Obstetric & Gynaecology Malaysia


What is influenza (the flu)?

Influenza (the flu) is more than a bad cold. Influenza is a highly infectious respiratory viral illness that is transmitted from person to person via respiratory droplets. The contagious period is from 1 day before the onset of symptoms till 5 to 7 days after onset. Common symptoms include fever, headache, chills, cough, sore throat, muscle aches, generalised malaise and fatigue.

Who is at risk of developing complications from the flu?

Certain people have an increased risk of developing flu complications eg pneumonia, ICU care eg adults >65 years, children < 5 years, people who have chronic illnesses and pregnant women.

How does being pregnant increase my risk of complications from the flu?

Normal changes in the immune system that occur during pregnancy may increase your risk of flu complications. You are more likely to be hospitalized if you get the flu while you are pregnant. There is increased risk of spontaneous miscarriage, preterm delivery, low birth weight, need of emergency LSCS for fetal distress and fetal death. Your risk of dying from the flu is increased as well.

What is the impact of influenza on the fetus or neonate?

  • Potential increased risk of miscarriage or congenital anomalies in the first trimester of pregnancy
  • Maternal hyperthermia may increase the risk of certain birth defects
  • Infants less than 6 months old (neonates) infected with the influenza virus have the highest rates of hospitalisation and mortality compared to children of other older age groups

Who should get vaccinated against the flu?

The Centers for Disease Control and Prevention (CDC) recommend that everyone 6 months of age and older to get the flu vaccine each year. If you are pregnant, it is best to get the vaccine early in the flu season (October through May), as soon as the vaccine is available. You can get the shot at any time during your pregnancy. If you are not vaccinated early in the flu season, you still can get the vaccine later in the flu season.

How does the flu vaccine work?

The flu vaccine triggers your immune system to make antibodies against the flu virus. Antibodies circulate in the bloodstream. If they encounter a flu virus, they “tag” it for destruction by other parts of the immune system. It takes about 2 weeks for the body to build up protective antibodies after you get the flu shot.

How often should I get the flu vaccine?

With some types of vaccines, the antibodies that are made remain active for many years. But the types of viruses that cause the flu can change every year. The antibodies made in response to one year’s flu vaccine may not work against the next year’s flu viruses. For this reason, the flu vaccine is updated each year.

How does getting the flu vaccine when I am pregnant help my baby?

The flu vaccine does “double duty” by protecting both you and your baby vaccine until they are 6 months. When you get a flu shot during pregnancy, the protective antibodies made in your body are transferred to your baby. These antibodies will protect your baby until he or she can get the vaccine at 6 months of age.

Are vaccines safe?

Vaccines are developed with the highest safety standards. The U.S. Food and Drug Administration approves all vaccines. The CDC continues to monitor all vaccines after they are approved. They have been used for many years in millions of pregnant women and are not known to cause pregnancy problems or birth defects.

Can vaccines made with thimerosal cause autism?

There is no scientific evidence that vaccines made with thimerosal, a mercury-containing preservative, can cause autism or other health problems in babies.

Do vaccines have any side effects?

Most side effects of vaccines are mild, such as a sore arm or a low fever, and go away within a day or two. Severe side effects and reactions are rare. If you have concerns about vaccine side effects, talk to your obstetrician or other member of your health care team.

What should I do if I get the flu while I am pregnant?

If you think you have the flu and you are pregnant (or you have had a baby within the past 2 weeks), contact your obstetrician right away or go to Delivery Suite if fever. Taking an antiviral medication as soon as possible is recommended. Flu symptoms may include the following:

  • Fever or feeling feverish, chills, fatigue, headache or body ache, cough, sore throat, runny or stuffy nose

Antiviral medication is available by prescription. It is most effective when taken within 48 hours of the onset of flu symptoms, but there still is some benefit to taking it up to 4–5 days after symptoms start. An antiviral drug does not cure the flu, but it can shorten how long it lasts and how severe it is.

What should I do if I come into close contact with someone who has the flu while I am pregnant?

You also should call your obstetrician if you are pregnant and come in close contact with someone who has the flu. This includes living with, caring for, or talking face-to-face with someone who may have the flu. You may be prescribed an antiviral drug to reduce the risk that you will get the flu.

Tetanus, Diphtheria & Pertusis(Tdap) vaccination in pregnancy

Pertussis, also known as whooping cough, is a highly contagious respiratory disease caused by the bacterium Bordetella pertussis. It is transmitted from person to person usually via coughing or sneezing, or via close contact in an enclosed environment.

Symptoms usually develop within 5 to 10 days after exposure, but sometimes not for as long as 3 weeks. Pertussis has an insidious onset with catarrhal symptoms and intermittent cough.

Pregnant women are encouraged to undergo vaccination against tetanus toxoid(given by KKIA at 20 weeks pregnancy), reduced diphtheria toxoid and acellular pertussis (Tdap).

The main aim of the antenatal Tdap vaccination is to provide passive protection to the neonate/infant via trans-placental transmission of antibodies (especially since the Tdap vaccine will only be administered to infants from 5 months of age). Unvaccinated infants who are less than 12 months of age have a high risk of severe illness. Infants with pertussis who need treatment in hospital have an approximately 61% risk of apnoea, 23% risk of pneumonia, 1.1% risk of seizures, 1% risk of death and 0.3% risk of encephalopathy.

The vaccine is administered as a single dose intramuscularly, preferably at the deltoid area, between the 16th to 32nd week of each pregnancy. Vaccination is recommended with each pregnancy to provide maximal protection to every infant, as vaccine induced pertussis antibodies wane over time and the protective antibody levels required in newborn infants is unknown