H1N1 - Evaluation Resources

OBJECTIVE: The objective of the study was to characterize severe illness because of the 2009 pandemic influenza A (H1N1) infection in postpartum women. STUDY DESIGN: We reviewed case reports of infected hospitalized postpartum (
6 months from delivery) women identified through statewide surveillance in California. From April 23 through August 11, 2009, all hospitalizations and/or deaths were reported. After August 11, reporting was limited to cases requiring intensive care or deaths. RESULTS: From April 23 to December 31, 2009, 15 cases were reported; 11 (73%) had symptom onset within 7 days postpartum. Of 10 hospitalized cases reported through August 11, 4 required intensive care, 3 required mechanical ventilation, and 2 died. Of 5 cases requiring intensive care reported after August 11, all required mechanical ventilation and 1 died. Overall, 6 (43%) received antivirals within 48 hours of symptom onset. CONCLUSION: The 2009 H1N1 can cause severe illness in postpartum women, especially in the first week following delivery.

An "In The Trenches" article (no formal abstract). Two cases of very severe maternal H1N1 illness are presented. This is followed by proposed guidelines for evaluation and treatment of H1N1 in pregnancy with extensive discussion in a Q&A format.

Provides up to date links to a variety of good resources. Includes information for pregnant women and parents; information for clinicians and health officials, general H1N1 and seasonal flu information.

Clinician Outreach Communication Activity (COCA) Conference Calls are designed to serve as the venue for timely education and two-way communication with CDC Subject Matter Experts (SME).
FIND: Scroll to the September 29, 2009 date.
CONTENTS: Transcript and MP3 audio recording that go with the Slide Set (Slides are in the CMQCC H1N1 Documents area (below) or can be directly downloaded from this same site). The presentation is broken into 5 areas: Overview of influenza; Infection control guidance; Testing and treatment; Vaccination; and The Atlanta experience.

This guideline represents a tweaking of the CDC/Emory evaluation algorithm to be pregnancy specific. It is an excellent summary of current thinking.

SUMMARY: This is an algorithm developed by the Emory School of Medicine and used widely on the East Coast. ACOG has adopted it with minor modifications for use in telephone triage for OB's offices. Teo key elements for OB's are: 1) be sure the patient knows to call back and seek care if she worsens or does not improve, and 2) there needs to be a clear plan and site for evaluation other than the OB's office.

Slide set (55 slides) discussing the latest CDC guidelines with some background. Largely replaces the earlier CDC COCA slides.

A good general slide set made for OB Grand Rounds or Nursing Education. Covers epidemiology, pregnancy risks, triage assessment, treatment and prophylaxis, vaccine issues, and isolation/visitor policies.

Clinician Outreach Communication Activity (COCA) Conference Calls are designed to serve as the venue for timely education and two-way communication with CDC Subject Matter Experts (SME).
SLIDE SET: broken into 5 areas: Overview of influenza; Infection control guidance; Testing and treatment; Vaccination; and The Atlanta experience. Note that this slide set is in.pps format so that it is not editable.
TRANSCRIPT AND AUDIO TAPE: can be obtained using the citation noted in Web Resources with the same authors.