Guidance for the Prevention and Control of Influenza in the Peri- and Postpartum Settings
The following guidance is current for the 2018-2019 influenza season. Please see Recommendations of the Advisory Committee on Immunization Practices – United States, 2018-19 Seasonpdf icon for the latest information regarding recommended influenza vaccines. Please see Antiviral Drugs: Information for Health Care Professionals for the current summary of recommendations for clinical practice regarding the use of influenza antiviral medications.
Pregnant women have been shown to be at increased risk of severe influenza, including illness resulting in hospitalization. Maternal influenza also may be harmful for a pregnant woman’s developing baby. General Prevention Strategies for Seasonal Influenza in Health Care Settings are currently available and apply to all health care settings. Those general strategies outline infection control precautions for all patient care including care of women and newborns within the labor, delivery, recovery, and postpartum settings. The following highlights some of the important recommendations contained in this guidance as well as supplemental strategies specific to hospitalized pregnant, intrapartum, and postpartum women and their newborns during the birth hospitalization. Additional information about the use of antiviral drugs in pregnant and postpartum women is also available on the CDC web site. While data are limited, these recommendations are based upon evidence available to date, and will be revised accordingly if new data are available in the future.
- Prior to delivery, a hospitalized pregnant woman with suspected or laboratory-confirmed influenza should be placed in a private room on Droplet Precautions and instructed to follow respiratory hygiene and cough etiquette, including wearing a facemask, if being transported outside of her room.
- Health care personnel entering rooms of pregnant women with suspected or confirmed influenza should adhere to Standard and Droplet Precautions, including donning a facemask upon entry into the room, performing hand hygiene, wearing gloves for any contact with potentially infectious materials, and wearing gowns for any patient-care activity where contact with body fluids may occur.
Droplet Precautions should be continued for hospitalized patients with suspected or confirmed influenza for 7 days after illness onset or until 24 hours after the resolution of fever and respiratory symptoms, whichever is longer, while the patient is in a health care facility.
- Patients placed on Droplet Precautions should be discharged from medical care when clinically appropriate, not based on the period of potential virus shedding or recommended duration of Droplet Precautions.
- The peripartum patient and her family members and other visitors should be informed of the risks of influenza virus transmission and instructed to adhere to respiratory hygiene and cough etiquette, hand hygiene, and use of personal protective equipment (PPE) according to current facility policy.
- Patients with suspected or confirmed influenza who are in the labor and delivery suite should remain on Droplet Precautions.
- Health care personnel in the delivery suite should adhere to Standard and Droplet Precautions, including practicing hand hygiene before and after handling the newborn.
- Although it is well recognized that the ideal setting for care of a healthy term newborn while in the hospital is within the mother’s room, newborns that become infected with influenza virus are at increased risk for severe complications. To reduce the risk of influenza virus transmission to the newborn, CDC recommends that facilities consider temporarily separating the mother who is ill with suspected or confirmed influenza from her baby following delivery during the hospital stay. The risks and benefits of temporary separation of the mother from her baby should be discussed with the mother by the health care team, and decisions about temporary separation should be made in accordance with the mother’s wishes.
- Throughout the course of temporary separation, all feedings should be provided by a healthy caregiver if possible. Mothers who intend to breastfeed should be encouraged to express their milk to establish and maintain milk supply. This expressed breastmilk should be fed to the newborn by a healthy caregiver.
- The optimal length of temporary separation in the hospital has not been established, and will need to be assessed on a case-by-case basis after considering factors to balance the risk of mother-to-infant influenza virus transmission versus maintaining maternal-infant bonding. Some considerations might include –
- if the mother has been afebrile without antipyretics for >24 hours, and
- the mother is able to control her cough and respiratory secretions.
- If co-location (sometimes referred to as “rooming in”) of the newborn with his/her ill mother in the same hospital room occurs in accordance with the mother’s wishes or is unavoidable due to a hospital’s configuration, nursery constraints, lack of availability of isolation rooms, or other reasons, facilities should consider implementing measures to reduce influenza-virus exposure of the newborn including:
- using engineering controls like physical barriers (e.g., a curtain between the mother and newborn)
- keeping the newborn ≥6 feet away from the ill mother
- ensuring a healthy adult is present to care for the newborn. If no other healthy adult is present in the room to care for the newborn, a mother with suspected or confirmed influenza should put on a facemask and then practice hand hygiene before each feeding or other close contact with her newborn. The facemask should remain in place during contact with the newborn. These practices should continue while the mother is on Droplet Precautions in a health care facility.
- Once contact between mother and newborn is resumed, Droplet Precautions for influenza should continue to be observed in the hospital until at least 7 days after maternal illness onset.
- If a newborn of a mother with suspected or confirmed influenza is housed in the hospital nursery instead of the mother’s room, the newborn can be cared for by a non-ill person using Standard Precautions and be closely observed for signs of infection.
- Symptomatic mothers, care givers, and family members should not enter the nursery.
- A newborn that develops signs of possible illness should be placed on Droplet Precautions and examined by a physician. Influenza testing should be part of the assessment and treatment with oseltamivir should be considered.
- Visitors should be limited to persons who are necessary for the patient’s emotional well-being and care. Visitors who have been in contact with an infected patient before and during her hospitalization are a possible source of influenza for other patients, visitors, and staff. All visitors should be screened for signs and symptoms of acute respiratory illness before being allowed to enter the hospital or unit, and only asymptomatic persons should be allowed to visit.
- Facilities should provide instruction, before visitors enter patients’ rooms, on hand hygiene, limiting surfaces touched, and use of personal protective equipment (PPE) according to current facility policy while in the patient’s room.
- Visitors should be instructed to limit their movement within the facility.
- Influenza vaccination should be strongly encouraged and, when possible, provided for any unvaccinated family members aged 6 months and older and caregivers who will be in contact with the newborn.
- Caregivers should be advised to:
- contact their health care provider promptly if the newborn develops signs that suggest influenza virus infection.
- isolate any individuals in the home who become ill in order to minimize exposure to the newborn.
- if possible, have vaccinated non-ill adults provide care to the newborn at home until the mother’s illness resolves.
- ensure that the ill postpartum woman follows hand hygiene and respiratory hygiene and cough etiquette when having contact with her newborn.
For more detailed guidance on infection control precautions for influenza in health care settings, please visit Prevention Strategies for Seasonal Influenza in Health Care Settings.
Rasmussen SA, Jamieson DJ, MacFarlane K, et al. Pandemic influenza and pregnant women: Summary of a meeting of experts. Am J Public Health 2009;99 S248-54.
Rasmussen SA, Kissin DM, Yeung LF, et al. Preparing for influenza after 2009 H1N1: special considerations for pregnant women and newborns. Am J Obstet Gynecol. 2011; 204(6 Suppl 1): S13-20.