title: Mortality Associated With Seasonal and Pandemic Influenza Among Pregnant and Nonpregnant Women of Childbearing Age in a High-HIV-Prevalence Setting-South Africa, 1999-2009.
abstract: BACKGROUND
  Information on the mortality burden associated with seasonal and pandemic influenza virus infection among pregnant women is scarce in most settings, particularly in sub-Saharan Africa where pregnancy and maternal mortality rates as well as human immunodeficiency virus (HIV) prevalence are elevated.
  
  
  METHODS
  We used an ecological study design to estimate the seasonal and A(H1N1)pdm09 influenza-associated mortality among pregnant and nonpregnant women of childbearing age (15-49 years) by HIV serostatus during 1999-2009 in South Africa. Mortality rates were expressed per 100 000 person-years.
  
  
  RESULTS
  During 1999-2009, the estimated mean annual seasonal influenza-associated mortality rates were 12.6 (123 deaths) and 7.3 (914 deaths) among pregnant and nonpregnant women, respectively. Among pregnant women, the estimated mean annual seasonal influenza-associated mortality rates were 74.9 (109 deaths) among HIV-infected and 1.5 (14 deaths) among HIV-uninfected individuals. Among nonpregnant women, the estimated mean annual seasonal influenza-associated mortality rate was 41.2 (824 deaths) among HIV-infected and 0.9 (90 deaths) among HIV-uninfected individuals. Pregnant women experienced an increased risk of seasonal influenza-associated mortality compared with nonpregnant women (relative risk [RR], 2.8; 95% confidence interval [CI], 1.7-3.9). In 2009, the estimated influenza A(H1N1)pdm09-associated mortality rates were 19.3 (181 deaths) and 9.4 (1189 deaths) among pregnant and nonpregnant women, respectively (RR, 3.2; 95% CI, 2.3-4.1).
  
  
  CONCLUSIONS
  Among women of childbearing age, the majority of estimated seasonal influenza-associated deaths occurred in HIV-infected individuals. Pregnant women experienced an increased risk of death associated with seasonal and A(H1N1)pdm09 influenza infection compared with nonpregnant women.
authors.affiliation: Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia Influenza Program, Centers for Disease Control and Prevention, Pretoria Center for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service.
authors.forename: Stefano
authors.initials: S
authors.lastname: Tempia
authors.affiliation: Center for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Sibongile
authors.initials: S
authors.lastname: Walaza
authors.affiliation: Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia Influenza Program, Centers for Disease Control and Prevention, Pretoria.
authors.forename: Adam L
authors.initials: AL
authors.lastname: Cohen
authors.affiliation: Center for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Claire
authors.initials: C
authors.lastname: von Mollendorf
authors.affiliation: Center for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Jocelyn
authors.initials: J
authors.lastname: Moyes
authors.affiliation: Center for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service.
authors.forename: Johanna M
authors.initials: JM
authors.lastname: McAnerney
authors.affiliation: Center for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Cohen
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology / Q000401:mortality*; D006801:Humans; D007251:Influenza, Human / Q000150:complications / Q000453:epidemiology / Q000401:mortality*; D008875:Middle Aged; D058873:Pandemics; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology / Q000401:mortality*; D015995:Prevalence; D013019:South Africa / Q000453:epidemiology; D055815:Young Adult
keywords: HIV; South Africa; influenza; mortality; pregnancy