妊婦へのタミフル使用を推奨／米国医療事情 ＣＤＣ 豚インフルエンザ
初のアメリカ人感染者の死亡／豚インフルエンザ ＣＤＣ 学校閉鎖
Pregnant women with swine flu more at risk
By MARIA CHENG
The Associated Press
Wednesday, July 29, 2009; 3:56 AM
LONDON -- Pregnant women who get swine flu are at least four times as likely to be hospitalized as other people with the virus, a new study says.
While experts don't know if pregnant women are more susceptible to swine flu, they say once pregnant women are infected, they have a higher risk of complications.
Researchers at the U.S. Centers for Disease Control and Prevention analyzed the first 34 U.S. cases, including 6 deaths, of swine flu in pregnant women from April to mid-June.
They concluded that pregnant women suspected of having swine flu should be given Tamiflu as soon as possible, even before tests confirm the diagnosis. The experts also recommended that pregnant women be among the first in line when a vaccine is expected to be ready in the fall.
The study was published online Wednesday in the medical journal, the Lancet.
Like the general population, most pregnant women who get swine flu only have mild symptoms like fever and a cough, according to the World Health Organization. Denise Jamieson of the U.S. CDC, the study's lead researcher, said the agency doesn't recommend any special precautions for pregnant women to avoid catching the virus.
But if pregnant women do get swine flu, Jamieson said doctors need to act fast, preferably within 48 hours of developing symptoms.
"The message is don't delay appropriate treatment because she's pregnant," she said.
Health officials at WHO have previously reported that some doctors were reluctant to give the antiviral drug Tamiflu to pregnant women. While safety data on Tamiflu use in pregnant women is limited, Jamieson said it appears relatively safe.
Of the six fatal cases in the Lancet study, Jamieson said nearly all had viral pneumonia before experiencing acute respiratory problems, and were put on ventilators before they died. Aside from one woman who had asthma and another who was obese, Jamieson said the women were essentially healthy.
U.S. guidelines list pregnant women as a high-priority group for pandemic vaccines, although that is for vaccines without adjuvants, ingredients used to stretch a vaccine's active ingredient.
In the U.S., flu vaccines don't have adjuvants, but in Europe, many do. There is little data on how safe vaccines with adjuvants are in pregnant women.
Cecilia Nwobi, a London-based lawyer pregnant with her third child, said she hasn't yet decided if she will get a swine flu shot.
"People don't want to be guinea pigs for something that hasn't been tested in pregnant women," she said. "But if I'm faced with a more serious situation later, I might feel differently."
Advice from European authorities has varied widely - some British and Swiss officials even initially advised that women consider delaying having children until the pandemic ends - even though that might be more than a year away.
Britain's department of health quickly backed away from that guidance, although they still say pregnant women may want to avoid crowded places.
"The most important measures are for pregnant women to observe good hand and respiratory hygiene," said Dr. Boon Lim, a spokesman for Britain's Royal College of Obstetricians and Gynaecologists. "But if the situation worsens, further advice may be necessary."
Page last updated at 16:22 GMT, Wednesday, 29 July 2009 17:22 UK
Swine flu 'hits pregnant harder'
A pregnant woman
A suppressed immune system makes pregnant women more vulnerable
Pregnant women are four times more likely than the general population to need hospital treatment for H1N1 swine flu, data from the US suggests.
The findings suggest pregnancy does increase the risk of complications without speedy anti-viral treatment.
It also underlines the need to ensure pregnant women are made a top priority when a vaccine becomes available.
The study, by the US Centers for Disease Control and Prevention, appears in The Lancet medical journal.
Scientists studied 34 confirmed or probable cases of swine flu infection among pregnant women.
We must remember that most pregnant women who catch the disease are likely to make an uncomplicated recovery
Department of Health
They found 11 were admitted to hospital - a rate four times higher than that seen in the general population.
The women covered a broad range of ages and races and were in various stages of pregnancy. Six subsequently died after developing pneumonia.
None of the women who died had been given anti-viral drugs promptly, within the first 48 hours of symptoms occurring.
Five of these women underwent caesarean deliveries. Four of the babies have now left hospital, and the fifth, born very prematurely, is doing well. None of the babies showed any sign of swine flu infection.
The researchers accepted that doctors might be more likely to admit pregnant women to hospital than other patients - but said this was unlikely to be the only explanation for the higher rate of hospital admissions.
It may be that pregnancy weakens the immune system, making complications more likely.
Writing in The Lancet, the researchers, led by Dr Denise Jamieson, said: "On the basis of our investigation, pregnant women seem to be at increased risk for complications from pandemic H1N1 virus infection, with a higher estimated rate of hospital admission than in the general population.
"Although the decision to admit a pregnant woman is complex and might include considerations beyond simply the severity of disease, that a high proportion of influenza-related deaths in the US have been in pregnant women is concerning."
A similar pattern was seen in the flu pandemics of 1918 and 1957, when death rates for pregnant women were higher than for non-pregnant women.
A spokesman for the Department of Health said: "This study is a reminder that pregnant women can be at increased risk from swine flu, but we must remember that most pregnant women who catch the disease are likely to make an uncomplicated recovery.
"Pregnant women should make early contact with their GP if they have flu-like symptoms."
The spokesman said the anti-viral drug Relenza was available in an inhaled form which would not reach the foetus, and so pose no risk to it at all.
Pregnant Sharon Pentleton, from Saltcoats, Ayrshire, had to be flown to Sweden for specialist care last week after developing a rare complication following infection with swine flu.
Ms Pentleton, who is having her blood circulated through a machine, is described as "stable, but critical".
The Lancet, Early Online Publication, 29 July 2009
doi:10.1016/S0140-6736(09)61304-0Cite or Link Using DOI
H1N1 2009 influenza virus infection during pregnancy in the USA
Denise J Jamieson MD a Corresponding AuthorEmail Address, Margaret A Honein PhD b, Sonja A Rasmussen MD b, Jennifer L Williams MSN b, David L Swerdlow MD c, Matthew S Biggerstaff MPH c, Stephen Lindstrom PhD c, Janice K Louie MD e, Cara M Christ MD f, Susan R Bohm MS g, Vincent P Fonseca MD h, Kathleen A Ritger MD i, Daniel J Kuhles MD j, Paula Eggers RN k, Hollianne Bruce MPH l, Heidi A Davidson MPH m, Emily Lutterloh MD d n, Meghan L Harris MPH o, Colleen Burke MSN p, Noelle Cocoros MPH q, Lyn Finelli DrPH c, Kitty F MacFarlane CNM a, Bo Shu MD c, Sonja J Olsen PhD c, the Novel Influenza A (H1N1) Pregnancy Working Group‡
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.
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.
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.
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.
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