Pandemic influenza A (H1N1) in pregnant women: impact of early diagnosis and antiviral treatment

Evaluation of: Siston AM, Rasmussen SA, Honein MA et al. Pandemic 2009 influenza A (H1N1) virus illness among pregnant women in the United States. JAMA 303(15), 1517–1525 (2010).

Pregnant women are at increased risk for severe illness from influenza infection, particularly pandemics, including the current flu pandemic. Early antiviral therapy using oseltamivir or zanamivir may be beneficial, but limited information is available regarding their safety and effectiveness during pregnancy. The article by Siston et al. assessed the findings of a recently published paper describing the severity of illness due to 2009 influenza A (H1N1) infection among 788 pregnant women reported to the CDC, stratified by timing of antiviral therapy and pregnancy trimester at symptom onset. The authors’ findings highlight the potential for severe illness and high risk of mortality due to influenza A (H1N1) infection among pregnant women and suggest the benefit of early antiviral treatment in reducing intensive care unit admissions and mortality rate. The WHO and CDC recommendations including 2009 influenza A (H1N1) vaccination and early antiviral therapy in case of influenza-like illness for all pregnant women are discussed regarding the key findings of this paper and other published data on influenza A (H1N1) infection in pregnant women.     

H1N1 and influenza viruses: why pregnant women might be hesitant to be vaccinated

Question I have been encouraging pregnant women to receive both the H1N1 and influenza vaccines since I became aware of Health Canada’s guidelines. However, some of the women in my practice have heard conflicting information, often from media sources, and they are hesitant to be vaccinated. What is the evidence behind these guidelines, and should I really be convincing these women to be vaccinated?Answer Pregnant women and growing fetuses are considered a population vulnerable to H1N1 and influenza viruses. Health Canada published a report in late 2010 estimating that this population was at increased risk of hospitalization and severe outcomes of H1N1 infection. Recommendations included pregnant women as a priority group to receive the H1N1 vaccine as well as the influenza vaccine. This information should be explained unambiguously to pregnant women, and they should be made aware of the sensationalism of media reports, which are often based on opinion and not evidence.     

Clinical review: Considerations for the triage of maternity care during an influenza pandemic - one institution's approach

The ongoing pandemic of 2009 H1N1 swine-origin influenza A has heightened the world's attention to the reality of influenza pandemics and their unpredictable nature. Currently, the 2009 H1N1 influenza strain appears to cause mild clinical disease for the majority of those infected. However, the risk of severe disease from this strain or other future strains remains an ongoing concern and is noted in specific patient populations. Pregnant women represent a unique patient population that historically has been disproportionately affected by both seasonal and pandemic influenza outbreaks. Data thus far suggest that the current 2009 H1N1 outbreak is following this same epidemiologic tendency among pregnant women. The increased predilection to worse clinical outcomes among pregnant women has potential to produce an acute demand for critical care resources that may overwhelm supply in facilities providing maternity care. The ability of healthcare systems to optimize maternal-child health outcomes during an influenza pandemic or other biologic disaster may therefore depend on the equitable allocation of these limited resources. Triage algorithms for resource allocation have been delineated in the general medical population. However, no current guidance considers the unique aspects of pregnant women and their unborn fetuses. An approach is suggested that may help guide facilities faced with these challenges.     

儿童及孕期妇女流感疾病负担及预防进展

流行性感冒(流感)是一种急性上呼吸道传染性疾病。在全球范围内,流感的流行会使得儿童和孕妇的住院风险显著增加,造成巨大的疾病负担。接种流感疫苗是目前预防流感的最有效方法。本研究就国内外儿童及妇女的流感疾病负担及预防进行相关综述。     

Influenza vaccination during pregnancy: opinions and practices of obstetricians in an urban community

BACKGROUND: Influenza vaccination is recommended for all women who will be pregnant during the influenza season; however, little is known about the attitudes of physicians regarding vaccination of pregnant women. METHODS: We conducted a survey of all the fellows of the American College of Obstetricians and Gynecologists (ACOG) who live and practice in Nashville, Tennessee, focusing on physician knowledge, practices, and opinions regarding influenza vaccination of pregnant RESULTS: Thirty-seven of 58 (64%) eligible physicians participated. Obstetrician opinion on the earliest influenza vaccine administration for healthy pregnant women was 62% during the second trimester, 32% during the first trimester, and 6% felt that the vaccine should not be given during pregnancy. All physicians responded that pregnant women with an underlying high risk condition should be vaccinated. CONCLUSION: Practicing obstetricians differ in their preferences regarding the timing of influenza vaccine administration in pregnant women. Obstetrician and patient opinion and practice should be studied and considered in developing vaccine guidelines and vaccine implementation strategies.     

孕产期妇女甲型H1N1流感防治进展

与季节性流感和历次流感大流行相似,甲型H1N1流感大流行过程中,孕妇感染甲型H1N1流感的风险增高,孕妇甲型H1N1流感的患病率、病死率增高,易继发严重并发症.因此,基于疗效-风险评估,无接种禁忌证的孕妇,妊娠各期均应接种甲型H1N1流感疫苗.出现流感样症状或与甲型H1N1流感患者密切接触的孕妇,都应接受神经氨酸酶抑制剂(更推荐奥司他韦)治疗或预防,无需等待实验室检查结果证实甲型H1N1流感感染.感染甲型H1N1流感的哺乳产妇,神经氨酸酶抑制剂对接受授乳的婴儿是安全的.甲型H1N1流感流行期间,孕妇应采取非药物预防措施,降低感染甲型H1N1流感的风险.     

广东省深圳市首例孕妇感染H9N2禽流感病例流行病学调查

目的通过对广东省深圳市龙岗区报告的首例孕妇感染H9N2禽流感病例的流行病学调查,探明可能的感染来源,为今后防控H9N2等亚型禽流感疫情积累经验。方法2017－2018年采用现场流行病学方法系统收集深圳市龙岗区报告病例的流行病学资料,采集病例、密切接触者和暴露环境等样本;应用抗原检测的方法检测A型流感病毒;应用荧光定量PCR的方法检测禽流感病毒,并进行分型。采用Excel 2019软件对检验结果进行分析。结果患者咽拭子H9N2禽流感病毒核酸阳性,确诊为深圳市首例孕妇感染H9N2禽流感病例;8名密切接触者在医学观察期内均未出现流感样症状,流感抗原及禽流感核酸检测均呈阴性;2017年日常监测结果外环境H9病毒亚型阳性率为14.49%,在A型通用阳性中占比达62.69%;本次疫情共采集外环境标本103份,其中A型通用阳性15份,H9亚型阳性9份。 结论该患者感染来源可能为青峰乳鸽农庄,但也不能排除日常接触禽类制品暴露。深圳禽类市场外环境禽流感病毒污染情况仍然存在,流行季节高危人群仍有暴露感染的可能,需要予以重视。     

Influenza and Emergency Department Utilization by Elders

Objectives: Influenza outbreaks have been associated with worsened emergency department (ED) crowding. We sought to examine the mechanism behind this association. Methods: A retrospective time series analysis was conducted in Toronto from January 1996 to April 1999. Weekly data on laboratory-confirmed influenza and other respiratory virus cases in the community and visits to all city EDs ( n = 20) were obtained. In longitudinal analyses, we determined the association between influenza and changes in ED utilization by younger and older patients with specific diagnoses grouped as major influenza related (MIR) and upper respiratory infection (URI). Time trends in psychiatric visits and their relationship to influenza were used as a control group. Results: A mean of 11,075 ED visits occurred weekly (SD = 698; average age, 39.9 years; 51% women). Four influenza seasons occurred, with weekly incident case counts ranging from 0 to 236; there were a total of 81 weeks with zero new cases between seasons. In multivariable analyses, every ten new cases of influenza active in the community was associated with a 1.5% (95% confidence interval = 1.2 to 1.8) and 1.2% (95% confidence interval = 0.6 to 1.8) absolute increase in the proportion of ED patients who were elders with MIR conditions and URIs, respectively. Influenza was not significantly associated with ED utilization by younger patients; other respiratory viruses were not significantly associated with ED utilization for any patient group. Conclusions: Influenza season is associated with increased ED utilization by patients aged 65 years and older, most of whom have major respiratory illnesses and may require hospital admission. No association was seen between influenza and utilization by younger patients. Efforts to reduce the impact of influenza seasons on EDs should focus on elders.     

When should a diagnosis of influenza be considered in adults requiring intensive care unit admission? Results of population-based active surveillance in Toronto

Introduction

There is a paucity of data about the clinical characteristics that help identify patients at high risk of influenza infection upon ICU admission. We aimed to identify predictors of influenza infection in patients admitted to ICUs during the 2007/2008 and 2008/2009 influenza seasons and the second wave of the 2009 H1N1 influenza pandemic as well as to identify populations with increased likelihood of seasonal and pandemic 2009 influenza (pH1N1) infection.

Methods

Six Toronto acute care hospitals participated in active surveillance for laboratory-confirmed influenza requiring ICU admission during periods of influenza activity from 2007 to 2009. Nasopharyngeal swabs were obtained from patients who presented to our hospitals with acute respiratory or cardiac illness or febrile illness without a clear nonrespiratory aetiology. Predictors of influenza were assessed by multivariable logistic regression analysis and the likelihood of influenza in different populations was calculated.

Results

In 5,482 patients, 126 (2.3%) were found to have influenza. Admission temperature ≥38°C (odds ratio (OR) 4.7 for pH1N1, 2.3 for seasonal influenza) and admission diagnosis of pneumonia or respiratory infection (OR 7.3 for pH1N1, 4.2 for seasonal influenza) were independent predictors for influenza. During the peak weeks of influenza seasons, 17% of afebrile patients and 27% of febrile patients with pneumonia or respiratory infection had influenza. During the second wave of the 2009 pandemic, 26% of afebrile patients and 70% of febrile patients with pneumonia or respiratory infection had influenza.

Conclusions

The findings of our study may assist clinicians in decision making regarding optimal management of adult patients admitted to ICUs during future influenza seasons. Influenza testing, empiric antiviral therapy and empiric infection control precautions should be considered in those patients who are admitted during influenza season with a diagnosis of pneumonia or respiratory infection and are either febrile or admitted during weeks of peak influenza activity.     

Towards understanding the concept of risk for pregnant women: some nursing and midwifery implications

Aims and objectives. This paper aims to explore the concept of risk in pregnancy. Background. Notions of risk and ‘not knowing’ have always surrounded pregnant women, although in the last two decades trends of increased consumer confidence and midwifery activism have together promoted a greater appreciation of pregnancy as a normal life event. At the same time, advances in pregnancy‐related technologies have contributed new levels of concern related to an increasing ability to detect minor abnormalities by ultrasound. This, in turn, causes a concordant rise in the number of women referred to high‐risk pregnancy care to monitor suspect findings. Overall, it seems likely that this increasing emphasis on abnormality detection and risk may have serious implications for women. Design. Concept analysis. Method. In this paper, I undertake an exploration of the concept of risk as understood by health professionals and pregnant women. Then, using Deborah Lupton’s understanding of a ‘discourse of risk’, I discuss the ways pregnant women both contribute to and are enmeshed in, this discourse. In the final section, I consider how nurses act informally to shield vulnerable women. Conclusions. Health professionals and pregnant women understand risk differently. Women employ a subjective appraisal of risk, measuring it against their personal values and prior experience, while health professionals evaluate risk in an objective manner. Relevance to clinical practice. As increasing numbers of women are referred to ‘at risk’ care, it is important that health professionals understand and respond to maternal understandings of risk. Nurses and midwives particularly, have a role to play in assisting women to make sense of risk calculations. In this way, they can act to ameliorate the growing concept of risk for pregnant women.     

妊娠期重症甲型H1N1流感肺炎病例特点分析

目的 探讨妊娠期重症甲型H1N1流感肺炎患者的临床特点,提高对妊娠期重症甲型H1N1流感肺炎的认识.方法 分析我院2009年11月26日至12月20日收治的15例妊娠期重症甲型H1N1流感肺炎患者临床资料.结果 15例患者平均年龄24岁,平均孕周32周,白细胞总数平均值(6.76±3.30)×109/L[(1.30～14.60)×109/L],2例低于4×109/L,最低1.3×109/L;3例高于10×109/L,最高14.6×109/L.中性粒细胞比率(87.62±4.00)%[(79.40～92.90)%],均高于正常.淋巴细胞绝对值(0.70±0.24)×109/L[(0.20～1.20)×109/L],13例(86.7%)低于1×109/L.单核细胞计数平均值(0.10±0.13)×109/L[(0～0.4)×109/L],13例(86.7%)低于0.2 × 109/L,6例计数为0.12例患者检查T淋巴细胞亚群CD4/CD8中有6例(54.5%)<1.4,其中5例<1.CDl9相对值21.09±10.39(12～47),其中6例(40%)>18.CD16+56相对值为8.45±3.83(3～15),4例(26.7%)<8,其余所有测定值接近低限.14例患者血乳酸脱氢酶平均(400.84±262.84)U/L[(0.80～850.00)U/L],其中10例(71.4%)增高.肌酸激酶(512.47±1250.67)U/L[(25～5088)U/L],4例患者(26.6%)高于正常值,同时伴有同工酶升高.15例中4例(26.7%)血钾<3.5 mmol/L.12例患者免疫相关检查中有4例(33.3%)补体CA>0.36g/L,1例(6.7%)<0.09 g/L;4例(33.3%)C3<0.75 g/L;免疫球蛋白及免疫复合物大致正常.15例患者放射影像均确定存在多发、多叶肺炎,主要呈间质样改变或大片实变渗出.需要机械通气辅助呼吸的病例影像学特点为双肺弥漫大面积实变影,连续监测进展迅速,符合ARDS影像学表现.4例出现少量胸腔积液,1例合并少量心包积液.患者中有2例晚期妊娠孕妇胚胎死亡,7例及时终止妊娠者病情稳定.结论 妊娠期妇女是甲型H1N1病毒感染的高危人群,并易迅速发展成为ARDS.妊娠期免疫耐受可能参与重症H1N1流感肺炎肺部损伤过程.     

妊娠期重症甲型H1N1流感肺炎病例特点分析

目的 探讨妊娠期重症甲型H1N1流感肺炎患者的临床特点,提高对妊娠期重症甲型H1N1流感肺炎的认识.方法 分析我院2009年11月26日至12月20日收治的15例妊娠期重症甲型H1N1流感肺炎患者临床资料.结果 15例患者平均年龄24岁,平均孕周32周,白细胞总数平均值(6.76±3.30)×109/L[(1.30～14.60)×109/L],2例低于4×109/L,最低1.3×109/L;3例高于10×109/L,最高14.6×109/L.中性粒细胞比率(87.62±4.00)%[(79.40～92.90)%],均高于正常.淋巴细胞绝对值(0.70±0.24)×109/L[(0.20～1.20)×109/L],13例(86.7%)低于1×109/L.单核细胞计数平均值(0.10±0.13)×109/L[(0～0.4)×109/L],13例(86.7%)低于0.2 × 109/L,6例计数为0.12例患者检查T淋巴细胞亚群CD4/CD8中有6例(54.5%)<1.4,其中5例<1.CDl9相对值21.09±10.39(12～47),其中6例(40%)>18.CD16+56相对值为8.45±3.83(3～15),4例(26.7%)<8,其余所有测定值接近低限.14例患者血乳酸脱氢酶平均(400.84±262.84)U/L[(0.80～850.00)U/L],其中10例(71.4%)增高.肌酸激酶(512.47±1250.67)U/L[(25～5088)U/L],4例患者(26.6%)高于正常值,同时伴有同工酶升高.15例中4例(26.7%)血钾<3.5 mmol/L.12例患者免疫相关检查中有4例(33.3%)补体CA>0.36g/L,1例(6.7%)<0.09 g/L;4例(33.3%)C3<0.75 g/L;免疫球蛋白及免疫复合物大致正常.15例患者放射影像均确定存在多发、多叶肺炎,主要呈间质样改变或大片实变渗出.需要机械通气辅助呼吸的病例影像学特点为双肺弥漫大面积实变影,连续监测进展迅速,符合ARDS影像学表现.4例出现少量胸腔积液,1例合并少量心包积液.患者中有2例晚期妊娠孕妇胚胎死亡,7例及时终止妊娠者病情稳定.结论 妊娠期妇女是甲型H1N1病毒感染的高危人群,并易迅速发展成为ARDS.妊娠期免疫耐受可能参与重症H1N1流感肺炎肺部损伤过程.     

妊娠期重症甲型H1N1流感肺炎病例特点分析

目的 探讨妊娠期重症甲型H1N1流感肺炎患者的临床特点,提高对妊娠期重症甲型H1N1流感肺炎的认识.方法 分析我院2009年11月26日至12月20日收治的15例妊娠期重症甲型H1N1流感肺炎患者临床资料.结果 15例患者平均年龄24岁,平均孕周32周,白细胞总数平均值(6.76±3.30)×109/L[(1.30～14.60)×109/L],2例低于4×109/L,最低1.3×109/L;3例高于10×109/L,最高14.6×109/L.中性粒细胞比率(87.62±4.00)%[(79.40～92.90)%],均高于正常.淋巴细胞绝对值(0.70±0.24)×109/L[(0.20～1.20)×109/L],13例(86.7%)低于1×109/L.单核细胞计数平均值(0.10±0.13)×109/L[(0～0.4)×109/L],13例(86.7%)低于0.2 × 109/L,6例计数为0.12例患者检查T淋巴细胞亚群CD4/CD8中有6例(54.5%)<1.4,其中5例<1.CDl9相对值21.09±10.39(12～47),其中6例(40%)>18.CD16+56相对值为8.45±3.83(3～15),4例(26.7%)<8,其余所有测定值接近低限.14例患者血乳酸脱氢酶平均(400.84±262.84)U/L[(0.80～850.00)U/L],其中10例(71.4%)增高.肌酸激酶(512.47±1250.67)U/L[(25～5088)U/L],4例患者(26.6%)高于正常值,同时伴有同工酶升高.15例中4例(26.7%)血钾<3.5 mmol/L.12例患者免疫相关检查中有4例(33.3%)补体CA>0.36g/L,1例(6.7%)<0.09 g/L;4例(33.3%)C3<0.75 g/L;免疫球蛋白及免疫复合物大致正常.15例患者放射影像均确定存在多发、多叶肺炎,主要呈间质样改变或大片实变渗出.需要机械通气辅助呼吸的病例影像学特点为双肺弥漫大面积实变影,连续监测进展迅速,符合ARDS影像学表现.4例出现少量胸腔积液,1例合并少量心包积液.患者中有2例晚期妊娠孕妇胚胎死亡,7例及时终止妊娠者病情稳定.结论 妊娠期妇女是甲型H1N1病毒感染的高危人群,并易迅速发展成为ARDS.妊娠期免疫耐受可能参与重症H1N1流感肺炎肺部损伤过程.     

COVID‐19 and acute coagulopathy in pregnancy

We present a putative link between maternal COVID‐19 infection in the peripartum period and rapid maternal deterioration with early organ dysfunction and coagulopathy. The current pandemic with SARS‐CoV‐2 has already resulted in high numbers of critically ill patients and deaths in the non‐pregnant population, mainly due to respiratory failure. During viral outbreaks, pregnancy poses a uniquely increased risk to women due to changes to immune function, alongside physiological adaptive alterations, such as increased oxygen consumption and edema of the respiratory tract. The laboratory derangements may be reminiscent of HELLP (hemolysis, elevated liver enzymes, low platelet count) syndrome, and thus knowledge of the COVID‐19 relationship is paramount for appropriate diagnosis and management. In addition to routine measurements of D‐dimers, prothrombin time, and platelet count in all patients presenting with COVID‐19 as per International Society on Thrombosis and Haemostasis (ISTH) guidance, monitoring of activated partial thromboplastin time (APTT) and fibrinogen levels should be considered in pregnancy, as highlighted in this report. These investigations in SARS‐CoV‐2‐positive pregnant women are vital, as their derangement may signal a more severe COVID‐19 infection, and may warrant pre‐emptive admission and consideration of delivery to achieve maternal stabilization.     

USPSTF recommendations for STI screening

Since 2000, the U.S. Preventive Services Task Force (USPSTF) has issued eight clinical recommendation statements on screening for sexually transmitted infections. This article, written on behalf of the USPSTF, is an overview of these recommendations. The USPSTF recommends that women at increased risk of infection be screened for chlamydia, gonorrhea, human immunodeficiency virus, and syphilis. Men at increased risk should be screened for human immunodeficiency virus and syphilis. All pregnant women should be screened for hepatitis B, human immunodeficiency virus, and syphilis; pregnant women at increased risk also should be screened for chlamydia and gonorrhea. Nonpregnant women and men not at increased risk do not require routine screening for sexually transmitted infections. Engaging in high-risk sexual behavior places persons at increased risk of sexually transmitted infections. The USPSTF recommends that all sexually active women younger than 25 years be considered at increased risk of chlamydia and gonorrhea. Because not all communities present equal risk of sexually transmitted infections, the USPSTF encourages physicians to consider expanding or limiting the routine sexually transmitted infection screening they provide based on the community and populations they serve.     

Factors affecting influenza vaccination rates in older people admitted to hospital with acute medical problems

Influenza is a major problem both in the community and hospital and elderly people who are at particular risk should be included in vaccination programmes. In August 1998 the Chief Medical Officer for England extended the current influenza immunization policy to include all those aged 75 years or over. However, prior to this date only those patients with co-existing cardiac or respiratory diseases at increased risk of influenza were vaccinated routinely. In order to determine whether such patients had been immunized, we approached all patients admitted to Care of the Elderly wards during an 8-week period in January and February. The study additionally identified factors that may have influenced patients' participation in this immunization programme. Six hundred and forty-nine patients on Care of the Elderly wards with acute medical illness were questioned with regard to vaccination against influenza during the previous year. Of the 649 patients 279 were suitable for entry into the study. Of these 39% had been vaccinated against influenza. When considering the 171 who were not vaccinated, 25% (44 patients) had actually been offered and declined vaccination, in 46% of these cases due to previous side-effects, or fear of anticipated side-effects. In those unvaccinated three-quarters considered that the influenza vaccine was not efficacious. Unfortunately, patients with co-existing cardiac, respiratory or endocrine diseases were no more likely to have been vaccinated than were those without these diseases. Many older patients admitted with acute medical problems had not been vaccinated against influenza and the reasons for this included not being offered vaccination, a belief that influenza vaccination was not efficacious and concerns about possible side-effects. The role of community doctors and nurses in facilitating the vaccination of such an at-risk group is evident and should be incorporated into resource planning.     

Synergistic stimulation of type I interferons during influenza virus coinfection promotes Streptococcus pneumoniae colonization in mice

Pneumococcal infection of the respiratory tract is often secondary to recent influenza virus infection and accounts for much of the morbidity and mortality during seasonal and pandemic influenza. Here, we show that coinfection of the upper respiratory tract of mice with influenza virus and pneumococcus leads to synergistic stimulation of type I IFNs and that this impairs the recruitment of macrophages, which are required for pneumococcal clearance, due to decreased production of the chemokine CCL2. Type I IFN expression was induced by pneumococcal colonization alone. Colonization followed by influenza coinfection led to a synergistic type I IFN response, resulting in increased density of colonizing bacteria and susceptibility to invasive infection. This enhanced type I IFN response inhibited production of the chemokine CCL2, which promotes the recruitment of macrophages and bacterial clearance. Stimulation of CCL2 by macrophages upon pneumococcal infection alone required the pattern recognition receptor Nod2 and expression of the pore-forming toxin pneumolysin. Indeed, the increased colonization associated with concurrent influenza virus infection was not observed in mice lacking Nod2 or the type I IFN receptor, or in mice challenged with pneumococci lacking pneumolysin. We therefore propose that the synergistic stimulation of type I IFN production during concurrent influenza virus and pneumococcal infection leads to increased bacterial colonization and suggest that this may contribute to the higher rates of disease associated with coinfection in humans.     

2016-2020年贵阳市老年呼吸道感染住院患者呼吸道合胞病毒流行特征及流感病毒感染临床严重性比较

目的 了解老年人呼吸道感染住院患者呼吸道合胞病毒(RSV)感染的流行病学特征,比较RSV感染与流感病毒感染的临床严重性差异,探索影响老年人呼吸道感染住院期间死亡的危险因素。方法 收集2016年1月1日至2020年12月31日贵阳市2家医院收治的60岁以上老年人呼吸道感染住院患者的临床和病原学检测资料。比较RSV感染与流感病毒感染老年人在人口学特征、基础性疾病、临床表现,以及住院时间和住院期间死亡等临床结局上存在的差异,并采用多因素logistic回归模型探索影响老年人呼吸道感染住院期间死亡的危险因素。结果 5 131例60岁以上呼吸道感染住院患者中,RSV检测阳性率为2%,流感病毒检测阳性率为10%。77%(80/104)的RSV感染和63%(312/497)的流感病毒感染集中在每年的11月至次年2月,发病具有明显季节性。与流感病毒感染老年人比较,RSV感染的中位发病年龄(73岁vs. 74岁,P=0.997),ICU收治比例(7%vs. 6%,P=0.822)和住院期间死亡率(6%vs. 3%,P=0.233)差异无统计学意义。但RSV感染的老年人中位住院天数延长(14 d vs. ...     

Analysis of risk factors of fatal outcome in pregnant and puerperant patients with severe H1N1 influenza

As well as previous epidemics and pandemias of influenza, the 2009 H1N1 influenza pandemia increases the risk of severe illness in pregnant. Data were reported for 28 pregnant and 2 postpartum women who have been hospitalized in ICUs of Krasnodar Region with H1N1 influenza diagnosis. The laboratory tests for H1N1 were negative in 53.3% of suspected cases of H1N1 influenza (16 of 30). The major lethal risk factor in pregnant with H1N1 influenza is a development of septic shock with low PaO2\FiO2 ratio (less than 140) and high Murray's Acute Lung Injury Score (higher than 2.5). High Apache II, Apache III, SAPS 2, SAPS 3 and SOFA scores are the additional lethal risk factors. Lethal outcomes were more frequent in the end of the second trimester of pregnancy.     

Increased prevalence of intestinal helminth infection during pregnancy in a Sub-Saharan African community

Gestation is a unique physiologic state that carries with it several immunologic consequences and results in changing susceptibility to various diseases. In contrast to the well recognized excess vulnerability of primiparous women to Plasmodium falciparum infection in areas of high malaria transmission, it is not known whether pregnancy is associated with a higher prevalence of helminth infection. In Lambaréné, Gabon, 105 pregnant women were recruited and matched with non-gravid female controls. The prevalence of intestinal helminths was 66% (n=58) in the pregnant participants and 36% (n=32) in the non-pregnant controls (P<0.001). In multivariate analysis the pregnancy status was an independent risk factor for being infected with intestinal helminths (AOR and 95% CI: 3.0 [1.4-5.9]). These data show a previously undescribed susceptibility pattern of pregnant women to intestinal helminth infection in a sub-Saharan African community.