Sex: U
Vaccine: FLUX, FLUX
Symptoms: H1N1 influenza, Haemodialysis, Hypotension, Hypoxia, Influenza A virus test positive
Clinical narrative: Baby case: Case number PHHY2015US038994, is an initial literature case report received on 26 Mar 2015. The author in the article discussed about pregnancy and severe influenza infection in the 2013/2014 influenza season. This report refers to a neonate of unknown gender. The neonate's mother current conditions included congenital neutropenia, hypertension and recurrent skin abscesses. The neonate's mother's obstetric history included gravida 2 and para 1. The neonate's mother was on prenatal care. No concomitant medication was reported. The neonate's mother was vaccinated with seasonal influenza vaccine (manufacturer and batch number: not reported) on an unknown date. It was reported that the neonate's mother was vaccinated during pregnancy at least two weeks before the onset symptoms. The neonate's mother was evaluated in an outpatient setting for respiratory symptoms and received outpatient care before hospitalization. Four days after the onset of the symptoms the patient received antiviral treatment. On an unknown date after vaccination at 32 weeks of gestation, the neonate's mother experienced neutropenic fever, pneumonia and sepsis (see mother case: PHHY2015US039048). The neonate's mother had an emergent cesarean delivery on admission to alleviate maternal hypoxia and delivered neonate at a gestational age of 32 weeks. The neonate's mother required hemodialysis for acute renal failure, intravenous pressors for low blood pressure and was placed on mechanical ventilation. The outcome of the events neutropenic fever, acute renal failure, pneumonia, low blood pressure, maternal hypoxia and sepsis was not reported. The neonate's mother laboratory results confirmed positive for influenza A infection by polymerase chain reaction (PCR) and subtyped as pH1N1. The neonate's mother had no microbiologic evidence of a bacterial co-infection. The neonate's mother was in the hospital for seven days and the neonate's mother died in the hospital. Seriousness of the event "delivered neonate at a gestational age of 32 weeks" was upgraded based on information available in the source document. The author stated that influenza remains a significant cause of morbidity and mortality in pregnant and postpartum women. Although vaccination was not 100 percent effective given the higher risk of influenza complications among pregnant and postpartum women, it was incumbent that health care providers and obstetricians provide education and counseling to every pregnant woman about its benefits for both mother and neonate. The author concluded that most of the pregnant women in the current literature case series had previously given birth, suggesting the possibility that other small children in the household could also be a source of transmission. Because influenza vaccination was universally recommended, strategies for reducing transmission in pregnant and postpartum women should include vaccination of the entire household unit; likewise, early initiation of antiviral treatment in infected household members who may have close contact with pregnant and postpartum women should be considered.