017; Rasmussen, 2012). Severe infection has a maternal mortality rate of 1 percent (Duryea, 2015). And from 2009 to 2010, widespread inluenza A infection afected pregnant women and caused 12 percent of pregnancy-related deaths (Callaghan, 2015).
No firm evidence links inluenza A virus and congenital malformations (Irving, 2000; Zerbo, 2017). Conversely,
TABLE 64-2. Outpatient Influenza A and B Virus Testing Methods aNasopharyngeal or throat swab.
RT-PCR = reverse transcription-polymerase chain reaction. Data from Centers for Disease Control and Prevention, 201r7e.
Lynberg and colleagues (1994) reported higher rates of neuraltube defects in neonates born to women with inluenza early in pregnancy. his was possibly associated with hyperthermia. Viremia is infrequent, and transplacental passage is rare (Rasmussen, 2012). Stillbirth, preterm delivery, and irst-trimester abortion have all been reported, but usually correlate with the severity of maternal infection (Centers for Disease Control and Prevention, 2011; Fell, 2017; vleijer, 2015).
Inluenza may be detected in nasopharyngeal swabs using viral antigen rapid detection assays (Table 64-2). Reverse transcriptase-polymerase chain reaction (RT-PCR) is the more sensitive and specific test, although not widely available (Cohen, 2015b). In contrast, rapid influenza diagnostic tests (RIDTs) are least indicative, with sensitivities of 40 to 70 percent. Decisions to administer antiviral medications or inluenza treatment or chemoprophylaxis should be based on clinical symptoms and epidemiological actors. Specifically, the start of therapy should not be delayed pending testing results (Centers for Disease Control and Prevention, 2017 e).
Two classes of antiviral medications are currently available. Neuraminidase inhibitors are highly efective for the treatment of early inluenza A and B. hese include oseltamivir (Tamilu), which is taken orally for treatment and for chemoprophylaxis; zanamivir (Relenza), which is inhaled for treatment; andperamivir (Rapivab), which is administered intravenously.