Article

A case-control study on risk factors associated with death in pregnant women with severe pandemic H1N1 infection

Acute Infectious Disease Prevention and Control, Anhui Provincial CDC, Hefei, Anhui, China.
BMJ Open (Impact Factor: 2.27). 07/2012; 2(4). DOI: 10.1136/bmjopen-2012-000827
Source: PubMed

ABSTRACT

To describe the risk factors associated with death in pregnant women with severe pandemic H1N1 infection.
Case-control study.
Anhui, China.
A total of 46 pregnant women with severe pandemic H1N1 infection were studied during June 2009-April 2011. PRIMARY AND SECONDARY OUTCOME MEASURES: All the cases were confirmed by the clinicians and epidemiologists together based on the positive laboratory result.
Of the seven pregnant women who died of the pandemic H1N1 infection, five (70%) cases were in their third trimester. Twenty-nine (63%) cases from the surviving group were admitted to hospital within 3 days after the onset of symptoms, while only one (2%) case from the death group took the earliest admission 2 days after the onset. There was a significant difference on how soon to be admitted between the death and the surviving groups (OR 0.09, 95% CI 0.01 to 0.68). The median time of administrating corticosteroids was 5 days after the onset in the death group and 3 days in the surviving group showing no significant difference between them (p=0.056).
For the pregnant women with severe p(H1N1) infection, the risk factors associated with death were as follows: the delay of antiviral treatment and being in the third trimester. The corticosteroids therapy appeared to have no effects on preventing the cases from death.

Download full-text

Full-text

Available from: Furong Li, Nov 25, 2015
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective: At the time of the outbreak of influenza A H1N1, mostly known as swine flu, first case in Turkey was diagnosed in May 2009. The period from June 2009 to August 2010 was declared to be pandemy H1N1 by World Health Organization (WHO). In this study we aimed to assessthe maternal and fetal outcomes of pregnant women with the diagnosis of H1N1viral infection, who were hospitalized during 2009 pandemy. Materials andmethods: The clinical data, treatment modalities and maternal and fetal outcomes of 9 pregnantwomen with H1N1 infectionwere retrieved from patientsfile and evaluated retrospectively.Patientswere classified as precise case if the nasopharyngealswabs were positive with real time PCR (rRT-PCR) and potential case if rRT-PCR was negative. Results: At admission one patient wasin first trimester, 2were in second trimester and other 6 patientswere in third trimester. The presenting symptomswere cough (77%), fever(77%), sore throat (11%), dyspnea/respiratory distress (44%) and malaise (22%). All of the patientswere treatedwith oseltamivir and if the patient had secondary bacterial pneumonia. Median hospitalisation time was 23 days (7-40). Five patients required mechanical ventilatory support. One of the patients and 2 of the neonates passed away. Conclusion: Although swine flu causes mild to moderate flu like symptomsin most of the population, in pregnant women it may lead to lethal complications. Thusthe appropriate antiviral treatmentshould begin immediatelywithin 48 hours.
    Full-text · Article · Jan 2013 · Turk Jinekoloji ve Obstetrik Dernegi Dergisi
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: Most studies have reported that corticosteroid therapy adversely influences influenza-related outcomes. Methods: Electronic databases were searched from inception to March 2013 for experimental and observational studies investigating systemic corticosteroid therapy for presumed influenza-associated complications. Meta-analysis of Observational Studies in Epidemiology guidelines were adopted. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using random-effects models, and heterogeneity was assessed using the I(2) statistic. Quality of evidence was assessed using the Grading Assessment, Development, and Evaluation system. Results: We identified 16 eligible studies (3039 individuals), all of which were observational; 10 (1497 individuals) were included in the meta-analysis of mortality, of which 9 studied patients with 2009 pandemic influenza A virus subtype H1N1. Risk of bias was greatest in the comparability domain of the Newcastle-Ottawa scale, consistent with potential confounding by indication, and data specific to mortality were of low quality. Meta-analysis found an increased odds of mortality (OR, 2.12; 95% CI, 1.36-3.29) associated with corticosteroid therapy. Subgroup analysis of adjusted estimates from 4 studies with very low statistical heterogeneity found a similar association (OR, 2.58; 95% CI, 1.39-4.79). Conclusions: No completed clinical trials were identified. Evidence from observational studies, with important limitations, suggests that corticosteroid therapy for presumed influenza-associated complications is associated with increased mortality.
    Preview · Article · Nov 2014 · The Journal of Infectious Diseases