Journal Article•
1918 pandemic influenza and pneumonia in a large civil hospital.
TL;DR: Following the reports of a rapidly spreading and highly fatal pandemic of influenza and pneumonia in the Eastern States, and while the epidemic of influenza was raging at the Great Lakes Naval Training Station, a severe outbreak of this disease appeared among the civil population of Chicago, more than 2,000 patients were admitted to the wards of Cook County Hospital.
Abstract: Following the reports of a rapidly spreading and highly fatal pandemic of influenza and pneumonia in the Eastern States, and while the epidemic of influenza was raging at the Great Lakes Naval Training Station, a severe outbreak of this disease appeared among the civil population of Chicago. During the past five weeks, from September 23 to October 29, more than 2,000 patients were admitted to the wards of Cook County Hospital. Of these, 642 died, a mortality of 31 per cent. . . . The age period of highest mortality falls between 25 and 30 years.
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TL;DR: If severe pandemic influenza is largely a problem of viral-bacterial copathogenesis, pandemic planning needs to go beyond addressing the viral cause alone (e.g., influenza vaccines and antiviral drugs).
Abstract: Background
Despite the availability of published data on 4 pandemics that have occurred over the past 120 years, there is little modern information on the causes of death associated with influenza pandemics.
1,448Â citations
Centers for Disease Control and Prevention1, National Center for Immunization and Respiratory Diseases2, California Department of Public Health3, Arizona Department of Health Services4, Michigan Department of Community Health5, Texas Department of State Health Services6, Chicago Department of Public Health7, Massachusetts Department of Public Health8
TL;DR: Cases and deaths associated with pandemic H1N1 virus in pregnant women identified in the USA during the first month of the present outbreak lend support to the present recommendation to promptly treat pregnant women with H 1N1 influenza virus infection with anti-influenza drugs.
1,246Â citations
TL;DR: Pregnant women had a disproportionately high risk of mortality due to 2009 influenza A(H1N1), and early antiviral treatment appeared to be associated with fewer admissions to an ICU and fewer deaths.
Abstract: Context Early data on pandemic 2009 influenza A(H1N1) suggest pregnant women are at increased risk of hospitalization and death. Objective To describe the severity of 2009 influenza A(H1N1) illness and the association with early antiviral treatment among pregnant women in the United States. Design, Setting, and Patients Surveillance of 2009 influenza A(H1N1) in pregnant women reported to the Centers for Disease Control and Prevention (CDC) with symptom onset from April through December 2009. Main Outcome Measures Severity of illness (hospitalizations, intensive care unit [ICU] admissions, and deaths) due to 2009 influenza A(H1N1) among pregnant women, stratified by timing of antiviral treatment and pregnancy trimester at symptom onset. Results We received reports on 788 pregnant women in the United States with 2009 influenza A(H1N1) with symptom onset from April through August 2009. Among those, 30 died (5% of all reported 2009 influenza A[H1N1] influenza deaths in this period). Among 509 hospitalized women, 115 (22.6%) were admitted to an ICU. Pregnant women with treatment more than 4 days after symptom onset were more likely to be admitted to an ICU (56.9% vs 9.4%; relative risk [RR], 6.0; 95% confidence interval [CI], 3.5-10.6) than those treated within 2 days after symptom onset. Only 1 death occurred in a patient who received treatment within 2 days of symptom onset. Updating these data with the CDC's continued surveillance of ICU admissions and deaths among pregnant women with symptom onset through December 31, 2009, identified an additional 165 women for a total of 280 women who were admitted to ICUs, 56 of whom died. Among the deaths, 4 occurred in the first trimester (7.1%), 15 in the second (26.8%), and 36 in the third (64.3%); Conclusions Pregnant women had a disproportionately high risk of mortality due to 2009 influenza A(H1N1). Among pregnant women with 2009 influenza A(H1N1) influenza reported to the CDC, early antiviral treatment appeared to be associated with fewer admissions to an ICU and fewer deaths.
863Â citations
TL;DR: The major viral infections relevant to pregnancy are reviewed and potential mechanisms for the associated adverse pregnancy outcomes are offered.
Abstract: Viral infections during pregnancy have long been considered benign conditions with a few notable exceptions, such as herpes virus. The recent Ebola outbreak and other viral epidemics and pandemics show how pregnant women suffer worse outcomes (such as preterm labor and adverse fetal outcomes) than the general population and non-pregnant women. New knowledge about the ways the maternal-fetal interface and placenta interact with the maternal immune system may explain these findings. Once thought to be 'immunosuppressed', the pregnant woman actually undergoes an immunological transformation, where the immune system is necessary to promote and support the pregnancy and growing fetus. When this protection is breached, as in a viral infection, this security is weakened and infection with other microorganisms can then propagate and lead to outcomes, such as preterm labor. In this manuscript, we review the major viral infections relevant to pregnancy and offer potential mechanisms for the associated adverse pregnancy outcomes.
382Â citations
TL;DR: There is strong and consistent evidence of epidemiologically and clinically important interactions between influenza and secondary bacterial respiratory pathogens, including during the 1918 pandemic, which prompted major focuses of pandemic-related research, prevention, and response planning.
Abstract: It is commonly believed that the clinical and epidemiological characteristics of the next influenza pandemic will mimic those of the 1918 pandemic. Determinative beliefs regarding the 1918 pandemic include that infections were expressed as primary viral pneumonias and/or acute respiratory distress syndrome, that pandemic-related deaths were the end states of the natural progression of disease caused by the pandemic strain, and that bacterial superinfections caused relatively fewer deaths in 1918 than in subsequent pandemics. In turn, response plans are focused on developing and/or increasing inventories of a strain-specific vaccine, antivirals, intensive care beds, mechanical ventilators, and so on. Yet, there is strong and consistent evidence of epidemiologically and clinically important interactions between influenza and secondary bacterial respiratory pathogens, including during the 1918 pandemic. Countermeasures (eg, vaccination against pneumococcal and meningococcal disease before a pandemic; mass uses of antibiotic(s) with broad spectrums of activity against common bacterial respiratory pathogens during local epidemics) designed to prevent or mitigate the effects of influenza-bacterial interactions should be major focuses of pandemic-related research, prevention, and response planning.
357Â citations
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TL;DR: There is every indication that this outbreak of influenza in the First Naval District will soon spread all over the country, as the last pandemic moved from east to west along the lines of travel.
Abstract: During the past two weeks, August 28 to September 11, there has begun a severe and rapidly spreading epidemic of influenza in the First Naval District. More than 2,000 cases have been reported in these two weeks, and there are indications of a rapid spread of the infection. This is undoubtedly the same disease which, first heard of in Spain last spring, and hence called Spanish influenza, has in recent months spread over nearly all of Europe, including Germany, Italy, France, England and Ireland, attacking from 30 to 40 per cent. of the people. The outstanding feature of this epidemic is its high degree of communicability; in fact, in pandemics of this nature, influenza is the most contagious of all infections. The last pandemic (1889-1890) also moved from east to west along the lines of travel. We, therefore, have every indication that this outbreak will soon spread all over the
29Â citations