Janice K Louie

Publications of Janice K Louie

• Infants hospitalized in intensive care units with 2009 H1N1 influenza infection, California, 2009-2010.

  Authors: Cynthia J Yen, Janice K Louie, Robert Schechter

  The Pediatric infectious disease journal. 03/2012; 31(3):e52-5.

  The 2009 H1N1 influenza virus emerged in April 2009 and primarily affected children and young adults. Few reports describe 2009 H1N1 influenza infection in infants. This report describes the clinicalThe 2009 H1N1 influenza virus emerged in April 2009 and primarily affected children and young adults. Few reports describe 2009 H1N1 influenza infection in infants. This report describes the clinical and epidemiologic features of 2009 H1N1 influenza in critically ill infants younger than 1 year of age. Laboratory-confirmed cases were reported to the California Department of Public Health as part of public health surveillance for 2009 H1N1 influenza. Data were collected using standardized report forms and medical-chart abstractions. From April 23, 2009 through May 1, 2010, 82 cases of infants hospitalized in the intensive care unit with 2009 H1N1 influenza were reported in California. Medical charts were available for 77 of the infants, whose median age was 109 days (range: 1-361 days). Twenty-seven (35%) infants had a gestational age of 36 weeks or less. More than half (46; 60%) of the infants had at least 1 reported chronic medical condition. Thirty-five (45%) infants required mechanical ventilation; 7 (9%) died. Five infants were hospitalized since birth and acquired influenza infection during their admission; 2 (40%) of these infants died. Infants who are premature or with chronic conditions seem to be at increased risk for developing severe 2009 H1N1 influenza infection. We encourage clinicians to maintain high suspicion for influenza in infants when influenza viruses are circulating. Vaccination should be encouraged among contacts of infants <6 months of age, who are too young to be immunized or treated with licensed antivirals. Infection control measures should also be implemented in hospital settings to reduce nosocomial transmission.

• 2009 pandemic influenza A (H1N1) and vaccine failure in pregnancy.

  Authors: Janice K Louie, Debra A Wadford, Agnes Norman, Denise J Jamieson

  Obstetrics and gynecology. 02/2011; 117(2 Pt 2):470-2.

  Emerging data suggest that pregnancy conveys high risk for severe complications from the 2009 pandemic influenza A virus (2009 H1N1) infection. We describe an infected pregnant woman with criticalEmerging data suggest that pregnancy conveys high risk for severe complications from the 2009 pandemic influenza A virus (2009 H1N1) infection. We describe an infected pregnant woman with critical illness owing to acute respiratory distress syndrome despite previous vaccination. Early serologic testing indicated absent immunity, followed 11 days later by a robust immune response. The patient required mechanical ventilation for 11 days, but ultimately improved, and was discharged home on hospital day 14. With the expectation that 2009 H1N1 will continue to cause disease in the immediate future, the virus has been included as a component of the 2010-2011 seasonal influenza vaccine. Vaccination of pregnant women is strongly encouraged. However, regardless of vaccination history, clinicians should remain vigilant for 2009 H1N1 infection when the virus is in circulation, and should not delay antiviral treatment of pregnant women with suspected influenza.

• 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.

• HIV-infected hospitalized patients with 2009 pandemic influenza A (pH1N1)--United States, spring and summer 2009.

  Authors: Philip J Peters, Jacek Skarbinski, Janice K Louie, Seema Jain, Michelle Roland, Shilpa G Jani, Lyn Finelli, John T Brooks

  Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 01/2011; 52 Suppl 1:S183-8.

  We describe the clinical findings of HIV-infected patients hospitalized with 2009 pandemic influenza A (pH1N1). Data were derived from 3 separate case series in the United States. Among 911 adultsWe describe the clinical findings of HIV-infected patients hospitalized with 2009 pandemic influenza A (pH1N1). Data were derived from 3 separate case series in the United States. Among 911 adults hospitalized with pH1N1 influenza, 31 (3.4%) were HIV infected compared with an HIV prevalence of 0.45% in the general US adult population. HIV-infected influenza patients experienced similar rates of intensive care unit admission (29% vs 34%) and death (13% vs 13%) compared with non-HIV-infected patients. Among HIV-infected patients with available data, 14 (50%) of 28 patients had a CD4 cell count <200 cells/μL, which was not associated with an increased risk of an intensive care unit admission or death. Overall, 25 (81%) HIV-infected patients received influenza antiviral therapy, but treatment was initiated within 48 h of illness onset in only 33% of cases. Clinicians should consider early empiric influenza antiviral treatment in HIV-infected patients presenting with suspected influenza.

• Epidemiology of 2009 pandemic influenza A (H1N1) deaths in the United States, April-July 2009.

  Authors: Ashley L Fowlkes, Paul Arguin, Matthew S Biggerstaff, Jacqueline Gindler, Dianna Blau, Seema Jain, Roseline Dhara, Joe McLaughlin, Elizabeth Turnipseed, John J Meyer [......] Christie K McDonald, Meredith Vandermeer, Kirsten Waller, Utpala Bandy, Timothy F Jones, Lesley Bullion, Valoree Vernon, Kathryn H Lofy, Thomas Haupt, Lyn Finelli

  Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 01/2011; 52 Suppl 1:S60-8.

  During the spring of 2009, pandemic influenza A (H1N1) virus (pH1N1) was recognized and rapidly spread worldwide. To describe the geographic distribution and patient characteristics ofDuring the spring of 2009, pandemic influenza A (H1N1) virus (pH1N1) was recognized and rapidly spread worldwide. To describe the geographic distribution and patient characteristics of pH1N1-associated deaths in the United States, the Centers for Disease Control and Prevention requested information from health departments on all laboratory-confirmed pH1N1 deaths reported from 17 April through 23 July 2009. Data were collected using medical charts, medical examiner reports, and death certificates. A total of 377 pH1N1-associated deaths were identified, for a mortality rate of .12 deaths per 100,000 population. Activity was geographically localized, with the highest mortality rates in Hawaii, New York, and Utah. Seventy-six percent of deaths occurred in persons aged 18-65 years, and 9% occurred in persons aged ≥ 65 years. Underlying medical conditions were reported for 78% of deaths: chronic lung disease among adults (39%) and neurologic disease among children (54%). Overall mortality associated with pH1N1 was low; however, the majority of deaths occurred in persons aged <65 years with underlying medical conditions.

• 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.

• 2009 pandemic influenza A (H1N1) virus infection in postpartum women in California.

  Authors: Janice K Louie, Denise J Jamieson, Sonja A Rasmussen

  American journal of obstetrics and gynecology. 11/2010; 204(2):144.e1-6.

  The objective of the study was to characterize severe illness because of the 2009 pandemic influenza A (H1N1) infection in postpartum women. We reviewed case reports of infected hospitalizedThe objective of the study was to characterize severe illness because of the 2009 pandemic influenza A (H1N1) infection in postpartum women. We reviewed case reports of infected hospitalized postpartum (≤ 6 months from delivery) women identified through statewide surveillance in California. From April 23 through August 11, 2009, all hospitalizations and/or deaths were reported. After August 11, reporting was limited to cases requiring intensive care or deaths. From April 23 to December 31, 2009, 15 cases were reported; 11 (73%) had symptom onset within 7 days postpartum. Of 10 hospitalized cases reported through August 11, 4 required intensive care, 3 required mechanical ventilation, and 2 died. Of 5 cases requiring intensive care reported after August 11, all required mechanical ventilation and 1 died. Overall, 6 (43%) received antivirals within 48 hours of symptom onset. The 2009 H1N1 can cause severe illness in postpartum women, especially in the first week following delivery.

• Rapid influenza antigen test for diagnosis of pandemic (H1N1) 2009.

  Authors: Janice K Louie, Hugo Guevara, Erica Boston, Melissa Dahlke, Maria Nevarez, Tong Kong, Robert Schechter, Carol A Glaser, David P Schnurr

  Emerging infectious diseases. 05/2010; 16(5):824-6.

  We compared the QuickVue Influenza test with PCR for diagnosing pandemic (H1N1) 2009 in 404 persons with influenza-like illness. Overall sensitivity, specificity, and positive and negative predictiveWe compared the QuickVue Influenza test with PCR for diagnosing pandemic (H1N1) 2009 in 404 persons with influenza-like illness. Overall sensitivity, specificity, and positive and negative predictive values were 66%, 84%, 84%, and 64%, respectively. Rapid test results should be interpreted cautiously when pandemic (H1N1) 2009 virus is suspected.

• Invasive group A streptococcal infection concurrent with 2009 H1N1 influenza.

  Authors: Cynthia Jean, Janice K Louie, Carol A Glaser, Kathleen Harriman, Jill K Hacker, Faisal Aranki, Elizabeth Bancroft, Susan Farley, Michele Ginsberg, Lisa B Hernandez, Catherine S Sallenave, Allen B Radner

  Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 04/2010; 50(10):e59-62.

  We describe 10 patients with 2009 H1N1 influenza and concurrent invasive group A streptococcal infection with marked associated morbidity and mortality. Seven patients required intensive care, 8We describe 10 patients with 2009 H1N1 influenza and concurrent invasive group A streptococcal infection with marked associated morbidity and mortality. Seven patients required intensive care, 8 required mechanical ventilation, and 7 died. Five of the patients, including 4 of the fatalities, were previously healthy.

• 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.

• Pandemic influenza: implications for programs controlling for HIV infection, tuberculosis, and chronic viral hepatitis.

  Authors: James D Heffelfinger, Pragna Patel, John T Brooks, Helene Calvet, Charles L Daley, Hazel D Dean, Brian R Edlin, Kathleen F Gensheimer, John Jereb, Charlotte K Kent, Jeffrey L Lennox, Janice K Louie, Ruth Lynfield, Philip J Peters, Lauretta Pinckney, Philip Spradling, Andrew C Voetsch, Anthony Fiore

  American journal of public health. 10/2009; 99 Suppl 2:S333-9.

  Among vulnerable populations during an influenza pandemic are persons with or at risk for HIV infection, tuberculosis, or chronic viral hepatitis. HIV-infected persons have higher rates ofAmong vulnerable populations during an influenza pandemic are persons with or at risk for HIV infection, tuberculosis, or chronic viral hepatitis. HIV-infected persons have higher rates of hospitalization, prolonged illness, and increased mortality from influenza compared with the general population. Persons with tuberculosis and chronic viral hepatitis may also be at increased risk of morbidity and mortality from influenza because of altered immunity and chronic illness. These populations also face social and structural barriers that will be exacerbated by a pandemic. Existing infrastructure should be expanded and pandemic planning should include preparations to reduce the risks for these populations.

• Re-emergence of another vaccine-preventable disease?-Two cases of rubella in older adults.

  Authors: Janice K Louie, Rina Shaikh-Laskos, Christopher Preas, Vi T Nguyen, Anne Peters, Sharon Messenger

  Journal of clinical virology : the official publication of the Pan American Society for Clinical Virology. 10/2009; 46(1):98-100.

  Unlike its devastating teratogenic effects, post-natal infection with rubella typically causes subclinical or inapparent illness. While rubella has been largely eliminated from the United StatesUnlike its devastating teratogenic effects, post-natal infection with rubella typically causes subclinical or inapparent illness. While rubella has been largely eliminated from the United States following the introduction of an efficacious live-attenuated vaccine in 1969, a small proportion of the population remains susceptible. Recent declining vaccination rates have resulted in a rising incidence of sporadic and outbreak-associated measles, reminding us that an increasing proportion of the population is also susceptible to, and may be reservoirs of transmission for, rubella. We describe two rare adult cases with no clear exposure. These cases serve as a reminder that clinicians should remain vigilant and consider rubella infection in susceptible patients, including older adults, presenting with febrile rash illness.

• H1N1 2009 influenza virus infection during pregnancy in the USA.

  Authors: Denise J Jamieson, Margaret A Honein, Sonja A Rasmussen, Jennifer L Williams, David L Swerdlow, Matthew S Biggerstaff, Stephen Lindstrom, Janice K Louie, Cara M Christ, Susan R Bohm [......] Hollianne Bruce, Heidi A Davidson, Emily Lutterloh, Meghan L Harris, Colleen Burke, Noelle Cocoros, Lyn Finelli, Kitty F Macfarlane, Bo Shu, Sonja J Olsen

  Lancet. 08/2009;

  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 infectionBACKGROUND: 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.

• 5' noncoding region alone does not unequivocally determine genetic type of human rhinovirus strains.

  Authors: Carita Savolainen-Kopra, Soile Blomqvist, Teemu Smura, Merja Roivainen, Tapani Hovi, David Kiang, Ishmeet Kalra, Shigeo Yagi, Janice K Louie, Homer Boushey, John Boothby, David P Schnurr

  Journal of clinical microbiology. 05/2009; 47(4):1278-80.

• Rhinovirus associated with severe lower respiratory tract infections in children.

  Authors: Janice K Louie, Arup Roy-Burman, Lilly Guardia-LaBar, Erica J Boston, David Kiang, Tasha Padilla, Shigeo Yagi, Sharon Messenger, Ann M Petru, Carol A Glaser, David P Schnurr

  The Pediatric infectious disease journal. 05/2009; 28(4):337-9.

  Rhinovirus is a respiratory virus most typically associated with the common cold and asthma exacerbations, and has not traditionally been considered to play a major role in severe lower respiratoryRhinovirus is a respiratory virus most typically associated with the common cold and asthma exacerbations, and has not traditionally been considered to play a major role in severe lower respiratory tract infections (LRTIs). As part of a surveillance program for respiratory pathogens of public health importance, children consecutively admitted to intensive care for LRTI at a large tertiary children's hospital were tested with polymerase chain reaction for 11 respiratory viruses and Mycoplasma pneumoniae from February 21 to October 31, 2007; 43 cases were enrolled and rhinovirus was the most frequently detected pathogen, with 21 (49%) positive. Rhinovirus cases frequently were young (median age, 1.4 years [range, 44 days-15 years]), hospitalized for pneumonia (10; 48%), had chronic underlying illnesses (15; 71%), had abnormal chest radiographs (18; 86%), required mechanical ventilation (12; 57%), and had prolonged hospitalization (median length, 7 days [range, 1-29 days]). Coinfection with other viruses or bacteria was common (10; 47%). Rhinovirus may be associated with more severe LRTI in children than previously reported, particularly in the noninfluenza, nonrespiratory syncytial virus season.

• Identification of cardioviruses related to Theiler's murine encephalomyelitis virus in human infections.

  Authors: Charles Y Chiu, Alexander L Greninger, Kimberly Kanada, Thomas Kwok, Kael F Fischer, Charles Runckel, Janice K Louie, Carol A Glaser, Shigeo Yagi, David P Schnurr, Tom D Haggerty, Julie Parsonnet, Don Ganem, Joseph L DeRisi

  Proceedings of the National Academy of Sciences of the United States of America. 10/2008;

  Cardioviruses comprise a genus of picornaviruses that cause severe illnesses in rodents, but little is known about the prevalence, diversity, or spectrum of disease of such agents among humans. ACardioviruses comprise a genus of picornaviruses that cause severe illnesses in rodents, but little is known about the prevalence, diversity, or spectrum of disease of such agents among humans. A single cardiovirus isolate, Saffold virus, was cultured in 1981 in stool from an infant with fever. Here, we describe the identification of a group of human cardioviruses that have been cloned directly from patient specimens, the first of which was detected using a pan-viral microarray in respiratory secretions from a child with influenza-like illness. Phylogenetic analysis of the nearly complete viral genome (7961 bp) revealed that this virus belongs to the Theiler's murine encephalomyelitis virus (TMEV) subgroup of cardioviruses and is most closely related to Saffold virus. Subsequent screening by RT-PCR of 719 additional respiratory specimens [637 (89%) from patients with acute respiratory illness] and 400 cerebrospinal fluid specimens from patients with neurological disease (aseptic meningitis, encephalitis, and multiple sclerosis) revealed no evidence of cardiovirus infection. However, screening of 751 stool specimens from 498 individuals in a gastroenteritis cohort resulted in the detection of 6 additional cardioviruses (1.2%). Although all 8 human cardioviruses (including Saffold virus) clustered together by phylogenetic analysis, significant sequence diversity was observed in the VP1 gene (66.9%-100% pairwise amino acid identities). These findings suggest that there exists a diverse group of novel human Theiler's murine encephalomyelitis virus-like cardioviruses that hitherto have gone largely undetected, are found primarily in the gastrointestinal tract, can be shed asymptomatically, and have potential links to enteric and extraintestinal disease.

• An assay for 5' noncoding region analysis of all human rhinovirus prototype strains.

  Authors: David Kiang, Ishmeet Kalra, Shigeo Yagi, Janice K Louie, Homer Boushey, John Boothby, David P Schnurr

  Journal of clinical microbiology. 09/2008;

  Increasing recognition of the association of rhinovirus with severe lower respiratory tract illnesses has clarified the need to understand the relationship between specific serotypes of rhinovirusIncreasing recognition of the association of rhinovirus with severe lower respiratory tract illnesses has clarified the need to understand the relationship between specific serotypes of rhinovirus and their clinical consequences. To accomplish this, a specific and sensitive assay to detect and serotype rhinovirus directly from clinical specimens is needed. Traditional methods of serotyping using culture and serum neutralization are time consuming, limited to certain reference labs, and complicated by the existence of over 100 serotypes of human rhinoviruses. Accordingly, we have developed a sequence-based assay which targets a 390 bp fragment, accounting for approximately two-thirds of the 5' noncoding region (NCR). Our goal was to develop an assay permitting amplification of target sequences directly from clinical specimens and distinction among all 101 prototype strains of rhinoviruses. We determined the sequence of all 101 prototype strains of human rhinovirus in this region to enable differentiation of virus genotypes in both viral isolates and clinical specimens. We evaluated this assay in a total of 101 clinical viral isolates and 24 clinical specimens and compared our findings to genotyping results using a different region of the HRV genome (VP4-VP2 region). Five specimens associated with severe respiratory disease in children did not correlate to any known serotype of rhinovirus and were found to belong to a novel genogroup of rhinovirus, genogroup C. Isolates were also found that corresponded to the genogroup A2 variant identified in New York and Australia and two other novel group A clusters (GAC1 and 2).

• Severe pneumonia due to adenovirus serotype 14: a new respiratory threat?

  Authors: Janice K Louie, Adriana E Kajon, Mark Holodniy, Lilly Guardia-LaBar, Brian Lee, Ann M Petru, Jill K Hacker, David P Schnurr

  Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 03/2008; 46(3):421-5.

  BACKGROUND: Adenoviruses are associated with sporadic infection and community and institutional outbreaks; they can cause especially severe disease in infants, young children, immunocompromisedBACKGROUND: Adenoviruses are associated with sporadic infection and community and institutional outbreaks; they can cause especially severe disease in infants, young children, immunocompromised persons, and transplant recipients. Fifty-two adenovirus serotypes have been recognized and classified within 7 subgroups or species (A-G), with limited data available on associated clinical syndromes and disease severity in more than one-half of the known serotypes. METHODS: We describe the clinical presentation and virologic characterization of 1 adult and 2 pediatric patients admitted to 2 separate hospitals during April-May 2006 with severe acute respiratory tract infection. All patients had underlying chronic pulmonary disease; none were severely immunocompromised. All 3 experienced serious chronic sequelae or died. RESULTS: Adenovirus was isolated from all 3 case patients. Adenovirus serotype 14, a subspecies B2 serotype not previously associated with severe clinical illness, was confirmed by neutralization assay and sequencing of the hexon gene. Restriction enzyme analysis with BamHI, BglII, HindIII, and SmaI showed all 3 viruses to be identical and to belong to a new genome type that we have designated "Ad14a." CONCLUSIONS: Our identification of severe respiratory illness due to a previously rarely reported adenovirus serotype may signify the emergence in the United States of a new genomic variant that has the potential to spread globally and cause epidemics. These case reports highlight the need for rapid diagnosis and improved surveillance, with serotyping and molecular characterization, to identify emerging variants of adenovirus, which may assist with targeted development of antiviral agents or type-specific vaccines.