Influenza A H1N1 virus infection among pregnant women in a tertiary hospital in Belgrade, Serbia (original) (raw)
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American Journal of Obstetrics and Gynecology, 2011
T he emergence of 2009 pandemic influenza A (H1N1) virus (2009 H1N1) resulted in the first influenza pandemic in over 40 years. The Centers for Disease Control and Prevention (CDC) estimated that about 61 million people were infected, 274,000 were hospitalized, and about 12,740 died due to 2009 H1N1 in the United States. 1 About 90% of all hospitalizations and 87% of all deaths during the 2009 H1N1 pandemic were among people Ͻ65 years in contrast with experience from seasonal influenza when about 40% of all hospitalizations and 10% of deaths were found in this age group. 1 It is well recognized that pregnancy represents a risk factor for influenza complications and death during both pandemic and seasonal influenza. 2-6 Thus, with illness being widespread among the younger segments of the population We sought to describe characteristics of hospitalized reproductive-aged (15-44 years) women with seasonal (2005/2006 through 2008/2009) and 2009 pandemic influenza A (H1N1) virus infection. We used population-based data from the Emerging Infections Program in 10 US states, and compared characteristics of pregnant (n ϭ 150) and nonpregnant (n ϭ 489) seasonal, and pregnant (n ϭ 489) and nonpregnant (n ϭ 1088) pandemic influenza cases using 2 and Fisher's exact tests. Pregnant women represented 23.5% and 31.0% of all reproductive-aged women hospitalized for seasonal and pandemic influenza, respectively. Significantly more nonpregnant than pregnant women with seasonal (71.2% vs 36.0%) and pandemic (69.7% vs 31.9%) influenza had an underlying medical condition other than pregnancy. Antiviral treatment was significantly more common with pandemic than seasonal influenza for both pregnant (86.5% vs 24.0%) and nonpregnant (82.0% vs 55.2%) women. Pregnant women comprised a significant proportion of influenza-hospitalized reproductive-aged women, underscoring the importance of influenza vaccination during pregnancy.
Antiviral Therapy, 2011
was significantly more severe in pregnant than in nonpregnant women. In Spain, antiviral therapy was recommended for pregnant women from the beginning of the 2009 pandemic. Methods: The prospective cohort study included consecutive pregnant and non-pregnant women of reproductive age with a proven diagnosis of 2009 A(H1N1)v admitted to any of the 13 participating Spanish hospitals between 12 June and 10 November 2009. Results: In total, 98 pregnant and 112 non-pregnant women with proven 2009 A(H1N1)v hospitalized during the study period were included. Influenza was more severe among non-pregnant patients than pregnant patients with respect to outcomes of both intensive care unit admission (18% versus 2%; P<0.001) and death (5 versus 0; P=0.06). Pregnant women had fewer associated comorbid conditions other than pregnancy (18% versus 44%; P<0.001); they were also admitted earlier than non-pregnant women (median days since onset of symptoms: 2 versus 3; P<0.001) and a higher percentage received early antiviral therapy (41% versus 28%; P=0.03). Neither a multivariate nor a matched cohort analysis found pregnancy to be associated with greater severity than that associated with hospitalized, seriously ill non-pregnant women. Conclusions: 2009 A(H1N1)v influenza was not associated with worse outcomes in hospitalized pregnant women compared with non-pregnant ones of reproductive age in a context of early diagnosis and antiviral therapy.
Severe 2009 A/H1N1v influenza in pregnant women in Spain*
Critical Care Medicine, 2011
Objectives: To describe the severity of the 2009 influenza H1N1v illness among pregnant women admitted to Spanish intensive care units. Design and Patients: Prospective, observational, multicenter study conducted in 148 Spanish intensive care units. We reviewed demographic and clinical data from the Spanish Society of Intensive Care Medicine database reported from April 23, 2009, to February 15, 2010. We included women of reproductive age (15-44 yrs) with confirmed H1N1v infection admitted to intensive care units.
Journal of Infectious Diseases, 2012
Background. Pregnant women were at increased risk for serious outcomes of 2009 pandemic influenza A virus subtype H1N1 (influenza A[H1N1]pdm09) infection, but little is known about the overall impact of the pandemic on neonatal and maternal outcomes. Methods. We identified live births that occurred from 1 July 2008 through 31 May 2010 in 5 Kaiser Permanente regions. Pregnant women were considered to have influenza if they had a positive result of a laboratory test for influenza virus or if they received a diagnosis of influenza during a period in which seasonal influenza virus or A(H1N1)pdm09 was the predominant circulating virus. Results. There were 111 158 births from 109 015 pregnancies involving 107 889 mothers; 368 pregnant women (0.3%) received a diagnosis of influenza due to seasonal virus, and 959 (0.9%) received a diagnosis of influenza due to A(H1N1)pdm09; 107 688 did not receive an influenza diagnosis. Pregnant women with influenza due to A(H1N1)pdm09 were more likely than women with seasonal influenza infection to be hospitalized within 30 days of the diagnosis (27% vs 12%; odds ratio [OR], 2.84 [95% confidence interval {CI}, 2.01-4.02]). Pregnant women with A(H1N1)pdm09 who started antiviral treatment ≥2 days after the diagnosis were significantly more likely to be hospitalized than those who started antiviral treatment <2 days after diagnosis (OR, 3.43 [95% CI, 1.55-7.56]). Mothers with seasonal influenza virus infection had an increased risk for having a small-forgestational-age infant (OR, 1.59 [95% CI, 1.15-2.20]). Conclusions. In this large, geographically diverse population, A(H1N1)pdm09 infection increased the risk for hospitalization during pregnancy. Late initiation of antiviral treatment was also associated with an increased risk for hospitalization.
FATAL PROGNOSIS OF H1N1 INFLUENZA IN LATE TRIMESTER OF PREGNANCY: DESCRIPTIVE ANALYSIS OF FOUR CASES
International Journal of Pharmacy and Pharmaceutical Sciences, 2016
Influenza infection in late trimester associated with complications is attributable risk factors for critical illness among pregnant women. We have analyzed the medical records of four pregnant women retrospectively who were admitted in a medical intensive care unit of tertiary care center with influenza-like symptoms of breathlessness, fever, headache, myalgia and cough. Their mean age was 26.5 (19-30). They were confirmed to have H1N1infection by real-time reverse transcriptase polymerase chain reaction assay. Chest x-ray of all patients showed abnormalities like pulmonary edema and suggestive of acute respiratory distress syndrome. Arterial blood gas analysis of all four patients shown severe hypoxia and all of them was mechanically ventilated. Oseltemivir was started for all four from the day of admission. Pipracillin-tazobactum combination along with other antibiotics was given as prophylaxis and treatment of different infections. Midazolam and morphine were given together to reduce the restlessness and ventilator-associated distress. Furosemide was given to all for breathing problems and pulmonary edema. Despite of all the management provided none of the patients survived due to the progression of H1N1 into septic shock and multiple organs dysfunction syndromes.
IP innovative publication pvt. ltd, 2019
Introduction: Pregnant females are at higher risk for development of respiratory complications women mainly because of their altered immunity and physiological adaptations. Compared to non-pregnant individuals, pregnant women are more likely to develop influenzaassociated complications, severe disease, and death. This study is carried out to analyze the epidemiological factors associated with outcome in pregnant women who suffered from H1N1 infection as well as to compare the outcome of HINI infection in pregnant and nonpregnant women. Materials and Methods: Descriptive and hospital based study of all Swine flu positive pregnant and non-pregnant females reported to OPD & admitted in Isolation and ICU from Jan to Dec 2015 were included in the study. The demographic data was collected for each patient and the following details were noted and analyzed: gestational age at diagnosis, duration of hospitalization, place of admission, mechanical ventilation status and maternal neonatal outcome. Results: The study revealed that during study period total 2344 women attended swine flu OPD, out of them 686 women tested by RTPCR. In 282 cases, RT PCR was H1N1 positive. Out of them 147 women were admitted in isolation ward and ICU for further investigation and treatment. Out of 147 admitted confirmed cases, 30 females were pregnant, 67 were admitted in ICU. Total 33 swine positive females were expired, out of them 28 were put on ventilator and 7 were pregnant. Most of the females belong to rural background. Healthcare seeking behaviour was higher in Pregnant female with significantly higher duration of stay in hospital. More pregnant women (69.23%) put on ventilator than non-pregnant (38.89%). Case fatality rate in pregnant females (23.33%) was higher in compare to non-pregnant population (22.22%). Conclusions: Pregnancy is associated with high CFR, longer duration of hospitalization, more need of ICU admission as well as mechanical ventilation. ICU. It may be due to low awareness and late presentation especially in the women belonged to rural areas.
Severity of influenza and noninfluenza acute respiratory illness among pregnant women, 2010-2012
American journal of obstetrics and gynecology, 2014
The objective of the study was to identify characteristics of influenza illness contrasted with noninfluenza acute respiratory illness (ARI) in pregnant women. ARI among pregnant women was identified through daily surveillance during 2 influenza seasons (2010-2012). Within 8 days of illness onset, nasopharyngeal swabs were collected, and an interview was conducted for symptoms and other characteristics. A follow-up telephone interview was conducted 1-2 weeks later, and medical records were extracted. Severity of illness was evaluated by self-assessment of 12 illness symptoms, subjective ratings of overall impairment, highest reported temperature, illness duration, and medical utilization. Of 292 pregnant women with ARI, 100 tested positive for influenza viruses. Women with influenza illnesses reported higher symptom severity than those with noninfluenza ARI (median score, 18 vs 16 of 36; P < .05) and were more likely to report severe subjective feverishness (18% vs 5%; P < .00...