Infant Respiratory Outcomes Associated with Prenatal Exposure to Maternal 2009 A/H1N1 Influenza Vaccination.

BACKGROUND: Infants are at high risk for influenza illness, but are ineligible for vaccination before 6 months. Transfer of maternal antibodies to the fetus has been demonstrated for 2009 A/H1N1 pandemic vaccines; however, clinical effectiveness is unknown. Our objective was to evaluate the association between 2009 A/H1N1 pandemic vaccination during pregnancy and rates of infant influenza and pneumonia. METHODS: We linked a population-based birth cohort to administrative databases to measure rates of influenza and pneumonia diagnosed during ambulatory physician visits, hospitalizations and emergency department visits during one year of follow-up. We estimated incidence rate ratios and 95% confidence intervals (95% CI) using Poisson regression, comparing infants born to A/H1N1-vaccinated women (vaccine-exposed infants) with unexposed infants, adjusted for confounding using high-dimensional propensity scores. RESULTS: Among 117,335 infants in the study, 36,033 (31%) were born to A/H1N1-vaccinated women. Crude rates of influenza during the pandemic (per 100,000 infant-days) for vaccine-exposed and unexposed infants were similar (2.19, 95% CI: 1.27-3.76 and 3.60, 95% CI: 2.51-5.14, respectively), as were crude rates of influenza and pneumonia combined. We did not observe any significant differences in rates of study outcomes between study groups during the second wave of the 2009 A/H1N1 pandemic, nor during any post-pandemic time period. CONCLUSION: We observed no difference in rates of study outcomes among infants born to A/H1N1-vaccinated mothers relative to unexposed infants born during the second A/H1N1 pandemic wave; however, due to late availability of the pandemic vaccine, the available follow-up time during the pandemic time period was very limited.

Gestational influenza and bipolar disorder in adult offspring.

IMPORTANCE: Gestational influenza has been associated previously with schizophrenia in offspring, but the relationship between this exposure and bipolar disorder (BD) is unclear. The identification of gestational influenza as a risk factor for BD may have potential for preventive approaches. OBJECTIVE: To test the hypothesis that maternal influenza during pregnancy is related to BD among offspring. DESIGN: Nested case-control study of a population-based birth cohort from the Child Health and Development Study (CHDS). From January 1, 1959, through December 31, 1966, the CHDS recruited nearly all pregnant women receiving obstetric care from the Kaiser Permanente Medical Care Plan, Northern California Region (KPNC). Data on treated maternal influenza from the CHDS were used. Potential cases with BD from the cohort were identified by database linkages of identifiers among the CHDS, Kaiser Permanente database, and a large county health care database; by a mailed questionnaire to the CHDS cohort with subsequent interviews; and from an earlier psychiatric follow-up study on this birth cohort. SETTING: The CHDS, Kaiser Permanente, and county health care databases. PARTICIPANTS: Cases of BD (n = 92) confirmed by structured research interviews and consensus diagnosis among the 214 subjects (48% of those ascertained) who participated and control subjects (n = 722) matched on date of birth, sex, and membership in KPNC or residence in Alameda County. EXPOSURES: Influenza. MAIN OUTCOME AND MEASURES: Bipolar I or II disorder, BD not otherwise specified, or BD with psychotic features. RESULTS: We found a significant, nearly 4-fold increase in the risk of BD (odds ratio, 3.82 [95% CI, 1.58-9.24; P = .003]) after exposure to maternal influenza at any time during pregnancy. The findings were not confounded by maternal age, race, educational level, gestational age at birth, and maternal psychiatric disorders. CONCLUSIONS AND RELEVANCE: Maternal influenza may be a risk factor for BD. Although replication is required, the findings suggest that prevention of maternal influenza during pregnancy may reduce the risk of BD.

Severe hypothalamopituitary dysfunction accompanied by influenza-associated encephalopathy: report of two pediatric cases.

Severe influenza infection may lead to neurological damage, such as encephalopathy. This may, in turn, cause acquired hypothalamopituitary dysfunction, which can result in severe morbidity and even death. We herein report two pediatric patients who developed influenza-associated hypopituitarism and were subsequently diagnosed with encephalopathy. They were diagnosed with acute necrotizing encephalopathy and postresuscitation encephalopathy, respectively. Both showed evidence of endocrine dysfunction, and hormone replacement therapy of adrenal, thyroid, and antidiuretic hormones are resulting in continued cardiac activity and resulted in prolonged survival. Screening for endocrine function is important in patients with severe central nervous system dysfunction.

[Congenital encephalomyelopathy as a possible slow infection in humans]. / Vrozhdennaia éntsefalomielopatiia kak vozmozhnaia medlennaia grippoznaia infektsiia u cheloveka.

A slow influenzal congenital infection of man (in a child aged 2.5 years) is described for the first time. The infection manifests itself by encephalomyelopathy (retarded psychomotor development, sluggish spinal pareses of the limbs) and resembles Werdnig-Hoffmann amyotrophy. Besides, one can ses neuroendocrine disorders (hypophyseal nanism, hypogonadism ) and the signs of immunodeficiency. The long-term persistence of influenza A virus, its defective form was detected in the blood and CSF by means of molecular hybridization. In addition, the summarized data on the clinical studies of congenital influenzal injuries to the CNS in children, carried out by the author are provided. The theoretical evidence for the work was experimental slow influenzal infection in mice obtained for the first time at the N.F.Gamaleia Institute of Epidemiology and Microbiology (Moscow).

Malformational complex in an infant with intrauterine influenza viral infection.

An infant with complex malformations of the central nervous system is described. The abnormalities included ependymal damage, aqueduct forking, hydrocephalus, and neuronal heterotopias; agenesis of the cerebellum, pontine, and inferior olivary neutrons; agenesis of the optic and olfactory systems and corpus callosum; and a highly unusual course of the corticospinal fibers in the spinal cord. Immunohistochemical test results showed the presence of influenza virus antigens in the brain. Possible pathogenetic mechanisms are presented.

Uncommon virus infections of the mother, fetus, and newborn: influenza, mumps and measles.

The literature contains reports of epidemics of varying sizes, which in the aggregate suggest that congenital malformations are not attributable to maternal measles infection during pregnancy, that the incidence of prematurity may be somewhat higher among infected mothers, and that the incidence of abortion also may be somewhat higher. Before the introduction of measles vaccine in this country, the universality of childhood experience rendered adult infection a rare event. Gestational measles was thus uncommon. With the introduction of measles vaccine, these numbers can be expected to have decreased substantially.

[Intrauterine infections in the perinatal period]. / Vnutriutrobnye infektsii v perinatal'nom periode.

The results of examinations of autopsy materials in Leningrad and the data from the literature indicate that infectious diseases occupy a significant place in perinatal mortality. It is emphasized that if the autopsy materials are not sufficiently examined using not only light but also immunofluorescent microscopy, a considerable portion of these infections is not diagnosed and the pathological proprocess in such cases in considered to be aspiration pneumonia, hyaline membrane disease, etc. The paper briefly characterizes intrauterine bacterial infections (listeriasis, syphilis, staphylococcal infections, etc.) with special reference to virus diseases (cytomegaly, herpes infection, lesions caused by respiratory viruses, etc) and mycoplasmosis. It is shown that a relatively high incidence of lesions is caused by respiratory viruses and particularly mycoplasma. The possibility of protozoan and mycotic lesions is also indicated. The frequent occurrence of combined intrauterine infections is emphasized.