key: cord-008866-be7725ap
authors: Su, Lin Lin; Chan, Jerry; Chong, Yap Seng; Choolani, Mahesh; Biswas, Arijit; Yong, EL
title: Pregnancy and H1N1 infection
date: 2009-10-22
journal: Lancet
DOI: 10.1016/s0140-6736(09)61854-7
sha: 
doc_id: 8866
cord_uid: be7725ap

nan

These observations suggest that antivirals ought to be used to prevent and treat H1N1 infection in highrisk pregnant women. Indeed, the US Centers for Disease Control and Pre vention recommend chemoprophyl axis with either oseltamivir or zanamivir against H1N1 infl uenza for people at risk of complications, including pregnant women. 2 However, a survey 3 has shown that oseltamivir has important side-eff ects (including gastrointestinal and neuropsychiatric symptoms) in more than half of treated children, raising serious questions about the wide use of this compound, not only in children, but also in pregnancy.

This side-eff ect profi le, together with the detection of oseltamivirresis tant strains, 4 suggests that novel safe com pounds are necessary for the treatment of H1N1 infection in pregnan cy. Two human anti-infl uenza A H5N1 monoclonal anti bodies (hMAbs) 5 have been cloned, and their H5N1-neu tral ising potential has been assessed against highly pathogenic avian strains, indicating that powerful and safe treatment of infl uenza H5N1 infections with hMAbs is possible. From this point of view, a strategy for the treatment and prevention of H1N1 infection in pregnancy based on neutralising human monoclonal antibodies should be planned in the future, being also aware of the effi cient protection of the fetus by circulating IgGs.

We declare that we have no confl icts of interest. Denise Jamieson and colleagues 1 highlight high morbidity and mortality rates in pregnant women infected with the H1N1 infl uenza virus. Admission rates were 41% and the median time from symptom onset to receipt of antiviral therapy was 9 days. Could earlier initiation of antiviral treatment have resulted in a better outcome? In 2003, Singapore was notably aff ected by severe acute respiratory syndrome (SARS), 2 which led to the formation of a rapid response team, hospital quarantine, infect ious disease control measures, temperature screening at borders and in public buildings and spaces, timely public education, and constant communication with the public. 3, 4 In response to the Centers for Disease Control and Prevention's advice on poorer outcomes in H1N1-aff ected pregnant women on May 12, 2009, the above SARS strategies, coupled with rapid access to quantitative reverse-transcriptase PCR within 24 h of presentation and early institution of antiviral therapy, was started from June 30, 2009, in Singapore.

Between July 7 and Aug 9, 2009, 28 pregnant women were diagnosed with H1N1 at the National University Hospital in Singapore. The time from symptom onset to initiation of oseltamivir treatment was a median of 2 days. Three women were admitted for observation, and one developed pneumonia; initiation of treatment was 4 days after symptom onset in this woman. No deaths have been reported nationwide in pregnant women thus far.

Our experience suggests that timely medical attention with early recourse to antiviral therapy is associated with a better outcome in H1N1-aff ected pregnant women.

infl uenza virus infection during pregnancy in the USA

Acute respiratory distress syndrome in critically ill patients with severe acute respiratory syndrome

Crisis prevention and management during SARS outbreak

Public health measures implemented during the SARS outbreak in Singapore

We declare that we have no confl icts of interest.

Department of Obstetrics and Gynaecology, National University Singapore, 5 Lower Kent Ridge Road, Singapore 119074, Singapore

We agree with Roberto Burioni and colleagues that novel treatment approaches for infl uenza virus infection such as use of antiinfl uenza monoclonal antibodies might hold promise and are certainly worth pursuing. However, most investigations have used animals, and treatment in human beings has mainly focused on the most severe cases. Treatment with anti-infl uenza virus antibodies has not yet been shown safe and eff ective for use in non-pregnant people. 1 It will probably be even longer before such treatment options would be considered for pregnant women since additional iStockphoto The printed journal includes an image merely for illustration