H1N1 - Treatment/Prophylaxis Resources

An "In The Trenches" article (no formal abstract). Two cases of very severe maternal H1N1 illness are presented. This is followed by proposed guidelines for evaluation and treatment of H1N1 in pregnancy with extensive discussion in a Q&A format.

Comprehensive Website for California-specific information.
PREVENTION: Provides general information and access to posters and brochures.
VACCINATION: Information about the status of California's vaccine supply.
WHATS NEW: H1N1 (2009) Influenza Data and Statistics Update with reported hospitalized, ICU, and fatal cases of H1N1 (2009) influenza virus infections in California.
GUIDANCE: In the box section on the right, there is a section for California-specific guideline updates from CDPH.

Provides up to date links to a variety of good resources. Includes information for pregnant women and parents; information for clinicians and health officials, general H1N1 and seasonal flu information.

OVERVIEW: The single best place to visit for connections to a wide variety of resources (some of which we have individually indexed).
KEY STEP: Visit here often for updates.

Great site for a large variety of PDFs of education materials for general use, parents, pregnant women, vaccine, and anti-flu drugs. Many are also in Spanish and a few in Chinese.

Clinician Outreach Communication Activity (COCA) Conference Calls are designed to serve as the venue for timely education and two-way communication with CDC Subject Matter Experts (SME).
FIND: Scroll to the September 29, 2009 date.
CONTENTS: Transcript and MP3 audio recording that go with the Slide Set (Slides are in the CMQCC H1N1 Documents area (below) or can be directly downloaded from this same site). The presentation is broken into 5 areas: Overview of influenza; Infection control guidance; Testing and treatment; Vaccination; and The Atlanta experience.

This guideline represents a tweaking of the CDC/Emory evaluation algorithm to be pregnancy specific. It is an excellent summary of current thinking.

SUMMARY: This document has been developed to provide guidance for prevention and management of novel H1N1 flu infection in inpatient and out-patient obstetric settings. Severe illnesses among pregnant woman and infants have been reported in this outbreak, although the epidemiology and spectrum of illness among pregnant woman and infants are not fully understood at this time and are under investigation. Prevention of infection with novel influenza A (H1N1) virus in pregnant women and infants is the highest priority message in this guidance. Healthy pregnant women should have access to prenatal care and labor and delivery services in settings where they can be separated from persons who are ill or potentially ill with novel H1N1 flu infection. In addition, a cautious approach to the management of neonates with ill mothers is recommended which includes isolation and close observation. Recommendations are interim, based on current knowledge of the novel H1N1 flu outbreak in the United States, and may be revised as more information becomes available.
COMMENT: It is widely anticipated that this document will be revised shortly, particularly the sections on isolation.

Released on 9/17/09: Pregnant women are at higher risk for severe complications and death from influenza, including both 2009 H1N1 influenza and seasonal influenza. Treatment with oseltamivir (Tamiflu®) or zanamivir (Relenza®) is recommended for pregnant women with suspected or confirmed influenza and can be taken during any trimester of pregnancy. The duration of antiviral treatment is 5 days. See Table 1 (below) for dosing information. Oseltamivir and zanamivir are "Pregnancy Category C" medications, indicating that no clinical studies have been conducted to assess the safety of these medications for pregnant women. However, the available risk-benefit data indicate pregnant women with suspected or confirmed influenza should receive prompt antiviral therapy. Pregnancy should not be considered a contraindication to oseltamivir or zanamivir use. Treatment should be initiated as early as possible because studies show that treatment initiated early (i.e., within 48 hours of illness onset) is more likely to provide benefit. Treatment should not wait for laboratory confirmation of influenza because laboratory testing can delay treatment and because a negative rapid test for influenza does not rule out influenza. The sensitivity of rapid tests can range from 10 % to 70%. View information on the use of rapid influenza diagnostic tests.

UPDATES INCLUDE: 1. Clarify treatment and chemoprophylaxis considerations for persons vaccinated with the 2009 H1N1 and seasonal influenza vaccines. 2. Include women up to 2 weeks postpartum at higher risk for complications from 2009 H1N1 influenza. 3. Provide additional oseltamivir dosing instructions for children younger than 1 year of age. 4. Review adverse events and contraindications associated with oseltamivir and zanamivir.

SUMMARY: This is an algorithm developed by the Emory School of Medicine and used widely on the East Coast. ACOG has adopted it with minor modifications for use in telephone triage for OB's offices. Teo key elements for OB's are: 1) be sure the patient knows to call back and seek care if she worsens or does not improve, and 2) there needs to be a clear plan and site for evaluation other than the OB's office.

Slide set (55 slides) discussing the latest CDC guidelines with some background. Largely replaces the earlier CDC COCA slides.

A good general slide set made for OB Grand Rounds or Nursing Education. Covers epidemiology, pregnancy risks, triage assessment, treatment and prophylaxis, vaccine issues, and isolation/visitor policies.

Clinician Outreach Communication Activity (COCA) Conference Calls are designed to serve as the venue for timely education and two-way communication with CDC Subject Matter Experts (SME).
SLIDE SET: broken into 5 areas: Overview of influenza; Infection control guidance; Testing and treatment; Vaccination; and The Atlanta experience. Note that this slide set is in.pps format so that it is not editable.
TRANSCRIPT AND AUDIO TAPE: can be obtained using the citation noted in Web Resources with the same authors.