Hein Bogers, Dominique Bos, Sam Schoenmakers and Johannes J Duvekot
Erasmus MC, University Medical Centre Rotterdam, Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, University Medical Centre Rotterdam.
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Although influenza A/H1N1pdm09 is not causing a pandemic anymore, we recently observed two critically ill pregnant women infected by this virus. We present these cases to illustrate the possible severe complications of an – at that moment – seasonal influenza in pregnancy. We discuss the epidemiological differences between the pandemic and post pandemic phase and try to explain the high virulence of influenza A/H1N1pdm09 -infections in pregnancy by discussing insights in immunology during pregnancy. We conclude that although influenza A/H1N1pdm09 is in the post pandemic phase, infection by this influenza virus still needs to be considered in pregnant women with progressive respiratory dysfunction.
During the influenza A/H1N1pdm09 or swine flu pandemic, pregnant women appeared to be at increased risk for admission to an intensive care unit (ICU) because of complications of this viral disease. Although the World Health Organization has announced the disease to be postpandemic since August 2010, several mutations capable of causing severe illness have been isolated afterwards. After this pandemic phase, we admitted several pregnant women who were severely affected by influenza A/H1N1pdm09. In this article, we would like to draw attention to the possible severe complications of an - at that moment - seasonal influenza in pregnancy and try to explain its immunological origins. We hope to contribute to a greater awareness of influenza-related morbidity during pregnancy to prepare for future influenza pandemics.
None of the authors has any interest to disclose. No financial support was given to prepare this manuscript.