Meileen Acosta

Publications of Meileen Acosta

• Pandemic 2009 influenza A (H1N1) in 71 critically ill pregnant women in California.

  Authors: Sascha R Ellington, Laura K Hartman, Meileen Acosta, Miguel Martinez-Romo, Lewis Rubinson, Denise J Jamieson, Janice Louie

  American journal of obstetrics and gynecology. 06/2011; 204(6 Suppl 1):S21-30.

  We sought to describe the characteristics and clinical management of 71 critically ill pregnant women with pandemic 2009 influenza A (H1N1 [2009 H1N1]). This was a retrospective case series fromWe sought to describe the characteristics and clinical management of 71 critically ill pregnant women with pandemic 2009 influenza A (H1N1 [2009 H1N1]). This was a retrospective case series from April 23, 2009, through March 18, 2010, of pregnant women with 2009 H1N1 in intensive care units in California. Among 71 critically ill pregnant women with 2009 H1N1, rapid decline in clinical status was noted with a median duration of 1 day from hospital admission to intensive care unit admission. Adverse events were common, and included sepsis (n = 26), hematologic disorder (n = 17), and pneumothorax (n = 15). Of 42 women requiring invasive ventilation, 15 (36%) died. In total, 23 women required rescue therapies for severe gas exchange abnormalities. Adverse events were significantly associated with survival (P = .0003). Women who received early antiviral treatment were significantly more likely to survive (relative risk, 1.43; 95% confidence interval, 1.18-1.75). Critically ill pregnant women with 2009 H1N1 declined rapidly and developed frequent adverse events including death.

• A novel risk factor for a novel virus: obesity and 2009 pandemic influenza A (H1N1).

  Authors: Janice K Louie, Meileen Acosta, Michael C Samuel, Robert Schechter, Duc J Vugia, Kathleen Harriman, Bela T Matyas

  Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 02/2011; 52(3):301-12.

  many critically ill patients with 2009 pandemic influenza A (H1N1) (2009 H1N1) infection were noted to be obese, but whether obesity, rather than its associated co-morbidities, is an independent riskmany critically ill patients with 2009 pandemic influenza A (H1N1) (2009 H1N1) infection were noted to be obese, but whether obesity, rather than its associated co-morbidities, is an independent risk factor for severe infection is unknown. using public health surveillance data, we analyzed demographic and clinical characteristics of California residents hospitalized with 2009 H1N1 infection to assess whether obesity (body mass index [BMI] ≥ 30) and extreme obesity (BMI ≥ 40) were an independent risk factor for death among case patients ≥ 20 years old. during the period 20 April-11 August 2009, 534 adult case patients with 2009 H1N1 infection for whom BMI information was available were observed. Two hundred twenty-eight patients (43%) were ≥ 50 years of age, and 378 (72%) had influenza-related high-risk conditions recognized by the Advisory Committee on Immunization Practices as risk factors for severe influenza. Two hundred and seventy-four (51%) had BMI ≥ 30, which is 2.2 times the prevalence of obesity among California adults (23%) and 1.5 times the prevalence among the general population of the United States (33%). Of the 92 case patients who died (17%), 56 (61%) had BMI ≥ 30 and 28 (30%) had BMI ≥ 40. In multivariate analysis, BMI ≥ 40 (odds ratio [OR], 2.8; 95% confidence interval [CI], 1.4-5.9) and BMI ≥ 45 (OR, 4.2; 95% CI, 1.9-9.4), age ≥ 50 years (OR, 2.1; 95% CI, 1.2-3.7), miscellaneous immunosuppressive conditions (OR, 3.9; 95% CI, 1.6-9.5), and asthma (OR, 0.5; 95% CI, 0.3-0.9) were associated with death. half of Californians ≥ 20 years of age hospitalized with 2009 H1N1 infection were obese. Extreme obesity was associated with increased odds of death. Obese adults with 2009 H1N1 infection should be treated promptly and considered in prioritization of vaccine and antiviral medications during shortages.

• A review of adult mortality due to 2009 pandemic (H1N1) influenza A in California.

  Authors: Janice K Louie, Cynthia Jean, Meileen Acosta, Michael C Samuel, Bela T Matyas, Robert Schechter

  PloS one. 01/2011; 6(4):e18221.

  While children and young adults had the highest attack rates due to 2009 pandemic (H1N1) influenza A (2009 H1N1), studies of hospitalized cases noted high fatality in older adults. We analyzedWhile children and young adults had the highest attack rates due to 2009 pandemic (H1N1) influenza A (2009 H1N1), studies of hospitalized cases noted high fatality in older adults. We analyzed California public health surveillance data to better characterize the populations at risk for dying due to 2009 H1N1. A case was an adult ≥20 years who died with influenza-like symptoms and laboratory results indicative of 2009 H1N1. Demographic and clinical data were abstracted from medical records using a standardized case report form. From April 3, 2009-August 10, 2010, 541 fatal cases ≥20 years with 2009 H1N1 were reported. Influenza fatality rates per 100,000 population were highest in persons 50-59 years (3.5; annualized rate = 2.6) and 60-69 years (2.3; annualized rate = 1.7) compared to younger and older age groups (0.4-1.9; annualized rates = 0.3-1.4). Of 486 cases hospitalized prior to death, 441 (91%) required intensive care unit (ICU) admission. ICU admission rates per 100,000 population were highest in adults 50-59 years (8.6). ICU case-fatality ratios among adults ranged from 24-42%, with the highest ratios in persons 70-79 years. A total of 425 (80%) cases had co-morbid conditions associated with severe seasonal influenza. The prevalence of most co-morbid conditions increased with increasing age, but obesity, pregnancy and obstructive sleep apnea decreased with age. Rapid testing was positive in 97 (35%) of 276 tested. Of 482 cases with available data, 384 (80%) received antiviral treatment, including 49 (15%) of 328 within 48 hours of symptom onset. Adults aged 50-59 years had the highest fatality due to 2009 H1N1; older adults may have been spared due to pre-existing immunity. However, once infected and hospitalized in intensive care, case-fatality ratios were high for all adults, especially in those over 60 years. Vaccination of adults older than 50 years should be encouraged.

• Children hospitalized with 2009 novel influenza A(H1N1) in California.

  Authors: Janice K Louie, Shilpa Gavali, Meileen Acosta, Michael C Samuel, Kathleen Winter, Cynthia Jean, Carol A Glaser, Bela T Matyas, Robert Schechter

  Archives of pediatrics & adolescent medicine. 11/2010; 164(11):1023-31.

  To describe clinical and epidemiologic features of 2009 novel influenza A(H1N1) in children. Analysis of data obtained from standardized report forms and medical records. Statewide public healthTo describe clinical and epidemiologic features of 2009 novel influenza A(H1N1) in children. Analysis of data obtained from standardized report forms and medical records. Statewide public health surveillance in California. Three hundred forty-five children who were hospitalized with or died of 2009 novel influenza A(H1N1). Laboratory-confirmed 2009 novel influenza A(H1N1). Hospitalization and death. From April 23 to August 11, 2009, 345 cases in children younger than 18 years were reported. The median age was 6 years. The hospitalization rate per 100 000 per 110 days was 3.5 (0.97 per 100 000 person-months), with rates highest in infants younger than 6 months (13.9 per 100 000 or 3.86 per 100 000 person-months). Two-thirds (230; 67%) had comorbidities. More than half (163 of 278; 59%) had pneumonia, 94 (27%) required intensive care, and 9 (3%) died; in 3 fatal cases (33%), children had secondary bacterial infections. More than two-thirds (221 of 319; 69%) received antiviral treatment, 44% (88 of 202) within 48 hours of symptom onset. In multivariate analysis, congenital heart disease (odds ratio [OR], 5.0; 95% confidence interval [CI], 1.9-13.5) and cerebral palsy/developmental delay (OR, 3.5; 95% CI, 1.7-7.4) were associated with increased likelihood of intensive care unit admission and/or death; likelihood was decreased in Hispanic (OR, 0.4; 95% CI, 0.2-0.8) and black (OR, 0.3; 95% CI, 0.1-1.0) children compared with white children. More than one-quarter of children hospitalized with 2009 novel influenza A(H1N1) reported to the California Department of Public Health required intensive care and/or died. Regardless of rapid test results, when 2009 novel influenza A(H1N1) is circulating, clinicians should maintain a high suspicion in children with febrile respiratory illness and promptly treat those with underlying risk factors, especially infants.

• Severe 2009 H1N1 influenza in pregnant and postpartum women in California.

  Authors: Janice K Louie, Meileen Acosta, Denise J Jamieson, Margaret A Honein

  The New England journal of medicine. 01/2010; 362(1):27-35.

  Like previous epidemic and pandemic diseases, 2009 pandemic influenza A (H1N1) may pose an increased risk of severe illness in pregnant women. Statewide surveillance for patients who wereLike previous epidemic and pandemic diseases, 2009 pandemic influenza A (H1N1) may pose an increased risk of severe illness in pregnant women. Statewide surveillance for patients who were hospitalized with or died from 2009 H1N1 influenza was initiated by the California Department of Public Health. We reviewed demographic and clinical data reported from April 23 through August 11, 2009, for all H1N1-infected, reproductive-age women who were hospitalized or died--nonpregnant women, pregnant women, and postpartum women (those who had delivered < or = 2 weeks previously). Data were reported for 94 pregnant women, 8 postpartum women, and 137 nonpregnant women of reproductive age who were hospitalized with 2009 H1N1 influenza. Rapid antigen tests were falsely negative in 38% of the patients tested (58 of 153). Most pregnant patients (89 of 94 [95%]) were in the second or third trimester, and approximately one third (32 of 93 [34%]) had established risk factors for complications from influenza other than pregnancy. As compared with early antiviral treatment (administered < or = 2 days after symptom onset) in pregnant women, later treatment was associated with admission to an intensive care unit (ICU) or death (relative risk, 4.3). In all, 18 pregnant women and 4 postpartum women (total, 22 of 102 [22%]) required intensive care, and 8 (8%) died. Six deliveries occurred in the ICU, including four emergency cesarean deliveries. The 2009 H1N1 influenza-specific maternal mortality ratio (the number of maternal deaths per 100,000 live births) was 4.3. 2009 H1N1 influenza can cause severe illness and death in pregnant and postpartum women; regardless of the results of rapid antigen testing, prompt evaluation and antiviral treatment of influenza-like illness should be considered in such women. The high cause-specific maternal mortality rate suggests that 2009 H1N1 influenza may increase the 2009 maternal mortality ratio in the United States.

• Factors associated with death or hospitalization due to pandemic 2009 influenza A(H1N1) infection in California.

  Authors: Janice K Louie, Meileen Acosta, Kathleen Winter, Cynthia Jean, Shilpa Gavali, Robert Schechter, Duc Vugia, Kathleen Harriman, Bela Matyas, Carol A Glaser, Michael C Samuel, Jon Rosenberg, John Talarico, Douglas Hatch

  JAMA : the journal of the American Medical Association. 11/2009; 302(17):1896-902.

  CONTEXT: Pandemic influenza A(H1N1) emerged rapidly in California in April 2009. Preliminary comparisons with seasonal influenza suggest that pandemic 2009 influenza A(H1N1) disproportionatelyCONTEXT: Pandemic influenza A(H1N1) emerged rapidly in California in April 2009. Preliminary comparisons with seasonal influenza suggest that pandemic 2009 influenza A(H1N1) disproportionately affects younger ages and causes generally mild disease. OBJECTIVE: To describe the clinical and epidemiologic features of pandemic 2009 influenza A(H1N1) cases that led to hospitalization or death. DESIGN, SETTING, AND PARTICIPANTS: Statewide enhanced public health surveillance of California residents who were hospitalized or died with laboratory evidence of pandemic 2009 influenza A(H1N1) infection reported to the California Department of Public Health between April 23 and August 11, 2009. MAIN OUTCOME MEASURE: Characteristics of hospitalized and fatal cases. RESULTS: During the study period there were 1088 cases of hospitalization or death due to pandemic 2009 influenza A(H1N1) infection reported in California. The median age was 27 years (range, <1-92 years) and 68% (741/1088) had risk factors for seasonal influenza complications. Sixty-six percent (547/833) of those with chest radiographs performed had infiltrates and 31% (340/1088) required intensive care. Rapid antigen tests were falsely negative in 34% (208/618) of cases evaluated. Secondary bacterial infection was identified in 4% (46/1088). Twenty-one percent (183/884) received no antiviral treatment. Overall fatality was 11% (118/1088) and was highest (18%-20%) in persons aged 50 years or older. The most common causes of death were viral pneumonia and acute respiratory distress syndrome. CONCLUSIONS: In the first 16 weeks of the current pandemic, the median age of hospitalized infected cases was younger than is common with seasonal influenza. Infants had the highest hospitalization rates and persons aged 50 years or older had the highest mortality rates once hospitalized. Most cases had established risk factors for complications of seasonal influenza.