2009 pandemic influenza A (H1N1) and vaccine failure in pregnancy.
BACKGROUND
Emerging data suggest that pregnancy conveys high risk for severe complications from the 2009 pandemic influenza A virus (2009 H1N1) infection.


METHODS
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.


CONCLUSIONS
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.
From the California Department of Public Health, Richmond, California; the Sacramento County Department of Health and Human Services, Sacramento, California; and the National Center for Chronic Disease Prevention and Health Promotion and the Centers for Disease Control and Prevention, Atlanta, Georgia.
Janice K
JK
Louie
Debra A
DA
Wadford
Agnes
A
Norman
Denise J
DJ
Jamieson
D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D002585:Cesarean Section; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D053118:Influenza A Virus, H1N1 Subtype / Q000276:immunology*; D007252:Influenza Vaccines / Q000008:administration & dosage* / Q000276:immunology; D007251:Influenza, Human / Q000150:complications* / Q000453:epidemiology / Q000517:prevention & control; D053139:Oseltamivir / Q000627:therapeutic use; D058873:Pandemics / Q000517:prevention & control*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control / Q000821:virology*; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000175:diagnosis* / Q000628:therapy / Q000821:virology*; D017211:Treatment Failure
D000998:Antiviral Agents; D007252:Influenza Vaccines; D053139:Oseltamivir
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