Impact of Novel H1N1 on Children & Pregnant Women

Impact of Novel H1N1 Influenza on Children and Pregnant Women:  Planning for the Fall

Prepared by the Centers for Disease Control and Prevention, Atlanta, GA 

Novel H1N1 influenza is a new virus causing illness in people in this country and around the world. The Centers for Disease Control and Prevention (CDC) anticipates that there will be more cases, more hospitalizations and more deaths associated with this pandemic in the United States over the summer and into the fall and winter.  Children, particularly those who are less than 5 years old and pregnant women are at higher risk for complications if they become ill with novel H1N1 influenza. This article includes messages that can be given to parents of infants and young children and pregnant women about steps they can take to protect themselves and others. 

Impact of H1N1 on young children

Children, especially those younger than 5 years of age and those with high-risk medical conditions (such as asthma, diabetes, or a neurologic problem) are at increased risk of influenza-related complications. In a recent study, half of influenza-associated deaths in children were among those with an underlying medical condition.  

Young children are less likely to have typical influenza symptoms (e.g., fever and cough) and infants may have fever, increased sleep, decreased activity, but may not have cough or other respiratory symptoms.  Children may not be able to tell their caregiver about their symptoms or if they are worsening, thus delaying diagnosis, and leading to additional complications. Parents of young children should be instructed to watch closely for signs of flu-like illness so they can contact their healthcare provider immediately. 

Public health authorities may recommend that schools and childcare programs close or dismiss students from classes in the fall if the severity of the novel H1N1 influenza outbreak calls for these protective measures. Children are often sensitive to disruption in routine, such as closure of schools or child care, which may cause them to worry and question why it is happening and how it can be fixed.  Parental confidence and calm attitude will help children ease their worries and feel safe and secure. 

Impact of novel H1N1 influenza on pregnant women 

Consistent with past experience during influenza pandemics, pregnant women who have been infected with the novel H1N1 virus have become more seriously ill than non-pregnant women.  A recent study shows that the rate of hospitalization for pregnant women is more than four times that of the general population. Adverse outcomes among pregnant women reported during the current outbreak include hospitalization, pneumonia requiring mechanical ventilation, maternal death, spontaneous abortion, and preterm birth. Prompt recognition of influenza-like illness (ILI) and prompt treatment of pregnant women with antiviral medications should be strongly encouraged.  Treatment with antiviral medications should be started as soon as possible and the greatest benefits are expected if treatment is started within the first 48 hours after the onset of ILI symptoms. See CDC’s  Interim Guidance for Clinicians on Identifying and Caring for Patients with Swine-origin Influenza A (H1N1) Virus Infection for more information.  

What should parents of infants do?

Infants are thought to be at particularly high risk for severe illness from novel H1N1 infection and very little is known about prevention of the infection in infants.  Babies who are not breastfed get sick from infections like the flu more often and more severely than babies who are breastfed.  Mothers pass on antibodies to their baby during breastfeeding, which help fight infection.  Steps that parents of infants can take include:

§  Call your infant’s health care provider if you think that your infant is ill or has had close contact with a person who has novel H1N1 influenza. 

§  If your baby is ill with novel H1N1 influenza, do not stop breastfeeding.  Your baby needs frequent breastfeeding throughout the illness.  Choose breastfeeding over anything else, including water, juice, or Pedialyte.  If your baby is too sick to breastfeed, he or she can drink your milk from a cup, bottle, syringe, or eyedropper.

§  Do not give aspirin (acetylsalicylic acid) or products that contain aspirin (e.g. bismuth subsalicylate – Pepto Bismol) to infants.

§  Children younger than 4 years of age should not be given over-the-counter cold medications without first speaking with a health care provider. 

§  Make sure your infant gets an immunization for the seasonal flu and that other routine vaccinations are up to date. As soon as a vaccine for novel H1N1 flu is available, get your child (over the age of 6 months) vaccinated for novel H1N1 flu. The seasonal flu shot will only help protect your child from regular flu.  The novel H1N1 flu shot will help protect them from the novel virus.  There is a chance that it will take two shots, about three weeks apart, to get the full benefit from the novel H1N1 flu vaccine.

§  Take everyday precautions such as washing hands or using alcohol-based hand gel frequently to keep your hands clean and especially after sneezing or coughing.

§  Try not to cough or sneeze in your baby’s face when you are close to the infant, and cover your mouth and nose with a tissue when coughing or sneezing.

§  If you are sick with novel H1N1 influenza, ask for help from family members and friends who are not ill to feed and care for your baby, if possible.  If not, wear a facemask, if available and tolerable, especially while in close contact, such as while feeding the baby.

§  Ensure your baby continues to breastfeed and receive breast milk.  Continue breastfeeding even if you are taking medication to prevent novel H1N1 influenza. If you are ill with novel H1N1 influenza, call a health professional such as a lactation consultant for help on expressing and storing milk so someone who is not ill can give your baby your expressed milk. 

§  Ask your infant’s child care provider about their plans for preventing novel H1N1 infection and controlling spread of disease.

§  Have an alternative care plan in case your infant’s child care program closes or care provider becomes ill.

What should parents of school-age children do?

§  Keep sick children home from school for at least 24 hours after their fever is gone, except to seek medical care. (Fever should be gone without the use of a fever-reducing medicine.)

§  Do not give aspirin (acetylsalicylic acid) or products that contain aspirin (e.g. bismuth subsalicylate – Pepto Bismol) to children or teenagers 18 years old or younger.

§  Children younger than 4 years of age should not be given over-the-counter cold medications without first speaking with a health care provider.   

§  Make sure your child gets an immunization for the seasonal flu and that other routine vaccinations are up to date. As soon as a vaccine for novel H1N1 flu is available, get your child vaccinated for novel H1N1 flu. The seasonal flu shot will only help protect your child from regular flu.  The novel H1N1 flu shot will help protect them from the novel virus.  There is a chance that it will take two shots, one month apart, to get the full benefit from the novel H1N1 flu vaccine.

§  Wash hands frequently with soap and water for 20 seconds (long enough for children to sing the “Happy Birthday” song twice).

§  Set a good example for children to cough and sneeze into a tissue and throw the tissue away immediately.  Wash hands after coughing or sneezing.

§  Help children remember not to share cups, water bottles, utensils, or any other items that go in their mouths.

§  Keep children at least six feet away from people who are sick.

§  Encourage children to eat well, sleep well, and play outside. 

Other tips for parents of children include:

§  Keep activities as consistent and normal as possible

§  Ask the child what they have heard about novel H1N1 flu. Answer questions openly and honestly, at a level they can understand. Be concrete and do not avoid difficult questions.

§  Limit unsupervised exposure to media and adult conversations about novel H1N1 flu and make sure you are available to answer questions.

§  See http://www.cdc.gov./h1n1flu/talkingtokids.htm for more information on talking to kids.   

What should pregnant women do?

Pregnant women should be aware that they need to watch for flu symptoms (primarily fever with cough or sore throat) and contact their healthcare provider immediately if they develop these symptoms or if they have had close contact with someone who is sick with the flu.  Pregnant women with novel H1N1 flu should start antiviral treatment as soon as possible, while those who have been exposed to the virus through close contact with someone who is ill should talk to their healthcare provider about the possible need for antiviral medication to prevent getting sick.  Fever in pregnant women should be treated promptly with acetaminophen.  All pregnant women should be vaccinated once a novel H1N1 vaccine becomes available. Getting vaccinated against both seasonal influenza and novel H1N1 flu, when available, is a critical action that pregnant women can take to prevent influenza illness.  Since the novel H1N1 flu vaccine is likely to require two doses, about three weeks apart, health care providers, health departments and organizations interested in the health of pregnant women should be preparing for the challenges of communicating the need for multiple vaccinations for influenza in the coming season.   

In summary, pregnant women, or those who might be pregnant, should: 

  • Know the signs and symptoms of flu and seek care early. Influenza illness, even seasonal influenza, can be serious in a pregnant woman. Antiviral medications used to treat influenza illness work best if taken within two days of getting sick. It is also very important to treat fever quickly.  Fever in a pregnant woman can cause serious problems for her baby. 
  • Stay home if they are sick. Pregnant women who are ill with flu like symptoms should stay home and not go to work or in the community for at least 24 hours after fever is gone, except to seek medical care or for other necessities. (Fever should be gone without the use of a fever-reducing medicine.)
  • As soon as possible, get a flu shot.  Seasonal influenza vaccine is recommended for all women who are or will be pregnant during the 2009-2010 influenza season – roughly October through March of the following year.  Flu shots can be given to pregnant women at any time during pregnancy.
  • As soon as a vaccine for novel H1N1 flu is available, get vaccinated for novel H1N1 flu. The seasonal flu shot will only help protect you from regular flu.  The novel H1N1 flu shot will help protect you from the novel virus.  There is a chance that it will take two shots, about three weeks apart, to get the full benefit from the novel H1N1 flu vaccine. 
  • Use everyday precautions: wash your hands often and cover your coughs and sneezes with a tissue.  Encourage all of your family members to use these precautions too. 
  • Decide now how you will ask for help from your family or neighbors if you or your children get sick with the flu.  Pregnant women who get the flu sometimes get very sick.  Someone will need to make sure you have the care you need, lots of rest, and fluids, and have nourishing meals.  If your children get sick, you may need someone to help care for them so that you aren’t exposed to their germs.
  • Stay informed. Information will likely change as we learn more about the novel H1N1 flu virus and as the pandemic progresses.  For more information, talk with your health care provider and see the CDC website (www.cdc.gov/H1N1/ ). 

Contributors

Lisa M. Koonin MN, MPH; Georgina Peacock, MD, MPH; CAPT Kitty MacFarlane, CNM, MPH; Juliette Kendrick, MD; Katherine Shealy, MPH, IBCLC, RLC; Jennifer Williams, FNP, MPH; Tiffany Colarusso, MD  

References

Bhat, Wright, Broder, et al. Influenza-associated deaths among children in the United States, 2003–2004. N Engl J Med. 2005;353 (24):2559 –2567 

Jamieson et. al  H1N1 2009 influenza virus infection during pregnancy in the USA. The Lancet. www.thelancet.com Published online July 29, 2009 DOI:10.1016/S0140-6736(09)61304-0 

What Pregnant Women Should Know About H1N1 (formerly called swine flu) Virus  http://www.cdc.gov/h1n1flu/guidance/pregnant.htm 

Considerations Regarding Novel H1N1 Flu Virus in Obstetric Settings http://www.cdc.gov/h1n1flu/guidance/obstetric.htm