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Louie J.K.,50 Marina Bay Pkwy | Jamieson D.J.,Centers for Disease Control and Prevention | Rasmussen S.A.,Centers for Disease Control and Prevention
American Journal of Obstetrics and Gynecology | Year: 2011

Objective The objective of the study was to characterize severe illness because of the 2009 pandemic influenza A (H1N1) infection in postpartum women. Study Design We reviewed case reports of infected hospitalized postpartum (≤6 months from delivery) women identified through statewide surveillance in California. From April 23 through August 11, 2009, all hospitalizations and/or deaths were reported. After August 11, reporting was limited to cases requiring intensive care or deaths. Results From April 23 to December 31, 2009, 15 cases were reported; 11 (73%) had symptom onset within 7 days postpartum. Of 10 hospitalized cases reported through August 11, 4 required intensive care, 3 required mechanical ventilation, and 2 died. Of 5 cases requiring intensive care reported after August 11, all required mechanical ventilation and 1 died. Overall, 6 (43%) received antivirals within 48 hours of symptom onset. Conclusion The 2009 H1N1 can cause severe illness in postpartum women, especially in the first week following delivery. © 2011 Mosby, Inc.

Louie J.K.,50 Marina Bay Pkwy | Yang S.,50 Marina Bay Pkwy | Acosta M.,50 Marina Bay Pkwy | Yen C.,50 Marina Bay Pkwy | And 4 more authors.
Clinical Infectious Diseases | Year: 2012

Background: Neuraminidase inhibitor (NAI) antiviral drugs can shorten the duration of uncomplicated influenza when administered early (<48 hours after illness onset) to otherwise healthy outpatients, but the optimal timing of effective therapy for critically ill patients is not well established.Methods: We analyzed California surveillance data to characterize the outcomes of patients in intensive care units (ICUs) treated with NAIs for influenza A(H1N1)pdm09 (pH1N1). Demographic and clinical data were abstracted from medical records, using standardized case report forms.Results: From 3 April 2009 through 10 August 2010, 1950 pH1N1 cases hospitalized in ICUs were reported. Of 1859 (95%) with information available, 1676 (90) received NAI treatment, and 183 (10%) did not. The median age was 37 years (range, 1 week-93 years), 1473 (79%) had ≥1 comorbidity, and 492 (26%) died. The median time from symptom onset to starting NAI treatment was 4 days (range, 0-52 days). NAI treatment was associated with survival: 107 of 183 untreated case patients (58%) survived, compared with 1260 of 1676 treated case patients (75%; P ≤. 0001). There was a trend toward improved survival for those treated earliest (P <. 0001). Treatment initiated within 5 days after symptom onset was associated with improved survival compared to those never treated (P <. 05).Conclusions: NAI treatment of critically ill pH1N1 patients improves survival. While earlier treatment conveyed the most benefit, patients who started treatment up to >5 days after symptom onset also were more likely to survive. Further research is needed about whether starting NAI treatment >5 days after symptom onset may also convey benefit. © 2012 Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved.

Pinney S.M.,University of Cincinnati | Biro F.M.,University of Cincinnati | Biro F.M.,Cincinnati Childrens Hospital Medical Center | Windham G.C.,50 Marina Bay Pkwy | And 9 more authors.
Environmental Pollution | Year: 2014

PFC serum concentrations were measured in 6-8 year-old girls in Greater Cincinnati (GC) (N = 353) and the San Francisco Bay Area (SFBA) (N = 351). PFOA median concentration was lower in the SFBA than GC (5.8 vs. 7.3 ng/mL). In GC, 48/51 girls living in one area had PFOA concentrations above the NHANES 95th percentile for children 12-19 years (8.4 ng/mL), median 22.0 ng/mL. The duration of being breast fed was associated with higher serum PFOA at both sites and with higher PFOS, PFHxS and Me-PFOSA-AcOH concentrations in GC. Correlations of the PFC analytes with each other suggest that a source upriver from GC may have contributed to exposures through drinking water, and water treatment with granular activated carbon filtration resulted in less exposure for SWO girls compared to those in NKY. PFOA has been characterized as a drinking water contaminant, and water treatment systems effective in removing PFCs will reduce body burdens. © 2013 Elsevier Ltd. All rights reserved.

Louie J.K.,50 Marina Bay Pkwy | Acosta M.,50 Marina Bay Pkwy | Jamieson D.J.,Centers for Disease Control and Prevention | Honein M.A.,Centers for Disease Control and Prevention
New England Journal of Medicine | Year: 2010

BACKGROUND: Like previous epidemic and pandemic diseases, 2009 pandemic influenza A (H1N1) may pose an increased risk of severe illness in pregnant women. METHODS: Statewide surveillance for patients who were hospitalized with or died from 2009 H1N1 influenza was initiated by the California Department of Public Health. We reviewed demographic and clinical data reported from April 23 through August 11, 2009, for all H1N1-infected, reproductive-age women who were hospitalized or died - nonpregnant women, pregnant women, and postpartum women (those who had delivered ≤2 weeks previously). RESULTS: Data were reported for 94 pregnant women, 8 postpartum women, and 137 nonpregnant women of reproductive age who were hospitalized with 2009 H1N1 influenza. Rapid antigen tests were falsely negative in 38% of the patients tested (58 of 153). Most pregnant patients (89 of 94 [95%]) were in the second or third trimester, and approximately one third (32 of 93 [34%]) had established risk factors for complications from influenza other than pregnancy. As compared with early antiviral treatment (administered ≤2 days after symptom onset) in pregnant women, later treatment was associated with admission to an intensive care unit (ICU) or death (relative risk, 4.3). In all, 18 pregnant women and 4 postpartum women (total, 22 of 102 [22%]) required intensive care, and 8 (8%) died. Six deliveries occurred in the ICU, including four emergency cesarean deliveries. The 2009 H1N1 influenza-specific maternal mortality ratio (the number of maternal deaths per 100,000 live births) was 4.3. CONCLUSIONS: 2009 H1N1 influenza can cause severe illness and death in pregnant and postpartum women; regardless of the results of rapid antigen testing, prompt evaluation and antiviral treatment of influenza-like illness should be considered in such women. The high cause-specific maternal mortality rate suggests that 2009 H1N1 influenza may increase the 2009 maternal mortality ratio in the United States. Copyright © 2009 Massachusetts Medical Society.

Jean C.,50 Marina Bay Pkwy | Louie J.K.,50 Marina Bay Pkwy | Glaser C.A.,50 Marina Bay Pkwy | Harriman K.,50 Marina Bay Pkwy | And 6 more authors.
Clinical Infectious Diseases | Year: 2010

We describe 10 patients with 2009 H1N1 influenza and concurrent invasive group A streptococcal infection with marked associated morbidity and mortality. Seven patients required intensive care, 8 required mechanical ventilation, and 7 died. Five of the patients, including 4 of the fatalities, were previously healthy. © 2010 by the Infectious Diseases Society of America. All rights reserved.

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