Age: 22.0
Sex: F
Vaccine: FLUX, FLUX
Symptoms: Acute kidney injury, Caesarean section, Death, Exposure during pregnancy, Febrile neutropenia
Clinical narrative: Mother case: Case number PHHY2015US039048, is an initial literature case report received on 26 Mar 2015. The author in the article discussed about the pregnancy and severe influenza infection in the 2013/2014 influenza season. This report refers to a 22-year-old female pregnant patient. The patient's current conditions included congenital neutropenia, hypertension and recurrent skin abscesses. The patient's obstetric history included gravida 2 and para 1. The patient was on prenatal care. No concomitant medication was reported. The patient was vaccinated with seasonal influenza vaccine (manufacturer and batch number: not reported) on an unknown date. It was reported that the patient was vaccinated during pregnancy at least two weeks before the onset of symptoms. The patient 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 patient experienced neutropenic fever, pneumonia and sepsis. The patient had an emergent cesarean delivery on admission to alleviate maternal hypoxia and delivered neonate at a gestational age of 32 weeks (see child case: PHHY2015US038994). The patient 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. Patient's laboratory results confirmed positive for influenza A infection by polymerase chain reaction (PCR) and subtyped as pH1N1. The patient had no microbiologic evidence of a bacterial co-infection. The patient was in the hospital for seven days and the patient died in the hospital. Seriousness of the event "confirmation of influenza A infection by polymerase chain reaction (PCR) and subtyped as pH1N1 (vaccination failure)" was upgraded based on NVS-IME list. 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.