CDC 妊娠女性と新型インフルエンザ A (H1N1)情報と 感染研 新型インフルエンザの診断および治療・予防投薬の流れ

　　　　

（関連目次）→新型インフルエンザについても集めてみましたo(^-^)o

　　　　　　　　　　　　　　　　　　　　　　　　　　　　ぽち→ 

（投稿：ｂｙ　僻地の産科医）

私にとってのメインは、
下のCDC　妊娠女性と新型インフルエンザ情報ですo(^-^)o ..｡*♡

刻々と書き換えられているようですので、日本語訳の労力は取りませんが、
ざっと大事そうなところのみ赤にしてあります。

　　　

【関連記事】

豚インフルエンザ 「医師ですがアメリカから帰ってきて検疫を受けました」→日本の「新型インフルエンザ」対策は「水際防衛」から「市街戦対策」に転換を
天漢日乗　2009-05-08
http://iori3.cocolog-nifty.com/tenkannichijo/2009/05/post-3fed.html

　　

　　　

　　　　　感染研が新型インフルエンザの診断

　　　　　　および治療・予防投薬の流れ発表

　　　　　　連絡なし受診に備え玄関への掲示徹底を

　　

　　　　　　　　　　　　　　小島　領平　

　　　　　　　　　　　MTpro 2009年5月7日

　　　http://mtpro.medical-tribune.co.jp/mtpronews/0905/090506.html?ap

　依然として世界的に感染が拡大している新型インフルエンザ（ブタインフルエンザA/H1N1）ウイルス。世界保健機関（WHO）によると，5月6日（日本時間5月7日）現在の感染者数（確定例）は世界合計1,893例（うち死亡31例）※にのぼっている。わが国ではまだ感染確定例が現れていないが，国内で発症する可能性は否定できない。こうした中で国立感染症研究所感染症情報センターは昨日（5月6日），新型インフルエンザの診断および抗ウイルス薬による治療・予防投薬の流れを発表した。連絡なしに感染疑い例が受診するケースを想定し，すべての医療機関に玄関で患者を適切に誘導する掲示を行うよう求めている。

　　　　

診療スタッフに個人予防衣の装着呼びかけ

　診断の流れでは，都道府県が定める発熱外来あるいは感染症指定医療機関とそれ以外の医療機関での対応に大別。前者には，電話連絡があった疑い例に対して

（1）何時に，どこの入り口から受診するかなど受診方法を指定する

（2）自宅あるいは連絡があった医療機関から指定医療機関まではマスクを装着したうえで，可能な限り公共交通機関を利用せずに受診するよう指導する―ように呼びかけた。

　　　

　一方，後者には

（1）患者の氏名，年齢，性，所在地（居住地から離れている場合があるので現在所在している場所），連絡先，症状，渡航歴，確定例との接触歴を問診する

（2）疑い例と判断した場合，所在地の最寄りの発熱外来もしくは感染症指定医療機関の電話番号を伝え，患者から直接電話してもらう

（3）患者に電話番号を伝えた発熱外来などへ，問診内容とともに患者から連絡があることを伝える

（4）最寄りの保健所に上記の情報を直ちに連絡する―とした。

　また，いずれの医療機関に対しても，疑い例が電話連絡なしに受診した場合の対処法として，施設の玄関に適切な掲示を行い，受付で再度インフルエンザを疑う症状（発熱，呼吸器症状など）や渡航歴，感染確定例との接触歴の有無を確認するよう求めている。掲示内容の例は以下の通り。

　インフルエンザを疑う症状（発熱，呼吸器症状等）を有し，渡航歴があるあるいは，新型インフルエンザの患者様との接触歴がある場合には，直ちに受付スタッフ（医療機関に応じて，適切な部署を明記する）に連絡してください。連絡せずに，待合室で長時間待っていることがないよう，十分に注意してください。感染拡大防止のため，皆様のご協力をお願いいたします。

　診療に従事するスタッフへは，自身は個人予防衣（PPE：国内患者発生がないあるいは少数時点ではN95マスク，ゴーグルまたはフェースシールド，ガウン，手袋）を装着し，疑い例の問診は患者にサージカルマスクを装着させて感染予防が可能な部屋で行うよう呼びかけている。

　　　

医師の判断で1歳未満患児への抗ウイルス薬投与も可能

　抗ウイルス薬による治療の流れでは，WHOや米疾病管理センター（CDC）などの海外情報に基づきオセルタミビルとザナミビルの投与が可能と紹介。両薬の最適な投与時期，投与量，投与方法については，今後の情報蓄積によって臨機応変に変更していく必要性を説明したうえで，「季節性インフルエンザと同様に考えることが妥当であろう」としている。

　両薬の1歳未満の患児に対する安全性は確立されていないものの，症状，所見から重症化が予想され，保護者へのインフォームド・コンセントが十分に得られた場合に限って「医師の判断に基づいて投与することもあり得る」とした。妊婦に両薬を投与する際は，治療上の有益性が危険性を上回ると判断される場合に投与するとし，授乳中の女性については授乳を避けるよう指導することを求めている。

　10歳以上の未成年者へのオセルタミビル投与については，厚生労働省が薬剤添付文章上の「10歳以上の未成年の患者においては，因果関係は不明であるものの，本剤の服用後に異常行動を発現し，転落等の事故に至った例が報告されている。このため，この年代の患者には，合併症，既往歴等からハイリスク患者と判断される場合を除いては，原則として本剤の使用を差し控えること」の指導を解除する見込みだ。

　予防投薬の流れでは，第三段階（感染拡大期）までは原則として患者と十分な防御なく濃厚に接触した者（同居者など）の経過観察期間を定め，外出自粛などの指導を行うとともに，抗ウイルス薬の予防投与の実施を促した。現時点での投与量，投与期間については，季節性インフルエンザに準じるとしている。

　　

　　　

産婦人科の方々へ
　　　

一応、今のところの最新情報です。

Pregnant Women and Novel Influenza A (H1N1) Considerations for Clinicians
May 7, 2009 4:35 PM ET
http://www.cdc.gov/h1n1flu/clinician_pregnant.htm

　　

Background
Human infections with a novel influenza A (H1N1) virus that is easily transmissible among humans were first identified in April 2009. The epidemiology and clinical presentations of these infections are currently under investigation. There are insufficient data available at this point to determine who at higher risk for complications of novel influenza A (H1N1) virus infection. However, it’s reasonable to assume that the same age and risk groups who are at higher risk for seasonal influenza complications also should be considered at higher risk for novel influenza A (H1N1) complications.

Evidence that influenza can be more severe in pregnant women comes from observations during previous pandemics and from studies among pregnant women who had seasonal influenza. An excess of influenza-associated excess deaths among pregnant women were reported during the pandemics of 1918–1919 and 1957–1958. Adverse pregnancy outcomes have been reported following previous influenza pandemics, with increased rates of spontaneous abortion and preterm birth reported, especially among women with pneumonia. Case reports and several epidemiologic studies conducted during interpandemic periods also indicate that pregnancy increases the risk for influenza complications for the mother and might increase the risk for adverse perinatal outcomes or delivery complications.

　　

Clinical presentation
Pregnant women with novel influenza A (H1N1) virus would be expected to present with typical acute respiratory illness (e.g., cough, sore throat, rhinorrhea) and fever or feverishness. Many pregnant women will go on to have a typical course of uncomplicated influenza. However, for some pregnant women, illness might progress rapidly, and might be complicated by secondary bacterial infections including pneumonia. Fetal distress associated with severe maternal illness can occur. Pregnant women who have suspected novel influenza A (H1N1) virus infection should be tested, and specimens from women who have unsubtypeable influenza A virus infections should have specimens sent to the state public health laboratory for additional testing to identify novel influenza A (H1N1).

　　

Treatment and chemoprophylaxis
The currently circulating novel influenza A (H1N1) virus is sensitive to the neuraminidase inhibitor antiviral medications zanamivir (Relenza®) and oseltamivir (Tamiflu®), but is resistant to the adamantane antiviral medications, amantadine (Symmetrel®) and rimantadine (Flumadine®). Pregnant women who meet current case-definitions for confirmed, probable or suspected novel influenza A (H1N1) infection should receive empiric antiviral treatment. Pregnant women who are close contacts with persons with suspected, probable or confirmed cases of novel influenza A (H1N1) should receive chemoprophylaxis.

As is recommended for other persons who are treated, antiviral treatment with zanamivir or oseltamivir should be initiated as soon as possible after the onset of influenza symptoms, with benefits expected to be greatest if started within 48 hours of onset, based on data from studies of seasonal influenza. However, some data from studies on seasonal influenza indicate benefit for hospitalized patients even if treatment is started more than 48 hours after onset. Recommended duration of treatment is five days, and for chemoprophylaxis is 10 days. Oseltamivir and zanamivir treatment and chemoprophylaxis regimens recommended for pregnant women are the same as those recommended for adults who have seasonal influenza. Recommendations for use of antivirals for pregnant women might change as data on antiviral susceptibilities become available.

One of the more well-studied adverse effects of influenza is its associated hyperthermia. Studies have shown that maternal hyperthermia during the first trimester doubles the risk of neural tube defects and may be associated with other birth defects and adverse outcomes. Limited data suggest that the risk for birth defects associated with fever might be mitigated by antipyretic medications or multivitamins that contain folic acid. Maternal fever during labor has been shown to be a risk factor for adverse neonatal and developmental outcomes, including neonatal seizures, encephalopathy, cerebral palsy, and neonatal death. Even though distinguishing the effects of the cause of fever from the hyperthermia itself is difficult, fever in pregnant women should be treated because of the risk that hyperthermia appears to pose to the fetus. Acetaminophen appears to be the best option for treatment of fever during pregnancy, although data on even this common exposure are also limited.

Pregnancy should not be considered a contraindication to oseltamivir or zanamivir use. Pregnant women might be at higher risk for severe complications from novel influenza A (H1N1), and the benefits of treatment or chemoprophylaxis with zanamivir or oseltamivir likely outweigh the theoretical risks of antiviral use. Oseltamivir and zanamivir are "Pregnancy Category C" medications, indicating that no clinical studies have been conducted to assess the safety of these medications for pregnant women. Because of the unknown effects of influenza antiviral drugs on pregnant women and their fetuses, oseltamivir or zanamivir should be used during pregnancy only if the potential benefit justifies the potential risk to the embryo or fetus. Although a few adverse effects have been reported in pregnant women who took these medications, no relation between the use of these medications and those adverse events has been established. Because of its systemic activity, oseltamivir is preferred for treatment of pregnant women. The drug of choice for prophylaxis is less clear. Zanamivir may be preferable because of its limited systemic absorption; however, respiratory complications that may be associated with zanamivir because of its inhaled route of administration need to be considered, especially in women at risk for respiratory problems.

　　

Other ways to reduce risk for pregnant women
There is no vaccine available yet to prevent novel influenza A (H1N1); however, the risk for novel influenza A (H1N1) might be reduced by taking steps to reduce the chance of being exposed to respiratory infections. These actions include frequent handwashing, covering coughs, and having ill persons stay home except to seek medical care, and minimize contact with others in the household. Additional measures that can limit transmission of a new influenza strain include voluntary home quarantine of members of households with confirmed or probable novel influenza A (H1N1) cases, reduction of unnecessary social contacts, and avoidance whenever possible of crowded settings. If used correctly, facemasks and respirators may help reduce the risk of getting influenza, but they should be used along with other preventive measures, such as avoiding close contact and maintaining good hand hygiene. A respirator that fits snugly on the face can filter out small particles that can be inhaled around the edges of a facemask, but compared with a facemask it is harder to breathe through a respirator for long periods of time.

　

Breastfeeding considerations
Infants who are not breastfeeding are particularly vulnerable to infection and hospitalization for severe respiratory illness. Women who deliver should be encouraged to initiate breastfeeding early and feed frequently. Ideally, babies should receive most of their nutrition from breast milk. Eliminate unnecessary formula supplementation, so the infant can receive as much maternal antibodies as possible.

If a woman is ill, she should continue breastfeeding and increase feeding frequency. If maternal illness prevents safe feeding at the breast, but she can still pump, encourage her to do so. The risk for novel influenza A (H1N1) transmission through breast milk is unknown. However, reports of viremia with seasonal influenza infection are rare.

Expressed milk should be used for infants too ill to feed at the breast. In certain situations, infants may be able to use donor human milk from a HMBANA-certified milk bank.

Antiviral medication treatment or prophylaxis is not a contraindication for breastfeeding.

Instruct parent and caretakers on how to protect their infant from the spread of germs that cause respiratory illnesses like novel influenza A (H1N1):

Wash adults’ and infants’ hands frequently with soap and water, especially after infants place their hands in their mouths.
Keep infants and mothers as close together as possible and encourage early and frequent skin-to-skin contact between mothers and their infants.
Limit sharing of toys and other items that have been in infants' mouths. Wash thoroughly with soap and water any items that have been in infants' mouths.
Keep pacifiers (including the pacifier ring/handle) and other items out of adults' or other infants' mouths prior to giving to the infant.
Practice cough and sneeze etiquette.

　　　　

（関連目次）→新型インフルエンザについても集めてみましたo(^-^)o

　　　　　　　　　　　　　　　　　　　　　　　　　　　　ぽち→ 

（投稿：ｂｙ　僻地の産科医）

私にとってのメインは、
下のCDC　妊娠女性と新型インフルエンザ情報ですo(^-^)o ..｡*♡

刻々と書き換えられているようですので、日本語訳の労力は取りませんが、
ざっと大事そうなところのみ赤にしてあります。

　　　

【関連記事】

豚インフルエンザ 「医師ですがアメリカから帰ってきて検疫を受けました」→日本の「新型インフルエンザ」対策は「水際防衛」から「市街戦対策」に転換を
天漢日乗　2009-05-08
http://iori3.cocolog-nifty.com/tenkannichijo/2009/05/post-3fed.html

　　

　　　

　　　　　感染研が新型インフルエンザの診断

　　　　　　および治療・予防投薬の流れ発表

　　　　　　連絡なし受診に備え玄関への掲示徹底を

　　

　　　　　　　　　　　　　　小島　領平　

　　　　　　　　　　　MTpro 2009年5月7日

　　　http://mtpro.medical-tribune.co.jp/mtpronews/0905/090506.html?ap

　依然として世界的に感染が拡大している新型インフルエンザ（ブタインフルエンザA/H1N1）ウイルス。世界保健機関（WHO）によると，5月6日（日本時間5月7日）現在の感染者数（確定例）は世界合計1,893例（うち死亡31例）※にのぼっている。わが国ではまだ感染確定例が現れていないが，国内で発症する可能性は否定できない。こうした中で国立感染症研究所感染症情報センターは昨日（5月6日），新型インフルエンザの診断および抗ウイルス薬による治療・予防投薬の流れを発表した。連絡なしに感染疑い例が受診するケースを想定し，すべての医療機関に玄関で患者を適切に誘導する掲示を行うよう求めている。

　　　　

診療スタッフに個人予防衣の装着呼びかけ

　診断の流れでは，都道府県が定める発熱外来あるいは感染症指定医療機関とそれ以外の医療機関での対応に大別。前者には，電話連絡があった疑い例に対して

（1）何時に，どこの入り口から受診するかなど受診方法を指定する

（2）自宅あるいは連絡があった医療機関から指定医療機関まではマスクを装着したうえで，可能な限り公共交通機関を利用せずに受診するよう指導する―ように呼びかけた。

　　　

　一方，後者には

（1）患者の氏名，年齢，性，所在地（居住地から離れている場合があるので現在所在している場所），連絡先，症状，渡航歴，確定例との接触歴を問診する

（2）疑い例と判断した場合，所在地の最寄りの発熱外来もしくは感染症指定医療機関の電話番号を伝え，患者から直接電話してもらう

（3）患者に電話番号を伝えた発熱外来などへ，問診内容とともに患者から連絡があることを伝える

（4）最寄りの保健所に上記の情報を直ちに連絡する―とした。

　また，いずれの医療機関に対しても，疑い例が電話連絡なしに受診した場合の対処法として，施設の玄関に適切な掲示を行い，受付で再度インフルエンザを疑う症状（発熱，呼吸器症状など）や渡航歴，感染確定例との接触歴の有無を確認するよう求めている。掲示内容の例は以下の通り。

　インフルエンザを疑う症状（発熱，呼吸器症状等）を有し，渡航歴があるあるいは，新型インフルエンザの患者様との接触歴がある場合には，直ちに受付スタッフ（医療機関に応じて，適切な部署を明記する）に連絡してください。連絡せずに，待合室で長時間待っていることがないよう，十分に注意してください。感染拡大防止のため，皆様のご協力をお願いいたします。

　診療に従事するスタッフへは，自身は個人予防衣（PPE：国内患者発生がないあるいは少数時点ではN95マスク，ゴーグルまたはフェースシールド，ガウン，手袋）を装着し，疑い例の問診は患者にサージカルマスクを装着させて感染予防が可能な部屋で行うよう呼びかけている。

　　　

医師の判断で1歳未満患児への抗ウイルス薬投与も可能

　抗ウイルス薬による治療の流れでは，WHOや米疾病管理センター（CDC）などの海外情報に基づきオセルタミビルとザナミビルの投与が可能と紹介。両薬の最適な投与時期，投与量，投与方法については，今後の情報蓄積によって臨機応変に変更していく必要性を説明したうえで，「季節性インフルエンザと同様に考えることが妥当であろう」としている。

　両薬の1歳未満の患児に対する安全性は確立されていないものの，症状，所見から重症化が予想され，保護者へのインフォームド・コンセントが十分に得られた場合に限って「医師の判断に基づいて投与することもあり得る」とした。妊婦に両薬を投与する際は，治療上の有益性が危険性を上回ると判断される場合に投与するとし，授乳中の女性については授乳を避けるよう指導することを求めている。

　10歳以上の未成年者へのオセルタミビル投与については，厚生労働省が薬剤添付文章上の「10歳以上の未成年の患者においては，因果関係は不明であるものの，本剤の服用後に異常行動を発現し，転落等の事故に至った例が報告されている。このため，この年代の患者には，合併症，既往歴等からハイリスク患者と判断される場合を除いては，原則として本剤の使用を差し控えること」の指導を解除する見込みだ。

　予防投薬の流れでは，第三段階（感染拡大期）までは原則として患者と十分な防御なく濃厚に接触した者（同居者など）の経過観察期間を定め，外出自粛などの指導を行うとともに，抗ウイルス薬の予防投与の実施を促した。現時点での投与量，投与期間については，季節性インフルエンザに準じるとしている。

　　

　　　

産婦人科の方々へ
　　　

一応、今のところの最新情報です。

Pregnant Women and Novel Influenza A (H1N1) Considerations for Clinicians
May 7, 2009 4:35 PM ET
http://www.cdc.gov/h1n1flu/clinician_pregnant.htm

　　

Background
Human infections with a novel influenza A (H1N1) virus that is easily transmissible among humans were first identified in April 2009. The epidemiology and clinical presentations of these infections are currently under investigation. There are insufficient data available at this point to determine who at higher risk for complications of novel influenza A (H1N1) virus infection. However, it’s reasonable to assume that the same age and risk groups who are at higher risk for seasonal influenza complications also should be considered at higher risk for novel influenza A (H1N1) complications.

Evidence that influenza can be more severe in pregnant women comes from observations during previous pandemics and from studies among pregnant women who had seasonal influenza. An excess of influenza-associated excess deaths among pregnant women were reported during the pandemics of 1918–1919 and 1957–1958. Adverse pregnancy outcomes have been reported following previous influenza pandemics, with increased rates of spontaneous abortion and preterm birth reported, especially among women with pneumonia. Case reports and several epidemiologic studies conducted during interpandemic periods also indicate that pregnancy increases the risk for influenza complications for the mother and might increase the risk for adverse perinatal outcomes or delivery complications.

　　

Clinical presentation
Pregnant women with novel influenza A (H1N1) virus would be expected to present with typical acute respiratory illness (e.g., cough, sore throat, rhinorrhea) and fever or feverishness. Many pregnant women will go on to have a typical course of uncomplicated influenza. However, for some pregnant women, illness might progress rapidly, and might be complicated by secondary bacterial infections including pneumonia. Fetal distress associated with severe maternal illness can occur. Pregnant women who have suspected novel influenza A (H1N1) virus infection should be tested, and specimens from women who have unsubtypeable influenza A virus infections should have specimens sent to the state public health laboratory for additional testing to identify novel influenza A (H1N1).

　　

Treatment and chemoprophylaxis
The currently circulating novel influenza A (H1N1) virus is sensitive to the neuraminidase inhibitor antiviral medications zanamivir (Relenza®) and oseltamivir (Tamiflu®), but is resistant to the adamantane antiviral medications, amantadine (Symmetrel®) and rimantadine (Flumadine®). Pregnant women who meet current case-definitions for confirmed, probable or suspected novel influenza A (H1N1) infection should receive empiric antiviral treatment. Pregnant women who are close contacts with persons with suspected, probable or confirmed cases of novel influenza A (H1N1) should receive chemoprophylaxis.

As is recommended for other persons who are treated, antiviral treatment with zanamivir or oseltamivir should be initiated as soon as possible after the onset of influenza symptoms, with benefits expected to be greatest if started within 48 hours of onset, based on data from studies of seasonal influenza. However, some data from studies on seasonal influenza indicate benefit for hospitalized patients even if treatment is started more than 48 hours after onset. Recommended duration of treatment is five days, and for chemoprophylaxis is 10 days. Oseltamivir and zanamivir treatment and chemoprophylaxis regimens recommended for pregnant women are the same as those recommended for adults who have seasonal influenza. Recommendations for use of antivirals for pregnant women might change as data on antiviral susceptibilities become available.

One of the more well-studied adverse effects of influenza is its associated hyperthermia. Studies have shown that maternal hyperthermia during the first trimester doubles the risk of neural tube defects and may be associated with other birth defects and adverse outcomes. Limited data suggest that the risk for birth defects associated with fever might be mitigated by antipyretic medications or multivitamins that contain folic acid. Maternal fever during labor has been shown to be a risk factor for adverse neonatal and developmental outcomes, including neonatal seizures, encephalopathy, cerebral palsy, and neonatal death. Even though distinguishing the effects of the cause of fever from the hyperthermia itself is difficult, fever in pregnant women should be treated because of the risk that hyperthermia appears to pose to the fetus. Acetaminophen appears to be the best option for treatment of fever during pregnancy, although data on even this common exposure are also limited.

Pregnancy should not be considered a contraindication to oseltamivir or zanamivir use. Pregnant women might be at higher risk for severe complications from novel influenza A (H1N1), and the benefits of treatment or chemoprophylaxis with zanamivir or oseltamivir likely outweigh the theoretical risks of antiviral use. Oseltamivir and zanamivir are "Pregnancy Category C" medications, indicating that no clinical studies have been conducted to assess the safety of these medications for pregnant women. Because of the unknown effects of influenza antiviral drugs on pregnant women and their fetuses, oseltamivir or zanamivir should be used during pregnancy only if the potential benefit justifies the potential risk to the embryo or fetus. Although a few adverse effects have been reported in pregnant women who took these medications, no relation between the use of these medications and those adverse events has been established. Because of its systemic activity, oseltamivir is preferred for treatment of pregnant women. The drug of choice for prophylaxis is less clear. Zanamivir may be preferable because of its limited systemic absorption; however, respiratory complications that may be associated with zanamivir because of its inhaled route of administration need to be considered, especially in women at risk for respiratory problems.

　　

Other ways to reduce risk for pregnant women
There is no vaccine available yet to prevent novel influenza A (H1N1); however, the risk for novel influenza A (H1N1) might be reduced by taking steps to reduce the chance of being exposed to respiratory infections. These actions include frequent handwashing, covering coughs, and having ill persons stay home except to seek medical care, and minimize contact with others in the household. Additional measures that can limit transmission of a new influenza strain include voluntary home quarantine of members of households with confirmed or probable novel influenza A (H1N1) cases, reduction of unnecessary social contacts, and avoidance whenever possible of crowded settings. If used correctly, facemasks and respirators may help reduce the risk of getting influenza, but they should be used along with other preventive measures, such as avoiding close contact and maintaining good hand hygiene. A respirator that fits snugly on the face can filter out small particles that can be inhaled around the edges of a facemask, but compared with a facemask it is harder to breathe through a respirator for long periods of time.

　

Breastfeeding considerations
Infants who are not breastfeeding are particularly vulnerable to infection and hospitalization for severe respiratory illness. Women who deliver should be encouraged to initiate breastfeeding early and feed frequently. Ideally, babies should receive most of their nutrition from breast milk. Eliminate unnecessary formula supplementation, so the infant can receive as much maternal antibodies as possible.

If a woman is ill, she should continue breastfeeding and increase feeding frequency. If maternal illness prevents safe feeding at the breast, but she can still pump, encourage her to do so. The risk for novel influenza A (H1N1) transmission through breast milk is unknown. However, reports of viremia with seasonal influenza infection are rare.

Expressed milk should be used for infants too ill to feed at the breast. In certain situations, infants may be able to use donor human milk from a HMBANA-certified milk bank.

Antiviral medication treatment or prophylaxis is not a contraindication for breastfeeding.

Instruct parent and caretakers on how to protect their infant from the spread of germs that cause respiratory illnesses like novel influenza A (H1N1):

Wash adults’ and infants’ hands frequently with soap and water, especially after infants place their hands in their mouths.
Keep infants and mothers as close together as possible and encourage early and frequent skin-to-skin contact between mothers and their infants.
Limit sharing of toys and other items that have been in infants' mouths. Wash thoroughly with soap and water any items that have been in infants' mouths.
Keep pacifiers (including the pacifier ring/handle) and other items out of adults' or other infants' mouths prior to giving to the infant.
Practice cough and sneeze etiquette.