Age: 27.0
Sex: F
Vaccine: FLUX
Symptoms: Exposure during pregnancy, Foetal disorder, Hypotension, Influenza, Influenza A virus test positive
Clinical narrative: Initial unsolicited pregnancy report received from literature on 19 November 2015. This case is linked to 2015SA192129 (same literature). Abstract: Given the illness and deaths caused by respiratory syncytial virus (RSV) infection during the first year of life, preventing infant RSV infections through maternal vaccination is intriguing. However, little is known about the extent and maternal effects of RSV infection during pregnancy. We describe 3 cases of maternal RSV infection diagnosed at a center during winter 2014. Case-patient 1 (26 years old, week 33 of gestation) received a diagnosis of RSV infection and required mechanical ventilation. Case-patient 2 (27 years old, week 34 of gestation) received a diagnosis of infection with influenza A (H1N1) virus and RSV and required mechanical ventilation. Case-patient 3 (21 years old, week 32 of gestation) received a diagnosis of group A streptococcus pharyngitis and RSV infection and was monitored as an outpatient. Clarifying the effects of maternal RSV infection could yield valuable insights into potential maternal and fetal benefits of an effective RSV vaccination program. This case involves a 27-year-old female patient who was vaccinated with influenza vaccine (batch number, site of administration were not reported) on unspecified date during pregnancy. It was reported that at the time of vaccination the patient was 34 weeks and day 4 pregnant (gravida), LMP not reported. Hence, it was a case of drug exposure during pregnancy. The patient's prior obstetric history was notable for a spontaneous abortion at 8 weeks, and her medical history was notable for childhood asthma and smoking one half to 1 pack of cigarettes per day before pregnancy and concomitant medications were not reported. On an unspecified date after vaccination, patient presented worsening cough, congestion, fevers, chills, dyspnea, fetal hydrocephalus consistent with aqueductal stenosis (which was diagnosed during the second trimester), on hospitalization day 2 experienced membranes ruptured, breech presentation, congestion, pulmonary edema, cough was productive for green sputum, evoked concern for pneumonia, exacerbation of asthma, hypotension, tachycardia. Later the patient was diagnosed with group influenza A (H1N1) virus and RSV (Respiratory syncytial virus infection). On an unknown date patient was hospitalized. Laboratory investigations included rapid influenza test which was negative, leukocyte count was 21*109 cells/L, chest radiograph showed a nonspecific opacity in the right middle lobe, oxygen saturation was stable (94 percent to 94 percent on room air) and nasopharyngeal aspirate was sent to be tested by viral respiratory PCR panel (eSensor; GenMarkDx) which panel was positive for influenza A (H1N1) virus and RSV respectively. The patient was treated with a 5-day course of prednisone and albuterol for exacerbation of asthma, azithromycin for cough and fever and ceftriaxone, vancomycin, azithromycin, and oseltamivir for secondary bacterial infection. At the time of this report patient was not recovered from the events and on an unknown date, patient recovered from pulmonary edema. On hospitalization day 3 at 39 weeks of gestation, the patient underwent a classical cesarean delivery of a (birth weight 3,640 grams) female infant with Apgar scores of 3 and 7 at 1 and 5 minutes. Patient remained intubated and was transported to the surgical ICU after delivery. She was extubated without difficulty within an hour of ICU admission and transferred to the postpartum unit 12 hours after delivery. On hospitalization day 10, patient was discharged (discharge date not reported) home with percentage of oxygen saturation in the mid-90s on room air. Upon internal review, the case was assessed as serious due to important medical events fetal hydrocephalus consistent with aqueductal stenosis and membranes ruptured. Documents held by sender: none.