Swine-flu risks make pregnant women a priority: CDC

Pregnant women suspected of having swine flu should be given antiviral drugs as soon as flu symptoms appear, even if the diagnosis is not confirmed,say researchersat the U.S. Centers for Disease Control and Prevention.

Pregnant women should also be made a priority group for receiving a vaccine against the H1N1 virus when it is ready, the researchers said.

A U.S. government panel recommended Wednesday that pregnant women, health-care workers, and children six months and older be among those placed first in line for swine flu vaccine.

The advisory committee on immunization practicesalso recommended that parents and other caregivers of infants (who are too young to be vaccinated themselves), non-elderly adults who have high-risk medical conditions, and young adults ages 19 to 24 be given priority for receiving a pandemic vaccine first.

Federal health officials in the U.S. usually follow the panel'srecommendations.

Unlike the U.S, Canada has yet to draft a priority list for who should get a pandemic vaccine first when it becomes available, said Dr. David Butler-Jones, Canada's chief public health officer.

Butler-Jonessaid Canadian experts want to collect as much information as possible, including data from clinical trials of vaccines in other countries, before making a priority list of who should get the shots first.

"I think the point for Canadians is that, assuming there isn't a huge problem that is unanticipated, unlike most countries, we actually have sufficient vaccine to provide that to the population who needs it and wants to have it," Butler-Jones told a news conference on Wednesday.

Pregnant women are one of the groups health officials hope to vaccinate early on, he said.

The U.S. pregnancy findings, published in Wednesday's online issue of The Lancet, werebased on a small number of cases, and can't address whetherpregnancy makes a woman susceptible to H1N1.

Don't delay treatment

"There are a lot of changes during pregnancy," said the study's lead author, Dr. Denise Jamieson of the CDC's National Center for Chronic Disease Prevention and Health Promotion in Atlanta.

"For example, as the uterus grows, it pushes up the diaphragm and there's less room for the lungs, so the lung capacity is decreased. There are also immunologic changes, and all of these changes render pregnant women more susceptible to and more severely affected by certain viruses."

If a pregnant women feels like she may have influenza, it's important for her to call a health-care provider right away to receive antiviral treatment quickly, preferably within 48 hours of symptoms appearing, Jamieson said.

Of 302 deaths attributed to swine flu to date in the U.S., the CDC has detailed information on 266 of them. The agency has found that 15 of the 266 were pregnant women or aboutsix per cent.

Of the six fatal pregnancies cases out of 45 deaths described in the study, nearly all the pregnant women had viral pneumonia before experiencing acute respiratory problems. They were put on ventilators before they died. The deaths related to swine flu were reported to CDC between April 15 and June 16.

The women were generally healthy, aside from one women who had asthma and another who was obese.

In the U.S., none of the pregnant women who died was given Tamiflu in a timely fashion.

Years of experience with Tamiflu during pregnancy suggest the benefits outweigh the risks, said Dr. Don Low, chief microbiologist at Mount Sinai Hospital in Toronto.

"I think the data now is pretty clear that even in seasonal flu, this is not a disease you want to get during pregnancy," said Low. "And especially during a pandemic with a new strain like H1N1, this is a risk to you and your fetus."

Pregnant women told to avoid large crowds

The study's authors also concluded that the risks of getting seriously ill from swine flu is likely more serious than possible side-effects from antiviral drugs or a vaccine.

Among Canadian women betweenages 15 and 50 who were hospitalized, admitted to intensive care or died as a result of H1N1, the following number were pregnant at the time, according to the Public Health Agency of Canada:

• Forty-five, or 19.1 per cent, of the 235 women hospitalized.
• Nine, or 15 per cent, of the 60 women admitted to intensive care.
• Two, or 40 per cent, of the five women who died.

Federal health officials toldCBC News they don't know if the women were treated with antivirals or when.

Also on Wednesday, Health Minister Leona Aglukkaq told a news conference that Canada's supplier of pandemic vaccine remains on track to start immunization campaigns by the late fall.

The Public Health Agency of Canada released new information to guidehealth-care workers in acute-care facilities, long-term-care facilities, and for emergency response workers such as paramedics, ambulance attendants, police officers and firefighters.

The guidelines advice emergency responders on what screening questions to ask, suggested precautions to take during transport, and when health care workers should use masks and other protective equipment, and how to dispose of them, said Butler-Jones.

Nearly three weeks ago, the Public Health Agency of Canada suggested that pregnant women avoid large crowds such as summer festivals or crowded marketplaces, but continue to go to work and church.

The Canadian guidelines for pregnant women also recommend they:

• Be vigilant about hand washing.
• Carry a hand sanitizer.
• Check that surfaces and items are clean and disinfected.

Britain's Department of Health also suggests pregnant women may want to avoid crowded places.