1. Disaster preparedness – Pandemic influenza prevention/preparedness for pregnant women
By Chimfumnanya Nwanze, MPH Student
Walden University
PUBH
Instructor: Dr Rebecca Heick.
Fall Quarter, 2009.
Good day to you all,
My name is Chychy Nwanze and today I will be presenting an issue on disaster preparedness for pregnant women on preventing and preparing for the pandemic flu season.

2. Purpose of Presentation
To educate and equip pregnant women on the effects of the pandemic flu and how they can prevent and/or take care of themselves during the flu season.
this presentation is aimed at pregnant women to educate them on the effects of the pandemic flu and equip them with the knowledge of how to prevent infection and how to take care of themselves during the flu season.

3. What is the flu?
Flu refers to illnesses caused by a number of different influenza viruses. Flu can cause a range of symptoms and effects, from mild to deadly.
The three common strains of flu are: the seasonal flu virus, the H1N1 (commonly known as swine flu) and the H5N1 (avian or bird) flu.
(Reference: Flu.gov (2009a). About the flu. Retrieved October 18, 2009 from
The flu is caused by influenza viruses. These viruses exist in three common strains, they are: the seasonal flu virus, the H1N1 virus which is popularly called swine flu and the H5N1 virus also known as the avian flu and exists a lot outside the United States.

4. How the flu spreads From person to person From person to an object
Sharing personal belongings with infected persons e.g. eating utensils
(Reference:) CDC (2009, September 30). How flu spreads. Retrieved October 18, 2009 from
Influenza viruses mainly spread from person to person through respiratory droplets of coughs and sneezes. This is known as droplet spread. This occurs when droplets from an infected person are carried through the air and settle on the mouth or nose of another person.
Flu viruses can also be spread by the droplets from an infected person touching objects such as door handles, computers etc and these objects are touched by other people before being cleaned or disinfected.
Also, sharing items like linens, eating utensils etc with infected persons can help spread the virus to non-infected people.

5. Signs and symptoms of the flu
Fever, coughing, sore throat, runny or stuffy nose, headaches, body aches, chills and fatigue.
Vomiting, diarrhea
Eye infections, pneumonia, severe respiratory diseases (e.g. acute respiratory distress), and other severe and life-threatening complications.
References:
Flu.gov (2009b). Flu symptoms. Retrieved October 18, 2009 from
Flu.gov (2009c). H5N1 (Bird flu). Retrieved October 19, 2009 from
Flu symptoms usually include fever, coughing, sore throat, runny or stuffy nose, headaches, body aches, chills and fatigue.
The H1N1 flu symptoms are similar to that of the season flu but also include vomiting and diarrhea.
The H5N1 flu symptoms also typically include those of the seasonal flu and also eye infections, pneumonia, severe respiratory diseases (such as acute respiratory distress), and other severe and life-threatening complications

6. The effects of flu on pregnant women
Increased heart rate
Increased stroke volume
Increased oxygen consumption and
Decreased lung capacity
Vulnerability to pathogens due to immunologic changes during pregnancy
(Reference: Rasmussen, S, Jamieson, D, & Bresee, J. (2008). Pandemic influenza and pregnant women. Emerging Infectious Diseases, 14(1), retrieved October 17, 2009 from )
Pregnancy is and has been a risk factor for the rise in illnesses and deaths for both pandemic and seasonal flu. This risk is due to the physiological changes that happen during pregnancy. The hormonal and mechanical changes brought about by pregnancy also affect the respiratory and cardiovascular systems and leads to increased heart rates, increased oxygen consumption, increased stroke volume and decreased lung capacity.
Also, pregnancy causes immunologic changes resulting in a shift away from cell-mediated immunity to humoral immunity. This change increases the risk rate of pregnant women and leaves them vulnerable to pathogens including the flu viruses.

7. Effects of the flu on the fetus
Increased risk for birth defects - cleft lip with or without cleft palate, and neural tube and congenital heart defects.
Childhood leukemia, schizophrenia, and Parkinson’s disease
Hyperthermia is associated with an increased risk for neural tube defects
(Reference: Rasmussen, S, Jamieson, D, & Bresee, J. (2008). Pandemic influenza and pregnant women. Emerging Infectious Diseases, 14(1), retrieved October 17, 2009 from )
Although studies for the effects of influenza on the fetus have been inconsistent, most studies have shown a small increased risk for birth defects such as cleft lip, congenital heart defect and neural tube defect.
However, the use of anti-fever medications for pregnant women who become sick and folic acid before and during pregnancy has shown a much reduced risk for fetal effects.
Also, effects of influenza on the fetus had been associated with diseases occurring long after birth. These diseases include schizophrenia, Parkinson’s disease and childhood leukemia etc. These diseases however are not necessarily caused by the influenza virus but by the fever that usually is associated with the influenza infection. Hyperthermia has been associated with an increased risk for neural tube defects.

8. Prevention and treatment
Cover nose and mouth with a tissue when coughing or sneezing. Dispose of the tissue in the trash after use.
Wash hands often with soap and water, especially after coughing or sneezing or use alcohol-based hand sanitizers.
Avoid touching the eyes, nose or mouth
Avoid close contact with sick people.
Heed public health advice such as avoiding crowds and social gatherings.
(Reference: Flu.gov (2009d). Prevention and treatment. Retrieved October 19, 2009 from
Taking precautionary measures such as hand washing, avoiding crowds and sick people etc can help reducing the risks of getting infected by the influenza virus.
The CDC refers to these methods of prevention as “non pharmaceutical interventions”

9. Prevention and treatment (cont’d).
Vaccines
Antiviral medications – such as Oseltamivir [oral] (Tamiflu) and Zanamivir [inhaler] (Relenza).
Antibiotics to prevent bacterial pneumonia and antipyretic medications to reduce fevers.
(Reference: Rasmussen, S, Jamieson, D, & Bresee, J. (2008). Pandemic influenza and pregnant women. Emerging Infectious Diseases, 14(1), retrieved October 17, 2009 from )
Getting the flu vaccine at all trimesters of pregnancy is very vital in preventing influenza infections during pregnancy. Studies have shown that the flu vaccine is safe for pregnant women and has no effect on the fetus. The Advisory Committee on Immunization Practices and the American College of Obstetricians and Gynecologists strongly recommend that pregnant women should receive the influenza vaccine during the flu season (October – May) (Rasmussen et al., 2008).
Live attenuated influenza vaccine are however not approved for pregnant women because of the risks involved with the use of live vaccines during pregnancy.
Also, antiviral medications such as oral (oseltamivir [Tamiflu]) and inhaler (zanamivir [Relenza]) can be used to treat the symptoms of influenza and prevent a full infection.
Antibiotics for secondary bacterial pneumonia and antipyretic medications for fever control can also be used. Healthcare providers however have to explain the benefits of these medications and vaccines to their pregnant patients in order to help alleviate any fears/concerns the patients may have for the fetus.

10. Conclusion Pregnant women should be of top priority during flu seasons
The use of anti-fever medications should be used by pregnant women who get sick
Set up strategies and plans to educate and rapidly assess pregnant women during the flu season
Plan of care & interventions to ensure the safety of pregnant women and their fetuses.
Due to high risks for serious illnesses, diseases and death for both a woman and her unborn baby, pregnant women should be at the forefront of the list in any influenza pandemic.
Pregnant women who become sick should be treated with anti-fever medications and comply with their doses of folic acid consumption.
Plans to rapidly assess and aid pregnant women during pandemic influenza should be incorporated and strategies to educate and enlighten pregnant women in the communities should be set.
Care planning, considerations, implementations and effective interventions will go a long way to ensure the health and safety of pregnant women and their unborn babies.

11. Questions?
Thank you for giving me the opportunity to give this presentation. Are there any questions?

12. References
CDC (2009, September 30). How flu spreads. Retrieved October 18, from
Flu.gov (2009a). About the flu. Retrieved October 18, 2009 from
Flu.gov (2009b). Flu symptoms. Retrieved October 18, 2009 from ml
Flu.gov (2009c). H5N1 (Bird flu). Retrieved October 19, 2009 from
Flu.gov (2009d). Prevention and treatment. Retrieved October 19, from
Rasmussen, S, Jamieson, D, & Bresee, J. (2008). Pandemic influenza and pregnant women. Emerging Infectious Diseases, 14(1), retrieved October 17, 2009 from