Influenza in Pregnancy: Prevention and Treatment

Publication Date: January 31, 2024
Last Updated: February 16, 2024

Summary of Recommendations and Conclusions

Based on the principles outlined in this Committee Statement, the American College of Obstetricians and Gynecologists (ACOG) makes the following recommendations and conclusions:
  • The Centers for Disease Control and Prevention (CDC) and the American College of Obstetricians and Gynecologists (ACOG) recommend that all adults receive an annual influenza vaccine and that individuals who are or will be pregnant during influenza season receive an inactivated or recombinant influenza vaccine as soon as it is available.
  • Ideally, influenza vaccination should be given by the end of October, but vaccination at any time during the influenza season is encouraged to ensure protection during the period that virus is circulating in the community.
  • If the timing of the influenza vaccine aligns with other inactivated or non–virus-containing vaccines recommended in pregnancy, such as the tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine; respiratory syncytial virus (RSV) vaccine; or coronavirus disease 2019 (COVID-19) vaccine, it is safe and effective to administer these vaccines during the same visit.
  • Obstetrician–gynecologists and other obstetric health care professionals should confidently recommend influenza vaccination and counsel pregnant individuals about the benefits of influenza vaccination for themselves as well as advocate for the benefits of passive immunity for their newborns conferred by maternal immunization.
  • Obstetrician–gynecologists and other obstetric health care professionals should consider both influenza and SARS-CoV-2 infection for pregnant individuals who present with symptoms of respiratory illness.
  • Clinicians should initiate empiric antiviral treatment as soon as possible, ideally within 48 hours of symptom onset, for all pregnant individuals with suspected influenza.
  • Patients with moderate risk of severe illness should be seen in an ambulatory setting for in-person evaluation as soon as possible.
  • Patients with high risk of severe illness should be seen in an emergency department or equivalent setting as soon as possible.
  • Antiviral treatment should not be delayed while awaiting respiratory infection test results, and a patient’s vaccination status should not affect the decision to treat.
  • If there is suspected or confirmed co-infection with influenza and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), both oseltamivir (Tamiflu®) and nirmatrelvir and ritonavir (Paxlovid®) should be prescribed and can be taken together.

Recommendation Grading

Disclaimer

The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.

Overview

Title

Influenza in Pregnancy: Prevention and Treatment

Authoring Organization

American College of Obstetricians and Gynecologists

Publication Month/Year

January 31, 2024

Last Updated Month/Year

April 1, 2024

Supplemental Implementation Tools

Document Type

Consensus

Country of Publication

US

Document Objectives

Pregnant and postpartum individuals are at significantly higher risk of serious complications related to seasonal and pandemic influenza infections compared with nonpregnant people. The Centers for Disease Control and Prevention and the American College of Obstetricians and Gynecologists (ACOG) recommend that all adults receive an annual influenza vaccine and that individuals who are or will be pregnant during influenza season receive an inactivated or recombinant influenza vaccine as soon as it is available. Although the influenza vaccine significantly lowers the risk of severe disease, it will not prevent all infections. Obstetrician–gynecologists and other obstetric health care professionals should consider both influenza and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection for pregnant individuals who present with symptoms of respiratory illness. Antiviral treatment should not be delayed while awaiting respiratory infection test results, and a patient's vaccination status should not affect the decision to treat. Obstetrician–gynecologists and other obstetric care professionals can help reduce disparities in influenza vaccination rates as well as severe outcomes related to influenza infection by strongly recommending influenza vaccination to all patients.

Inclusion Criteria

Female, Adolescent, Adult

Health Care Settings

Ambulatory

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Management, Prevention

Diseases/Conditions (MeSH)

D011247 - Pregnancy, D007252 - Influenza Vaccines

Keywords

influenza, pregnancy, influenza vaccines

Source Citation

Influenza in Pregnancy: Prevention and Treatment: ACOG Committee Statement No. 7. Obstet Gynecol. 2024 Feb 1;143(2):e24-e30. doi: 10.1097/AOG.0000000000005479. PMID: 38016152.