[Originally published online Sept. 1, 2011. Updated and revised in 2013.]

This article addresses disaster agents and the unique risks and management of the pregnant woman, her fetus, and the neonate. The Perinatal Disaster Management tool on the next page summarizes management issues and could be essential in a disaster where rapid access is critical and electronic technology may be absent.

Since the original publication (www.acep.org/Content.aspx??id=82657), there have been important developments.

Influenza: Antivirals: Although zanamivir can be used in pregnancy, oseltamivir is preferred for active infection in pregnant and postpartum women of less than two weeks because of its systemic absorption. Dosing is: Oseltamivir: 75 mg BID X 5 days for acute infection, X 10 days for post-exposure prophylaxis. In a pandemic, pre- and post-exposure prophylaxis should be considered for pregnant women. Dosing for oseltamivir is the same as above; alternate option is zanamivir: two 5-mg inhalations (10 mg total) BID. Duration depends on duration of influenza activity in the community and exposure risk.¹ Influenza vaccine has continually demonstrated safety in pregnancy. ^1,2,3

SARS: According to the CDC, “SARS might be more severe for pregnant than for non-pregnant women.” Ribavirin is no longer recommended for the treatment of coronaviruses or SARS due to the lack of evidence for efficacy and known severe toxicity. Reports also concluded Interferon α, β, and γ may be efficacious in the treatment of SARS; however, more studies are needed to substantiate a recommendation for their use.⁴ No new cases of SARS have been reported in the world since 2004. The “CDC recommends the same treatment that would be used for a patient with any serious community- acquired atypical pneumonia” as the presentations, especially in the acute phase, are similar, and concurrent infections have been well documented.⁵

Anthrax: The CDC further clarifies ciprofloxacin as first line treatment, with use of doxycycline only if a contraindication to other antibiotics exists. Treatment should be switched to amoxicillin if the B. anthracis is found to be sensitive to penicillin.⁶ In regard to the AVA vaccine,⁷ the benefits appear to outweigh risks in cases of a high risk of exposure to inhalational anthrax. In such a case, antibiotic treatment should also be initiated concurrently for 60 days. The vaccine is not recommended for pre-exposure prophylaxis in pregnant women.⁷

Hemorrhagic Fever Virus (HFV)⁸:

According to the San Francisco Department of Public Health, ribavirin is indicated only for suspect or unknown HFV types, suspect or probable Arenavirus (Lassa fever and New World hemorrhagic fever) or Bunyavirus (Rift Valley Fever, Crimean-Congo fever, and “agents of hemorrhagic fever with renal syndrome” such as Hantavirus). It has not been shown efficacious in Filovirus (Ebola and Marburg viruses) or Flavivirus (yellow fever, Omsk hemorrhagic fever, Kyasanur Forest disease, and dengue fever) and is not recommended in such cases.