新型インフルエンザで妊婦28人が死亡 100人がＩＣＵ治療／米国 新型H1N1インフルエンザ
H1N1 Flu Hit Pregnant Women Hard
Getting treatment quickly was key to avoiding life-threatening illness, CDC study found
By Serena GordonHealthDay Reporter
Getting treatment quickly was key to avoiding life-threatening illness, CDC study found.
TUESDAY, April 20 (HealthDay News) -- Although pregnant women make up about 1 percent of the U.S. population at any given time, during the 2009 H1N1 swine flu outbreak they made up 5 percent of deaths, a new study has found.
Researchers also found that pregnant women who waited four days before seeking treatment were admitted to the intensive care unit (ICU) nearly 57 percent of the time, compared to only about 9 percent for pregnant women who didn't delay seeking treatment.
The H1N1-linked death rate among pregnant women was "more than we would have expected," said one of the study's authors, Dr. Sonja Rasmussen, a medical officer with the U.S. Centers for Disease Control and Prevention. "We also learned that early treatment with anti-viral medications lowers the chances of being admitted to the ICU, and lowers the chances of death."
Results of the study were published in the April 21 issue of the Journal of the American Medical Association.
H1N1 flu was first reported in the United States on April 21, 2009, by officials at the CDC. Two children in California had been infected with the new virus. The virus rapidly spread worldwide and was declared a pandemic in June, according to background information in the study.
Because pregnant women tend to be more vulnerable in any flu outbreak, the CDC asked local and state health departments to report any confirmed or probably case of H1N1 in a pregnant woman from April 2009 through Dec. 31, 2009.
They received reports on 788 pregnant women with H1N1 symptoms during that time period. Thirty of the women died from complications of H1N1, which represents 5 percent of all H1N1 deaths, according to the study.
In total, 509 of the women were hospitalized, and of those, 115 were admitted to the intensive care unit.
The study found that when pregnant women sought early treatment -- within two days of symptom onset -- they had less than a 10 percent chance of being admitted to the ICU, while women who waited more than four days for treatment had almost a 60 percent risk of ending up in intensive care.
Only one death occurred among pregnant women who sought early treatment, the study found.
The researchers also found that more deaths -- more than 64 percent -- occurred in the third trimester of pregnancy, compared to the second trimester (almost 27 percent) or the first trimester (about 7 percent).
Dr. John Carpenter, division director of infectious disease at Scott & White Healthcare in Temple, Texas, said part of the reason why women may have more trouble with flu as they get farther along in their pregnancies is that the uterus is pushing on the diaphragm, making breathing a little bit harder, and making it more difficult to push out a good cough.
"While you're pregnant, be especially alert for respiratory illnesses," advised Carpenter. He said that antiviral medications, such as Tamiflu, can be given during pregnancy.
Rasmussen agreed that drugs such as Tamiflu can be given during pregnancy, and there are no known serious risks to mother or baby from these medications.
The bottom line, said Rasmussen, is that "early treatment makes a difference in complications and mortality."
Carpenter also advised getting a flu shot before getting pregnant and to avoid people with respiratory illnesses during your pregnancy.
While Rasmussen said the CDC can't predict whether the H1N1 virus will be a big threat again, it is already being included in this year's seasonal flu vaccine. And, she said, if women haven't gotten a flu vaccine prior to pregnancy, they can get one at any time during their pregnancy.
Learn more about H1N1 flu and pregnant women from the U.S. Centers for Disease Control and Prevention.
SOURCES: Sonja Rasmussen, M.D., medical officer, U.S. Centers for Disease Control and Prevention, Atlanta; John Carpenter, M.D., division director, infectious disease, Scott & White Healthcare, Temple, Texas; April 21, 2010, Journal of the American Medical Association
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Pandemic 2009 Influenza A(H1N1) Virus Illness Among Pregnant Women in the United States
Alicia M. Siston, PhD; Sonja A. Rasmussen, MD; Margaret A. Honein, PhD; Alicia M. Fry, MD; Katherine Seib, BS; William M. Callaghan, MD; Janice Louie, MD; Timothy J. Doyle, MPH; Molly Crockett, MPH; Ruth Lynfield, MD; Zack Moore, MD; Caleb Wiedeman, MPH; Madhu Anand, MPH; Laura Tabony, MPH; Carrie F. Nielsen, PhD; Kirsten Waller, MD; Shannon Page, BS; Jeannie M. Thompson, MPH; Catherine Avery, CFNP; Chasisity Brown Springs, MSPH; Timothy Jones, MD; Jennifer L. Williams, MSN; Kim Newsome, MPH; Lyn Finelli, DrPH; Denise J. Jamieson, MD; for the Pandemic H1N1 Influenza in Pregnancy Working Group
Context Early data on pandemic 2009 influenza A(H1N1) suggest pregnant women are at increased risk of hospitalization and death.
Objective To describe the severity of 2009 influenza A(H1N1) illness and the association with early antiviral treatment among pregnant women in the United States.
Design, Setting, and Patients Surveillance of 2009 influenza A(H1N1) in pregnant women reported to the Centers for Disease Control and Prevention (CDC) with symptom onset from April through December 2009.
Main Outcome Measures Severity of illness (hospitalizations, intensive care unit [ICU] admissions, and deaths) due to 2009 influenza A(H1N1) among pregnant women, stratified by timing of antiviral treatment and pregnancy trimester at symptom onset.
Results We received reports on 788 pregnant women in the United States with 2009 influenza A(H1N1) with symptom onset from April through August 2009. Among those, 30 died (5% of all reported 2009 influenza A[H1N1] influenza deaths in this period). Among 509 hospitalized women, 115 (22.6%) were admitted to an ICU. Pregnant women with treatment more than 4 days after symptom onset were more likely to be admitted to an ICU (56.9% vs 9.4%; relative risk [RR], 6.0; 95% confidence interval [CI], 3.5-10.6) than those treated within 2 days after symptom onset. Only 1 death occurred in a patient who received treatment within 2 days of symptom onset. Updating these data with the CDC's continued surveillance of ICU admissions and deaths among pregnant women with symptom onset through December 31, 2009, identified an additional 165 women for a total of 280 women who were admitted to ICUs, 56 of whom died. Among the deaths, 4 occurred in the first trimester (7.1%), 15 in the second (26.8%), and 36 in the third (64.3%);
Conclusions Pregnant women had a disproportionately high risk of mortality due to 2009 influenza A(H1N1). Among pregnant women with 2009 influenza A(H1N1) influenza reported to the CDC, early antiviral treatment appeared to be associated with fewer admissions to an ICU and fewer deaths.
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