title: Benefit of Early Initiation of Influenza Antiviral Treatment to Pregnant Women Hospitalized With Laboratory-Confirmed Influenza.
abstract: We describe the impact of early initiation of influenza antiviral treatment among pregnant women hospitalized with laboratory-confirmed influenza during the 2010-2014 influenza seasons.
  
  
  
  Severe influenza was defined as illness with ≥1 of the following: intensive care unit admission, need for mechanical ventilation, respiratory failure, pulmonary embolism, sepsis, or death. Within severity stratum, we used parametric survival analysis to compare length of stay by timing of antiviral treatment, adjusting for underlying conditions, influenza vaccination, and pregnancy trimester.
  
  
  
  Among 865 pregnant women, the median age was 27 years (interquartile range [IQR], 23-31 years). Most (68%) were healthy, and 85% received antiviral treatment. Sixty-three women (7%) had severe influenza, and 4 died. Severity was associated with preterm delivery and fetal loss. Women with severe influenza were less likely to be vaccinated than those without severe influenza (14% vs 26%; P = .03). Among women treated with antivirals ≤2 days versus those treated >2 days from illness onset, the median length of stay was 2.2 days (interquartile range [IQR], 0.9-5.8 days; n = 8) versus 7.8 days (IQR, 3.0-20.6 days; n = 7), respectively, for severe influenza (P = .03) and 2.4 days (IQR, 2.3-2.5 days; n = 153) versus 3.1 days (IQR, 2.8-3.5 days; n = 62), respectively, for nonsevere influenza (P < .01).
  
  
  
  Early initiation of influenza antiviral treatment to pregnant women hospitalized with influenza may reduce the length of stay, especially among those with severe influenza. Influenza during pregnancy is associated with maternal and infant morbidity, and annual influenza vaccination is warranted.
authors.affiliation: Epidemic Intelligence Service Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Ikwo K
authors.initials: IK
authors.lastname: Oboho
authors.affiliation: Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Carrie
authors.initials: C
authors.lastname: Reed
authors.affiliation: Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Paul
authors.initials: P
authors.lastname: Gargiullo
authors.affiliation: Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Michelle
authors.initials: M
authors.lastname: Leon
authors.affiliation: Colorado Department of Public Health and Environment, Denver.
authors.forename: Deborah
authors.initials: D
authors.lastname: Aragon
authors.affiliation: Connecticut Emerging Infections Program, Yale School of Public Health, New Haven.
authors.forename: James
authors.initials: J
authors.lastname: Meek
authors.affiliation: Department of Medicine, Emory University School of Medicine Atlanta Veterans Affairs Medical Center, Georgia.
authors.forename: Evan J
authors.initials: EJ
authors.lastname: Anderson
authors.affiliation: Maryland Department of Health and Mental Hygiene, Baltimore.
authors.forename: Patricia
authors.initials: P
authors.lastname: Ryan
authors.affiliation: Minnesota Department of Health, St. Paul.
authors.forename: Ruth
authors.initials: R
authors.lastname: Lynfield
authors.affiliation: Minnesota Department of Health, St. Paul.
authors.forename: Craig
authors.initials: C
authors.lastname: Morin
authors.affiliation: New Mexico Department of Health, Santa Fe.
authors.forename: Marisa
authors.initials: M
authors.lastname: Bargsten
authors.affiliation: New York State Department of Health, Albany.
authors.forename: Shelley M
authors.initials: SM
authors.lastname: Zansky
authors.affiliation: Ohio Department of Health, Columbus.
authors.forename: Brian
authors.initials: B
authors.lastname: Fowler
authors.affiliation: Emerging Infections Program, Oregon Public Health Division, Portland.
authors.forename: Ann
authors.initials: A
authors.lastname: Thomas
authors.affiliation: Vanderbilt University School of Medicine, Nashville, Tennessee.
authors.forename: Mary Lou
authors.initials: ML
authors.lastname: Lindegren
authors.affiliation: Vanderbilt University School of Medicine, Nashville, Tennessee.
authors.forename: William
authors.initials: W
authors.lastname: Schaffner
authors.affiliation: Salt Lake County Health Department, Salt Lake City, Utah.
authors.forename: Ilene
authors.initials: I
authors.lastname: Risk
authors.affiliation: Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Lyn
authors.initials: L
authors.lastname: Finelli
authors.affiliation: Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Sandra S
authors.initials: SS
authors.lastname: Chaves
mesh_terms: D000293:Adolescent; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D005260:Female; D006760:Hospitalization; D006801:Humans; D007251:Influenza, Human / Q000188:drug therapy*; D007902:Length of Stay; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy*; D055502:Secondary Prevention; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000998:Antiviral Agents
keywords: early antiviral treatment; influenza; influenza antiviral treatment; length of stay; pregnancy