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（投稿：ｂｙ 僻地の産科医）
お久しぶりですo(^-^)o ..｡*♡
なかなかハードな私生活が続いていまして、なかなかブログの更新ができません。産婦人科、やっぱりハードですね（しみじみ）。もうやだよ～。
さて、久しぶりっ！！！
世界のことならこの方にお任せ（＞▽＜）！！！
いつもありがとうございます。
鶴亀松五郎先生より投稿がありました。
すごっく参考になる文献です。
時間が出来たら原典にあたってみたいと思います。
ではどうぞ！！！！
＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝
ランセットに掲載されたアメリカＣＤＣの新型Fluのリポートのカバー記事です。
大まかな内容は・・・
妊婦さんが新型Flu A(H1N1)にかかると重症化して死亡率も高いというリポートです。
アメリカＣＤＣに報告された2009年4月から6月までの死者45名のうち、6名が妊婦さん。死亡した妊婦さんは、それまでは健康であったが、fluにかかってからは重症化し、肺炎→人工呼吸器装着のコースをたどった。
死者45名のうちの妊婦の比率は１６％。
また、現在までの米国での死亡者302名のうち、ＣＤＣは266名の詳細なデータを把握しているが、そのうち妊婦さんの死亡者は15名で、死亡者中の比率は６％。
アメリカの全人口のうち、妊婦の比率は1年のどの時期をとっても人口の１％なので、総人口で見た場合の新型flu感染の妊婦の死亡率はかなり高い。
妊娠を延期したり、過度に不安になる必要はないが、新型fluにかかったと思ったらすぐに、医者を受診して出来るだけ早く、48時間以内に抗ウィルス薬を開始する必要がある。
また、病院では健康な妊婦と、状態の悪い妊婦を別のエリアにわけて診察して、感染拡大を予防すべきとのこと。
季節性のインフルエンザでも、予防接種をうける妊婦は14％未満なので、予防的なワクチン接種を考慮すべきである。
◎Swine flu striking pregnant women hard: CDC study
ロイター Wed Jul 29, 2009
（１）http://www.reuters.com/article/swineFlu/idUSTRE56S1GW20090729?pageNumber=1&virtualBrandChannel=0
（２）http://www.reuters.com/article/swineFlu/idUSTRE56S1GW20090729?pageNumber=2&virtualBrandChannel=0
By Julie Steenhuysen
CHICAGO (Reuters) - Pregnant women infected with the new H1N1 swine flu have a much higher risk of severe illness and death, U.S. government researchers said on Wednesday, confirming a trend that has worried global health experts.
While pregnant woman have always had a higher risk of severe disease from influenza in general, the new H1N1 virus is taking an exceptionally heavy toll, the researchers said.
"We do see a fourfold increase in hospitalization rates among ill pregnant women compared to the general population," Dr. Denise Jamieson of the U.S. Centers for Disease Control and Prevention said in a telephone interview.
"We're also seeing a relatively large proportion of deaths among pregnant women. We report 13 percent in the paper, but that is a very unstable number based on a small number of deaths reported," said Jamieson, whose study appears in the journal Lancet.
The study was based on the deaths of six pregnant women out of 45 deaths related to H1N1 reported to the CDC between April 15 and June 16.
All of the women were healthy prior to infection, and all developed pneumonia and needed to be put on a ventilator.
Jamieson said 302 deaths have been officially reported to the CDC from the new H1N1 virus.
"Among those, we have relatively complete information on 266 deaths. And of those, 15 have been among pregnant women, which is about 6 percent," Jamieson said.
Given that at any point, about 1 percent of the U.S. population is pregnant, she said, pregnant women "are definitely over-represented in terms of the proportion of deaths."
She said pregnant women do not need to change the way they live because of the new H1N1 flu.
"There is no reason to delay pregnancy or to be overly concerned. We do not have evidence that pregnant women have increased susceptibility or are more likely to acquire influenza," Jamieson said.
"It's just that when they have influenza they are at increased risk of having severe disease," she said.
Jamieson said pregnant women who suspect they have influenza should call their doctors promptly.
And she said doctors need to provide a separate waiting area for pregnant women who suspect they are ill, to protect healthy pregnant women from infection.
Jamieson said pregnant women with influenza should be given antiviral drugs as soon as possible, within the first 48 hours to be most effective.
Despite recommendations from the Advisory Committee on Immunization Practices and the American College of Obstetricians and Gynecologists that all pregnant women get a seasonal flu shot, less than 14 percent do, according to the CDC.
The ACIP, which advises the CDC, is meeting later on Wednesday to decide who should be first to get the new H1N1 vaccine.
(Editing by Maggie Fox and Vicki Allen)
ソースは↓
Abstractをあげておきます。
◎H1N1 2009 influenza virus infection during pregnancy in the USA
http://www.thelancet.com/
Original Text
Denise J Jamieson MD a , Margaret A Honein PhD b, Sonja A Rasmussen MD b, Jennifer L Williams MSN b, David L Swerdlow MD c, Matthew S Biggerstaff MPH c, Stephen Lindstrom PhD c, Janice K Louie MD e, Cara M Christ MD f, Susan R Bohm MS g, Vincent P Fonseca MD h, Kathleen A Ritger MD i, Daniel J Kuhles MD j, Paula Eggers RN k, Hollianne Bruce MPH l, Heidi A Davidson MPH m, Emily Lutterloh MD d n, Meghan L Harris MPH o, Colleen Burke MSN p, Noelle Cocoros MPH q, Lyn Finelli DrPH c, Kitty F MacFarlane CNM a, Bo Shu MD c, Sonja J Olsen PhD c, the Novel Influenza A (H1N1) Pregnancy Working Group
Summary
Background
Pandemic H1N1 2009 influenza virus has been identified as the cause of a widespread outbreak of febrile respiratory infection in the USA and worldwide. We summarised cases of infection with pandemic H1N1 virus in pregnant women identified in the USA during the first month of the present outbreak, and deaths associated with this virus during the first 2 months of the outbreak.
Methods
After initial reports of infection in pregnant women, the US Centers for Disease Control and Prevention (CDC) began systematically collecting additional information about cases and deaths in pregnant women in the USA with pandemic H1N1 virus infection as part of enhanced surveillance. A confirmed case was defined as an acute respiratory illness with laboratory-confirmed pandemic H1N1 virus infection by real-time reverse-transcriptase PCR or viral culture; a probable case was defined as a person with an acute febrile respiratory illness who was positive for influenza A, but negative for H1 and H3. We used population estimates derived from the 2007 census data to calculate rates of admission to hospital and illness.
Findings
From April 15 to May 18, 2009, 34 confirmed or probable cases of pandemic H1N1 in pregnant women were reported to CDC from 13 states. 11 (32%) women were admitted to hospital. The estimated rate of admission for pandemic H1N1 influenza virus infection in pregnant women during the first month of the outbreak was higher than it was in the general population (0·32 per 100 000 pregnant women, 95% CI 0·13—0·52 vs 0·076 per 100 000 population at risk, 95% CI 0·07—0·09). Between April 15 and June 16, 2009, six deaths in pregnant women were reported to the CDC; all were in women who had developed pneumonia and subsequent acute respiratory distress syndrome requiring mechanical ventilation.
Interpretation
Pregnant women might be at increased risk for complications from pandemic H1N1 virus infection. These data lend support to the present recommendation to promptly treat pregnant women with H1N1 influenza virus infection with anti-influenza drugs.
Funding
US CDC.
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関連サイト；
同じくロイターですが、アメリカの感染症の専門家が、政府に対して新型flu A(H1N1)ワクチン接種の優先順位を設定したというニュースです。
医療従事者、妊婦さん、喘息やDMの患者に対して最初にワクチン接種を奨めるという内容。
Vaccine experts who advise the U.S. government are likely on Wednesday to put healthcare workers, pregnant women and patients with asthma and diabetes at the front of the line to get vaccinated against the new pandemic H1N1 influenza.
◎U.S. panel to set priorities for H1N1 flu vaccines
ロイター Tue Jul 28, 2009
http://www.reuters.com/article/GCA-SwineFlu/idUSTRE56R6MH20090728
CDCが7月29日に新型flu A(H1N1)ワクチン接収の優先順位を発表しています。
妊婦さん、第一に挙げられていますね。
The committee recommended the vaccination efforts focus on five key populations.
・pregnant women,
・people who live with or care for children younger than 6 months of age,
・health care and emergency services personnel,
・persons between the ages of 6 months through 24 years of age,
・people from ages 25 through 64 years who are at higher risk for novel H1N1 because of chronic health disorders or compromised immune systems.
とくにワクチンの不足も予測されるので、
・pregnant women,
・people who live with or care for children younger than 6 months of age,
・health care and emergency services personnel with direct patient contact,
・children 6 months through 4 years of age, and
・children 5 through 18 years of age who have chronic medical conditions.
は、他のグループよりも先にワクチン接種すべきと。
先に、ハイリスク・グループのワクチン接種を満たしたあとで、比較的リスクの少ないグループ、すなわち特に65歳以上のグループに接種していくように。
65歳以上のグループはむしろ、季節性fluワクチンが供給できしだい、すぐに接種すべきでる。
新型flu A(H1N1)ワクチンは季節性fluワクチンに置き換わるものではないので、季節性fluワクチンは並行して接種することも考慮すべき。
二つのワクチンを同じ日に提供すること（接種する？）も可能である。
本文はこちら↓
◎CDC Advisors Make Recommendations for Use of Vaccine Against Novel H1N1
http://www.cdc.gov/media/pressrel/2009/r090729b.htm
The Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) met today to make recommendations for use of vaccine against novel influenza A (H1N1).
The committee met to develop recommendations on who should receive vaccine against novel influenza A (H1N1) when it becomes available, and to determine which groups of the population should be prioritized if the vaccine is initially available in extremely limited quantities.
The committee recommended the vaccination efforts focus on five key populations. Vaccination efforts are designed to help reduce the impact and spread of novel H1N1. The key populations include those who are at higher risk of disease or complications, those who are likely to come in contact with novel H1N1, and those who could infect young infants. When vaccine is first available, the committee recommended that programs and providers try to vaccinate:
・pregnant women,
・people who live with or care for children younger than 6 months of age,
・health care and emergency services personnel,
・persons between the ages of 6 months through 24 years of age,
・and people from ages 25 through 64 years who are at higher risk for novel H1N1 because of chronic health disorders or compromised immune systems.
The groups listed above total approximately 159 million people in the United States.
The committee does not expect that there will be a shortage of novel H1N1 vaccine, but availability and demand can be unpredictable. There is some possibility that initially the vaccine will be available in limited quantities. In this setting, the committee recommended that the following groups receive the vaccine before others:
・pregnant women,
・people who live with or care for children younger than 6 months of age,
・health care and emergency services personnel with direct patient contact,
・children 6 months through 4 years of age, and
・children 5 through 18 years of age who have chronic medical conditions.
The committee recognized the need to assess supply and demand issues at the local level. The committee further recommended that once the demand for vaccine for these prioritized groups has been met at the local level, programs and providers should begin vaccinating everyone from ages 25 through 64 years. Current studies indicate the risk for infection among persons age 65 or older is less than the risk for younger age groups. Therefore, as vaccine supply and demand for vaccine among younger age groups is being met, programs and providers should offer vaccination to people over the age of 65.
The committee also stressed that people over the age of 65 receive the seasonal vaccine as soon as it is available. Even if novel H1N1 vaccine is initially only available in limited quantities, supply and availability will continue, so the committee stressed that programs and providers continue to vaccinate unimmunized patients and not keep vaccine in reserve for later administration of the second dose.
The novel H1N1 vaccine is not intended to replace the seasonal flu vaccine. It is intended to be used alongside seasonal flu vaccine to protect people. Seasonal flu and novel H1N1 vaccines may be administered on the same day.
投稿情報: 鶴亀松五郎 | 2009年7 月31日 (金) 00:50
英国ガーディアン紙もランセットに掲載されたCDCの論文のカバー記事を出しています。妊婦はまず最初に新型flu A(H1N1)ワクチンを接種すべきという内容です。
また、胎児に関する抗ウィルス薬のリスクは不明だが、リスクよりもベネフィットの方が大きいとランセットの論文を書いた科学者は述べています。
CDCの分析でも、新型flu感染の妊婦の入院は、一般人の4倍になる。
また、死亡率も高い（妊婦は米国人口の１％だが、現在までの新型fluによる死者の6％を占める）。
4月から6月までの米国における新型fluの死者のうち、妊婦は16％にものぼる。
1918年と1957年のインフルエンザ・パンデミックの時の妊婦の死亡率も、妊婦でない人々より高かった。
1957年の時のアジアfluのとき、ミネソタ州において、妊娠可能な年代の女性のうちの死者の50％は妊婦だった。
48時間以内に即座に新型fluに対して、抗ウィルス薬を処方された妊婦のなかで、死者は出なかった。
新型fluのワクチンが出たら、妊婦は優先的にワクチン接種をすべきであるが、胎児への影響を恐れてワクチン接種を控える妊婦がいる。
本文はこちら↓
◎Give pregnant women priority for swine flu vaccine
study urgesArticle in Lancet says risk of complications is higher, with worrying death rate from virus among expectant mothers
ガーディアン Wednesday 29 July 2009
http://www.guardian.co.uk/world/2009/jul/29/swine-flu-pregnant-woman-lancet
Pregnant women should be prioritised for the flu vaccine as soon as it is available, according to the authors of a study showing they are more at risk of complications and more likely to end up in hospital than other people.
Women expecting a baby should also be given antiviral drugs as soon as they get the flu, says the paper published online today by the Lancet medical journal. Little is known about the possible ill-effects of the drugs on the foetus but scientists say their benefits are likely to be greater than the risks.
The research comes from the US, where six pregnant women died of swine flu complications between 15 April and 18 May. In that month, 34 confirmed or probable cases of swine flu were reported to the Centres for Disease Control and Prevention (CDC) from 13 states. Eleven of them were admitted to hospital.
The rate of admission to hospital is four times higher than in the general population, say the authors, Dr Denise Jamieson from the CDC's division of reproductive health in Atlanta and colleagues. That could be because doctors are more nervous about the effects if flu on pregnant women and are more likely to admit them, but the death rate among pregnant women is high.
"Although the decision to admit a pregnant woman is complex and might include considerations beyond simply the severity of disease, that a high proportion (greater than 10%) of influenza-related deaths in the USA have been in pregnant women is concerning," they write.
"In the previous influenza pandemics of 1918 and 1957, mortality seemed to be higher in pregnant women than in non-pregnant populations ... During the pandemic of 1957, 50% of deaths due to Asian influenza in Minnesota among women of reproductive age occurred in pregnant women."
None of the women who died had been given antiviral drugs promptly, within the first 48 hours of symptoms occurring, they write.
Once a vaccine is available, pregnant women will be a high priority, the authors say. However they are concerned that women may not come forward to be vaccinated because of fear of any effect on their baby. Few pregnant women choose to be immunised against winter flu.
投稿情報: 鶴亀松五郎 | 2009年7 月31日 (金) 03:11
貴重なインフルエンザ情報有難う御座います。
日々の仕事が大変そうですが、体を壊さない程度に、ご自愛なさって下さい。
投稿情報: 風はば | 2009年7 月31日 (金) 08:38
うわぁ～い（＞▽＜）！！！
ありがとうございます。
もう、アレなコレで、かなりアレげな感じです。（わからないですね（笑）。）ま、そもそも全体的に腐臭が漂っているというか。
＞返事はない。ただの屍のようだ。
（あ、ちなみにドラクエはやっていません）
ほにゃらら～。
投稿情報: 僻地の産科医 | 2009年7 月31日 (金) 23:22