My Pandemic Plan

BEIJING, China (CNN) — The world will soon see an “explosion” of swine flu cases as the H1N1 virus spreads rapidly around the world, a top World Health Organization official said Friday.

Spread of the H1N1 virus is entering an “acceleration period,” WHO official says.

Spread of the virus is entering an “acceleration period” and it is certain that there will be more cases and more deaths, said Dr. Shin Young-soo, the organization’s regional director for the Western Pacific.

“Most countries may see a doubling of cases every three to four days for two months until peak transmission is reached,” he said at a symposium in Beijing, China. “At a certain point, there will seem to be an explosion in case numbers. I believe it is very likely that all countries will see community-level transmission by the end of the year.”

More than 1,490 people around the world have died from the virus since it emerged this spring, Shin said.

Swine flu is the first influenza pandemic in more than 40 years. So far, it has caused mostly mild illness, but Shin warned “the virus has a sting in its tail” because it is very infectious and “has the potential to cause more serious disease.”

Any widespread resistance to antiviral drugs, expected to be available this fall, could make the situation worse, he said.

The virus so far has shown itself to be unpredictable, Shin said, so the public needs to be prepared. He called for accurate and timely public health messages and early treatment of severe cases.

The public needs to comply with these health messages, and everyone needs to be able to recognize symptoms early and get timely medical care, he said.

“We will only be safe when we have applied these lessons in every country dealing with this virus,” Shin said. “We need to learn quickly since, as I believe, it appears that this pandemic will get worse before the situation gets better.”

lkrieger@mercurynews.com

Updated: 07/31/2009 01:04:27 PM PDT

Swine-flu virus has claimed the lives of two Bay Area women who recently gave birth, adding to the growing body of evidence that pregnancy puts women at increased risk of flu-related hospitalization and death.

News of the deaths comes as the federal Centers for Disease Control and Prevention recommends that pregnant women be among the first to receive a vaccine, when it’s available. The CDC also urges that anti-viral drugs like Tamiflu or Relenza be quickly administered to pregnant women with suspected influenza.
Pregnancy changes both the lung capacity and immunology of women, making it harder for them to fend off respiratory infections. But while health officials are urging quicker response, they say vigilance and common sense can reduce the risk of infection.

“The most important thing is hand hygiene: soap and water, or alcohol-based products,” said Dr. Steven Parodi, regional chief of infectious disease with Kaiser Permanente, which was not involved in either death.

In Marin County, 33-year-old Jamie Norman was hospitalized in June with flu symptoms and gave birth to her son nearly two months early. She was able to hold Jack, her first child, but died June 30.

In Alameda County, the coroner’s office confirmed this week that Hayward resident Nicole Savoy, 33, died July 12 of pneumonia due to the virus. She had given birth June 15 and was released to go home the following day, but began to feel sick a few days later. On June 21, she returned to the hospital, where she remained until she died July 12 of pneumonia caused by the virus.

The CDC has details on 266 of the 305 U.S. swine-flu deaths reported as of July 29. Fifteen of these 266 deaths — about 6 percent — were among pregnant women. At any time, only 1 percent of the general population is pregnant. 

While many victims of swine-flu virus are vulnerable due to other health problems, like emphysema, heart disease or diabetes, most pregnant women who have died of swine flu were healthy when they caught the pandemic virus.

One CDC study found that all of the pregnant women who died had been healthy before contracting swine flu — but subsequently developed primary viral pneumonia and had to be put on ventilators. They, or their doctors, waited too long to start them on anti-viral drugs like Tamiflu or Relenza. These drugs work best when started within two days of symptoms.

It’s general wisdom to avoid unnecessary medications during pregnancy, but anti-viral treatment poses far less risk than the flu virus itself.

Although pregnant women have many of the same initial virus symptoms as other people, they face greater odds of complications, Parodi said.

“During pregnancy, the immune system has different components. A pregnant woman’s immune system shifts away from the ability to fight off viruses and shifts more toward fighting bacteria,” Parodi said. “It puts them at higher risk of viral influenza.”

The growth of the baby compresses a woman’s lungs, so her breathing capacity is reduced. “With less lung capacity, you’re more likely to get sick,” he said. “And if you get an infection, it’s harder to clear.”

Flu seems to also increase the risk of delivery complications, such as spontaneous abortion and preterm birth, especially among women with pneumonia.

Additionally, it poses problems for the baby, if the woman has high fever. Studies show that maternal fever during the first trimester doubles the risk of neural tube defects and other birth defects. Maternal fever during labor is a risk factor for seizures, encephalopathy, cerebral palsy and infant death. Doctors recommend treatment with acetaminophen to reduce a pregnant woman’s fever.

In England, initial hysteria over infection caused the nation’s Department of Health to advise women to consider delaying conception until the pandemic passed. The Royal College of Midwives and the Royal College of Obstetricians and Gynecologists also advised pregnant women to avoid rush hour, stay indoors and restrict the movement of other children so the virus didn’t get brought home. But both groups have since softened their stance.

Pregnant women should feel free to work, play and do other normal activities, Parodi said.

“Pregnant women should avoid people who are coughing or actively ill,” he said. “And if we’re ill, we should protect them, by not going to work. It’s a way we can all help.”

An elevated number of influenza-associated deaths among pregnant women were reported during the pandemics of 1918-1919 and 1957-1958. In a study of 1,350 women who had flu during the 1918 pandemic, about half the women got pneumonia and about half of the women with pneumonia died — a case-fatality rate of 27 percent. During the 1957 flu pandemic, pregnant women accounted for half of the flu deaths in a study of Minnesota women of reproductive age.

“If you’re pregnant, take precautions,” Parodi said. “And when a vaccine is available, get vaccinated.”