Announcement

Collapse
No announcement yet.

Pregnant Women are 4 Times More Likely to Develop Severe Swine Flu Illness Than Other People

Collapse
X
 
  • Filter
  • Time
  • Show
Clear All
new posts

  • Pregnant Women are 4 Times More Likely to Develop Severe Swine Flu Illness Than Other People

    A study by the CDC will show that when pregnant women become ill with swine flu they are four times more likely to develop severe illness that requires hospitalization than other people infected with the virus.



    Pregnant Women and Novel Influenza A (H1N1)
    Virus: Considerations for Clinicians


    June 30, 2009 10:19 AM ET

    This document provides updated, interim guidance on the use of influenza antiviral treatment of pregnant women who are sick with novel influenza A (H1N1). The highest priority message is to treat pregnant women with influenza-like illness as soon as possible; treatment should not be withheld pending results of testing for influenza, if testing is done. Influenza antiviral chemoprophylaxis recommendations have been updated to be consistent with CDC recommendations for chemoprophylaxis for high risk groups. Finally, infant feeding recommendations have been updated to reflect current mask use guidance and the need for a cautious approach to preventing infection in infants, even though clinical data are lacking. Recommendations are interim, based on current knowledge of the H1N1 outbreak in the United States, and may be revised as more information becomes available.

    <!-- mobile syndication block 1 end--> On this Page







    <!-- mobile syndication block 2 start--> Background

    Human infections with a novel influenza A (H1N1) virus that is easily transmissible among humans were first identified in April 2009. Severe illnesses among pregnant woman and infants have been reported in this outbreak although the epidemiology and spectrum of illness among pregnant woman and infants are not fully understood at this time and are under investigation.

    However, evidence that influenza can be more severe in pregnant women is available from observations during previous pandemics and from studies among pregnant women who had seasonal influenza. An excess of influenza-associated 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 infection would be expected to present with typical acute respiratory influenza-like illness (e.g., cough, sore throat, rhinorrhea) and fever. Other symptoms can include body aches, headache, fatigue, vomiting and diarrhea. 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. Case reports of adverse pregnancy outcomes and maternal deaths have been associated with severe illness. Ideally, pregnant women who have suspected novel influenza A (H1N1) virus infection should be tested for influenza. However, treatment should not be delayed pending results of testing and treatment should not be withheld in the absence of testing. This is because antiviral treatment is most effective when started as early as possible after the onset of symptoms (i.e. within the first 2 days). Testing is not available in many instances and, when available, results of novel H1N1 testing often take several days. Clinicians should be aware of circulation of H1N1 in their area and not wait for test results to initiate influenza treatment in women who have symptoms consistent with influenza illness.

    Treatment and chemoprophylaxis

    Early treatment with influenza antiviral medications is recommended for pregnant women with suspected influenza illness. Clinicians should not wait for test results to initiate treatment since these medications work best if started as early as possible after illness onset. The currently circulating novel influenza A (H1N1) virus is sensitive to the neuraminidase inhibitor antiviral medications zanamivir (Relenza&#174 and oseltamivir (Tamiflu&#174, but is resistant to the adamantane antiviral medications, amantadine (Symmetrel&#174 and rimantadine (Flumadine&#174. Oseltamivir is given orally and results in systemic absorption; by contrast, zanamivir is given by inhalation and results in lower systemic absorption. Oseltamivir and zanamivir treatment and chemoprophylaxis regimens recommended for pregnant women are the same as those recommended for adults who have seasonal influenza. Pregnancy should not be considered a contraindication to oseltamivir or zanamivir use. Pregnant women appear to be at higher risk for severe complications from novel influenza A (H1N1) virus infection, and the benefits of treatment or chemoprophylaxis with oseltamivir or zanamivir outweigh the theoretical risks of antiviral use. 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. More information on influenza antiviral medications is available at: CDC Interim Guidance on Antiviral Recommendations for Patients with Novel Influenza A (H1N1) Virus Infection and Their Close Contacts.
    Treatment Recommendations
    Pregnant women with influenza-like illnesses should receive empiric antiviral treatment. Because of its systemic activity, the drug of choice for treatment of pregnant women is oseltamivir. Recommended duration of treatment is five days. Treatment should not be delayed while waiting for the results of viral testing. As is recommended for other persons who are treated, antiviral treatment 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, data from studies on seasonal influenza indicate benefit for hospitalized patients even if treatment is started more than 48 hours after onset. Thus, antiviral medications are recommended for high risk persons, including pregnant women, presenting for care more than 48 hours after illness onset, particularly for those who require hospitalization
    Chemoprophylaxis Recommendations
    Post exposure antiviral chemoprophylaxis can be considered for pregnant women who are close contacts of persons with suspected or laboratory confirmed novel influenza A (H1N1) virus infection. The drug of choice for prophylaxis is probably zanamivir 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. For these women, oseltamivir is a reasonable alternative. Recommended duration of chemoprophylaxis is for 10 days after the last known exposure to novel influenza A (H1N1). In situations where multiple exposures are likely to occur, such as within families, the total length of chemoprophylaxis for a pregnant woman may depend on clinical considerations. Close monitoring for influenza like illness in exposed pregnant women is recommended.
    Fever Treatment
    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 and/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.

    Table 1 below is extracted from the guidance on influenza antiviral medications. Additional information on influenza antiviral medications can be found at recommendations.
    <table class="table" align="center" border="1" cellpadding="3" cellspacing="0" width="100&#37;"> <caption> Table 1. Antiviral medication dosing recommendations for treatment or chemoprophylaxis of novel influenza A (H1N1) infection
    (Table extracted from IDSA guidelines for seasonal influenza.) </caption> <tbody><tr> <th colspan="2" scope="col">Agent, group</th> <th scope="col">Treatment</th> <th scope="col">Chemoprophylaxis</th> </tr> <tr> <td colspan="4" bgcolor="#ebebeb">Oseltamivir</td> </tr> <tr> <td colspan="2" scope="row">Adults</td> <td>75-mg capsule twice per day for 5 days</td> <td>75-mg capsule once per day</td> </tr> <tr> </tr> <tr> <td colspan="4" bgcolor="#ebebeb">Zanamivir</td> </tr> <tr> <td colspan="2" scope="row">Adults</td> <td>Two 5-mg inhalations (10 mg total) twice per day for 5 days</td> <td>Two 5-mg inhalations (10 mg total) once per day</td> </tr> </tbody></table> Other ways to reduce risk for pregnant women

    There is no vaccine available yet to prevent novel influenza A (H1N1) virus infection; however, the risk for novel influenza A (H1N1) virus infection might be reduced by taking steps to reduce the chance of being exposed to respiratory infections. These steps include:
    1. Frequent hand washing.
    2. Minimizing contact with sick individuals.
    3. Having ill persons stay home (except to seek medical care).
    4. Having ill persons cover coughs.
    5. Avoiding, whenever possible, crowded settings in communities having outbreaks of novel influenza A (H1N1) virus.
    6. And using facemasks and respirators correctly if they are used (see Interim Recommendations for Facemask and Respirator Use to Reduce Novel Influenza A (H1N1) Virus Transmission).

    Infant feeding considerations

    Infants who are not breastfeeding are more vulnerable to infection and hospitalization for severe respiratory illness than infants who are breastfeeding. Women who are not ill with influenza 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
    Infants are thought to be at higher risk for severe illness from novel influenza A (H1N1) infection and very little is known about prevention of novel H1N1 flu infection in infants. If possible, only adults who are not sick should care for infants, including providing feedings. The risk for novel influenza A (H1N1) transmission through breast milk is unknown. However, reports of viremia with seasonal influenza infection are rare, which suggests that the risk of virus crossing into breast milk is also probably rare. Sick women who are able to express their milk for bottle feedings by a healthy family member should be encouraged to do so. Antiviral medication treatment or prophylaxis is not a contraindication for breastfeeding.
    Careful adherence to hand hygiene and cough etiquette is critical, especially for sick women who do not have anyone to help with infant care while they are ill. Women with influenza-like illness are recommended to use facemasks when providing infant care and feedings (see Interim Recommendations for Facemask and Respirator Use to Reduce Novel Influenza A (H1N1) Virus Transmission).
    Instruct parent and caretakers on how to protect their infant from the spread of germs, like novel influenza A (H1N1) virus, that cause respiratory illnesses:
    • Practice hand hygiene and cough etiquette at all times
    • Keep the infant away from persons who are ill and out of crowded areas.
    • 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.

  • #2
    Re: Pregnant Women are 4 Times More Likely to Develop Severe Swine Flu Illness Than Other People

    from CCIDRAP

    About 6% of pandemic H1N1 deaths in the United States have occurred in pregnant women, though they make up just 1% of the population, the Associated Press reported today. The numbers are based on 266 detailed death reports that the Centers for Disease Control and Prevention (CDC) has received. Fifteen deaths occurred in pregnant women.
    I am no sure I have sufficient data but it looks like pregnant women are 4 x more likely to get seriously ill, and have an even higher odds ratio for fatality.
    Despite discussion in the news article that pregnant women have high morbidity and mortality from seasonal flu, I cannot find any data on death in pregancy attributed to seasonal flu. I hope that the true data for seasonal flu and pregnancy is forthcoming for perspective.
    JT
    Thought has a dual purpose in ethics: to affirm life, and to lead from ethical impulses to a rational course of action - Teaching Reverence for Life -Albert Schweitzer. JT

    Comment


    • #3
      Re: Pregnant Women are 4 Times More Likely to Develop Severe Swine Flu Illness Than Other People

      via email -

      WASHINGTON, July 29, 2009 (AFP) - Pregnant women who contract
      swine flu are four times more likely to develop severe illness that
      requires hospitalization than other people infected with the virus,

      a US study showed Wednesday.

      They are also more likely to die of swine flu or even seasonal
      flu, and yet only 15 percent of pregnant women in the United States
      follow the advice of the Centers for Disease Control and Prevention
      (CDC) and get an annual flu shot.

      Data collected and analyzed by the CDC for the study showed
      there were 34 confirmed cases of (A)H1N1 influenza among pregnant
      women in the United States between mid-April and mid-May
      , the first
      month of the outbreak that has since been declared a pandemic by the
      World Health Organization.

      Eleven of the pregnant women, or about a third, were admitted to
      hospital.
      The hospitalization rate for members of the general public
      infected with swine flu was around eight percent, or a quarter of
      the rate among pregnant women, the study showed.

      One of the women sickened in that first month died, but five
      more pregnant women died of swine flu in the United States during
      the following month of the outbreak, the report said.

      All of them had developed pneumonia and acute respiratory
      distress syndrome requiring mechanical ventilation,
      it said.

      "We know that in seasonal influenza as well as in pandemic
      influenza situations that pregnant women have an increased risk of
      severe disease and of dying," the CDC's Denise Jamieson, lead author
      of the study which will be published in the August 8 issue of the
      Lancet, told AFP.


      The increased risk is likely due to the changes that take place
      in a woman's body during pregnancy, she said.

      "There are mechanical and hormonal changes in pregnancy, there
      are changes in the cardiovascular and respiratory systems, there are
      immunologic changes," Jamieson explained.

      "Lung capacity decreases because as the uterus grows it moves
      the diaphragm up and there's basically less room for the lungs. All
      these changes make pregnant women more susceptible to and more
      severely affected by certain viruses, including influenza."

      The six pregnant women who died sought medical care within one
      to seven days of showing flu-like symptoms. All were given
      anti-virals which have been shown to be effective against the new
      strain of swine flu, but none received the medication until at least
      six days after the onset of symptoms.

      Anti-virals oseltamivir and zanamivir, which have been shown to
      be effective against the (A)H1N1 virus, are most successful in
      reducing the severity of flu if started within 48 hours of the onset
      of illness.

      The CDC began closely monitoring (A)H1N1 infections in pregnant
      women in May after a previously healthy, 33-year-old woman in her
      35th week of pregnancy became the second person in the United States
      to die of swine flu.

      The United States has confirmed 302 swine flu deaths as of July
      24, the highest death toll in the world.

      Pharmaceutical companies are racing to develop a vaccine against
      the new strain of swine flu, and the CDC's Advisory Committee on
      Immunization Practices (ACIP) is due to meet Wednesday to establish
      recommendations on whom to vaccinate against (A)H1N1 in the United
      States when flu season returns in the autumn.

      "Since there's not yet an H1N1 vaccine, there are not yet
      recommendations about pregnant women. But we do recommend that
      pregnant women be vaccinated against seasonal influenza," said
      Jamieson.

      Despite the CDC recommending since 2004 that expectant US
      mothers be inoculated against seasonal flu, less than 15 percent
      take up the recommendation, partly out of fear of the possible
      side-effects on their unborn baby, she said.

      The babies of five of the six pregnant women who died during the
      study period were delivered by Caesarean section.

      None had any evidence of influenza infection and all but one,
      who was born 13 weeks before term, have been discharged in good
      health, the study said.

      The baby born at 27 weeks was still in hospital and doing well.

      The sixth woman was only 11 weeks pregnant and her baby died
      when she did, the study said.

      Comment


      • #4
        Re: Pregnant Women are 4 Times More Likely to Develop Severe Swine Flu Illness Than Other People

        Pregnancy Poses Higher Risk of Dying From Swine Flu, Study Says

        By Jason Gale
        July 29 (Bloomberg) -- Swine flu in pregnancy can cause life-threatening disease and warrants treatment with antiviral drugs as soon as possible, a study in the medical journal Lancet found.

        The study, to be published in the Aug. 8 issue, found about one in eight people who died after contracting the new virus was pregnant. The hospitalization rate for pregnant women was more than four times that of the general population, the study showed.

        The findings support advice from health authorities including the World Health Organization that pregnancy may put women at greater risk of developing complications from the pandemic H1N1 flu. The data collected and analyzed by the U.S. Centers for Disease Control and Prevention are the most comprehensive available to date on the impact of this novel flu virus among pregnant women, the Atlanta-based agency said in a statement today.

        “If a pregnant woman feels like she may have influenza, she needs to call her health-care provider right away,” Denise Jamieson, lead author of the study, said in the statement. “Clinicians who treat pregnant women should have a system in place for triaging pregnant women with influenza-like symptoms and they should not delay in initiating appropriate antiviral therapy.”

        Six deaths of pregnant women with H1N1 were reported to the CDC between April 15 and June 16, representing 13 percent of the 45 fatalities made known to the agency during that period.

        All were healthy before they caught the virus, which caused them to develop viral pneumonia leading to acute respiratory distress requiring mechanical ventilation. All pregnant women who died didn’t start taking antiviral medicines soon enough, according to the CDC statement.

        Committee Meeting

        A federal advisory committee on vaccines will meet today on immunization for swine flu and who should get priority for the shot.
        Pregnant women’s greater risk of death will make them likely to be among the first group in the U.S. advised to get vaccinated against the pandemic virus, the Associated Press reported yesterday.

        GlaxoSmithKline Plc’s Relenza, a powder administered using a disk-shaped inhaler, is recommended in the U.K. for pregnant women because it easily reaches the throat and lungs, where it is needed, and doesn’t lead to significant levels in the blood or placenta, according to the National Health Service.

        Roche Holding AG’s Tamiflu, the world’s bestselling flu medicine, is taken as a pill and is absorbed throughout the body, making it the CDC’s preferred treatment in pregnancy.
        Some clinicians hesitate to treat pregnant women with antiviral medications because of unfounded concerns for the developing fetus, the CDC’s Jamieson said.
        ‘Wrong Approach’

        “This is the wrong approach,” she said. “It is critical that pregnant women, in particular, be treated promptly.”

        While pregnant women don’t seem to be at greater risk than the general population of catching the pandemic bug, they do seem to be more likely than non-pregnant women to develop complications from any type of flu infection, said Shaun Brennecke, chair of obstetrics and gynecology at the University of Melbourne. This is especially the case during the latter stages of pregnancy, he said.

        An excess of influenza-associated deaths among pregnant women were reported during the pandemics of 1918-1919 and 1957- 1958, according to the CDC. A similar pattern with swine flu is being reported by doctors in Australia and New Zealand, where colder winter weather is driving a surge in flu cases.
        Deteriorating Condition

        “We have also noticed that with pregnant women, their condition will deteriorate quite fast,” said Tim Smyth, deputy director general of health for New South Wales, Australia’s most-populous state.

        Christchurch Hospital, the main public hospital in the city in New Zealand, has treated two critically ill pregnant women with severe viral pneumonia, said Geoff Shaw, a consultant in the intensive care unit. One was 21 weeks pregnant and the other 34 weeks, he said.

        “It’s almost unheard of for healthy, pregnant women to get a severe, life-threatening pneumonia, and we have two at the same time,” Shaw said over the telephone last week. “We have never seen that before.”

        The reasons for the higher risk are speculative, Brennecke said. Possible causes include subtle changes in a pregnant woman’s immunological resilience for dealing with certain viral infections, he said in an e-mailed response to questions last month.

        Other reasons may include changes in lung functioning late in pregnancy caused by the enlarged uterus pressing up against the lungs, limiting lung expansion, modified coughing capacity and possibly changing blood flow through various areas of lung tissue, he said.

        Combined Effect

        “The combination of these effects may impair the lungs’ natural ability to deal with airborne viruses such as flu viruses,” Brennecke said.

        More than 800 people have died in the pandemic since it emerged in Mexico earlier this year and spread globally, according to the WHO.

        Risk factors for serious pandemic disease aren’t known definitively, though cardiovascular disease, respiratory disease, diabetes and cancer make people more vulnerable to developing complications from the infection, the Geneva-based agency said July 24. Asthma, other forms of respiratory disease, as well as obesity may also put people at increased risk.

        To contact the reporter on this story: Jason Gale in Singapore at j.gale@bloomberg.net.
        Last Updated: July 29, 2009 03:59 EDT

        Comment

        Working...
        X