Influenza vaccination in pregnancy: A review
Following the 2009/10 influenza A/H1N1 pandemic, it was recognised that pregnant women were disproportionately represented in cases of hospitalisation and complications of the infection. This, coupled with evidence showing a strong link between influenza infection in pregnancy and increased risk of miscarriage, low birth weight, premature birth, and maternal morbidity and mortality, led to the introduction of pregnant women as an ‘at risk’ group who, in 2010, were recommended to receive annual seasonal influenza immunisation. Uptake of the immunisation remains relatively low, with only 44.9% of women in England receiving the vaccination in the 2016/17 season. Midwives should discuss the potential risks of influenza with pregnant women, promoting vaccination and administering it where commissioned and able to do so, or signposting them to their GP or local pharmacy to receive it, thereby protecting the health of the women and babies.
Influenza (or ‘flu’) is a highly infectious viral illness of the respiratory tract, with a usual incubation period of 1–3 days (Public Health England, 2013a). It can be spread by respiratory droplets, aerosols and direct contact with infected respiratory secretions (Lau et al, 2010).
Typical characteristics of the disease are the rapid onset of fever, chills, headache, myalgia and extreme fatigue. There are many other common symptoms, such as a dry cough, sore throat and congested nose. For most healthy people, influenza is an unpleasant but usually self-limiting disease, with recovery seen within 5–7 days (Heymann, 2008). The illness can be complicated by otitis media, bronchitis, secondary bacterial pneumonia, and more rarely by meningitis, encephalitis or meningoencephalitis, which could ultimately lead to death (Heymann, 2008; Hawker et al, 2012). Although influenza infection can happen all year round, most influenza infections in the UK occur in an 8–10 week period during the winter.
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