Potential impact of pandemic influenza on blood safety and availability

Maternal Influenza and Offspring Neurodevelopment

This review examines the complex interactions between maternal influenza infection, the immune system, and the neurodevelopment of the offspring. It highlights the importance of high-quality studies to clarify the association between maternal exposure to the virus and neuropsychiatric disorders in the offspring. Additionally, it emphasizes that the development of accurate animal models is vital for studying the impact of infectious diseases during pregnancy and identifying potential therapeutic targets. By drawing attention to the complex nature of these interactions, this review underscores the need for ongoing research to improve the understanding and outcomes for pregnant women and their offspring.

Pregnancy and SARS-CoV-2 infection with a focus on its vertical transmission, breastfeeding, cord blood banking, and vaccination during COVID-19 infection

The SARS-CoV-2 outbreak led to a health crisis worldwide. This infection can infect individuals, particularly pregnant women. In this review, we tried to find the possibility of vertical transmission of COVID-19 and investigate the effects of COVID-19 on pregnancy, breastfeeding, cord blood banking, and the effects of recommended vaccines on pregnant and lactating women. Keywords include COVID-19, congenital infection, SARS-CoV-2, pregnancy, and COVID-19 vaccines. Vertical transmission of SARS-CoV-2 was searched in scientific databases, such as PubMed, Google Scholar, and Scopus. The criteria for including studies in this article are the study of SARS-CoV-2 infection in pregnant women, fetuses, and neonates during pregnancy and while breastfeeding, and also the effect of COVID-19 vaccines on them. There are several conflicting results in the transmission of SARS-CoV-2 from the maternal-fetal interface. Since many neonates born from COVID-19-infected mothers had no signs of this infection, the possibility of SARS-CoV-2 congenital transmission cannot be confirmed. Also, SARS-CoV-2-infected women can breastfeed their babies if they have mild symptoms. Up till now, no adverse effect of COVID-19 vaccines has been identified on mothers, infants, and the fertility of men or women. Even so, more investigations are needed on the long-term effects of COVID-19 vaccines.

Infectious diseases and the impact on transfusion medicine: A historical review and lessons for the future

Blood transfusion saves millions of lives each year. It is a well-established treatment, and many procedures are applied to avoid transmitted infections. However, throughout the history of transfusion medicine, many infectious diseases arose or were recognised, bringing up an impact on the blood supply, as the difficulties in diagnosing new diseases, the decrease in blood donors, the challenges for the medical team, the risks for the receptor and the related costs. This study aims to review historically the principal infectious diseases transmitted through the blood that circulated worldwide in the 20th and 21st centuries, considering the impact on the blood banks. Despite the current blood bank control of transfusion risks and the hemovigilance improvements, transmitted and emerging infections can still compromise the blood bank supply, as we have witnessed during the first waves of the COVID-19 pandemic. Moreover, new pathogens will continue emerging, and we must be prepared for the future.

Silk Fibroin Particles as Carriers in the Development of Hemoglobin-Based Oxygen Carriers

Oxygen therapeutics have a range of applications in transfusion medicine and disease treatment. Synthetic molecules and all-natural or semi-synthetic hemoglobin-based oxygen carriers (HBOCs) have seen success as potential circulating oxygen carriers. However, many early HBOC products stalled in development due to side effects from excess hemoglobin in the blood stream and hemoglobin entering the tissue. To overcome these issues, research has focused on increasing the molecular diameter of hemoglobin by polymerizing hemoglobin molecules or encapsulating hemoglobin in liposomal carriers. This work leverages the properties of silk fibroin, a cytocompatible and non-thrombogenic biopolymer, known to entrap protein-based cargo, to engineer a fully protein-based oxygen carrier. Herein, an all-aqueous solvent evaporation technique was used to form silk particles via phase separation from a bulk polyvinyl alcohol phase (PVA). Particles size was tuned, and particles were formed with and without hemoglobin. The encapsulation efficiency and ferrous state of hemoglobin were analyzed, resulting in 60% encapsulation efficiency and a maximum of 20% ferric hemoglobin, yielding 100 µg/mL active hemoglobin in certain sfHBOC formulations. The system did not elicit a strong inflammation response in vitro, demonstrating the potential for this particle system to serve as an injectable HBOC.

Roles of TGF-β1 in Viral Infection during Pregnancy: Research Update and Perspectives

Transforming growth factor-beta 1 (TGF-β1) is a pleiotropic growth factor playing various roles in the human body including cell growth and development. More functions of TGF-β1 have been discovered, especially its roles in viral infection. TGF-β1 is abundant at the maternal-fetal interface during pregnancy and plays an important function in immune tolerance, an essential key factor for pregnancy success. It plays some critical roles in viral infection in pregnancy, such as its effects on the infection and replication of human cytomegalovirus in syncytiotrophoblasts. Interestingly, its role in the enhancement of Zika virus (ZIKV) infection and replication in first-trimester trophoblasts has recently been reported. The above up-to-date findings have opened one of the promising approaches to studying the mechanisms of viral infection during pregnancy with links to corresponding congenital syndromes. In this article, we review our current and recent advances in understanding the roles of TGF-β1 in viral infection. Our discussion focuses on viral infection during pregnancy, especially in the first trimester. We highlight the mutual roles of viral infection and TGF-β1 in specific contexts and possible functions of the Smad pathway in viral infection, with a special note on ZIKV infection. In addition, we discuss promising approaches to performing further studies on this topic.

Silk Fibroin Particles as Carriers in the Development of All-Natural Hemoglobin-Based Oxygen Carriers (HBOCs)

Oxygen therapeutics have a range of applications in transfusion medicine and disease treatment. Synthetic molecules and all-natural or semi-synthetic hemoglobin-based oxygen carriers (HBOCs) have seen success as potential circulating oxygen carriers. However, many early HBOC products were removed from the market due to side effects from excess hemoglobin in the blood stream and hemoglobin entering the tissue. To overcome these issues, research has focused on increasing the molecular diameter of hemoglobin by polymerizing hemoglobin molecules or encapsulating hemoglobin in liposomal carriers, where immune responses and circulation times remain a challenge. This work looks to leverage the properties of silk fibroin, a cytocompatible and non-thrombogenic biopolymer, known to entrap protein-based cargo, to engineer a silk fibroin-hemoglobin-based oxygen carrier (sfHBOC). Herein, an all-aqueous solvent evaporation technique was used to form silk fibroin particles with and without hemoglobin to tailor the formulation for specific particle sizes. The encapsulation efficiency and ferrous state of hemoglobin were analyzed, resulting in 60% encapsulation efficiency and a maximum of 20% ferric hemoglobin, yielding 100 µg/mL active hemoglobin in certain sfHBOC formulations. The system did not elicit a strong inflammation response in vitro, demonstrating the potential for this particle system to serve as an injectable HBOC.

Analysis of Influenza A virus infection in human induced pluripotent stem cells (hiPSCs) and their derivatives

Influenza A virus (IAV) infection in pregnant women is a major public health concern. However, the effect of IAV infection on human embryogenesis is still unclear. Here we show that human induced pluripotent stem cells (hiPSCs) and hiPSC-derived ectodermal, mesodermal and endodermal cells are susceptible to IAV infection. These cell types stained positive for α2,6-linked sialic acid, the receptor for IAV infection expressed on the cell surface. While hiPSCs produced high viral titers for up to 7 days with increasing infected cell number suggesting that the viral progenies produced from hiPSCs without exogenous protease were infectious and could spread to other cells, the three germ-layer cells showed a decline in viral titers suggesting the lack of viral spreading. Amongst the three germ layers, endodermal cells were less susceptible than ectodermal and mesodermal cells. These results indicate the permissiveness of cells of early embryogenesis, and suggest a risk of detrimental effects of IAV infection in early human embryonic development.

The impact of COVID-19 on blood donations

During a crisis, society calls for individuals to take prosocial actions that promote crisis management. Indeed, individuals show higher willingness to help after a disaster. However, the COVID-19 pandemic presents significant differences as it is an ongoing crisis that affects all individuals and has the potential to pose a direct health threat to anyone. Therefore, we propose that the pandemic may also negatively affect willingness to help, specifically blood donation intentions. It requires a high level of willingness to donate blood beyond the crisis outbreak, as more blood will be needed when postponed surgeries resume. When comparing blood donation intentions from a pre-pandemic study to results from a six-wave (bi-weekly) panel study conducted in Germany during the first pandemic phase (April to June 2020), we find lower medium and long-term blood donation intentions. While active donors show increased awareness of ability and eligibility to donate at the beginning of the pandemic compared to pre-pandemic, they feel significantly less able to donate as the pandemic progresses. Furthermore, inactive donors’ perceived ability to donate significantly decreases in the pandemic phase compared to the pre-pandemic phase. Crucially, both active and inactive donors feel less responsible and less morally obliged to donate, resulting in an overall negative pandemic effect on blood donation intentions. The COVID-19 pandemic compromises blood donations endangering the life-saving blood supply. These alarming results offer evidence-based grounds for practical implications for driving donations in the event of a pandemic.

Impact of COVID-19 on Blood Donation and Supply: A Multicenter Cross-Sectional Study from Saudi Arabia

Background

The coronavirus disease-19 (COVID-19) pandemic caused a major impact on blood donation process and supply globally. A lockdown management procedure was launched nationally in Saudi Arabia to manage this global health crisis. The main aim of this study was to determine the effect of COVID-19 lockdown on blood donation services and supply in different regions of Saudi Arabia. Study Design and Methods. A retrospective cross-sectional study was conducted in the blood bank centers of 5 major cities including Riyadh, Jeddah, Dammam, Hail, and Jizan in Saudi Arabia. Demographic and blood characteristics were retrieved from the first 6 months of 2019 (January–June) and compared to the same period of 2020.

Results

Our findings showed variation in the characteristics of blood donation and supply among the centers surveyed, as some of these centers were adversely affected, while others showed an increase in the availability of blood products during the pandemic. For example, Jeddah's center was significantly affected by COVID-19 lockdown whereas Hail's center showed a significant increase in the analyzed characteristics of blood donation services in 2020 compared to 2019. Overall, there was no major difference among the surveyed centers between 2020 and 2019, and this might be due to the effective management of blood supply and transfusion. Discussion. Although blood supply and transfusion practice was slightly affected at various degree among the surveyed centers, the whole process did not show a significant effect on the overall outcome. This is in fact due to the proper preparedness, management of blood requirements and supplies, and efficient response of the surveyed centers in Saudi Arabia.

Systems dynamics and the uncertainties of diagnostics, testing and contact tracing for COVID-19

The current COVID-19 pandemic contains an unprecedented amount of uncertainty and variability and thus, there is a critical need for understanding of the variation documented in the biological, policy, sociological, and infrastructure responses during an epidemic to support decisions at all levels. With the significant asymptomatic spread of the virus and without an immediate vaccine and pharmaceuticals available, the best feasible strategies for testing and diagnostics, contact tracing, and quarantine need to be optimized. With potentially high false negative test results, infected people would not be enrolled in contact-trace programs and thus, may not be quarantined. Similarly, without broad testing, asymptomatic people are not identified and quarantined. Interconnected system dynamics models can be used to optimize strategies for mitigations for decision support during a pandemic. We use a systems dynamics epidemiology model along with other interconnected system models within public health including hospitals, intensive care units, masks, contact tracing, social distancing, and a newly developed testing and diagnostics model to investigate the uncertainties with testing and to optimize strategies for detecting and diagnosing infected people. Using an orthogonal array Latin Hypercube experimental design, we ran 54 simulations each for two scenarios of 10% and 30% asymptomatic people, varying important inputs for testing and social distancing. Systems dynamics modeling, coupled with computer experimental design and statistical analysis can provide rapid and quantitative results for decision support. Our results show that widespread testing, contacting tracing and quarantine can curtail the pandemic through identifying asymptomatic people in the population.

Exploration of COVID-19 related fears deterring from blood donation in India

Introduction

The coronavirus pandemic (COVID‐19) has impacted and pushed the healthcare settings to extremes across the globe. It was extremely challenging to sustain blood donation, and strategies could be formulated on knowing fears hindering blood donation.

Methods

A cross‐sectional survey using Google Forms^® through WhatsApp and email after obtaining the ethical clearance. The survey questionnaire was validated for content using the Delphi technique, and pilot tested for finalization.

Results

The survey was attempted by 1066 participants, and 749 participants who had not donated since pandemic were included in the study. A little more than half, 415 (55%) reported either one or more than one fear during the pandemic which hindered blood donation. They reported lack of confidence in the safety measures at the hospitals and fear of transmitting infection to family, in 415 (55%) of the participants each, respectively. The fear of COVID‐19 hospital infection risk and hospital entry was statistically significant across the age groups that are eligible for blood donation.

Conclusions

The clear and dedicated confidence building measures to sustain blood donation using all communication modalities clearly emerge as the most important strategies to augment blood donation in the COVID‐19 pandemic. The measures should include information about implementation of safety measures to mitigate COVID‐19 transmission at the blood centres and that the act of blood donation does not increase risk of COVID‐19 and therefore the risk of transmission of infection to family.

Motivation zur Vollblutspende während pandemischer Ereignisse

Auch während Pandemien müssen die Blutspendedienste kontinuierlich BlutspenderInnen rekrutieren, um die Versorgung mit Blutprodukten zu gewährleisten. Während im Anschluss an andere Katastrophen wie Erdbeben oder Terroranschlägen die Spendebereitschaft meist sprunghaft ansteigt, zeigte sich in der Vergangenheit bei beginnenden Pandemien zunächst ein Rückgang des Spendenaufkommens. Viele SpenderInnen fürchten eine Infektion oder eine Schwächung ihres Immunsystems und bleiben zu Hause. Auch fällt es den Blutspendediensten zunächst schwer, die gewohnte Anzahl an mobilen Spendeterminen zu organisieren, wodurch das Spendenaufkommen zurückgeht. In der aktuellen SARS-CoV-2-Pandemie betrug dieser Rückgang in vielen Ländern mehr als 10%. SpenderInnen, die auch während einer Pandemie spenden, sind in der Regel erfahrener und besitzen bereits eine ausgebildete Spenderidentiät. Viele dieser SpenderInnen berichten, dass sie gezielt einen Beitrag zur Überwindung der Krise leisten möchten. Auch während einer Pandemie ist demnach eine hohe Solidarität unter BlutspenderInnen zu finden. Potenzielle ErstspenderInnen lassen sich durch die unsicheren Rahmenbedingungen dagegen von einer Spende eher abhalten und es bedarf gezielter Rekrutierungsstrategien unter Einsatz von Social-Media-Kanälen, um neue SpenderInnen zu gewinnen. Erste Befunde unter deutschen BlutspenderInnen lassen hierbei eine hohe Rückkehrintention der ErstspenderInnen erwarten. Um die Blutversorgung auch während einer Pandemie aufrechterhalten zu können, sollten die Blutspendedienste neben der Rekrutierung von ErstspenderInnen versuchen, schnell die Anzahl ihrer Spendetermine zu erhöhen. Die Ansprache bestehender SpenderInnen sollte vor allem die Verunsicherung reduzieren und das Vertrauen in die Blutspendedienste stärken. Je größer das Vertrauen in die Spendeeinrichtung ausfällt, desto geringer ist die Risikowahrnehmung der SpenderInnen. Auch sollten alternative Kontaktwege etwa über Messengerdienste getestet werden, da diese eine schnelle Ansprache erlauben.

Altered Influenza Vaccination Coverage and Related Factors in Pregnant Women in Korea from 2007 to 2019

BACKGROUND

Pregnant women are at a high-risk of influenza infection. We have previously reported a low influenza vaccination coverage rate (4.0%) in Korea during the 2006-2007 influenza season. We conducted follow-up studies in 2011-2012 and 2018-2019 to observe changes in influenza vaccination coverage.

METHODS

Women who delivered at Inha University Hospital (Incheon, Korea) in 2011-2012 and 2018-2019 were enrolled in the study. We surveyed the rate of influenza vaccination, perception scores, and related factors through telephonic interviews and compared the results from 2011-2012 and 2018-2019 with those from 2006-2007.

RESULTS

The number of survey respondents was 227 in 2006-2007, 152 in 2011-2012, and 171 in 2018-2019. The rate of vaccination coverage increased from 4.0% in 2006-2007 to 42.0% in 2011-2012 and 59.3% in 2018-2019. Perception scores also increased progressively from 3.8 in 2006-2007 to 4.2 in 2011-2012 and 5.1 in 2018-2019. Physician recommendations for influenza vaccination also increased from 4.8% in 2006-2007 to 36.8% in 2011-2012 and 49.7% in 2018-2019. The most common reason for not getting vaccinated was the lack of awareness of influenza vaccination during pregnancy (36.9%). The perception scores and physician recommendation rates were significantly lower for unvaccinated women (3.87 and 8.4%, respectively) than for vaccinated women (5.14 and 69.1%, respectively).

CONCLUSION

The influenza vaccination coverage rate in pregnant women has increased significantly since our study in 2006-2007. However, further improvement in the coverage rate is needed. There is a need for active and comprehensive publicity and education regarding this issue among physicians and pregnant women.

The impact of COVID-19 pandemic on blood supplies and transfusion services in Eastern Mediterranean Region

Background

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has spurred a global health crisis. The safety and supply of blood during this pandemic has been a concern of blood banks and transfusion services as it is expected to adversely affect blood system activities. We aim to assess the situation in the Eastern Mediterranean Region (EMR) during the first months of the pandemic.

Materials and methods

A survey was designed to address blood supply, transfusion demand, and donor management during the coronavirus disease-19 (COVID-19) pandemic. Medical directors of different blood banks were invited to participate.

Results

A total of 16 centers participated with representation from 15/19 countries in the region. In total, 75% were from national blood banks. Most centres had a decrease in the blood supply, ranging from 26–50%. Representatives from 14 countries (93.3%) believed that public fear has contributed to a decrease in donations. Most centres (n = 12, 75%) had a reduction in transfusion demand, while those who did not, reported heavy involvement in treating patients with underlying haemoglobinopathies and haematological malignancies. Half of the centres activated their contingency plans. Four centres had to alter the blood donor eligibility criteria to meet demands. All centres implemented donor deferral criteria in relation to SARS-CoV-2, but were variable in measures to mitigate the risk of donor and staff exposure.

Conclusion

Blood services in the region faced variable degrees of blood shortages. We summarize lessons learnt during this pandemic for the blood banks to consider to plan, assess, and respond proportionately to future similar pandemics.

Impact of influenza virus during pregnancy: from disease severity to vaccine efficacy

Pregnant women are among the individuals at the highest risk for severe influenza virus infection. Infection of the mother during pregnancy increases the probability of adverse fetal outcomes such as small for gestational age, preterm birth and fetal death. Animal models of syngeneic and allogeneic mating can recapitulate the increased disease severity observed in pregnant women and are used to define the mechanism(s) of that increased severity. This review focuses on influenza A virus pathogenesis, the unique immunological landscape during pregnancy, the impact of maternal influenza virus infection on the fetus and the immune responses at the maternal–fetal interface. Finally, we summarize the importance of immunization and antiviral treatment in this population and highlight issues that warrant further investigation.

The Long-Lasting Influenza: The Impact of Fetal Stress During the 1918 Influenza Pandemic on Socioeconomic Attainment and Health in Sweden, 1968-2012

The 1918 influenza pandemic had not only a massive instant death toll but also lasting effects on its survivors. Several studies have shown that children born in 1919, and thus exposed to the H1N1 virus in utero, experienced worse health and socioeconomic outcomes in older ages than surrounding birth cohorts. This study combines several sources of contemporary statistics with full-population individual-level data for Sweden during 1968-2012 to examine the influence of fetal exposure to the Spanish flu on health, adulthood income, and occupational attainment. For both men and women, fetal exposure resulted in higher morbidity in ages 54-87, as measured by hospitalization. For males, exposure during the second trimester also affected mortality in cancer and heart disease. Overall, the effects on all-cause mortality were modest, with about three months shorter remaining life expectancy for the cohorts exposed during the second trimester. For socioeconomic outcomes, results fail to provide consistent evidence supporting any long-term consequences of fetal exposure. We conclude that although the immediate health effects of exposure to the 1918 pandemic were huge, the long-term effects were modest in size.

Assessing the impact of respiratory infections and weather conditions on donor attendance and blood inventory in Hong Kong

BACKGROUND

Maintaining a stable, safe and sufficient blood supply is crucial to the healthcare system. Every year, seasonal influenza epidemics lead to substantial hospitalizations and pose intense pressure on blood transfusion service worldwide, especially in an ageing population of Hong Kong which often see bi-annual influenza outbreaks. However, limited quantitative studies have been performed to assess the impacts of influenza and other respiratory infections on blood supply.

METHODS

We estimated the impacts of respiratory infections on donor attendance and blood inventory, considering the confounding effects of weather conditions. The method only required influenza-like illness data from the existing sentinel surveillance network, local weather data, donor attendance records from blood transfusion service and blood inventory levels from local healthcare system.

RESULTS

We estimated the number of donor attendance dropped by 6-10% when the number of consultations with influenza-like illnesses (ILIs) reported by sentinel general outpatient clinics exceeded five per 1000 consultations, which is a moderate activity level and has been observed frequently in Hong Kong. Blood inventory decreased with increased ILI consultation rates reported by sentinel general outpatient clinics. Adverse weather conditions had negative impacts on both donor attendance and blood inventory.

CONCLUSION

Epidemics of influenza and other respiratory infections coupled with adverse weather conditions affected blood supply in Hong Kong. The pressure on blood transfusion service to maintain a stable and sufficient blood supply during influenza seasons should not be overlooked, especially in an ageing population of Hong Kong.

Viral infections during pregnancy

Viral infections during pregnancy have long been considered benign conditions with a few notable exceptions, such as herpes virus. The recent Ebola outbreak and other viral epidemics and pandemics show how pregnant women suffer worse outcomes (such as preterm labor and adverse fetal outcomes) than the general population and non-pregnant women. New knowledge about the ways the maternal-fetal interface and placenta interact with the maternal immune system may explain these findings. Once thought to be 'immunosuppressed', the pregnant woman actually undergoes an immunological transformation, where the immune system is necessary to promote and support the pregnancy and growing fetus. When this protection is breached, as in a viral infection, this security is weakened and infection with other microorganisms can then propagate and lead to outcomes, such as preterm labor. In this manuscript, we review the major viral infections relevant to pregnancy and offer potential mechanisms for the associated adverse pregnancy outcomes.

Risk management of seasonal influenza during pregnancy: current perspectives

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.

The influence of experimental infection of gilts with swine H1N2 influenza A virus during the second month of gestation on the course of pregnancy, reproduction parameters and clinical status

Background

The course of swine influenza in pigs is reported to be similar to human influenza. Occasionally abortions and other reproduction disorders have been associated with influenza A virus (IAV) infection in pigs. Abortions may be a consequence of high fever, pro-inflammatory cytokines or transplacental transmission of the virus.

The role of IAV in the complications observed during pregnancy has been scanty and the true importance of this agent as a cause of reproductive problems in swine is not known. The aim was to determine the possible involvement of swine H1N2 IAV strain on reproductive disorders in pregnant gilts under experimental conditions.

Results

The gestation length was from 113 to 116 days, no abortion or any other reproduction disorders were noted. A PCR assay confirms the presence of IAV in the nasal swabs taken from inoculated gilts between 1 and 5 dpi. In the nasal swabs from control gilts and newborn piglets, no IAV genetic material was found. No viral RNA was detected in samples of blood taken from gilts and piglets, placentas, lungs and tracheas taken from piglets euthanized after delivery. The significant decrease in the number and percentage of lymphocytes without leukopenia was observed at 4 dpi in inoculated gilts. The percentage of granulocytes increased significantly at 4 dpi in inoculated pigs. The concentration of IL-6, IL-10 and TNF-α were higher in inoculated gilts, while IL-4 and IFN-γ were not detected in the serum of any of animals. The serum concentrations of C-reactive protein remained stable during study, while haptoglobin concentrations increased significantly after inoculation.

Conclusions

The results of the study indicate that infection of pregnant gilts with swine H1N2 IAV in the second month of pregnancy does not cause abortion and other reproduction disorders. No evidence for transplacental transmission of swine H1N2 IAV was found. However, due to subclinical course of influenza in the present experiment caution should be taken in extrapolating these results to the cases of acute influenza. The other limitation is IAV diversity. It cannot be excluded that other subtypes of IAV could be associated to reproduction failure in pigs.

A stock-and-flow simulation model of the US blood supply

BACKGROUND

Lack of reporting requirements for the amount of blood stored in blood banks and hospitals poses challenges to effectively monitor the US blood supply. Effective strategies to minimize collection and donation disruptions in the supply require an understanding of the daily amount of blood available in the system.

STUDY DESIGN AND METHODS

A stock-and-flow simulation model of the US blood supply was developed to obtain estimates of the daily on-hand availability of blood, with uncertainty and by ABO/Rh type. The model simulated potential impact on supply of using different blood management practices for transfusion: first in-first out (FIFO), using the oldest stored red blood cell units first; non-FIFO likely oldest, preferentially selecting older blood; and non-FIFO likely newest, preferentially selecting younger blood.

RESULTS

Simulation results showed higher estimates of the steady-state of the blood supply level for FIFO (1,630,000 units, 95% prediction interval [PI] 1,610,000-1,650,000) than non-FIFO scenarios (likely oldest, 1,530,000 units, 95% PI 1,500,000-1,550,000; and likely newest, 1,190,000 units, 95% PI 1,160,000-1,220,000), either for overall blood or by blood types.

CONCLUSION

To our knowledge, this model represents a first attempt to evaluate the impact of different blood management practices on daily availability and distribution of blood in the US blood supply. The average storage time before blood is being issued was influenced by blood management practices, for preferences of blood that is younger and also that use specific blood types. The model also suggests which practice could best approximate the current blood management system and may serve as useful tool for blood management.

Influenza infection during pregnancy: virology, pathogenesis and clinical challenges

Seasonal influenza infections are an important cause of morbidity and mortality worldwide. Pregnant and postpartum women are at increased risk of complications from influenza infection, partly due to the altered physiologic and immunologic parameters of pregnancy. While most influenza infections in pregnant women will take a mild, self-limited course, a minority of susceptible pregnant women suffer a severe life-threatening respiratory illness. The morbidity of influenza infection during pregnancy is compounded by the potential for adverse obstetric outcomes as well as the potential for detrimental fetal and neonatal effects. Suspected or confirmed influenza infection in a pregnant woman warrants treatment with antiviral medications. Influenza vaccination is the most effective way to prevent influenza infection during pregnancy and is recommended for women who are or will be pregnant during influenza season.

Effects of influenza on pregnant women and infants

Influenza vaccination during pregnancy has been shown to decrease the risk of influenza and its complications among pregnant women and their infants up to 6 months old. To adequately assess the benefits and potential risks that are associated with the use of influenza vaccine during pregnancy, it is necessary to examine the influenza-associated complications that occur among pregnant women and their children. Pregnant women have been shown to be at increased risk for morbidity and death with influenza illness during seasonal epidemics and pandemics. Newborn infants born to mothers with influenza during pregnancy, especially mothers with severe illness, are at increased risk of adverse outcomes, such as preterm birth and low birthweight. Infants <6 months old who experience influenza virus infection have the highest rates of hospitalization and death of all children. Here we review the risks for influenza-associated complications among pregnant women and infants <6 months old.

Prevention of novel influenza infection in newborns in hospital settings: considerations and strategies during the 2009 H1N1 pandemic

During the 2009 influenza A (H1N1) pandemic, many pregnant women experienced severe illness and some gave birth while ill with suspected or confirmed pandemic (H1N1) 2009 influenza. Because of concerns about possible transmission of this novel virus to immunologically naïve newborns, and the absence of definitive studies regarding this risk, the Centers for Disease Control and Prevention (CDC) reviewed relevant literature to understand the potential burden of disease and routes of transmission affecting newborns. This report describes the issues considered during the 2009 H1N1 pandemic as CDC developed guidance to protect newborns in hospital settings. Also presented is a framework of protection efforts to prevent novel influenza infection in fetuses/newborns before birth and in hospital settings. Although developed specifically for the pandemic, the framework may be useful during future novel influenza outbreaks.

Pandemic influenza H1N1 2009 virus infection in pregnancy in Turkey

OBJECTIVES

To describe the clinical characteristics of the pregnant women who were hospitalized in a tertiary referral hospital with pandemic influenza H1N1 2009 virus infection and neonatal outcomes from October 2009 to December 2009 during which the pandemic influenza cases peaked in Turkey.

MATERIALS AND METHODS

Twenty-five pregnant women who were hospitalized with influenza-like illness and who had laboratory confirmation for pandemic influenza H1N1 virus infection were evaluated prospectively.

RESULTS

Of the 25 patients, 4 (16%) were in the first trimester, 8 (32%) were in the second trimester, and 13 (52%) were in the third trimester. The median time from the onset of symptoms to the initiation of antiviral therapy was 1 day (range 1-9 days). Nineteen (76%) patients received oseltamivir treatment. It took 1.6 days on the average for the fever defervescence after the initiation of treatment or hospitalization. Of the 14 patients who underwent chest radiography, three had findings consistent with pneumonia. The mean duration of hospitalization was 4.8 days. Four women (16%) were admitted to an intensive care unit, but there were no maternal or neonatal deaths in this series. At the time of their H1N1 hospitalization, seven women delivered by cesarean at 33-40 weeks gestation, two vaginally at 38 weeks gestation, and two had an abortion at 10 weeks and 16 weeks of gestation, respectively. None of the infants had any evidence of influenza infection.

CONCLUSION

Pregnant women are at increased risk for complications from pandemic influenza H1N1 virus infection. Timely medical attention with early recourse to antiviral therapy is associated with a better outcome in H1N1-affected pregnant women.

Beliefs underlying blood donors' intentions to donate during two phases of an avian influenza outbreak

Using a Theory of Planned Behavior (TPB) framework the current study explored the beliefs of current blood donors (N = 172) about donating during a low and high-risk phase of a potential avian influenza outbreak. While the majority of behavioral, normative, and control beliefs identified in preliminary research differed as a function of donors’ intentions to donate during both phases of an avian influenza outbreak, regression analyses suggested that the targeting of different specific beliefs during each phase of an outbreak would yield most benefit in bolstering donors’ intentions to remain donating. The findings provide insight in how to best motivate donors in different phases of an avian influenza outbreak.

Vaccination during pregnancy to protect infants against influenza: why and why not?

Influenza is a significant cause of morbidity and mortality for pregnant women and infants worldwide. Influenza vaccination during pregnancy has been shown to be safe and highly effective and should be recommended for all pregnant women before the influenza season. Despite existing recommendations, the vaccine is underused in most countries. Obstacles to immunization include insufficient awareness of the disease burden and of the importance and safety of immunization, fear of liability and the wish to minimize interventions during pregnancy. Therefore, educational interventions for the public and health care workers are necessary to increase protection of pregnant women and young infants from influenza related complications.

Epoetin alpha decreases the number of erythrocyte transfusions in patients with acute lymphoblastic leukemia, lymphoblastic lymphoma, and Burkitt leukemia/lymphoma: results of a randomized clinical trial

BACKGROUND

Anemia is an expected consequence of intensive chemotherapy regimens administered to patients with acute leukemia. This study was designed to determine whether epoetin alpha would decrease the number of transfusion events and units of packed erythrocytes (PRBCs) transfused, and the secondary objective was to study the effects of epoetin alpha on quality of life (QOL) and complete remission (CR) rates.

METHODS

Patients with acute lymphoblastic leukemia (ALL), lymphoblastic lymphoma (LL), or Burkitt lymphoma (BL) who were receiving frontline myelosuppressive chemotherapy were randomized to receive epoetin alpha or no epoetin during the first 6 cycles of their planned chemotherapy. QOL was assessed by using the Edmonton Symptom Assessment Scale (ESAS) and the Functional Assessment of Cancer Therapy (FACT)-Anemia questionnaires.

RESULTS

Fifty-five patients were randomized to receive epoetin alpha, and 54 patients received no epoetin. Transfusion data were available for 79 of 81 evaluable patients (98%) who completed the treatment/observation period. The trial was stopped early because of poor accrual before the target of 123 evaluable patients was met. A mean of 10.6 units of PRBCs over 5 months were administered to those who received epoetin alpha compared with 13 units for those who did not receive epoetin (P = .04). There was no significant difference in QOL as assessed by the FACT-Anemia or ESAS instruments. The CR rate and the 3-year CR duration were not affected adversely by use of epoetin alpha.

CONCLUSIONS

Epoetin alpha decreased the number of PRBC transfusions and did not appear to have a negative impact on remission duration. No difference in QOL was observed.

[Emergent viral threats in blood transfusion]

Au cours des 20 dernières années, la sécurité en transfusion sanguine a fait de très grands progrès vis-à-vis du risque infectieux et notamment de celui représenté par les rétrovirus (HIV et HTLV) et les virus des hépatites B et C. L’objet de cette revue est de répertorier les risques viraux résiduels ou émergents qui seraient susceptibles d’entraîner de nouvelles contaminations chez les receveurs. À côté de nombreux autres virus (HHV-8, erythrovirus B19, virus des hépatites A et E…), une place toute particulière est faite aux arboviroses émergentes (infections à West Nile virus, dengue et chikungunya) qui menacent de toucher le territoire métropolitain suite à l’implantation en Europe du moustique Aedes albopictus, principal vecteur de la dengue et du chikungunya dans les régions tempérées. Un autre risque sanguin émergent, particulièrement au Royaume-Uni et en France, est constitué par le prion à l’origine de la forme variante de la maladie de Creutzfeldt-Jakob. La revue se termine par un rapide panorama des mesures qui sont susceptibles de contrôler ces émergences : exclusion des donneurs à risque, tests diagnostiques spécifiques de tel ou tel agent, déleucocytation des produits sanguins labiles et traitements physiques ou chimiques capables d’inactiver de façon non spécifique les agents infectieux potentiellement contaminants sans trop altérer les propriétés des composants sanguins. La capacité à maîtriser de façon prospective les nouveaux risques viraux au niveau transfusionnel représente un vrai défi pour préserver la confiance retrouvée des prescripteurs et des receveurs vis-à-vis des produits sanguins.

Testing the Fetal Origins Hypothesis in a developing country: evidence from the 1918 Influenza Pandemic

The 1918 Influenza Pandemic is used as a natural experiment to test the Fetal Origins Hypothesis. This hypothesis states that individual health as well as socioeconomic outcomes, such as educational attainment, employment status, and wages, are affected by the health of that individual while in utero. Repeated cross sections from the Pesquisa Mensal de Emprego (PME), a labor market survey from Brazil, are used to test this hypothesis. I find evidence to support the Fetal Origins Hypothesis. In particular, compared to individuals born in the few years surrounding the Influenza Pandemic, those who were in utero during the pandemic are less likely to be college educated, be employed, have formal employment, or know how to read and have fewer years of schooling and a lower hourly wage. These results underscore the importance of fetal health especially in developing countries.

Mapping the risk of avian influenza in wild birds in the US

BACKGROUND

Avian influenza virus (AIV) is an important public health issue because pandemic influenza viruses in people have contained genes from viruses that infect birds. The H5 and H7 AIV subtypes have periodically mutated from low pathogenicity to high pathogenicity form. Analysis of the geographic distribution of AIV can identify areas where reassortment events might occur and how high pathogenicity influenza might travel if it enters wild bird populations in the US. Modelling the number of AIV cases is important because the rate of co-infection with multiple AIV subtypes increases with the number of cases and co-infection is the source of reassortment events that give rise to new strains of influenza, which occurred before the 1968 pandemic. Aquatic birds in the orders Anseriformes and Charadriiformes have been recognized as reservoirs of AIV since the 1970s. However, little is known about influenza prevalence in terrestrial birds in the order Passeriformes. Since passerines share the same habitat as poultry, they may be more effective transmitters of the disease to humans than aquatic birds. We analyze 152 passerine species including the American Robin (Turdus migratorius) and Swainson's Thrush (Catharus ustulatus).

METHODS

We formulate a regression model to predict AIV cases throughout the US at the county scale as a function of 12 environmental variables, sampling effort, and proximity to other counties with influenza outbreaks. Our analysis did not distinguish between types of influenza, including low or highly pathogenic forms.

RESULTS

Analysis of 13,046 cloacal samples collected from 225 bird species in 41 US states between 2005 and 2008 indicates that the average prevalence of influenza in passerines is greater than the prevalence in eight other avian orders. Our regression model identifies the Great Plains and the Pacific Northwest as high-risk areas for AIV. Highly significant predictors of AIV include the amount of harvested cropland and the first day of the year when a county is snow free.

CONCLUSIONS

Although the prevalence of influenza in waterfowl has long been appreciated, we show that 22 species of song birds and perching birds (order Passeriformes) are influenza reservoirs in the contiguous US.

Low clinical burden of 2009 pandemic influenza A (H1N1) infection during pregnancy on the island of La Réunion

Background

Pregnant women have been identified as a group at risk, both for respiratory complications than for the admissions to the Intensive Care Unit (ICU) during the 2009 H1N1 influenza pandemic (pdm). The purpose of this prospective register-based cohort-study was to characterize the clinical virulence of the pdm (H1N1/09)v during pregnancy in La Réunion.

Methods/Principal Findings

Over a twelve-week pdm wave (13 July to 3 October 2009), 294 pregnant women presented with an influenza-like illness (ILI) to one of the three maternity departments of the South Reunion area, Indian Ocean. Out of these, 278 were checked by RT-PCR for influenza viruses (157 positive and 121 negative, of whom, 141 with pdm flu and 132 with ILIs of non pdm origin, 5 untyped). The median body temperature was higher in women experiencing pdm flu than in those with non pdm ILI (38.9°C versus 38.3°C, P<0.0001), without evidence linked to circulating viremia. Oseltamivir was given for 86% of pdm flu cases in a median time inferior than 48 hrs (range 0–7 days). The hospitalization rate for pdm flu was of 60% and not associated with underlying conditions. Six viral pneumonia and fourteen asthma attacks were observed among 84 hospitalized pdm flu cases, of whom, only one led to the ICU for an acute lung injury. No maternal death occurred during the pdm wave. None adverse pregnancy outcome was associated with pdm flu. No congenital birth defect, nor early-onset neonatal influenza infection was attributable to pdm flu exposure.

Conclusions/Significance

This report mitigates substantially the presumed severity of pandemic H1N1/09 influenza infection during pregnancy. The reasons for which the clinical burden of H1N1/09 influenza virus may differ worldwide raise questions about a differential local viral-strain effect and public health preparedness, notably in timely access to special care and antiviral treatments.

Viral load in patients infected with pandemic H1N1 2009 influenza A virus

Viral shedding profile of infections caused by the pandemic H1N1 2009 influenza A virus has not been reported. The aim of this study was to determine the viral load in different body sites. Viral loads of pandemic H1N1 virus in respiratory specimens, stool, urine, and serum were determined by quantitative reverse transcriptase‐polymerase chain reaction (RT‐PCR). Respiratory specimens from patients with seasonal influenza were used as historical controls. Initial pre‐treatment viral load were compared between these two groups. Serial respiratory specimens from patients with pandemic H1N1 virus infection were obtained for analysis of viral dynamics. Twenty‐two pandemic H1N1 cases and 44 seasonal influenza historical controls were included. The mean initial viral load before oseltamivir therapy was 1.84 × 10⁸ copies/ml for pandemic H1N1 virus compared with 3.28 × 10⁸ copies/ml in seasonal influenza historical controls (P = 0.085). Among patients with pandemic H1N1 virus infection, peak viral load occurred on the day of onset of symptoms, and declined gradually afterwards, with no virus being detectable in respiratory specimens by RT‐PCR 8 days and by culture 5 days after the onset of symptoms respectively, except in one patient. Pandemic H1N1 virus was detected in stool and in urine from 4/9 and 1/14 patients, respectively. Viral culture was also positive from the stool sample with the highest viral load. Younger age was associated with prolonged shedding in the respiratory tract and higher viral load in the stool. Data from this quantitative analysis of viral shedding may have implications for formulating infection control measures. J. Med. Virol. 82:1–7, 2010. © 2009 Wiley‐Liss, Inc.

Novel H1N1 virus infection and pregnancy

Human infection with the novel H1N1 influenza virus, initially popularly termed "swine flu," was first reported in April 2009 and has since prompted the World Health Organization (WHO) to raise its pandemic alert to the highest level. During pregnancy both mother and baby are at increased risk when infected with either pandemic or seasonal influenza. Because of concerns about the severity of the disease during pregnancy, the Centers for Disease Control and Prevention (CDC) has implemented enhanced surveillance for infection with this novel virus in pregnant women and has placed them in a group that merits priority vaccine administration. The benefit of treatment with the antiviral medication oseltamivir outweighs its theoretical risk, as pregnant women are at increased risk of severe complications from H1N1 virus infection. In addition to confirmed H1N1 cases, the associated symptoms, particularly fever, merit immediate attention. Moreover, precautions must be taken by both patients and health care professionals when confirmed or suspected H1N1-infected pregnant women present to labor and delivery, or the doctor's office. After delivery, pregnant women infected with H1N1 may breastfeed but must follow specific guidelines. Although the current strain of H1N1 virus has fairly mild sequelae, the virus may have mutated over the summer months and we must anticipate a possible second wave of more severe illness moving into fall 2009 and winter 2010.

Management of blood supplies during an influenza pandemic

BACKGROUND

Blood supplies are delicate resources, particularly vulnerable to incidents affecting the health of donors. The critical impact of a pandemic on the availability of red blood cells (RBCs) has been demonstrated in previous research; however, a detailed estimate of the expected deficit is missing. This has become a priority issue in the face of the current influenza pandemic.

STUDY DESIGN AND METHODS

Data from several major blood donation services were used to analyze management of blood supplies in Germany. Routine management of RBCs was extrapolated to epidemic and pandemic situations using computer simulations with a mathematical model that allows for analysis of deficits in blood supplies.

RESULTS

Routine management and distribution of RBCs are driven by supply, which has marked fluctuations but does not appear to have seasonality. There seems to be a remarkable elasticity in the demand for RBCs that helps to mitigate minor crises in supply, but this is likely to be overstretched during a severe pandemic.

CONCLUSION

The supply-driven management of RBCs in Germany implies that assessment of severity of shortages due to a pandemic depends on detailed knowledge about the fraction of transfusions that do not allow for postponement. Pandemic preparedness should include criteria for prioritization of transfusions.

Emerging infectious disease agents and their potential threat to transfusion safety

BACKGROUND

Emerging infections have been identified as a continuing threat to human health. Many such infections are known to be transmissible by blood transfusion, while others have properties indicating this potential. There has been no comprehensive review of such infectious agents and their threat to transfusion recipient safety to date.

STUDY DESIGN AND METHODS

The members of AABB's Transfusion Transmitted Diseases Committee reviewed a large number of information sources in order to identify infectious agents with actual or potential risk of transfusion transmission now or in the future in the US or Canada; with few exceptions, these agents do not have available interventions to reduce the risk of such transmission. Using a group discussion and writing process, key characteristics of each agent were identified, researched, recorded and documented in standardized format. A group process was used to prioritize each agent on the basis of scientific/epidemiologic data and a subjective assessment of public perception and/or concern expressed by regulatory agencies.

RESULTS

Sixty-eight infectious agents were identified and are described in detail in a single Supplement to TRANSFUSION. Key information will also be provided in web-based form and updated as necessary. The highest priorities were assigned to Babesia species, Dengue virus, and vCJD.

CONCLUSION

The information is expected to support the needs of clinicians and transfusion medicine experts in the recognition and management of emerging infections among blood donors and blood recipients.

H3N2 influenza A virus replicates in immortalized human first trimester trophoblast cell lines and induces their rapid apoptosis

PROBLEM

Epidemiological data suggested that pandemic influenza increased the risks of spontaneous abortion and premature labor, while seasonal influenza also increased the risk of schizophrenia in adolescence. However, their pathogenesis is so far unknown.

METHOD OF STUDY

The first trimester trophoblast cell lines, namely, Swan71 and HTR8 cells were challenged with A/Udorn/72 influenza virus (H3N2). At indicated time points, cells were examined for expression of influenza proteins. Viral replication in culture media, apoptosis and the expression of human leukocyte antigen (HLA)-G were also examined.

RESULTS

Intracellular localization of viral proteins was observed. Twenty-four hours after inoculation, virus was detected in culture media while most cells fell into apoptosis. During apoptosis, expression of HLA-G was unchanged.

CONCLUSION

We revealed replication of low pathogenic influenza virus in the first trimester trophoblast cell lines. Placental damages are likely to be induced by direct cytopathic effects of influenza virus and subsequent apoptosis rather than down regulation of HLA-G expression and subsequent rejection by maternal immune system.

H1N1 2009 influenza virus infection during pregnancy in the USA

BACKGROUND

Pandemic H1N1 2009 influenza virus has been identified as the cause of a widespread outbreak of febrile respiratory infection in the USA and worldwide. We summarised cases of infection with pandemic H1N1 virus in pregnant women identified in the USA during the first month of the present outbreak, and deaths associated with this virus during the first 2 months of the outbreak.

METHODS

After initial reports of infection in pregnant women, the US Centers for Disease Control and Prevention (CDC) began systematically collecting additional information about cases and deaths in pregnant women in the USA with pandemic H1N1 virus infection as part of enhanced surveillance. A confirmed case was defined as an acute respiratory illness with laboratory-confirmed pandemic H1N1 virus infection by real-time reverse-transcriptase PCR or viral culture; a probable case was defined as a person with an acute febrile respiratory illness who was positive for influenza A, but negative for H1 and H3. We used population estimates derived from the 2007 census data to calculate rates of admission to hospital and illness.

FINDINGS

From April 15 to May 18, 2009, 34 confirmed or probable cases of pandemic H1N1 in pregnant women were reported to CDC from 13 states. 11 (32%) women were admitted to hospital. The estimated rate of admission for pandemic H1N1 influenza virus infection in pregnant women during the first month of the outbreak was higher than it was in the general population (0.32 per 100 000 pregnant women, 95% CI 0.13-0.52 vs 0.076 per 100 000 population at risk, 95% CI 0.07-0.09). Between April 15 and June 16, 2009, six deaths in pregnant women were reported to the CDC; all were in women who had developed pneumonia and subsequent acute respiratory distress syndrome requiring mechanical ventilation.

INTERPRETATION

Pregnant women might be at increased risk for complications from pandemic H1N1 virus infection. These data lend support to the present recommendation to promptly treat pregnant women with H1N1 influenza virus infection with anti-influenza drugs.

FUNDING

US CDC.