Pregnant women are at higher risk of hospitalization and death from influenza.
Though Oseltamivir is category C due to lack of trials in this group, it has been used successfully in all stages of pregnancy.
All pregnant women with influenza like illness (ILI) should be started on oseltamivir as early as possible.
Do not wait for lab confirmation before initiating treatment.
If pregnant women is exposed to known case of influenza a 10 day course of oseltamivir may be indicated as prophylaxis.
Prevention with vaccination with inactivated injectable vaccine is indicated in all pregnant women.
CDC reference for details
Most patients presenting to physician offices and emergency rooms with an influenza like illness (ILI) will not require antiviral treatment with Tamiflu (Oseltamivir).
The following groups have indications for treatment with antiviral agents
1. Early treatment with Oseltamivir is recommended for all hospitalized patients with suspected or confirmed ILI.
2. Patients with ILI and suspected lower respiratory tract illness, regardless of age or underlying conditions
3. The following should be treated with oseltamivir if presenting with an ILI even if not hospitalized
a. Symptomatic children <2 yrs of age
b. Symptomatic adults over the age of 65
c. Symptomatic pregnant women
d. Symptomatic persons with chronic diseases; asthma, cardiomyopathy, renal, hepatic, blood dyscrasias, diabetes. Also persons with ch neurologic conditions that may suffer with respiratory compromise such as seizures, spinal cord injuries, strokes.
e. symptomatic persons with long term immunosuppression including HIV
Both vaccines are effective. They are manufactured with similar ingredients and both have chicken eggs in them.
Live intranasal vaccine
1. At least in children appears to provide 30-50% greater immune response.
2. Easy to administer- no needles
3. No evidence that transmission of live virus to contacts occurs. Still would recommend precautions if taking care of patient with recent bone marrow transplant.
4. Not approved for 49 years or pregnancy
5. Should be avoided if taking other live vaccines such as MMR, shingles vaccine at the same time
6. Inactivated vaccines can be given with it, such as seasonal influenza
7. Should avoid Tamiflu for 48 hours before and 2 weeks after vaccine
Inactivated injectable vaccine
1. Lower response rate
2. Needs injections
3. Better safety data in the over 49yrs and in pregnancy
4. Can be given ages 6 months and up
5. Can be given with other vaccines
6. Can be given to very immunocompromised patients
7. Tamiflu does not interfere with it
Persons that are currently taking tamiflu can be vaccinated with inactivated injectable vaccine. This will not interfere with the response.
If you will be taking live intranasal vaccine. Tamiflu (oseltamivir) should not be taken for 2 days prior or 14 days after receiving the vaccine. The the Tamiflu will kill the virus in the vaccine and hence reduce the effectiveness.