FLU NEWS SCAN: Pregnancy and H1N1, oseltamivir for hospitalized children, H1N1 DNA vaccine

Apr 27, 2011

Study: One fifth of pregnant women with H1N1 in ICU died
Pregnant women in California intensive care units (ICUs) infected with 2009 pandemic H1N1 influenza tended to decline rapidly, often required intensive ventilation, and suffered serious adverse events, including death in 15 (21%) of the 71 women. Researchers retrospectively studied cases in California from Apr 23, 2009, through Mar 18, 2010, and found that their health rapidly declined, with a median of 1 day from hospital to ICU admission. Twenty-three women needed rescue therapies for severe gas-exchange abnormalities. Of 42 women requiring invasive ventilation, 15 (36%) died. Adverse events—including sepsis (in 26 patients), blood disorders (17), and pneumothorax (15)—were common and were significantly associated with death (100% of those who died had adverse events, compared with 52% of those who survived). Conditions that especially raised the risk of death were sepsis, pneumothorax, renal failure, and cardiac arrhythmia. In contrast, women who received early antiviral therapy were significantly more likely to survive.
Apr 25 Am J Obstet Gynecol abstract

Antiviral treatment shortened children's hospital stays during 2009 pandemic
Prompt antiviral treatment for patients with suspected influenza shortened hospital stays and helped stop a series of healthcare-associated flu cases during the first wave of the 2009 pandemic at a Canadian children's hospital, according to a report in Infection Control and Hospital Epidemiology (ICHE). The authors reviewed the cases of all patients who were treated for lab-confirmed flu at Winnipeg Children's Hospital from January through July of 2009. They counted 104 patients, 81 of whom had the pandemic H1N1 virus. The two groups did not differ in risk factors, presentation, or outcomes. Eight of the 2009 H1N1 cases were nosocomial. Among the non-nosocomial H1N1 cases, patients who received empiric oseltamivir (Tamiflu) treatment on admission were hospitalized an average of 3.7 days, versus 12.0 days for those who received delayed treatment. The authors say the nosocomial cases were stopped by instituting oseltamivir treatment for all patients with suspected flu and promptly modifying infection control practices, which included closing playrooms and increasing education of staff and visitors.
May ICHE abstract

Vical DNA H1N1 vaccine shows promise in early trial
Vical, a vaccine company based in San Diego, today announced promising phase 1 clinical trial results for a DNA-based 2009 H1N1 vaccine that contains Vaxfectin, its proprietary adjuvant. The company said in a press release that the vaccine generated protective levels of neutralizing antibodies in more than half of the study participants and was well tolerated but didn't specify how seroconversion was measured. The study was supported by federal funding from the Defense Threat Reduction Agency and the US Naval Medical Research Center (NMRC). In February Vical said it had extended its contract with the NMRC to develop the company's platform designed to speed the development and production of vaccines against emerging infectious disease threats. Larry R. Smith, PhD, Vical's vice president of vaccine research, said in the statement that the new findings, plus equivalent phase 1 findings for its similar H5N1 avian influenza vaccine, further validates the company's vaccine platform and adjuvant. He added that the goal is to first provide vaccines for military personnel, then eventually expand availability to the broader population.
Apr 27 Vical press release

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