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Wiley KE, Cooper SC, Wood N, Leask J. Understanding pregnant women's attitudes and behavior toward influenza and pertussis vaccination. QUALITATIVE HEALTH RESEARCH 2015; 25:360-370. [PMID: 25246330 DOI: 10.1177/1049732314551061] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Internationally, pregnant and postpartum women have been the focus of influenza and pertussis immunization campaigns, with differing levels of vaccine acceptance. We used semistructured interviews to explore pregnant women's perspectives on influenza vaccination during pregnancy and postpartum pertussis vaccination. Many women saw pregnancy as a busy time filled with advice on what they "should" and "should not" do to ensure the health of their fetus, and vaccinating themselves was regarded as just one of these tasks needing consideration. Women were more concerned about potential risks to their infants' health before their own. They saw influenza as a disease affecting the mother, whereas they viewed pertussis as a threat to the baby and therefore comparatively more risky. They were thus more likely to intend to vaccinate against pertussis to protect their infant. Framing of vaccination information toward protection of the baby might help increase vaccine uptake among pregnant women.
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Affiliation(s)
- Kerrie E Wiley
- The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Spring C Cooper
- The University of Sydney, Sydney, New South Wales, Australia
| | - Nicholas Wood
- The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Julie Leask
- The University of Sydney, Sydney, New South Wales, Australia
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152
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Klüwer B, Furuseth E, Trogstad L, Rydland KM. [Influenza vaccination in pregnancy]. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2015; 135:311-2. [PMID: 25707649 DOI: 10.4045/tidsskr.15.0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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153
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Pulmonary Disorders in Pregnancy. MEDICAL MANAGEMENT OF THE PREGNANT PATIENT 2015. [PMCID: PMC7120384 DOI: 10.1007/978-1-4614-1244-1_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Pregnancy is associated with some profound changes in the cardiovascular, respiratory, immune, and hematologic systems that impact the clinical presentation of respiratory disorders, their implications in pregnancy, and the decisions to treat. In addition, concerns for fetal well-being and safety of various interventions complicate the management of these disorders. In many circumstances, especially life-threatening ones, decisions are based upon a careful assessment of the risk benefit ratio rather than absolute safety of drugs and interventions. In this chapter, we review some of the common respiratory disorders that internists or obstetricians may be called upon to manage.
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154
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Airway mucosal immune-suppression in neonates of mothers receiving A(H1N1)pnd09 vaccination during pregnancy. Pediatr Infect Dis J 2015; 34:84-90. [PMID: 25229268 DOI: 10.1097/inf.0000000000000529] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND It is recommended to vaccinate pregnant women against influenza. A possible impact on the immune expression of the fetus has never been studied. We aim to study the immune signature in the upper airways and the incidence of infections in neonates born to mothers receiving Influenza A(H1N1)pnd09 vaccination during pregnancy. METHODS One hundred and fifty-six women from the unselected Copenhagen Prospective Study on Asthma in Childhood (COPSAC2010) received Influenza A(H1N1)pnd09-vaccination during the 2009 pandemic. Fifty-one mothers received the vaccine during pregnancy and 105 after pregnancy; 332 neonates of nonvaccinated mothers were included as secondary controls. Nasal mucosal lining fluid was sampled in 488 neonates and assessed for interleukin (IL)-12p70, IP-10, interferon-gamma (IFN)-γ, tumor necrosis factor-alpha (TNF)-α, MIP-1β, MCP-1, MCP-4, IL-4, IL-5, IL-13, eotaxin-1, eotaxin-3, TARC, MDC, IL-17, IL-1β, IL-8, transforming growth factor beta (TGF)-β1, IL-10 and IL-2. Infections were monitored the first year of life by daily diary cards and clinical controls. RESULTS Neonates of mothers vaccinated during pregnancy had significant up-regulation of TGF-β1 [ratio = 1.52 (1.22-1.90), P = 0.0002], and corresponding down-regulation (P < 0.05) of IL-12p70, IFN-γ, IL-5, eotaxin-1, TARC, MDC, IL-8 in comparison to those vaccinated after pregnancy. The lag-time from vaccination during pregnancy to assessment of the immune signature showed significant and positive association to up-regulation of TGF-β1 levels (P = 0.0003) and significant negative association to other mediators. The study was not powered to study differences in the incidence of infections in early infancy which did not differ between the study groups. CONCLUSION Influenza A(H1N1)pnd09 vaccination during pregnancy up-regulates TGF-β1 and down-regulates key mediators of the protective immunity.
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155
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Postpandemic Influenza A/H1N1pdm09 is still Causing Severe Perinatal Complications. Mediterr J Hematol Infect Dis 2015; 7:e2015007. [PMID: 25574366 PMCID: PMC4283922 DOI: 10.4084/mjhid.2015.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 11/26/2014] [Indexed: 12/05/2022] Open
Abstract
Although influenza A/H1N1pdm09 is not causing a pandemic anymore, we recently observed two critically ill pregnant women infected by this virus. We present these cases to illustrate the possible severe complications of an – at that moment – seasonal influenza in pregnancy. We discuss the epidemiological differences between the pandemic and post pandemic phase and try to explain the high virulence of influenza A/H1N1pdm09 -infections in pregnancy by discussing insights in immunology during pregnancy. We conclude that although influenza A/H1N1pdm09 is in the post pandemic phase, infection by this influenza virus still needs to be considered in pregnant women with progressive respiratory dysfunction.
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156
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Ghulmiyyah LM, Alame MM, Mirza FG, Zaraket H, Nassar AH. Influenza and its treatment during pregnancy: A review. J Neonatal Perinatal Med 2015; 8:297-306. [PMID: 26836818 DOI: 10.3233/npm-15814124] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The influenza viral infection has dramatic effects during pregnancy on the mother and the fetus. We present a review article on the prevention and treatment recommendations of influenza infection in pregnant women, and the effects of antiviral medications on maternal-fetal outcomes. This viral infection not only leads to miscarriages, preterm deliveries and a high maternal mortality rate, but it also poses negative risks to the fetus including small-for-gestational age infants, and admissions to neonatal intensive care units. Vaccination is the most effective strategy for preventing influenza infection during pregnancy whereby can protect both maternal and fetal immunities. The safety profiles of antiviral drugs during pregnancy are limited. Available risk-benefit evidence has indicated that pregnant women with suspected or confirmed influenza should receive prompt antiviral therapy where these medications reduce the risk of complications among pregnant women, and attenuate the teratogenic effects of the influenza infection. Post-exposure prophylaxis is not recommended for most pregnant women, but it may be prescribed in pandemic settings, particularly to non-vaccinated women. Although some ex vivo models for pharmacokinetic studies have revealed that the transplacental transfer of oseltamivir to fetal circuits may occur, there is no evidence of adverse fetal outcomes as a result of most in utero exposures to neuraminidase inhibitors. Due to the large number of confounding variables, large, population-based studies are needed to assess the association between in utero oseltamivir exposure and fetal outcome.
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Affiliation(s)
- L M Ghulmiyyah
- Department of Obstetrics and Gynecology, American University of Beirut Medical Centerm Beirut, Lebanon
| | - M M Alame
- Department of Obstetrics and Gynecology, American University of Beirut Medical Centerm Beirut, Lebanon
| | - F G Mirza
- Department of Obstetrics and Gynecology, American University of Beirut Medical Centerm Beirut, Lebanon
| | - H Zaraket
- Department of Experimental Pathology, Immunology & Microbiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - A H Nassar
- Department of Obstetrics and Gynecology, American University of Beirut Medical Centerm Beirut, Lebanon
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157
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Emerging and Reemerging Infectious Disease Threats. MANDELL, DOUGLAS, AND BENNETT'S PRINCIPLES AND PRACTICE OF INFECTIOUS DISEASES 2015. [PMCID: PMC7151803 DOI: 10.1016/b978-1-4557-4801-3.00014-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Shimada T, Sunagawa T, Taniguchi K, Yahata Y, Kamiya H, Yamamoto KU, Yasui Y, Okabe N. Description of hospitalized cases of influenza A(H1N1)pdm09 infection on the basis of the national hospitalized-case surveillance, 2009-2010, Japan. Jpn J Infect Dis 2014; 68:151-8. [PMID: 25672359 DOI: 10.7883/yoken.jjid.2014.125] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study reports the epidemiological characteristics of hospitalized cases of influenza A(H1N1)pdm09 infection analyzed on the basis of surveillance data collected from July 24, 2009, the date on which the hospital-based surveillance of influenza cases was implemented in Japan, to September 5, 2010. During the study period, 13,581 confirmed cases were reported. Among those cases with information regarding the reason for hospitalization, 39% were admitted to hospitals for non-therapeutic purposes such as medical observation and laboratory testing. The overall hospitalization rate was 5.8 cases per 100,000 population when cases hospitalized for non-therapeutic purposes were excluded. While those aged under 20 years accounted for over 85% of hospitalized cases, the largest proportion of fatal cases was observed in those aged over 65 years. The overall case fatality rate for all hospitalized cases was 1.5%. The year-round surveillance for hospitalized influenza-like illness cases was launched in 2011, and it was expected that this surveillance system could add value by monitoring changes in the epidemiological characteristics of hospitalized cases of seasonal influenza.
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Affiliation(s)
- Tomoe Shimada
- Infectious Disease Surveillance Center, National Institute of Infectious Diseases; Department of Infections Diseases and Infection Control, Jikei University School Medicine, Tokyo 105-0003, Japan.
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159
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Maternal mortality secondary to acute respiratory failure in Colombia: a population-based analysis. Lung 2014; 193:231-7. [PMID: 25534497 DOI: 10.1007/s00408-014-9677-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 12/15/2014] [Indexed: 12/27/2022]
Abstract
PURPOSE To estimate the mortality rate and trends of respiratory failure in the pregnant and postpartum population of Colombia. METHODS A retrospective analysis of the national registry of mortality in Colombia was performed from 1998 to 2009. Maternal death was defined as death that occurred during pregnancy or up to 42 days postpartum. Two independent investigators reviewed maternal deaths to determine deaths caused by respiratory failure. Inter-rater agreement was assessed by kappa correlation coefficient. Causes of respiratory failure were identified according to the International Classification of Diseases (ICD-10). RESULTS During the study period, 8,637,486 live births were reported with 6,676 maternal deaths for an overall maternal mortality rate (MMR) of 82.9 per 100,000 live births. Of these, a total of 835 cases were related to respiratory failure, with a specific MMR of 9.69 per 100,000 live births. The main causes of maternal deaths due to respiratory failure included pulmonary sepsis (284 cases, or 3.58 per 100,000 live births), pulmonary embolism (119 cases or 1.50 per 100,000 live births), and preeclampsia-related pulmonary edema (112 cases or 1.41 per 100,000 live births). All-cause maternal mortality ratio decreased yearly from 1998 to 2009 by -3.76% (95% CI -4.83 to -2.67), while the trend of mortality secondary to respiratory failure remained stable over time (P = 0.449). CONCLUSIONS Respiratory failure is an important cause of mortality in the obstetric population in Colombia, with pulmonary sepsis as the lead cause of respiratory failure among maternal deaths. While overall maternal mortality rates have decreased in the last decade, respiratory failure-related deaths have remained stable over time.
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160
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Campbell OMR, Benova L, Gon G, Afsana K, Cumming O. Getting the basic rights - the role of water, sanitation and hygiene in maternal and reproductive health: a conceptual framework. Trop Med Int Health 2014; 20:252-67. [PMID: 25430609 PMCID: PMC4681319 DOI: 10.1111/tmi.12439] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To explore linkages between water, sanitation and hygiene (WASH) and maternal and perinatal health via a conceptual approach and a scoping review. METHODS We developed a conceptual framework iteratively, amalgamating three literature-based lenses. We then searched literature and identified risk factors potentially linked to maternal and perinatal health. We conducted a systematic scoping review for all chemical and biological WASH risk factors identified using text and MeSH terms, limiting results to systematic reviews or meta-analyses. The remaining 10 complex behavioural associations were not reviewed systematically. RESULTS The main ways poor WASH could lead to adverse outcomes are via two non-exclusive categories: 1. 'In-water' associations: (a) Inorganic contaminants, and (b) 'water-system' related infections, (c) 'water-based' infections, and (d) 'water borne' infections. 2. 'Behaviour' associations: (e) Behaviours leading to water-washed infections, (f) Water-related insect-vector infections, and (g-i) Behaviours leading to non-infectious diseases/conditions. We added a gender inequality and a life course lens to the above framework to identify whether WASH affected health of mothers in particular, and acted beyond the immediate effects. This framework led us to identifying 77 risk mechanisms (67 chemical or biological factors and 10 complex behavioural factors) linking WASH to maternal and perinatal health outcomes. CONCLUSION WASH affects the risk of adverse maternal and perinatal health outcomes; these exposures are multiple and overlapping and may be distant from the immediate health outcome. Much of the evidence is weak, based on observational studies and anecdotal evidence, with relatively few systematic reviews. New systematic reviews are required to assess the quality of existing evidence more rigorously, and primary research is required to investigate the magnitude of effects of particular WASH exposures on specific maternal and perinatal outcomes. Whilst major gaps exist, the evidence strongly suggests that poor WASH influences maternal and reproductive health outcomes to the extent that it should be considered in global and national strategies.
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Affiliation(s)
- Oona M R Campbell
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
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161
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Keller-Stanislawski B, Englund JA, Kang G, Mangtani P, Neuzil K, Nohynek H, Pless R, Lambach P, Zuber P. Safety of immunization during pregnancy: a review of the evidence of selected inactivated and live attenuated vaccines. Vaccine 2014; 32:7057-64. [PMID: 25285883 DOI: 10.1016/j.vaccine.2014.09.052] [Citation(s) in RCA: 152] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 09/19/2014] [Accepted: 09/20/2014] [Indexed: 01/12/2023]
Abstract
Vaccine-preventable infectious diseases are responsible for significant maternal, neonatal, and young infant morbidity and mortality. While there is emerging scientific evidence, as well as theoretical considerations, indicating that certain vaccines are safe for pregnant women and fetuses, policy formulation is challenging because of perceived potential risks to the fetus. This report presents an overview of available evidence on pregnant women vaccination safety monitoring in pregnant women, from both published literature and ongoing surveillance programs. Safety data were reviewed for vaccines against diseases which increase morbidity in pregnant women, their fetus or infant as well as vaccines which are used in mass vaccination campaigns against diseases. They include inactivated seasonal and pandemic influenza, mono- and combined meningococcal polysaccharide and conjugated vaccines, tetanus toxoid and acellular pertussis combination vaccines, as well as monovalent or combined rubella, oral poliomyelitis virus and yellow fever vaccines. No evidence of adverse pregnancy outcomes has been identified from immunization of pregnant women with these vaccines.
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Affiliation(s)
| | - Janet A Englund
- Seattle Children's Hospital, Division of Infectious Diseases, 4800 Sand Point Way N.E., R5441, Seattle, WA 98105, USA.
| | - Gagandeep Kang
- Christian Medical College, Vellore 632 004, Tamil Nadu, India.
| | - Punam Mangtani
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
| | - Kathleen Neuzil
- University of Washington, PATH, Street: 2201 Westlake Avenue, Suite 200, Seattle, WA 98121, Seattle, WA 98109, USA; National Institute for Health and Welfare THL, P.O. Box 30, FI-00271 Helsinki, Finland.
| | - Hanna Nohynek
- National Institute for Health and Welfare THL, P.O. Box 30, FI-00271 Helsinki, Finland.
| | - Robert Pless
- Public Health Agency of Canada, 130 Colonnade Road, A/L 6502A, Ottawa, ON, K1A 0K9, Canada.
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Enhanced natural killer-cell and T-cell responses to influenza A virus during pregnancy. Proc Natl Acad Sci U S A 2014; 111:14506-11. [PMID: 25246558 DOI: 10.1073/pnas.1416569111] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Pregnant women experience increased morbidity and mortality after influenza infection, for reasons that are not understood. Although some data suggest that natural killer (NK)- and T-cell responses are suppressed during pregnancy, influenza-specific responses have not been previously evaluated. Thus, we analyzed the responses of women that were pregnant (n = 21) versus those that were not (n = 29) immediately before inactivated influenza vaccination (IIV), 7 d after vaccination, and 6 wk postpartum. Expression of CD107a (a marker of cytolysis) and production of IFN-γ and macrophage inflammatory protein (MIP) 1β were assessed by flow cytometry. Pregnant women had a significantly increased percentage of NK cells producing a MIP-1β response to pH1N1 virus compared with nonpregnant women pre-IIV [median, 6.66 vs. 0.90% (P = 0.0149)] and 7 d post-IIV [median, 11.23 vs. 2.81% (P = 0.004)], indicating a heightened chemokine response in pregnant women that was further enhanced by the vaccination. Pregnant women also exhibited significantly increased T-cell production of MIP-1β and polyfunctionality in NK and T cells to pH1N1 virus pre- and post-IIV. NK- and T-cell polyfunctionality was also enhanced in pregnant women in response to the H3N2 viral strain. In contrast, pregnant women had significantly reduced NK- and T-cell responses to phorbol 12-myristate 13-acetate and ionomycin. This type of stimulation led to the conclusion that NK- and T-cell responses during pregnancy are suppressed, but clearly this conclusion is not correct relative to the more biologically relevant assays described here. Robust cellular immune responses to influenza during pregnancy could drive pulmonary inflammation, explaining increased morbidity and mortality.
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163
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Hemagglutinin mutation D222N of the 2009 pandemic H1N1 influenza virus alters receptor specificity without affecting virulence in mice. Virus Res 2014; 189:79-86. [DOI: 10.1016/j.virusres.2014.05.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2013] [Revised: 04/12/2014] [Accepted: 05/01/2014] [Indexed: 12/25/2022]
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Szwarcwald CL, Escalante JJC, Rabello Neto DDL, Souza Junior PRBD, Victora CG. Estimação da razão de mortalidade materna no Brasil, 2008-2011. CAD SAUDE PUBLICA 2014; 30 Suppl 1:S1-12. [DOI: 10.1590/0102-311x00125313] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Accepted: 10/17/2013] [Indexed: 11/21/2022] Open
Abstract
Neste trabalho, propõe-se uma metodologia de estimação da razão de mortalidade materna (RMM), no Brasil, 2008-2011, por meio das informações do Ministério da Saúde. O método proposto leva em consideração, o sub-registro geral de óbitos, as proporções de investigação de mortes de mulheres em idade fértil, bem como as proporções de óbitos maternos que foram atribuídos, indevidamente, a outras causas antes da investigação. A RMM foi estimada por Unidade de Federação no triênio de 2009-2011. No Brasil, a RMM atinge o valor mínimo em 2011 (60,8/100 mil nascidos vivo) e o máximo em 2009 (73,1/100 mil nascidos vivos), explicado, provavelmente, pela epidemia de influenza A (H1N1). Os maiores valores da RMM foram encontrados no Maranhão e no Piauí, ultrapassando 100/100 mil nascidos vivos, e o menor foi apresentado por Santa Catarina, o único estado com magnitude inferior a 40/100 mil nascidos vivos. Os resultados indicaram valores superiores aos que deveriam ter sido alcançados de acordo com a quinta meta do milênio, mas apontaram para um decréscimo significativo no período de 1990-2011, se as estimativas anteriores da RMM forem consideradas.
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165
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Abstract
Influenza poses unique risks to pregnant women, who are particularly susceptible to morbidity and mortality. Historically, pregnant women have been overrepresented among patients with severe illness and complications from influenza, and have been more likely to require hospitalization and intensive care unit admission. An increased risk of adverse outcomes is also present for fetuses/neonates born to women affected by influenza during pregnancy. These risks to mothers and babies have been observed during both nonpandemic and pandemic influenza seasons. During the H1N1 influenza pandemic of 2009-2010, pregnant women were more likely to be hospitalized or admitted to intensive care units, and were at higher risk of death compared to nonpregnant adults. Vaccination remains the most effective intervention to prevent severe illness, and antiviral medications are an important adjunct to ameliorate disease when it occurs. Unfortunately, despite national guidelines recommending universal vaccination for women who are pregnant during influenza season, actual vaccination rates do not achieve desired targets among pregnant women. Pregnant women are also sometimes reluctant to use antiviral medications during pregnancy. Some of the barriers to use of vaccines and medications during pregnancy are a lack of knowledge of recommendations and of safety data. By improving knowledge and understanding of influenza and vaccination recommendations, vaccine acceptance rates among pregnant women can be improved. Currently, the appropriate use of vaccination and antiviral medications is the best line of defense against influenza and its sequelae among pregnant women, and strategies to increase acceptance are crucial. This article will review the importance of influenza in pregnancy, and discuss vaccination and antiviral medications for pregnant women.
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Affiliation(s)
- Mark H Yudin
- The Department of Obstetrics and Gynecology, St Michael’s Hospital, Li Ka Shing Knowledge Institute, University of Toronto, Toronto, ON, Canada
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166
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Fell DB, Platt RW, Lanes A, Wilson K, Kaufman JS, Basso O, Buckeridge D. Fetal death and preterm birth associated with maternal influenza vaccination: systematic review. BJOG 2014; 122:17-26. [PMID: 25040307 DOI: 10.1111/1471-0528.12977] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2014] [Indexed: 01/06/2023]
Abstract
BACKGROUND Before 2012, few studies had addressed pregnancy outcomes following maternal influenza vaccination; however, the number of publications on this topic has increased recently. OBJECTIVES To review comparative studies evaluating fetal death or preterm birth associated with influenza vaccination during pregnancy. SEARCH STRATEGY We searched bibliographic databases from inception to April 2014. SELECTION CRITERIA Experimental or observational studies assessing the relationship between influenza vaccination during pregnancy and fetal death or preterm birth. DATA COLLECTION AND ANALYSIS Two reviewers independently abstracted data from studies meeting the inclusion criteria. MAIN RESULTS We included one randomised clinical trial and 26 observational studies. Meta-analyses were not considered appropriate because of high clinical and statistical heterogeneity. Three studies of fetal death at any gestational age reported adjusted effect estimates in the range 0.56-0.79, and four of five studies of fetal death at <20 weeks reported adjusted estimates between 0.89 and 1.23, all with confidence intervals including 1.0. Adjusted effect estimates for four of five studies of fetal death at ≥20 weeks ranged from 0.44 to 0.77 (two with confidence intervals not crossing 1.0), whereas a fifth reported a non-significant effect in the opposite direction. Among 19 studies of preterm birth, there was no strong evidence suggesting any increased risk, and meta-regression did not explain the moderate between-study heterogeneity (I(2) = 57%). AUTHORS' CONCLUSIONS Most studies reported no association between fetal death or preterm birth and influenza vaccination during pregnancy. Although several reported risk reductions, results may be biased by methodological shortcomings of observational studies of influenza vaccine effectiveness.
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Affiliation(s)
- D B Fell
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada; Better Outcomes Registry & Network (BORN) Ontario, Ottawa, ON, Canada
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Lynfield R, Davey R, Dwyer DE, Losso MH, Wentworth D, Cozzi-Lepri A, Herman-Lamin K, Cholewinska G, David D, Kuetter S, Ternesgen Z, Uyeki TM, Lane HC, Lundgren J, Neaton JD. Outcomes of influenza A(H1N1)pdm09 virus infection: results from two international cohort studies. PLoS One 2014; 9:e101785. [PMID: 25004134 PMCID: PMC4086938 DOI: 10.1371/journal.pone.0101785] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 06/11/2014] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Data from prospectively planned cohort studies on risk of major clinical outcomes and prognostic factors for patients with influenza A(H1N1)pdm09 virus are limited. In 2009, in order to assess outcomes and evaluate risk factors for progression of illness, two cohort studies were initiated: FLU 002 in outpatients and FLU 003 in hospitalized patients. METHODS AND FINDINGS Between October 2009 and December 2012, adults with influenza-like illness (ILI) were enrolled; outpatients were followed for 14 days and inpatients for 60 days. Disease progression was defined as hospitalization and/or death for outpatients, and hospitalization for >28 days, transfer to intensive care unit (ICU) if enrolled from general ward, and/or death for inpatients. Infection was confirmed by RT-PCR. 590 FLU 002 and 392 FLU 003 patients with influenza A (H1N1)pdm09 were enrolled from 81 sites in 17 countries at 2 days (IQR 1-3) and 6 days (IQR 4-10) following ILI onset, respectively. Disease progression was experienced by 29 (1 death) outpatients (5.1%; 95% CI: 3.4-7.2%) and 80 inpatients [death (32), hospitalization >28 days (43) or ICU transfer (20)] (21.6%; 95% CI: 17.5-26.2%). Disease progression (death) for hospitalized patients was 53.1% (26.6%) and 12.8% (3.8%), respectively, for those enrolled in the ICU and general ward. In pooled analyses for both studies, predictors of disease progression were age, longer duration of symptoms at enrollment and immunosuppression. Patients hospitalized during the pandemic period had a poorer prognosis than in subsequent seasons. CONCLUSIONS Patients with influenza A(H1N1)pdm09, particularly when requiring hospital admission, are at high risk for disease progression, especially if they are older, immunodeficient, or admitted late in infection. These data reinforce the need for international trials of novel treatment strategies for influenza infection and serve as a reminder of the need to monitor the severity of seasonal and pandemic influenza epidemics globally. TRIAL REGISTRATION ClinicalTrials.gov Identifiers: FLU 002--NCT01056354, FLU 003--NCT01056185.
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Affiliation(s)
- Ruth Lynfield
- Infectious Disease Division, Minnesota Department of Health, St. Paul, Minnesota, United States of America
| | - Richard Davey
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Dominic E. Dwyer
- Department of Virology, Centre for Infectious Diseases and Microbiology, Westmead Hospital and University of Sydney, Westmead, New South Wales, Australia
| | - Marcelo H. Losso
- HIV Unit, Department of Medicine, Hospital José María Ramos Mejía, Buenos Aires, Argentina
| | - Deborah Wentworth
- Division of Biostatistics, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Alessandro Cozzi-Lepri
- Research Department of Infection and Population Health, University College London, London, England, United Kingdom
| | - Kathy Herman-Lamin
- Division of Biostatistics, University of Minnesota, Minneapolis, Minnesota, United States of America
| | | | - Daniel David
- Hospital Rawson, Infectología, Cordoba, Argentina
| | | | | | - Timothy M. Uyeki
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - H. Clifford Lane
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Jens Lundgren
- Department of Infectious Diseases, Copenhagen University Hospital/Rigshospitalet & University of Copenhagen, Copenhagen, Denmark
| | - James D. Neaton
- Division of Biostatistics, University of Minnesota, Minneapolis, Minnesota, United States of America
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168
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Affiliation(s)
- Athena P Kourtis
- From the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta (A.P.K., D.J.J.); and the Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco (J.S.R.)
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McMillan M, Kralik D, Porritt K, Marshall H. Influenza vaccination during pregnancy: a systematic review of effectiveness and safety. ACTA ACUST UNITED AC 2014. [DOI: 10.11124/jbisrir-2014-1269] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Abstract
Pregnant women are particularly susceptible to a number of infectious diseases, such as influenza, hepatitis E, malaria, and tuberculosis. The management of many other infections-including urinary tract infections, human immunodeficiency virus, and sexually transmitted diseases-is also made more complex by pregnancy; even if some infections do not pose a great risk to the expectant mother, they can impact fetal and neonatal development, thus posing a treatment challenge to physicians. By focusing on the most important diseases that physicians may encounter in pregnant patients, this review outlines the challenges associated with managing important infectious diseases in the pregnant population and references the most recent evidence and international treatment guidelines.
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Affiliation(s)
- Hugh Adler
- Mater Misericordiae University Hospital, Dublin, Ireland
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171
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Resende PC, Motta FC, Oliveira MDLA, Gregianini TS, Fernandes SB, Cury ALF, do Carmo D. Rosa M, Souza TML, Siqueira MM. Polymorphisms at residue 222 of the hemagglutinin of pandemic influenza A(H1N1)pdm09: association of quasi-species to morbidity and mortality in different risk categories. PLoS One 2014; 9:e92789. [PMID: 24667815 PMCID: PMC3965456 DOI: 10.1371/journal.pone.0092789] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Accepted: 02/25/2014] [Indexed: 02/05/2023] Open
Abstract
The D222G substitution in the hemagglutinin (HA) gene of the pandemic influenza A(H1N1)pdm09 virus has been identified as a potential virulence marker, because this change allows for virus invasion deeper into the respiratory tract. In this study, we analyzed D, G and N polymorphisms at residue 222 by pyrosequencing (PSQ). We initially analyzed 401 samples from Brazilian patients. These were categorized with respect to clinical conditions due to influenza infection (mild, serious or fatal) and sub-stratified by risky factors. The frequency of mixed population of virus, with more than one polymorphism at residue 222, was significantly higher in serious (10.6%) and fatal (46.7%) influenza cases, whereas those who showed mild influenza infections were all infected by D222 wild-type. Mixtures of quasi-species showed a significant association of mortality, especially for those with risk factors, in special pregnant women. These results not only reinforce the association between D222G substitution and influenza A(H1N1)pdm09-associated morbidity and mortality, but also add the perspective that a worse clinical prognosis is most likely correlated with mixtures of quasi-species at this HA residue. Therefore, quasi-species may have a critical and underestimated role in influenza-related clinical outcomes.
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Affiliation(s)
- Paola Cristina Resende
- Laboratório de Vírus Respiratórios e do Sarampo, Instituto Oswaldo Cruz/ FIOCRUZ, Rio de Janeiro, Rio de Janeiro, Brazil
- * E-mail:
| | - Fernando C. Motta
- Laboratório de Vírus Respiratórios e do Sarampo, Instituto Oswaldo Cruz/ FIOCRUZ, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Maria de Lourdes A. Oliveira
- Laboratório de Vírus Respiratórios e do Sarampo, Instituto Oswaldo Cruz/ FIOCRUZ, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Tatiana S. Gregianini
- Laboratório Central de Saúde Pública do Estado do Rio de Grande do Sul -Fundação estadual de produção e pesquisa em saúde seção de virologia, Porto Alegre, Rio Grande do Sul, Brazil
| | - Sandra B. Fernandes
- Laboratório Central de Saúde Pública do Estado de Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Ana Luisa F. Cury
- Laboratório Central de Saúde Pública do Estado de Minas Gerais/Instituto Octávio Magalhães e Fundação Ezequiel Dias, Belo Horizonte, Minas Gerais, Brazil
| | | | - Thiago Moreno L. Souza
- Laboratório de Vírus Respiratórios e do Sarampo, Instituto Oswaldo Cruz/ FIOCRUZ, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Marilda M. Siqueira
- Laboratório de Vírus Respiratórios e do Sarampo, Instituto Oswaldo Cruz/ FIOCRUZ, Rio de Janeiro, Rio de Janeiro, Brazil
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172
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Beau AB, Hurault-Delarue C, Vial T, Montastruc JL, Damase-Michel C, Lacroix I. Safety of oseltamivir during pregnancy: a comparative study using the EFEMERIS database. BJOG 2014; 121:895-900. [PMID: 24512604 DOI: 10.1111/1471-0528.12617] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To compare pregnancy outcome between women exposed and unexposed to oseltamivir during pregnancy. DESIGN A comparative observational cohort study of women exposed to oseltamivir during pregnancy. SETTING A French prescription database (EFEMERIS) that includes data for pregnant women was used. EFEMERIS records prescribed and dispensed reimbursed drugs during pregnancy and pregnancy outcomes in Haute-Garonne, South West France. POPULATION Women who delivered from 1 July 2004 to 31 December 2010. METHODS The study compared exposed and unexposed pregnant women. Two women unexposed to oseltamivir were individually matched, by maternal age, month, and year of delivery, with one women exposed to oseltamivir. Multivariable conditional logistic regression and multivariable Cox proportional hazards regression were used to evaluate associations between each outcome and exposure to oseltamivir during pregnancy. MAIN OUTCOME MEASURES Pregnancy loss for any cause, preterm delivery, low birthweight, neonatal pathology, and congenital malformation. RESULTS A cohort of 337 (0.58% of women included in EFEMERIS) women exposed to oseltamivir were compared with 674 unexposed women. The risk for pregnancy loss (HR 1.52; 95% CI 0.80-2.91), for preterm birth (adjusted OR 0.64; 95% CI 0.31-1.27), and for neonatal pathology (adjusted OR 0.62; 95% CI 0.23-1.54) did not differ between exposed and unexposed groups. When exposure during organogenesis was considered, one case of congenital anomaly (2.0%) among 49 exposed women and one case (1.0%) among 99 unexposed women were observed (crude OR 2.00; 95% CI 0.13-32.00). CONCLUSIONS There was no significant association between adverse pregnancy outcomes and exposure to oseltamivir during pregnancy.
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Affiliation(s)
- A-B Beau
- Service de Pharmacologie Médicale, CHU Toulouse, Université de Toulouse, INSERM 1027, Toulouse, France
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173
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Beau AB, Hurault-Delarue C, Vidal S, Guitard C, Vayssière C, Petiot D, Montastruc JL, Damase-Michel C, Lacroix I. Pandemic A/H1N1 influenza vaccination during pregnancy: a comparative study using the EFEMERIS database. Vaccine 2014; 32:1254-8. [PMID: 24486369 DOI: 10.1016/j.vaccine.2014.01.021] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Revised: 12/17/2013] [Accepted: 01/14/2014] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To evaluate the risk of adverse pregnancy outcomes following A/H1N1 vaccination in pregnant women. METHODS This observational cohort study compared vaccinated and non-vaccinated pregnant women in EFEMERIS, a French prescription database including pregnant women. Women who ended their pregnancy in South Western France between October 21, 2009 and November 30, 2010 (the period of the French vaccination campaign) were included. Two non-vaccinated women were individually matched to each vaccinated woman by month and year of pregnancy onset. Conditional logistic regression and Cox proportional hazards regression were used to evaluate associations between each outcome (all-cause pregnancy loss, preterm delivery, small for gestational age (SGA) and neonatal pathology) and A/H1N1 vaccination during pregnancy. RESULTS 1645 women of the 12,120 (13.6%) in the database who were administered A/H1N1 vaccine during pregnancy were compared to 3290 non-vaccinated women. Most were vaccinated in December 2009 (61%) with a non-adjuvanted vaccine (93%). The risks of pregnancy loss (adjusted HR=0.56; 95% CI=0.31-1.01), of preterm birth (adjusted HR=0.82; 95% CI=0.64-1.06), and of neonatal pathology (adjusted OR=0.70; 95% CI=0.49-1.02) did not differ between the vaccinated and the non-vaccinated groups. The rate of SGA was lower in the vaccinated group than in the non-vaccinated group (0.5% vs. 1.4%; adjusted OR=0.36; 95% CI=0.17-0.78). CONCLUSION There was no significant association between adverse pregnancy outcomes and vaccination with a non-adjuvanted A/H1N1 vaccine during pregnancy.
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Affiliation(s)
- A B Beau
- Service de Pharmacologie Médicale, CHU Toulouse, Université de Toulouse, Inserm 1027, Toulouse, France.
| | - C Hurault-Delarue
- Service de Pharmacologie Médicale, CHU Toulouse, Université de Toulouse, Inserm 1027, Toulouse, France
| | - S Vidal
- Caisse Primaire d'Assurance Maladie de la Haute-Garonne, CPAM, Toulouse, France
| | - C Guitard
- Service de Protection Maternelle et Infantile, Conseil Général de la Haute-Garonne, Toulouse, France
| | - C Vayssière
- Centre de Diagnostic Anténatal, CDA, CHU Toulouse, Toulouse, France
| | - D Petiot
- Programme de Médicalisation des Systèmes d'Information; PMSI, CHU Toulouse, Toulouse, France
| | - J L Montastruc
- Service de Pharmacologie Médicale, CHU Toulouse, Université de Toulouse, Inserm 1027, Toulouse, France
| | - C Damase-Michel
- Service de Pharmacologie Médicale, CHU Toulouse, Université de Toulouse, Inserm 1027, Toulouse, France
| | - I Lacroix
- Service de Pharmacologie Médicale, CHU Toulouse, Université de Toulouse, Inserm 1027, Toulouse, France
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174
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Wong VWY, Fong DYT, Tarrant M. Brief education to increase uptake of influenza vaccine among pregnant women: a study protocol for a randomized controlled trial. BMC Pregnancy Childbirth 2014; 14:19. [PMID: 24423245 PMCID: PMC3898030 DOI: 10.1186/1471-2393-14-19] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2013] [Accepted: 01/08/2014] [Indexed: 11/10/2022] Open
Abstract
Background Pregnant women are the highest priority group for annual influenza vaccination. Studies have shown unacceptably low uptake of both seasonal and pandemic A/H1N1 influenza vaccination among pregnant women. This paper will describe the study protocol and methodology of a randomised controlled trial designed to assess the effectiveness of a brief educational intervention in improving the uptake of seasonal influenza vaccine among pregnant women in Hong Kong. Methods A randomised controlled trial will be conducted with pregnant women in at least the second trimester of pregnancy from four publicly funded hospital antenatal clinics in Hong Kong. Participants will be randomly assigned to either one of the two treatment groups: standard care (control) or standard care plus brief education (intervention). Pregnant women in the standard care group will receive the usual antenatal care with an educational pamphlet developed by the Hong Kong Centre for Health Protection and those in the intervention group will be provided with usual care plus a brief ten-minute education intervention. Content of the education session will cover four core components recommended in the research literature. The primary study outcome will be the proportion of participants who have received influenza vaccine during their pregnancy. A total of 184 pregnant women (92 per group) will be required to give an 80% power to detect a treatment effect of 15%. Discussion Most intervention studies aimed at improving influenza vaccination rates in pregnant women have targeted obstetric-care providers and the results of the two patient-oriented RCT interventions are conflicting. The high priority for vaccination given to pregnant women and the low influenza vaccination rate among pregnant women worldwide strongly indicates a need for interventions to improve uptake. Trial registration This trial is registered with the Clinical Trials Registry at www.clinicaltrials.gov(NCT01772901).
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Affiliation(s)
| | | | - Marie Tarrant
- School of Nursing, Li Ka Shing Faculty of Medicine, University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong, China.
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175
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Fléchelles O, Fowler R, Jouvet P. H1N1 pandemic: clinical and epidemiologic characteristics of the Canadian pediatric outbreak. Expert Rev Anti Infect Ther 2014; 11:555-63. [PMID: 23750727 DOI: 10.1586/eri.13.40] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Canada was one of the first countries affected by the 2009 influenza H1N1 pandemic with two waves - one from May to June and one from October to December. The 2009 influenza H1N1 pandemic had many unique features when compared with seasonal influenza, including the following: more than half of the affected people were children; asthma was the most significant risk factor for hospital admission; and Aboriginal and pregnant women had a higher risk of hospital admission and complications. Antiviral therapy was widely used but data did not show any effect on the pediatric population. Outbreak spread was possibly promoted from child-child and child-adult contact, and therefore the vaccination campaign targeted the pediatric population and achieved good coverage among young children (57%). Vaccination efficacy was difficult to test because of the vaccination delay. Improvement in models of prevention and treatment are urgently needed to prepare for the possible future pandemics.
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176
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Mollard EK, Guenzel N, Brown PA, Keeler HJ, Cramer ME. Policy considerations for improving influenza vaccination rates among pregnant women. Public Health Nurs 2014; 31:281-8. [PMID: 24386885 DOI: 10.1111/phn.12099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Influenza exposure during pregnancy can cause severe health problems for both the mother and her offspring, including an increased risk of mortality. Influenza vaccination during all trimesters of pregnancy is safe and effective, and recommended by professional organizations such as the American College of Obstetrics and Gynecology. Despite these recommendations, the U.S. vaccination rates remain low in this high-risk population. METHOD A policy analysis based on the five-part method identified by Teitelbaum and Wilensky () addresses factors to consider in identifying the best voluntary policy options to improve the vaccination rates. The authors provide discussion of the background, landscape, and stakeholder interests and the pros and cons of two voluntary policy options to increase vaccination. The policy options include: (a) financial incentives for providers and (b) an education emphasis for providers and staff. CONCLUSIONS The authors conclude that based on considerations of cost, provider preference, and practicality of implementation, a continuing educational intervention is the preferred policy venue to increase vaccination rates.
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177
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López-Medrano F, Fariñas MC, Payeras A, Pachón J. Antiviral treatment and vaccination for influenza A(H1N1)pdm09 virus: lessons learned from the pandemic. Enferm Infecc Microbiol Clin 2013; 30 Suppl 4:49-53. [PMID: 23116793 DOI: 10.1016/s0213-005x(12)70105-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The influenza pandemic that was declared by the World Health Organization in June 2009 created a new scenario for the use of influenza antivirals and vaccination. The new strain, influenza A(H1N1)pdm09, was resistant to amantadine and rimantadine, and the most frequently used antiviral was oseltamivir. Randomized studies were not performed comparing neuraminidase inhibitors with placebo. Nevertheless, experience from prospective and retrospective cohorts indicated that these drugs were useful for improving the prognosis of patients admitted to hospitals, especially for those with more severe disease. Treatment with oseltamivir was associated with a reduction in days of fever, length of hospital stay, use of mechanical ventilation and mortality. Treatment was more effective if it was begun within the first 48 h after the onset of symptoms, but it was also useful if begun later. A safe and effective vaccine to prevent disease from this new influenza strain was available in developed countries soon after the pandemic began; thus, the rate of adverse effects was comparable to that of seasonal influenza vaccines. The main barrier to its use was the concern of target populations about its necessity and safety. Therefore, the challenges for future pandemics will be to increase the population coverage of the vaccine in developed countries and to make it affordable for developing countries.
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Affiliation(s)
- Francisco López-Medrano
- Infectious Diseases Unit, Hospital Universitario 12 de Octubre, Department of Medicine, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain.
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178
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Chavant F, Ingrand I, Jonville-Bera AP, Plazanet C, Gras-Champel V, Lagarce L, Zenut M, Disson-Dautriche A, Logerot S, Auffret M, Coubret-Dumas A, Bruel ML, Boyer M, Bos-Thompson MA, Veyrac G, Carlier P, Beyens MN, Lates S, Damase-Michel C, Castot A, Kreft-Jaïs C, Pérault-Pochat MC. The PREGVAXGRIP study: a cohort study to assess foetal and neonatal consequences of in utero exposure to vaccination against A(H1N1)v2009 influenza. Drug Saf 2013; 36:455-65. [PMID: 23516007 DOI: 10.1007/s40264-013-0030-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In October 2009, in the context of an A(H1N1)v2009 influenza pandemic, a vaccination campaign was launched in France, in which one of the priority groups was pregnant women, on account of the high risk of developing complications following infection by this virus. OBJECTIVE The aim of this multicentric, prospective, observational study was to assess safety and pregnancy outcomes in a cohort of pregnant women when receiving the A(H1N1)v2009 influenza pandemic vaccine. METHODS This was a prospective study that followed up pregnant women recruited mainly in vaccination centres and maternity departments. Following the expected delivery date, follow-up data were collected concerning the delivery, the infant, and, if appropriate, the reasons why the pregnancy did not reach its term. RESULTS Between 1 November 2009 and 31 March 2010, 2,415 pregnant women were included at the time of vaccination; 97.6 % of women received a vaccine without adjuvant and 2.4 % received an adjuvanted vaccine. Ninety-two (3.9 %) women were vaccinated during the first trimester of pregnancy, 1,090 (46.5 %) during the second trimester, and 1,162 (49.6 %) during the third trimester. One hundred and thirty-three adverse events (5.5 % of women) were reported, of which 12 were unexpected or serious. There were 2,246 (93.0 %) known pregnancy outcomes with 12 spontaneous abortions (0.5 %), 6 stillbirths (0.3 %), and 4 therapeutic abortions (0.2 %). There were 65 neonates with congenital anomalies, among which 31 were major. But only one congenital malformation (1.4 %) was reported for the 92 women vaccinated in their first trimester. Of the women, 93.3 % were delivered full term and 6.7 % preterm. For 96 (4.2 %) neonates, a disorder was reported in the neonatal period and 130 (5.6 %) were transferred to the neonatology department. CONCLUSIONS This study suggests that exposure to the A(H1N1)v2009 pandemic influenza vaccine during pregnancy does not increase the risk of adverse pregnancy outcomes. However, because of the relatively small number of women exposed during the first trimester, other studies are needed to exclude an increased risk of malformation.
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Affiliation(s)
- F Chavant
- Service de Pharmacologie clinique, Centre Régional de PharmacoVigilance et de Renseignement sur les Médicaments, CHU de Poitiers, 2 rue de la Milétrie, 86021 Poitiers, France.
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Yuet Sheung Yuen C, Yee Tak Fong D, Lai Yin Lee I, Chu S, Sau-mei Siu E, Tarrant M. Prevalence and predictors of maternal seasonal influenza vaccination in Hong Kong. Vaccine 2013; 31:5281-8. [PMID: 24016814 DOI: 10.1016/j.vaccine.2013.08.063] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 07/17/2013] [Accepted: 08/09/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND Pregnant women infected with influenza virus are more likely to experience severe complications when compared with their non-pregnant peers. Yet influenza vaccine uptake is low among pregnant women. The purpose of this study was to assess the prevalence of seasonal influenza vaccine uptake among pregnant women in Hong Kong and to identify predictors of vaccine uptake. METHODS Using a multi-center cross-sectional design, we recruited 2822 new mothers during their immediate postpartum stay from all eight public obstetric hospitals in Hong Kong. We assessed antenatal maternal influenza vaccination status as well as health beliefs and perceptions toward influenza and influenza vaccination. Bivariable and multivariable logistic regression was used to identify the predictors of vaccination uptake. RESULTS Only 49 (1.7%; 95% CI 1.3-2.3%) participants were vaccinated during their pregnancy. Fear that the vaccine would cause harm to the fetus or themselves were the most common reasons for not being vaccinated. Being aware of the vaccination recommendations (OR=2.69; 95% CI 1.06-6.82), being advised by a health-care provider (OR=6.30; 95% CI 3.19-12.46), history of vaccination (OR=2.47; 95% CI 1.25-4.91), perceived susceptibility to influenza infection (OR=3.67; 95% CI 1.64-8.22), and perceived benefits of influenza vaccination (OR=9.98; 95% CI 3.79-26.24) were all independently associated with vaccination. Perceived barriers to vaccination (OR=0.17; 95% CI 0.07-0.40) were strongly associated with failure to vaccinate. CONCLUSIONS Low seasonal influenza vaccination uptake among Hong Kong pregnant women was related to a number of factors, all of which are amenable to interventions. Vaccination promotion strategies need to focus on encouraging health-care providers to discuss vaccination with their pregnant clients and in providing pregnant women with accurate and unbiased information about the risks of influenza infection and the benefits of vaccination.
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Affiliation(s)
- Carol Yuet Sheung Yuen
- School of Nursing, Li Ka Shing Faculty of Medicine, 21 Sassoon Road, Pokfulam, Hong Kong.
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Auffret M, Béné J, Gautier S, Moreau-Crépeaux S, Caron J. Pharmacovigilance monitoring of a cohort of pregnant women vaccinated against influenza A(H1N1) variant virus in the Nord-Pas de Calais region of northern France. Eur J Obstet Gynecol Reprod Biol 2013; 170:114-8. [DOI: 10.1016/j.ejogrb.2013.05.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Revised: 03/27/2013] [Accepted: 05/29/2013] [Indexed: 11/16/2022]
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Saito S, Minakami H, Nakai A, Unno N, Kubo T, Yoshimura Y. Outcomes of infants exposed to oseltamivir or zanamivir in utero during pandemic (H1N1) 2009. Am J Obstet Gynecol 2013; 209:130.e1-9. [PMID: 23583838 DOI: 10.1016/j.ajog.2013.04.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Revised: 02/25/2013] [Accepted: 04/04/2013] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess adverse fetal outcomes and short-term prognoses of infants exposed to oseltamivir or zanamivir in utero during pandemic (H1N1) 2009 in Japan. STUDY DESIGN Case series study. We asked the 2611 obstetric facilities in Japan that are members of the Japan Society of Obstetrics and Gynecology to participate, and data were provided from 157 facilities. We evaluated the numbers of pregnancy complications and neonatal abnormalities. RESULTS We evaluated 624 infants born to 619 women given oseltamivir and 50 infants born to 50 women given zanamivir. Of patients given oseltamivir before gestational week 22, 3 experienced miscarriage and 1 experienced induced abortion. The overall rate of congenital malformations was 2.1% (14/670). In infants exposed during the first trimester, the rate of malformations was 1.3% (2/156) with oseltamivir and 0.0% (0/15) with zanamivir, although in infants exposed during the second and third trimesters, this rate was 2.6% (12/464) with oseltamivir and 0.0% (0/35) with zanamivir. Increased rates of miscarriage in women given antiviral drugs before gestational week 22 (0.9% [3/322]), preterm delivery in women given antiviral drugs before gestational week 37 (5.5% [33/600]), stillbirth (0% [0/670]), neonatal death (0.15% [1/670]), birthweight <2500 g (8.7% [58/670]), small-for-gestational-age infants (8.4% [56/670]), necrotizing enterocolitis (0.0%), intraventricular hemorrhage (0.0%), seizures (0.15% [1/670]), and other transient abnormalities in the neonatal period (4.3% [29/670]) were not observed in those exposed to antiviral drugs before the corresponding episodes or complications. CONCLUSION Short-term prognoses of infants exposed to oseltamivir or zanamivir in utero were not adversely affected.
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182
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Beel ER, Rench MA, Montesinos DP, Mayes B, Healy CM. Knowledge and attitudes of postpartum women toward immunization during pregnancy and the peripartum period. Hum Vaccin Immunother 2013; 9:1926-31. [PMID: 23782490 DOI: 10.4161/hv.25096] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Influenza and pertussis prevention in young infants requires immunizing pregnant women and all caregivers (cocooning). We evaluated the knowledge and attitude of postpartum women about these two recommendations. A survey of predominantly Hispanic, underinsured, medically underserved postpartum women in Houston, Texas was performed during June 2010 through July 2012. Five hundred eleven postpartum women [mean age 28.8 y (18-45); 94% Hispanic] with a mean of 3 children (1-12) participated. Ninety-one (17.8%) were first-time mothers. Four hundred ninety-six (97.1%) received prenatal care; care was delayed in 24.3%. Only 313 (61.3%) received vaccine education while pregnant, and 291 (57%) were immunized. Four hundred seventy-four women (93%) were willing to be immunized during pregnancy if recommended by their healthcare provider, (the most trusted information source for 62%). Immunization of infants or infant caregivers had been discussed with 41% and 10% of mothers, respectively. Two hundred thirty women (45%) had received influenza vaccine; most intended to (79%) or had already received (15%) tetanus, diphtheria, and acellular pertussis (Tdap) vaccine. Preferred locations for cocooning were hospital or community clinics (97%). Insufficient knowledge (46.6%), cost (31.4%), lack of transportation (26%), work commitments (13.3%), and fear of needles (13.3%) were perceived barriers to cocooning. Level of formal education received by mothers had no effect on the quantity or quality of immunization education received during PNC or their attitude toward immunization. Immunization during pregnancy and cocooning, if recommended by providers, are acceptable in this high-risk population. Healthcare providers, as reported in infant studies, have the greatest influence on vaccine acceptance by pregnant and postpartum women.
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O'Hagan DT, Ott GS, Nest GV, Rappuoli R, Giudice GD. The history of MF59(®) adjuvant: a phoenix that arose from the ashes. Expert Rev Vaccines 2013; 12:13-30. [PMID: 23256736 DOI: 10.1586/erv.12.140] [Citation(s) in RCA: 221] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The first clinical trial of an MF59(®)-adjuvanted influenza vaccine (Novartis) was conducted 20 years ago in 1992. The product that emerged (Fluad(®), Novartis) was licensed first in Italy in 1997 and is now licensed worldwide in 30 countries. US licensure is expected in the coming years. By contrast, many alternative adjuvanted vaccines have failed to progress. The key decisions that allowed MF59 to succeed in such a challenging environment are highlighted here and the lessons that were learned along the way are discussed. MF59 was connected to vaccines that did not succeed and was perceived as a 'failure' before it was a success. Importantly, it never failed for safety reasons and was always well tolerated. Even when safety issues have emerged for alternative adjuvants, careful analysis of the substantial safety database for MF59 have shown that there are no significant concerns with widespread use, even in more 'sensitive' populations.
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Affiliation(s)
- Derek T O'Hagan
- Novartis Vaccines and Diagnostics, Cambridge, MA 02139, USA.
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184
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Jennings LC, Smith DW, Chan PKS. Report of the first Asia-Pacific Forum on antiviral treatment of influenza, Asia-Pacific Alliance for the Control of Influenza, Bangkok, 14 June 2012. Influenza Other Respir Viruses 2013; 7:987-90. [PMID: 23756551 PMCID: PMC4634249 DOI: 10.1111/irv.12130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2013] [Indexed: 11/27/2022] Open
Abstract
On 14 June 2012, the Asia–Pacific Alliance for the Control of Influenza (APACI) convened the first Antiviral Forum jointly with the Influenza Foundation of Thailand and the Thailand Department of Disease Control. The goals of the meeting were to improve pandemic planning in the region from lessons learned during the 2009 pandemic, particularly with regard to the safety and efficacy of antiviral use; gain a better understanding of the therapeutic use of antivirals in seasonal influenza; review and analyse the official influenza control policies of Asia–Pacific countries and evidence gaps to support policy development; and to establish collaborative relationships to promote best practices in the use of antivirals for the treatment of influenza. The urgent need for education highlighting the importance of influenza and the benefits of antiviral drug use in the Asia–Pacific region was identified.
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Affiliation(s)
- Lance C Jennings
- Canterbury Health Laboratories, Christchurch, New Zealand; Department of Pathology, University of Otago, Christchurch, New Zealand
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185
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Dickinson JE. Congenital viral infections: available strategies to decrease their prevalence. Aust N Z J Obstet Gynaecol 2013; 53:217-9. [PMID: 23731094 DOI: 10.1111/ajo.12100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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186
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Maternal immunization as a strategy to decrease susceptibility to infection in newborn infants. Curr Opin Infect Dis 2013; 26:248-53. [DOI: 10.1097/qco.0b013e3283607a58] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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187
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van Hasselt JGC, Andrew MA, Hebert MF, Tarning J, Vicini P, Mattison DR. The status of pharmacometrics in pregnancy: highlights from the 3(rd) American conference on pharmacometrics. Br J Clin Pharmacol 2013; 74:932-9. [PMID: 22452385 PMCID: PMC3522806 DOI: 10.1111/j.1365-2125.2012.04280.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Physiological changes during pregnancy may alter drug pharmacokinetics. Therefore, mechanistic understanding of these changes and, ultimately, clinical studies in pregnant women are necessary to determine if and how dosing regimens should be adjusted. Because of the typically limited number of patients who can be recruited in this patient group, efficient design and analysis of these studies is of special relevance. This paper is a summary of a conference session organized at the American Conference of Pharmacometrics in April 2011, around the topic of applying pharmacometric methodology to this important problem. The discussion included both design and analysis of clinical studies during pregnancy and in silico predictions. An overview of different pharmacometric methods relevant to this subject was given. The impact of pharmacometrics was illustrated using a range of case examples of studies around pregnancy.
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Affiliation(s)
- J G Coen van Hasselt
- Department of Clinical Pharmacology, Netherlands Cancer Institute, Amsterdam, the Netherlands.
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188
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López-Medrano F, Cordero E, Gavaldá J, Cruzado JM, Marcos MÁ, Pérez-Romero P, Sabé N, Gómez-Bravo MÁ, Delgado JF, Cabral E, Carratalá J. Management of influenza infection in solid-organ transplant recipients: consensus statement of the Group for the Study of Infection in Transplant Recipients (GESITRA) of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) and the Spanish Network for Research in Infectious Diseases (REIPI). Enferm Infecc Microbiol Clin 2013; 31:526.e1-526.e20. [PMID: 23528341 DOI: 10.1016/j.eimc.2013.01.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Accepted: 01/25/2013] [Indexed: 12/16/2022]
Abstract
BACKGROUND Solid organ transplant (SOT) recipients are at greater risk than the general population for complications and mortality from influenza infection. METHODS Researchers and clinicians with experience in SOT infections have developed this consensus document in collaboration with several Spanish scientific societies and study networks related to transplant management. We conducted a systematic review to assess the management and prevention of influenza infection in SOT recipients. Evidence levels based on the available literature are given for each recommendation. This article was written in accordance with international recommendations on consensus statements and the recommendations of the Appraisal of Guidelines for Research and Evaluation II (AGREE II). RESULTS Recommendations are provided on the procurement of organs from donors with suspected or confirmed influenza infection. We highlight the importance of the possibility of influenza infection in any SOT recipient presenting upper or lower respiratory symptoms, including pneumonia. The importance of early antiviral treatment of SOT recipients with suspected or confirmed influenza infection and the necessity of annual influenza vaccination are emphasized. The microbiological techniques for diagnosis of influenza infection are reviewed. Guidelines for the use of antiviral prophylaxis in inpatients and outpatients are provided. Recommendations for household contacts of SOT recipients with influenza infection and health care workers in close contact with transplant patients are also included. Finally antiviral dose adjustment guidelines are presented for cases of impaired renal function and for pediatric populations. CONCLUSIONS The latest scientific information available regarding influenza infection in the context of SOT is incorporated into this document.
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Affiliation(s)
- Francisco López-Medrano
- Unidad de Enfermedades Infecciosas, Hospital Universitario 12 de Octubre, Instituto de Investigación Biomédica 12 de Octubre (i+12), Departamento de Medicina, Universidad Complutense, Madrid, Spain.
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189
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Pregnancy Outcomes Among Hospitalized Patients Infected With 2009 H1N1 Influenza Virus in Qom, Iran, in Oct-Nov. 2009. Nurs Midwifery Stud 2013. [DOI: 10.5812/nms.8908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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190
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Moro PL, Tepper NK, Grohskopf LA, Vellozzi C, Broder K. Safety of seasonal influenza and influenza A (H1N1) 2009 monovalent vaccines in pregnancy. Expert Rev Vaccines 2013; 11:911-21. [PMID: 23002972 DOI: 10.1586/erv.12.72] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Inactivated influenza vaccines have been given to pregnant women since 1964. Since 2004, the Advisory Committee on Immunization Practices has recommended that pregnant women receive trivalent inactivated influenza vaccine at any time during pregnancy. Studies conducted before 2009 did not identify any safety concerns after trivalent inactivated influenza vaccine in mothers or their infants. During the 2009-2010 influenza A (H1N1) influenza vaccination program, several monitoring systems were established or enhanced to assess whether adverse events were associated with H1N1 2009 monovalent vaccines (2009 H1N1 influenza vaccines). Data from these systems did not identify any safety concerns in pregnant women who received 2009 H1N1 influenza vaccines or their infants. Although live attenuated influenza vaccines are not recommended in pregnant women, a small number of studies have not shown any safety concern among pregnant women or their infants who were inadvertently exposed to these vaccines. This review summarizes US and international safety data for influenza vaccines in pregnant women with an emphasis on 2009 H1N1 influenza vaccines.
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Affiliation(s)
- Pedro L Moro
- Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, MS D26, Atlanta, GA 30333, USA.
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191
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Sammon CJ, McGrogan A, Snowball J, de Vries CS. Pandemic influenza vaccination during pregnancy: an investigation of vaccine uptake during the 2009/10 pandemic vaccination campaign in Great Britain. Hum Vaccin Immunother 2013; 9:917-23. [PMID: 23364304 DOI: 10.4161/hv.23277] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Pregnant women in Great Britain were recommended to receive influenza A(H1N1)pdm09 vaccines during the 2009/10 influenza pandemic, however uptake of the vaccines by pregnant women was reported to have been very low. AIM We sought to estimate uptake of influenza A(H1N1)pdm09 vaccines and to investigate predictors of vaccine uptake in pregnant women in Great Britain during the 2009/10 pandemic. RESULTS Uptake of influenza A(H1N1)pdm09 vaccines by pregnant women was 21.6%. Pregnant women with an underlying health condition increasing the risk of influenza-related complications had a higher vaccination rate than pregnant women without such conditions. The hazard ratio comparing these two groups decreased logarithmically throughout pregnancy from 9.3 in the first week to 1.3 by the end of pregnancy. Increasing maternal age (HR 1.01, CI 95 1.01-1.01), having a previous delivery recorded (HR 1.21, CI95 1.16-1.27) and living in Scotland (HR 2.58, CI95 2.34-2.85) or Wales (HR 1.37, CI95 1.20-1.57) as opposed to England were all also associated with an increase in vaccination uptake rates throughout pregnancy. DISCUSSION Uptake of influenza A(H1N1)pdm09 vaccines by pregnant women was low. None of the potential predictors evaluated in this study were strong enough to account for this, however information on health beliefs and GP recommendation were not available. If the low rates reported here are to be improved new strategies to increase uptake of influenza vaccine in pregnant women need to be identified, evaluated and implemented. METHODS Uptake rates were calculated using data from the UK General Practice Research Database (GPRD). Predictors of vaccination were identified using a Cox proportional hazards model.
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Affiliation(s)
- Cormac J Sammon
- Department of Pharmacy and Pharmacology; University of Bath; Bath, UK
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Abstract
The treatment of gynecologic and other infections in obstetric patients involves consideration of the physiologic changes of pregnancy, the clinical implications of the infection for the patient as well as the fetus, and the safety of antimicrobials available for therapy. This article highlights the treatment of infections of the vagina, uterus, and urinary tract, with a focus on how therapy changes in obstetric patients. In addition, the emergency department management of other clinically important infections in pregnancy, such as those caused by the human immunodeficiency virus, influenza viruses, methicillin-resistant Staphylococcus aureus, Parvovirus, Listeria, and others is reviewed.
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Affiliation(s)
- Mercedes Torres
- Department of Emergency Medicine, University of Maryland School of Medicine, 110 South Paca Street, Sixth Floor, Suite 200, Baltimore, MD 21201, USA.
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Meaney-Delman D, Zotti ME, Rasmussen SA, Strasser S, Shadomy S, Turcios-Ruiz RM, Wendel GD, Treadwell TA, Jamieson DJ. Anthrax Cases in Pregnant and Postpartum Women. Obstet Gynecol 2012. [DOI: http:/10.1097/aog.0b013e318270ec08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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195
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Memoli MJ, Harvey H, Morens DM, Taubenberger JK. Influenza in pregnancy. Influenza Other Respir Viruses 2012; 7:1033-9. [PMID: 23170853 PMCID: PMC3582707 DOI: 10.1111/irv.12055] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Please cite this paper as: Memoli et al. (2012) Influenza in pregnancy. Influenza and Other Respiratory Viruses 00(00), 000–000. The 2009 pandemic served as a strong reminder that influenza‐induced disease can have a great impact on certain at‐risk populations and that pregnant women are one such important population. The increased risk of fatal and severe disease in these women was appreciated more than 500 years ago, and during the last century, pregnant women and their newborns have continued to be greatly affected by both seasonal and pandemic influenza. In this review, we briefly discuss the data collected both before and after the 2009 pandemic as it relates to the impact of influenza on pregnant women and their fetuses/newborns, as well as risk variables, clinical features, clues to pathophysiologic mechanisms, and approaches to treatment and prevention.
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Affiliation(s)
- Matthew J Memoli
- Viral Pathogenesis and Evolution Section, Laboratory of Infectious Diseases, National Institutes of HealthOffice of the Director, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
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196
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Honarvar B, Odoomi N, Mahmoodi M, Kashkoli GS, Khavandegaran F, Bagheri Lankarani K, Moghadami M. Acceptance and rejection of influenza vaccination by pregnant women in southern Iran: physicians' role and barriers. Hum Vaccin Immunother 2012; 8:1860-6. [PMID: 23032162 DOI: 10.4161/hv.22008] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE Vaccination provides the most effective protection against maternal, fetal and neonatal complications of influenza infection. This study aimed to determine the uptake rate of influenza vaccination including 2009 pandemic H1N1 influenza and seasonal influenza vaccination and the reasons for acceptance or rejection among pregnant women. RESULT Mean age of the 416 pregnant women enrolled in this study was 27.06 ± 5.27 y. Only 25 (6%) of 397 women had history of vaccination. Of 383 (92.06%) pregnant women who had rejected vaccination, 116 (30.28%) declared that they lacked information about influenza vaccination and 44 (11.48%) felt that they did not need vaccination. Concerns about the safety of influenza vaccination were reported by only 2 women (0.52%). Of the 25 (6%) pregnant women who were vaccinated against influenza, 15 (60%) accepted because of advice they received from persons other than physicians, 5 (20%) believed that influenza vaccination is necessary for everyone, and 3 (12%) accepted because of a history of frequent influenza virus infections in previous years. METHOD This questionnaire based study was conducted at obstetrics and maternity hospitals affiliated with Shiraz University of Medical Sciences, Shiraz, Iran. Pregnant women were interviewed individually and privately. SPSS was used for data analysis. CONCLUSION Most of the unvaccinated and vaccinated pregnant women lacked sufficient knowledge about influenza. Education of pregnant women about influenza vaccination and encouragement from physicians may have a remarkable effect on turning poor compliance into high flu vaccination uptake among pregnant women.
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Affiliation(s)
- Behnam Honarvar
- Community and Preventive Medicine, Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
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Gervasi MT, Romero R, Bracalente G, Chaiworapongsa T, Erez O, Dong Z, Hassan SS, Yeo L, Yoon BH, Mor G, Barzon L, Franchin E, Militello V, Palù G. Viral invasion of the amniotic cavity (VIAC) in the midtrimester of pregnancy. J Matern Fetal Neonatal Med 2012; 25:2002-13. [PMID: 22524157 PMCID: PMC3498469 DOI: 10.3109/14767058.2012.683899] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION The prevalence of viral infections in the amniotic fluid (AF) has not yet been ascertained. The aim of this study was to determine the prevalence of specific viral nucleic acids in the AF and its relationship to pregnancy outcome. STUDY DESIGN From a cohort of 847 consecutive women undergoing midtrimester amniocentesis, 729 cases were included in this study after exclusion of documented fetal anomalies, chromosomal abnormalities, unavailability of AF specimens and clinical outcomes. AF specimens were tested by quantitative real-time PCR for the presence of genome sequences of the following viruses: adenoviruses, herpes simplex virus (HSV), varicella zoster virus (VZV), human herpesvirus 6 (HHV6), human cytomegalovirus (HCMV), Epstein-Barr virus (EBV), parvovirus B19 and enteroviruses. Viral nucleic acid testing was also performed in maternal blood and cord blood in the population of women in whom AF was positive for viruses and in a control group of 29 women with AF negative for viral nucleic acids. The relationship between the presence of viruses and pregnancy and neonatal outcome was examined. The correlation between the presence of nucleic acids of viruses in the AF and the concentration of the cytokine interleukin-6 (IL-6) and the T cell chemokine CXCL-10 (or IP-10) in AF and maternal blood were analyzed. RESULTS Viral genome sequences were found in 16 of 729 (2.2%) AF samples. HHV6 was the most commonly detected virus (7 cases, 1.0%), followed by HCMV (6 cases, 0.8%), parvovirus B19 (2 cases, 0.3%) and EBV (1 case, 0.1%), while HSV, VZV, enteroviruses and adenoviruses were not found in this cohort. Corresponding viral DNA was also detected in maternal blood of six out of seven women with HHV6-positive AF and in the umbilical cord plasma, which was available in one case. In contrast, viral DNA was not detected in maternal blood of women with AF positive for parvovirus B19, HCMV, EBV or of women with AF negative for viruses. HHV6 genome copy number in AF and maternal blood was consistent with genomic integration of viral DNA and genetic infection in all women. There was no significant difference in the AF concentration of IL-6 and IP-10 between patients with and without VIAC. However, for HCMV, there was a significant relationship between viral copy number and IP-10 concentration in maternal blood and AF. The group of women with AF positive for viral DNA delivered at term healthy neonates without complications in 14 out of 16 cases. In one case of HHV6 infection in the AF, the patient developed gestational hypertension at term, and in another case of HHV6 infection in the AF, the patient delivered at 33 weeks after preterm premature rupture of membranes (PPROM). CONCLUSION Viral nucleic acids are detectable in 2.2% of AF samples obtained from asymptomatic women in the midtrimester. HHV6 was the most frequently detected virus in AF. Adenoviruses were not detected. Vertical transmission of HHV6 was demonstrated in one case.
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Affiliation(s)
- Maria-Teresa Gervasi
- Ob/Gyn Unit, Department for Health of Mothers and Children, Azienda Ospedaliera, Padova, Italy
| | - Roberto Romero
- Perinatology Research Branch, NICHD/NIH/DHHS, Detroit, MI, and Bethesda, MD, USA
| | - Gabriella Bracalente
- Ob/Gyn Unit, Department for Health of Mothers and Children, ASL 9 Treviso, Italy
| | - Tinnakorn Chaiworapongsa
- Perinatology Research Branch, NICHD/NIH/DHHS, Detroit, MI, and Bethesda, MD, USA
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, USA
| | - Offer Erez
- Department of Obstetrics and Gynecology, Soroka University Medical Center, School of Medicine, Faculty of Health Sciences, Ben Gurion University of The Negev, Beer Sheva, Israel
| | - Zhong Dong
- Perinatology Research Branch, NICHD/NIH/DHHS, Detroit, MI, and Bethesda, MD, USA
| | - Sonia S. Hassan
- Perinatology Research Branch, NICHD/NIH/DHHS, Detroit, MI, and Bethesda, MD, USA
- Ob/Gyn Unit, Department for Health of Mothers and Children, ASL 9 Treviso, Italy
| | - Lami Yeo
- Perinatology Research Branch, NICHD/NIH/DHHS, Detroit, MI, and Bethesda, MD, USA
- Ob/Gyn Unit, Department for Health of Mothers and Children, ASL 9 Treviso, Italy
| | - Bo Hyun Yoon
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Gil Mor
- Department of Obstetrics, Gynecology & Reproductive Sciences, Reproductive Immunology Unit, Yale University School of Medicine, New Haven, CT, USA
| | - Luisa Barzon
- Department of Molecular Medicine, University of Padova, Padova, Italy
| | - Elisa Franchin
- Department of Molecular Medicine, University of Padova, Padova, Italy
| | | | - Giorgio Palù
- Department of Molecular Medicine, University of Padova, Padova, Italy
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198
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Rodríguez-Baño J, Paño-Pardo JR, Múñez Rubio E, Segura Porta F. Pregnancy, obesity and other risk factors for complications in influenza A(H1N1) pdm09 infection. Enferm Infecc Microbiol Clin 2012; 30 Suppl 4:32-7. [DOI: 10.1016/s0213-005x(12)70102-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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199
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A review on the clinical spectrum and natural history of human influenza. Int J Infect Dis 2012; 16:e714-23. [DOI: 10.1016/j.ijid.2012.05.1025] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Accepted: 05/14/2012] [Indexed: 01/27/2023] Open
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200
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Translating vaccine policy into action: a report from the Bill & Melinda Gates Foundation Consultation on the prevention of maternal and early infant influenza in resource-limited settings. Vaccine 2012; 30:7134-40. [PMID: 23026690 DOI: 10.1016/j.vaccine.2012.09.034] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2012] [Revised: 09/08/2012] [Accepted: 09/13/2012] [Indexed: 11/24/2022]
Abstract
Immunization of pregnant women against influenza is a promising strategy to protect the mother, fetus, and young infant from influenza-related diseases. The burden of influenza during pregnancy, the vaccine immunogenicity during this period, and the robust influenza vaccine safety database underpin recommendations that all pregnant women receive the vaccine to decrease complications of influenza disease during their pregnancies. Recent data also support maternal immunization for the additional purpose of preventing disease in the infant during the first six months of life. In April 2012, the WHO Strategic Advisory Group of Experts (SAGE) on Immunization recommended revisions to the WHO position paper on influenza vaccines. For the first time, SAGE recommended pregnant women should be made the highest priority for inactivated seasonal influenza vaccination. However, the variable maternal influenza vaccination coverage in countries with pre-existing maternal influenza vaccine recommendations underscores the need to understand and to address the discrepancy between recommendations and implementation success. We present the outcome of a multi-stakeholder expert consultation on inactivated influenza vaccination in pregnancy. The creation and implementation of vaccine policies and regulations require substantial resources and capacity. As with all public health interventions, the existence of perceived and real risks of vaccination will necessitate effective and transparent risk communication. Potential risk allocation and sharing mechanisms should be addressed by governments, vaccine manufacturers, and other stakeholders. In resource-limited settings, vaccine-related issues concerning supply, formulation, regulation, evidence evaluation, distribution, cost-utility, and post-marketing safety surveillance need to be addressed. Lessons can be learned from the Maternal and Neonatal Tetanus Elimination Initiative as well as efforts to increase vaccine coverage among pregnant women during the 2009 influenza pandemic. We conclude with an analysis of data gaps and necessary activities to facilitate implementation of maternal influenza immunization programs in resource-limited settings.
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