tetano
Editor, Senior Moderator
Vaccine. 2016 Dec 23. pii: S0264-410X(16)31219-1. doi: 10.1016/j.vaccine.2016.12.012. [Epub ahead of print]
[h=1]Pregnancy as a risk factor for severe outcomes from influenza virus infection: A systematic review and meta-analysis of observational studies.[/h] Mertz D[SUP]1[/SUP], Geraci J[SUP]2[/SUP], Winkup J[SUP]3[/SUP], Gessner BD[SUP]4[/SUP], Ortiz JR[SUP]5[/SUP], Loeb M[SUP]6[/SUP].
[h=3]Author information[/h]
[h=3]Abstract[/h] [h=4]BACKGROUND:[/h] Pregnancy is considered to be an important risk factor for severe complications following influenza virus infection. As a consequence, WHO recommendations prioritize pregnant women over other risk groups for influenza vaccination. However, the risk associated with pregnancy has not been systematically quantified.
[h=4]PURPOSE:[/h] Systematic review and meta-analysis of observational studies that reported on pregnancy as a risk factor for severe outcomes from influenza virus infection.
[h=4]DATA SOURCE:[/h] MEDLINE, EMBASE, CINAHL, and CENTRAL up to April 2014.
[h=4]DATA SELECTION:[/h] Studies reporting on outcomes in pregnant women with influenza in comparison to non-pregnant patients with influenza. Outcomes included community-acquired pneumonia, hospitalization, admission to intensive care units (ICU), ventilatory support, and death.
[h=4]DATA EXTRACTION:[/h] Two reviewers conducted independent screening and data extraction. A random effects model was used to obtain risk estimates. Ecological studies were summarized descriptively.
[h=4]DATA SYNTHESIS:[/h] A total of 142 non-ecological and 10 ecological studies were included. The majority of studies (n=136, 95.8%) were conducted during the 2009 influenza A (pH1N1) pandemic. There was a higher risk for hospitalization in pregnant versus non-pregnant patients infected with influenza (odds ratio [OR] 2.44, 95% CI 1.22-4.87), but no significant difference in mortality (OR 1.04, 95% CI 0.81-1.33) or other outcomes. Ecologic studies confirmed the association between hospitalization risk and pregnancy and 4 of 7 studies reported higher mortality rates in pregnant women.
[h=4]LIMITATIONS:[/h] No studies were identified in which follow-up began prior to contact with the healthcare system and lack of adjustment for confounding factors.
[h=4]CONCLUSIONS:[/h] We found that influenza during pregnancy resulted in a higher risk of hospital admission than influenza infection in non-pregnant individuals, but that the risk of mortality following influenza was similar in both pregnant and non-pregnant individuals.
Copyright ? 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.
[h=4]KEYWORDS:[/h] Influenza; Pregnancy; Risk; Systematic review; Vaccination
PMID: 28024955 DOI: 10.1016/j.vaccine.2016.12.012
[PubMed - as supplied by publisher] Free full text
[h=1]Pregnancy as a risk factor for severe outcomes from influenza virus infection: A systematic review and meta-analysis of observational studies.[/h] Mertz D[SUP]1[/SUP], Geraci J[SUP]2[/SUP], Winkup J[SUP]3[/SUP], Gessner BD[SUP]4[/SUP], Ortiz JR[SUP]5[/SUP], Loeb M[SUP]6[/SUP].
[h=3]Author information[/h]
[h=3]Abstract[/h] [h=4]BACKGROUND:[/h] Pregnancy is considered to be an important risk factor for severe complications following influenza virus infection. As a consequence, WHO recommendations prioritize pregnant women over other risk groups for influenza vaccination. However, the risk associated with pregnancy has not been systematically quantified.
[h=4]PURPOSE:[/h] Systematic review and meta-analysis of observational studies that reported on pregnancy as a risk factor for severe outcomes from influenza virus infection.
[h=4]DATA SOURCE:[/h] MEDLINE, EMBASE, CINAHL, and CENTRAL up to April 2014.
[h=4]DATA SELECTION:[/h] Studies reporting on outcomes in pregnant women with influenza in comparison to non-pregnant patients with influenza. Outcomes included community-acquired pneumonia, hospitalization, admission to intensive care units (ICU), ventilatory support, and death.
[h=4]DATA EXTRACTION:[/h] Two reviewers conducted independent screening and data extraction. A random effects model was used to obtain risk estimates. Ecological studies were summarized descriptively.
[h=4]DATA SYNTHESIS:[/h] A total of 142 non-ecological and 10 ecological studies were included. The majority of studies (n=136, 95.8%) were conducted during the 2009 influenza A (pH1N1) pandemic. There was a higher risk for hospitalization in pregnant versus non-pregnant patients infected with influenza (odds ratio [OR] 2.44, 95% CI 1.22-4.87), but no significant difference in mortality (OR 1.04, 95% CI 0.81-1.33) or other outcomes. Ecologic studies confirmed the association between hospitalization risk and pregnancy and 4 of 7 studies reported higher mortality rates in pregnant women.
[h=4]LIMITATIONS:[/h] No studies were identified in which follow-up began prior to contact with the healthcare system and lack of adjustment for confounding factors.
[h=4]CONCLUSIONS:[/h] We found that influenza during pregnancy resulted in a higher risk of hospital admission than influenza infection in non-pregnant individuals, but that the risk of mortality following influenza was similar in both pregnant and non-pregnant individuals.
Copyright ? 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.
[h=4]KEYWORDS:[/h] Influenza; Pregnancy; Risk; Systematic review; Vaccination
PMID: 28024955 DOI: 10.1016/j.vaccine.2016.12.012
[PubMed - as supplied by publisher] Free full text