Pregnant Women Among Early Victims of H1N1 Influenza

In a reminder that the new strain of H1N1 influenza may not be as benign as originally thought, federal health officials reported Thursday that 100 pregnant women infected with the virus were hospitalized in intensive care units in the first four months of the outbreak, and 28 have died.

"What we are seeing is quite striking," said Anne Schuchat, a physician at the Centers for Disease Control and Prevention in Atlanta who is helping direct the government's response to the pandemic.

"The obstetric caregivers here, and the ones that we're speaking with [around the country] have rarely seen this kind of thing in practice," she told reporters at a weekly press briefing. The 28 deaths occurred between the emergence of the new strain in late April and the end of August.

Until this outbreak, hospitals were not required to report to public health authorities deaths from influenza, except in children. As a consequence, the "expected" mortality of pregnant women who become ill with seasonal flu strains isn't known.

However, pregnant women have been among the victims of the novel H1N1 strain since the first cases were found in California and Mexico.

"Whether this is more common or people are just noticing it because we're attending to this H1N1 virus, it's difficult to say," Schuchat said. However, she added, anecdotal reports are that "doctors around the country . . . have never seen this kind of thing before."

Most previous influenza pandemics have also had what appeared to be unusually high death rates in pregnant women.

In one series of 1,350 flu cases in pregnant women in the "Spanish flu" of 1918, 27 percent were fatal. In the "Asian flu" of 1957, half the women of reproductive age in Minnesota who died of the infection were pregnant.

Pregnant women are among the five "initial target groups" that government public health authorities say should be offered the pandemic H1N1 vaccine when it is available.

In the briefing, Schuchat said that 600,000 doses of the nasal-spray form of the vaccine will be delivered to 25 states and cities by next Tuesday. The shipments mark the start of the unprecedented effort to offer a pandemic flu shot to every American who wants one.

The orders accepted on Wednesday came from about half the jurisdictions -- states, territories and some large cities with their own health departments -- empowered to distribute the vaccine.

"We know that more will be ordering tomorrow, and the next day," Schuchat said.

The nasal vaccine is a live influenza virus that has been genetically weakened so that it can't cause illness and replicates only in the cooler temperatures of the nose. It can be taken by people from age 2 to 49, but not pregnant women or people with chronic illnesses such as asthma, diabetes and kidney failure.

About seven million doses of nasal vaccine should be available by the end of next week. The first doses of injectable vaccine -- which is made from genetically altered and killed virus -- will arrive soon thereafter.

Most states are expected to direct the early supply to health care workers. Ultimately, the vaccine will be available through at least 90,000 different clinics, hospitals, doctors' offices and stores.

Use of the H1N1 nasal vaccine may be complicated by the recommendation that it should be given at least four weeks apart from the seasonal flu nasal vaccine.

If someone has recently gotten that vaccine, their only option for becoming immunized against the novel H1N1 strain will be the pandemic flu shot, unless they wait at least a month.

The need for the interval doesn't involve safety, said Anthony Fiore, a CDC physician and epidemiologist. Instead, some virologists believe the two "live" vaccines could compete with each other for the immune system's attention, resulting in sub-optimal response to one of them.

At the moment, however, that problem is only theoretical, as there have never been two different nasal flu vaccines available in the same season.

"Given the urgency of getting vaccination done, we're looking at whether shorter intervals are feasible," Fiore said.

CDC reported "widespread" flu activity in 26 states last week. While the updated national picture of the epidemic won't be available until Friday, Schuchat said there is now "significant flu activity in virtually all. Link...