he adamantanes include amantadine and rimantadine, which were used for years for treatment and chemoprophylaxis of inluenza A. In 2005, inluenza A resistance to adamantine was reported to exceed 90 percent in the United States. hus, its use is not currently recommended. It is possible that these drugs may again be efective for subsequently mutated strains. Patterns of resistance are available at cdc.gov/flu.
Experience with all of these antiviral agents in pregnant women is limited (Beau, 2014; Beigi, 2014; Dunstan, 2014). hey are Food and Drug Administration category C drugs and thus used when potential benefits outweigh risks. At Parkland Hospital, we start oral oseltamivir treatment within 48 hours of symptom onset-75 mg twice daily for 5 days. Earlyadministration may reduce length of hospital stays (Meijer, 2015; Oboho, 2016). Prophylaxis with oseltamivir, 75 mg orally once daily for 7 days, is also recommended for signiicant exposures. Antibacterial medications are added when a secondary bacterial pneumonia is suspected (Chap. 51, p. 993).
Efective vaccines are formulated annually. Vaccination against inluenza throughout the influenza season, but optimally in October or November, is recommended by the Centers for Disease Control and Prevention (CDC) (2013a) and the American College of Obstetricians and Gynecologists (2016b) for all women who will be pregnant during the influenza season. his is especially important for those afected by chronic medical disorders such as diabetes, heart disease, asthma, or human immunodeficiency virus (HIV) infection. Inactivated vaccine prevents clinical illness in 70 to 90 percent of healthy adults. Importantly, there is no evidence of teratogenicity or other adverse maternal or fetal events (Chambers, 2016; Fell, 2017; Kharbanda, 2017; Polyzos, 2015; Sukumaran, 2015). Moreover, for mothers vaccinated during pregnancy, several studies found lower rates of influenza in their infants up to 6 months of age (Nunes, 2017; Steinhof, 2012; Zaman, 2008). Immunogenicity of the trivalent inactivated seasonal inluenza vaccine in pregnant women is similar to that in the nonpregnant individual. A live attenuated influenza virus vaccine is available for intranasal use but is not recommended for pregnant women (Cohen, 2015b).
his uncommon adult infection is caused by an RNA paramyxovirus. Because of childhood immunization, up to 90 percent of adults are seropositive (Rubin, 2012). The virus primarily infects the salivary glands but also may involve the gonads, meninges, pancreas, and other organs. It is transmitted by direct contact with respiratory secretions, saliva, or through fomites. Most transmission occurs before and within 5 days of parotitis onset, and droplet isolation is recommended during this time (Kutty, 2010). Treatment is symptomatic, and mumps during pregnancy is no more severe than in nonpregnant adults.
Women who develop mumps in the first trimester may have a greater risk of spontaneous abortion. Infection in pregnancy is not associated with congenital malformations, and fetal infection is rare (McLean, 2013).