Infection with the intestinal parasite giardia lamblia more than triples the risk of persistent irritable bowel syndrome (IBS) and chronic fatigue, lasting up to three years, indicates research published online in Gut.

Furthermore, the infection seems to spark an increased risk of having both conditions at the same time, prompting the authors to suggest that “the long-term clinical consequences of giardia may be more severe than previously thought”.

Giardia lamblia is a parasite that is found on every continent. It is a common source of acute and longer-term gut infection, and frequently implicated in travellers’ diarrhoea in tropical and subtropical areas, particularly where hygiene is poor.

It is mainly spread through contaminated drinking water, but it can also be passed on through person-to-person contact. It had been thought that once treated, it did not cause any long-term problems.

The researchers tracked the health of 817 local residents who had become infected with giardia in 2004 and more than 1,000 healthy people, matched for age and sex, for a period of three years. The source of the infection was contaminated water from a reservoir in Bergen, Norway.

They found that the prevalence of IBS was significantly higher in those who had had the infection. These people were more than three times as likely to have persistent IBS, after taking account of factors likely to unduly influence the results.

They were also four times as likely to have chronic fatigue symptoms.

What is more, the researchers found that the likelihood of having both conditions together was almost seven times as high among those who had had the infection.

Normally, the prevalence of IBS and chronic fatigue tends to be higher in women, but there was no evidence of a gender bias among the study participants.

Giardia infection is not endemic in Norway and the researchers cautioned that their findings may not be applicable to countries outside the developed world; further research would be needed before such conclusions could be drawn.

Gut (2011). doi:10.1136/gutjnl-2011-300220.

By Mary Anne Kenny.

No substantial link has been found between the swine flu vaccine and Guillain-Barré syndrome, experts have confirmed this week.

Adjuvanted vaccines used during the 2009 swine flu pandemic did not increase the risk of Guillain-Barré syndrome substantially, if at all, according to a large Europe-wide study just published on bmj.com. The study provides reassurance about potential risks of adjuvanted pandemic influenza vaccines. It also exemplifies the use of a newly available infrastructure in Europe, which may help to provide reliable risk assessments related to future concerns. An adjuvant is a substance added to a vaccine to stimulate the immune system to respond to the vaccine.

Guillain-Barré syndrome is a rare disorder in which a person’s own immune system damages the nerve cells, causing muscle weakness and sometimes paralysis.

In 1976, a vaccine used during a US flu pandemic was linked with the syndrome and vaccination was stopped abruptly. Since then, studies have shown no or only slight increases in risk but, to date, the role of flu vaccines as a trigger in Guillain-Barré syndrome has remained controversial.

The European Centre for Disease Prevention and Control requested and funded a consortium of European researchers (VAESCO) to estimate the risk of Guillain-Barré syndrome following pandemic influenza A (H1N1) 2009 vaccination.

The BMJ study was carried out in a population of 50 million people across five European countries that vaccinated people during the 2009 swine flu pandemic. A total of 104 cases of Guillain-Barré syndrome (and its variant Miller Fisher syndrome) were matched to one or more controls.

After adjusting for recognised risk factors, such as influenza-like illness or upper respiratory-tract infection and seasonal influenza vaccination, the researchers could find no association between pandemic flu vaccination and Guillain-Barré syndrome. The consistent pattern found across countries also provides reassurance about the findings, they added.

However, they pointed out that they could not rule out the possibility of a small increased risk remaining.

Based on these results, they estimated this risk to be less than three excess cases of Guillain-Barré syndrome for every million individuals protected by the vaccination.

They concluded: “This study provides reassurance that adjuvanted pandemic influenza A (H1N1) 2009 vaccines did not increase the risk of Guillain-Barré syndrome substantially, if at all.” They also said that larger studies, using different techniques to minimise bias, were currently under way that will give a clearer picture of the link between flu vaccines and Guillain-Barré syndrome.

This view was supported in an accompanying editorial by US researchers, who say the risk of Guillain-Barré syndrome was considerably smaller than that seen with the 1976 swine flu vaccines. They added that safety findings on adjuvanted flu vaccines were important if such vaccines were to become more common in future, whether in seasonal flu vaccines or for the next pandemic.

www.bmj.com/cgi/doi/10.1136/bmj.d3908

Female Anopheles stephensi mosquito feeding on human blood. This mosquito is a vector of the parasite Plasmodium, the agent of malaria

Dr Elizabeth Cullen discusses the possibility of malaria taking hold in Ireland as a result of climate change and the potential conditions required for such a scenario.

“It is well to remember the possibility of cases [of malaria] returning to Cork at some future date. For it is clear… that all that is necessary is a return of regularly recurring hotter summers over a definite period of years, and the malaria–carrying Anopheles will inevitably re-establish themselves and infect a certain proportion of the community, in the course of time. Given suitable breeding conditions, malaria becomes inevitable.”

Malaria is the world’s most important vector borne disease2, resulting in 247 million cases and one million deaths in 2008 globally.  Although not endemic in Ireland, malaria has been a cause of serious illness in the past. The disease was noted in the 17th Century by Cromwell’s physician4 and the high incidence of malaria in Cork in the mid-1880s was attributed to three factors, namely high temperatures, a boggy area in the vicinity, and the return of survivors from the war in the Crimea, where the disease was rampant.

Temperature is the most critical climatic factor in the distribution of malaria5 and mosquitoes may be amongst the first organisms to extend their range with climate change, because of the rapidity with which they can increase their numbers. The range where this disease may occur therefore is predicted to alter with climate change.

The evidence that the global climate system is warming is unequivocal.  An analysis of long-term meteorological data shows that Irish temperature trends have largely followed the global trend of increasing temperatures, with a mean increase of 0.7°C observed over the period 1890-2004. Warming of approximately 0.2°C per decade is projected for Ireland over the next two decades, with estimates ranging from 1.8°C-4.0°C during this century.

Southern Ireland
In addition, the impacts of climate change will result in a rise in sea level, with areas in southern Ireland likely to feel the effects initially, particularly low-lying coastal locations with little or no natural protection and located on ‘soft’ or easily-eroded material.

Malaria is a notifiable disease in Ireland since 1948  and cases of malaria today are generally associated with people travelling to Ireland from areas where it is endemic, in people who did not avail of full prophylactic treatment while abroad or have relapses of an earlier illness.

However, the reported number of cases of imported malaria has increased in recent years, from an average of 20 cases between 2001 and 2004, to an average of 77 per year from 2005-2009, when two deaths were reported.

While some of this increase may have been due to an increase in notifications, at least a portion of it reflects a genuine increase. Where the species was known, the more serious P Falciparum was the commonest organism found.

Transmission of malaria
The transmission of malaria is complex. Initially, female mosquitoes become infected with the causative plasmodium from a person who has already been bitten and whose blood contains the immature male and female developmental stages of the plasmodium. Following ingestion of such blood by a mosquito, the immature stages of the plasmodium unite in its stomach; after maturation, the plasmodium enters the human from its salivary gland when they are bitten.

Three elements are essential for malaria to be endemic in a country: firstly, mosquitoes must be present; secondly, there must be a supply of subjects with the causative plasmodium organism in their blood; and finally, the climate must be suitable for the development of the plasmodium in the mosquito.

The interaction of these three variables is clearly seen in Australia. Although the climate in the north is suitable for the transmission of malaria, and mosquitoes are plentiful, there are too few infected subjects to act as a reservoir of infection. In contrast, in the south, although there are more infected subjects, there are fewer mosquitoes and the mean temperatures are not adequate for the development of the parasite in the vector.

Future incidence
The future incidence of malaria in Ireland may be examined from the perspective of the three variables outlined, namely: the presence of mosquitoes; the presence of people with the plasmodium in their blood; and temperature.

At present there are at least four species of mosquito in Ireland capable of transmitting the less harmful P vivax, namely Anopheles atroparvus, An. algeriensis, An. claviger and An. plumbeus. However, additional species from warmer countries may establish in Ireland as a result of the increase in temperatures arising from climate change.

At present, An. atroparvus is considered the most important potential vector of malaria in the UK, as the distribution of this anthrophilic mosquito is coincident with the historical distribution of the disease in the UK. This mosquito prefers brackish water along river estuaries and a rise in sea levels may increase the number of salt marshes suitable for the survival of the mosquito.

There are over 200 salt marshes in Ireland at present.

In relation to the second requirement relating to the availability of a sufficient number of hosts with infected parasites in their blood, at present, this occurs when people with infected parasites in their blood travel to Ireland from areas of the world where malaria is endemic.

However, changes in the areas where malaria is endemic may alter as the impacts of climate change become manifest and increases in the incidence of malaria outside Ireland may therefore affect the risk of imported cases.

In addition, the number of international journeys taken by Irish residents has substantially increased in recent years, from 76,000 in 2003 to 153,000 in 2007. Significantly, almost three-quarters of people diagnosed with malaria in Ireland took no prophylaxis while travelling and of those who did, less than a quarter took it as directed.

In relation to the temperature, the development of P. vivax is completely inhibited at temperatures below 15°C and the more serious P. Falciparum, below 19°C13. The climate around Dublin Airport is climatically suitable at present for the survival of the Anopheles mosquito during the summer months. The estimated rise in mean summer temperatures of 2°C by 2050 therefore fulfils the temperature criteria for malaria to become endemic.

The possibility of malaria becoming a public health problem in Ireland depends on the interaction of the three variables outlined and the public health response to these developments. While the changes in temperature in Ireland may well become more suited to the development of the plasmodium in the mosquito and the habitat of the mosquito may increase, it is unlikely that the third criterion for malaria to become endemic will be met, namely, that there will be a sufficient number of people with the causative organism in their blood.

There is a risk of ‘airport malaria’ resulting from the inadvertent carriage of mosquitoes in airplanes. The mosquito can be found up to seven kilometres from the airport, or further if it is in baggage. A total of 89 cases of airport malaria were reported in 12 countries over a 30-year time period.

International Health Reg-ulations (IHR) require countries to check that airplanes coming from malaria-endemic areas are systematically disinfected. Nevertheless, although the possibility exists that airport malaria may occur, particularly if there are salt marshes in the vicinity of airports, existing public health resources, including disease surveillance, medical treatment and surface water management would make the re-emergence of malaria unlikely in Europe.

Surveillance
The need for continued surveillance and prompt investigations, alongside effective disinfection procedures on planes, has been stressed. In addition, as part of a long-term strategy for the control of malaria in Europe, the WHO Regional Office has set up the Malaria Surveillance and Control Programme, with the aims of establishing surveillance systems and strengthening national capabilities in case detection and treatment.

Guidelines have also been published in order to prevent a locally-acquired mosquito-transmitted malaria outbreak from becoming a source of sustained transmission.

It will also be necessary to implement a surveillance system for monitoring the distribution and abundance of mosquitoes.

In conclusion, while the multi-factorial aetiology of malaria makes it difficult to accurately quantify the impact of climate change on the incidence of malaria in Ireland, the risk of emergence of malaria in this country, in the absence of a collapse in public health structures, appears to be unlikely.

References on request

• This work was undertaken with the support of the Environmental Protection Agency doctoral scheme.

Dr Margaret Chan, WHO

Global partners use World TB Day to call for increased commitment to tackle multidrug-resistant TB, reports Dara Gantly.

The World Health Organization (WHO), the Global Fund to Fight AIDS, Tuberculosis and Malaria and the Stop TB Partnership are calling on world leaders to step up their commitment and contributions to meet the goal of diagnosing and treating one million people with multidrug-resistant tuberculosis (MDR-TB) between 2011 and 2015.

On World TB Day (March 23), the WHO released a report, ‘Towards Universal Access to Diagnosis and Treatment of MDR-TB and XDR-TB by 2015’, which presents progress in the MDR-TB and extensively drug-resistant tuberculosis (XDR-TB) response in the countries with the highest burden of drug-resistant TB.

“Many countries have made progress, but despite the recent scale-up in efforts, the world needs to do much more to get care to all MDR-TB patients who need it,” explained Dr Margaret Chan, WHO Director-General. “We cannot allow MDR-TB to spread unchecked.”

Leaving MDR-TB untreated increases the risk of spread of drug-resistant strains of TB. The WHO estimates there will be more than 2 million new cases of MDR-TB between 2011 and 2015.

Programmes financed by the Global Fund and following WHO treatment standards are expected to diagnose and treat about 200,000 people for MDR-TB by 2015, a fourfold increase from those 50,000 patients who are currently undergoing treatment.

“MDR-TB is a threat to all countries, as it is difficult and expensive to treat. Unless we make an extraordinary effort to tackle this problem, our ability to finance and secure continued progress against TB in general will be threatened,” added Prof Michel Kazatchkine, Executive Director of the Global Fund.

“It is time for countries with rapidly-growing economies and a heavy burden of MDR-TB to step up their commitment and financing for their own MDR-TB programmes. Several have the capacity to show new leadership on south-south co-operation and aid to neighbouring countries that are also affected,” stated Dr Jorge Sampaio, the UN Secretary-General’s Special Envoy to Stop TB.

Since 2009, the 23 countries most heavily affected by TB drug resistance have nearly doubled their budgets for MDR-TB. From 2002 through 2010, Global Fund-financed TB programmes around the world have provided treatment to 7.7 million people and saved the lives of 4.1 million.

“The Global Fund’s success can be measured in the number of lives that have been saved through care provided by the TB programmes it finances,” said Dr Lucica Ditiu, Executive Secretary of the Stop TB Partnership.

“Every TB patient should have access to proper care. We advocate on behalf of millions of patients worldwide and our strong partners, such as WHO and the Global Fund. To reach a million people with effective care for MDR-TB over the next five years, we will need to work closely with all partners, especially with affected communities.”

Comic relief: Luís Figo meets some children of an elementary school in Rome for the presentation of the comic strip ‘Luis Figo and the World Cup against tuberculosis’ to help in the fight against the killer disease

Richard Fitzpatrick interviews football legend Luís Figo, WHO Stop TB Ambassador, about giving the fight against tuberculosis a sporting chance.

Luís Figo is having an interesting second half. I caught up with the former FIFA World Player of the Year in a restaurant in the Madrid neighbourhood where he lives to chat to him about his football career and his work as a Goodwill Ambassador against TB. It was a couple of days before World TB Day, which fell on Thursday, March 24.

World TB Day has been marked since 1982, in recognition of the day in 1882 when Dr Robert Koch in Berlin announced he’d discovered the cause of tuberculosis which, at the time, was killing one in every seven people infected. It is still a huge killer. Globally, 4,500 people die from TB every day, according to the World Health Organization (WHO).

The number of cases of TB has been rising globally since 1985. More than 80 per cent of India’s adult population have had the disease at least once.

One-third of the world’s population carries the infection at present, according to the WHO, but it remains dormant in most incidences.

In Ireland, for example, about 5 per cent of the population has the latent form of the disease. Indeed, there has been a slight increase in the number of cases recorded in Ireland over the past decade.

In 2001, there were 381 cases; now it’s approximately 470 a year, according to Dr Joseph Keane, Consultant Respiratory Physician at St James’s Hospital, Dublin.

Inexpensive cure
“It is a disease that has a cure. That’s what people have to know,” explained Figo. “Also, that anyone can get it. Just a few days ago there were some cases reported in Milan in a wealthy neighbourhood. And its cure doesn’t cost much. In developing world countries, for example, it is treatable with approximately €20 of medicine over a six-month period.”

Figo set up a charitable foundation in his native Portugal in 2003, while at the height of his football fame, and worked for a couple of years as a goodwill ambassador with UNICEF. But the relationship ended through inactivity, he says. He’s far more enthused now about his relationship with the World Health Organization, where he has been a Stop TB  Ambassador since January 2008.

“I got started following an invitation by Jorge Sampaio, former President of Portugal, who is a worldwide ambassador of Stop TB,” he told me.

“Also, because it is an illness that kills about 4,500 people a day even though there’s a cure for it. Through the prestige I’ve earned in sports, we try to spread information about this disease. Sometimes it is just basic information that not too many people know, but can keep people away from the disease.

“The biggest surprise, for me, is that in 2011 about 1.7 million people are still dying of TB. Many organisations that had HIV programmes in the developing world didn’t have any to treat TB until recently, when, for example, we did an education campaign around a football event in Nairobi. That was in December 2009. Since then, we’ve established more prevention programmes.”

Comic campaigns
Figo has lent his image to a string of promotional vehicles, such as a 30-second ad that has aired on CNN, amongst other global TV networks; a six-minute animated film, which uses the narrative of a football match to educate kids about TB; and even a comic book. Interestingly, some of the younger children he’s met while on site visits in the developing world recognise him from the comic, but know nothing of his real-life prowess as a footballer. And what a career.

The Portuguese football star retired at the end of the 2009 season, his 20th as a professional player. With the exception of Ryan Giggs, it’s hard to think of another modern-era player who has played at the top for so long. Although good and all as the Manchester United winger is, he’s still not at Figo’s level. I once asked Manolo Sanchis, Real Madrid’s captain when the club won the Champions League crown in 1998, who was the most difficult opponent he’d ever played against. The grizzly old central defender said it was Figo — that he was even more of a handful than Diego Maradona or the Brazilian Ronaldo.

Figo won eight league medals in Spain and Italy, as well as a Champions League medal with Real Madrid in 2002. He played 127 times for Portugal and preceded his FIFA World Player of the Year award in 2001 with the Ballon d’Or award in 2000. That summer, he probably caused the biggest soccer transfer kerfuffle in history when he moved from Barcelona to their despised rivals, Real Madrid.

Three months after leaving Barcelona, when he returned to the Camp Nou with his new teammates for Real Madrid’s annual league fixture in the Catalan capital, the stadium was festooned with giant 5,000 peseta notes, his face superimposed on them along with the statement, ‘Figo, pesetero’ [money-grabbing or mercenary].

In the pantomime world of the Barcelona football fan, he was un traidor, a traitor. “We hate you so much because we loved you so much,” exclaimed one banner melodramatically. Fans yelled “Die Figo” as he took to the pitch, shattering previous records on the sound meter that Canal Plus television had installed for the match. Thousands of white handkerchiefs fluttered in the wind, a practice borrowed from bullfighting, signalling that he should be sentenced to death.

Anytime he ventured near one of the corners of the pitch, objects rained down on top of him. They included, recorded the referee in his notebook: coins; three mobile phones; several half-bricks; and a bicycle chain!

“I knew that the atmosphere was going to be bad,” he recalled about that night, “partly because the media created it that way, but I went with the idea of playing better football and to win more titles. I didn’t care much for the atmosphere.”

Pig’s head
The atmosphere was arguably worse two years later. In late-November 2002, in the same tie, the game had to be suspended for 16 minutes. Along with plastic bottles, lighters and beer cans, Figo had been assailed by a glass bottle of J&B Scotch whisky. Someone also tossed the head of a suckling pig at him, which, strangely, was in keeping with the sight of him at the corner flag — helplessly prey to flying objects as if he were a petty criminal pilloried in an Elizabethan marketplace.

When I ask him if he noticed the pig’s head, he says, smiling, that he didn’t.

These days life is at an easier pace. He doesn’t bother going to the Santiago Bernabéu, Real Madrid’s stadium, which is only a couple of kilometres from where he lives, to watch matches. He has other interests, including, of course, the Stop TB campaign. How long will he stay working with them? “Until they get tired of me,” he says, with a laugh.

For more information, visit: www.stoptb.org.

A group at UCD is researching the effects on electrical activity in their brain, which is related to learning, of a chemical found in high concentrations in Alzheimer’s disease patients.
The group — led by Dr Caroline Herron, Senior Lecturer at UCD’s School of Biomolecular and Biomedical Science — is investigating the effects of agents that interact with a set of cell surface proteins known as cannabinoid receptors. It has been shown that amyloids increase production of endocannabinoids.

The group hopes to determine if these agents could be used to protect normal brain cell function against the effects of amyloid beta protein. “Endogenous chemicals in the body act on cannabinoid receptors. These modulate activity in the brain at a low level,” said Dr Herron.
Local production of endocannabinoids in neuroinflammatory conditions is now considered a natural protective mechanism. CB2 receptors are present in a specific microglial cell type of the human cerebellum. These receptors are almost absent from the CNS in normal conditions but are up-regulated in glial cells under chronic neuroinflammatory stimuli – as has been described in AD. It is thought there is an increase in CB2 type microglial cells in inflammatory conditions.
In an attempt to understand the function of these receptors, a Spanish study tested their role in the process of A beta removal – currently considered as one of the most promising experimental approaches for the treatment of Alzheimer’s.
The Spanish team last year reported data indicating that the activation of CB2 receptors by low concentrations of the cannabinoid CB2 agonist JWH-015 resulted in the removal of pathological deposits with remarkable potency. Decreases of up to 64 per cent in plaque area were reported. The activation of cannabinoid CB2 receptors stimulates amyloid beta removal in situ and in vitro, it was found.

A targeted programme of preventive antiviral medication, combined with the use of hand sanitisers and surface contamination, was associated with containing the spread of the H1N1 virus in a summer camp setting, according to a new report.
With rare exceptions, the H1N1 virus has retained sensitivity to the antiviral medication oseltamivir phosphate. The drug has been proven to prevent the spread of seasonal flu in settings such as households and nursing homes.

Against that background, doctors investigated the targeted use of the drug in containing the spread of H1N1 at a boys’ camp in Alabama in July of 2009. A total of 171 campers, 48 camp counsellors and 27 camp staff were involved. Three campers tested positive for H1N1 during one of the camp’s two-week sessions.
These received oseltamivir and were immediately isolated and sent home. All campers and counsellors in the infected child’s adjoining cabins took oseltamivir prophylactically for 10 days. In addition, alcohol-based hand sanitisers were provided throughout the camp; counsellors also received advice about the spread of influenza and its prevention.
All surfaces in communal areas were also sprayed or wiped down every day. No additional campers, counsellors or staff members became ill during the session and no campers tested positive for H1N1 after returning home. The three infected campers constituted an attack rate – the percentage of individuals who get sick out of the total population – of 1.8 per cent.
Some 78 per cent of the staff and counsellors and about 31 per cent of campers experienced one or more adverse events, such as nausea, vomiting or headache, from the medication. However, none of the adverse events resulted in discontinuation of the therapy.
Online edition of Archives of Pediatrics and Adolescent Medicine, available at www.jamamedia.org

Among infants and children hospitalised in Kenya with severe pneumonia, respiratory syncytial virus (RSV) appears to be the predominant virus detected, according to a new study.
In the study, doctors examined the viral causes of severe pneumonia among infants and children at a rural Kenyan district hospital using comprehensive and sensitive molecular diagnostic techniques. Participants were children aged one day to 12 years who presented and were admitted to Kilifi District Hospital for severe pneumonia or very severe pneumonia; presented with mild upper respiratory tract infection but were not admitted who presented for immunisation.

Nasal wash samples were obtained from the children and analysed for the presence of respiratory viruses. From January 1, 2007, through December 31, 2007, there were 922 eligible infants and children with severe pneumonia or very severe pneumonia admitted, and viral screening was conducted on 82 per cent of patients.
One or more respiratory viruses were detected in 425 participants in the case group. The researchers found that RSV was the most commonly detected virus, present in 260 admissions overall and in 192 of 453 infants. Other respiratory viruses were detected in 219 admissions. From their findings, the study’s authors concluded that detection of RSV was associated with admission with severe disease when compared with well control participants, and that these findings offer support that RSV vaccination may offer considerable public health benefit.
JAMA 2010;303:2051-2057

In a tropical environment, influenza A(H1N1) appeared milder than seasonal flu, was less likely to cause fever and upset stomach and more likely to infect younger individuals, according to a new report.
In 2009, a new rapid detection method was designed to detect genes from the new influenza A(H1N1) virus and was used during a period of enhanced surveillance for influenza after global pandemic alerts were announced.

Against such a background, doctors analysed trends and symptoms among patients in Singapore during this period, from May to July 2009.
During the 12-week surveillance period, 2,683 individuals with symptoms, close contacts or travelers were tested using the rapid-detection assay. Of these, 742 (27.6 per cent) were positive for any type of influenza virus, including 547 cases (20.4 per cent) of influenza A(H1N1).
Early pandemic influenza cases appeared slightly milder than seasonal flu and had a different symptom pattern. The most common symptoms among individuals with pandemic influenza were cough (88.1 per cent), fever (79.3 per cent), sore throat (53.7 per cent) and runny nose (49.9 per cent). Individuals with the predominant strain of seasonal influenza most commonly had fever (88 per cent), cough (81.4 per cent), runny nose (55.7 per cent) and sore throat (38.3 per cent).
Seasonal influenza affected individuals of all ages, with a higher proportion of those five years and younger, while the pandemic virus was more likely to affect children and young adults and had very few elderly cases.
“It is likely that these symptom patterns will continue to evolve and change as the novel pandemic influenza A(H1N1/2009) eventually predominates, globally, in the susceptible human population,” the authors concluded from the findings.
“However, this early window period in this first wave of the pandemic has provided an opportunity to compare the symptomatology of these different influenza viruses in this particular tropical environment and ethnically diverse population during this transitional period.”
Archives of Internal Medicine 2010;170:861-867

Pregnant women who contract the H1N1 flu strain are at risk of developing obstetrical complications, including foetal distress, premature delivery, emergency Caesarean delivery and foetal death, according to a new report. It followed a study in which researchers analysed data from 18 patients admitted to two urban academic medical centres with a diagnosis of H1N1 from May 18-June 24, 2009.
The results were then compared with published reports of the H1N1 outbreak and reports of flu pandemics of 1918 and 1957.

All patients were treated with oseltamivir phosphate on admission. Three of the 18 were admitted to intensive care and seven delivered during their hospital stay – six prematurely. Of these six, five involved foetal distress and four were delivered via emergency Caesarean delivery. Two foetal deaths were recorded: no maternal deaths were reported.
“Little data are available regarding foetal outcomes and mortality rates among H1N1-infected mothers. Of the 18 patients in this series, one had a spontaneous abortion and one died post-natally from complications of extreme prematurity and sepsis,” the authors reported.
They conclude that the H1N1 virus poses a serious health threat to pregnant patients. They add that foetal distress necessitating emergency Caesarean delivery may result in significant illness; however, this study showed an absence of maternal deaths as compared to prior study results.
Archives of Internal Medicine 2010;170:868-873