Search

Patients with acute infectious respiratory illness may emit bio-aerosols containing pathogens to infect susceptible hosts, including other patients and healthcare workers. This study aimed to design the pediatric isolation (PI) bed and evaluate its purification effect on aerosols and microorganisms in the air in experiment rooms and verify the general wards' purification efficiency. The PI bed is connected to a purification device that surrounds the child's head to prevent contaminants' spread into the room. We test the purification effect of the PI bed in the experiment room and verified the purification effect of the PI bed in the hospital. The results showed that PI beds in the demonstration ward presented purifying effects on both smoke particulates and microorganisms like Staphylococcus albus (S. albus) and H1N1 virus. The Aerosol in the room in the hospital was then detected to validity the purification rate. Therefore, Isolation beds could be used in hospitals to reduce the risk of nosocomial infection to protect the health of doctors, patients, and visitors.

Broadly neutralizing antibodies are critical for protection against drifted and novel influenza viruses. Here, we reveal humans have pre-existing immunity against two broadly neutralizing epitopes of the HA head: the lateral patch and receptor-binding site (RBS). Monoclonal antibodies generated against these epitopes are broadly neutralizing against 40+ years of H1N1 evolution and provide potent protection in vivo. First exposure to the novel 2009 pandemic H1N1 virus recalls memory B cells that target the conserved RBS and lateral patch epitopes. We identified unique repertoire, structural, and binding features of lateral patch and RBS binding antibodies including a lateral patch binding motif shared across subjects. Together, our data indicate that the conserved RBS and lateral patch epitopes are readily targeted by the human memory B cell pool and that universal vaccine strategies should aim to drive antibodies against both conserved head and stalk domain epitopes.

Fil: Critto, María Elena. MELISA Institute. Division of Epidemiology; Chile Fil: Critto, María Elena. Pontificia Universidad Católica Argentina. Facultad de Ciencias Sociales. Programa de Doctorado en Sociología; Argentina Fil: Enríquez, Yordanis. Universidad Católica Sedes Sapientiae. Facultad de Ciencias de la Salud; Perú Fil: Bravo, Miguel. MELISA Institute. Division of Epidemiology; Chile Fil: Bravo, Miguel. University of Chile. Faculty of Medicine. School of Public Health; Chile Fil: De Janon Quevedo, Lenin. Pontificia Universidad Católica Argentina; Facultad de Ciencia Médicas; Argentina Fil: Weinbergf, Ruth. Universidad de Buenos Aires. Facultad de Ciencias Médicas; Argentina Fil: Etchegaray, Adolfo. Universidad Austral. Facultad de Medicina. Hospital Universitario Austral; Argentina Fil: Koch, Elard S. MELISA Institute. Division of Epidemiology; Chile Abstract: Abstract Background Emerging pandemic viruses may have multiple deleterious effects on maternal health. This study examines the effects of a pandemic influenza virus on cause-specific maternal mortality time series, using Argentinian vital statistics. Methods We conducted a population-based natural experiment from national vital records of maternal deaths between 1980 and 2017. Joinpoint regression models were used to model time series of the maternal mortality ratio (MMR). The sensitivity of the registry to detect the effects of the pandemic H1N1 2009 influenza virus on cause-specific MMR was analysed using a panel of parallel interrupted time series (ITS). Findings Over this 38-year study, the MMR decreased by 58¢6% (69¢5 to 28¢8 deaths/100,000 live births), transitioning from direct obstetric causes (67¢0 to 21¢1/100,000 live births; 68¢4% decrease) to indirect causes (2¢6 to 7¢7/ 100,000 live births; 196¢2% increase). The regression analysis showed an average reduction of -2¢2%/year (95% CI: -2¢9 to -1¢4) with 2 join points in the total trend (1998 and 2009). Parallel ITS analyses revealed the pandemic H1N1 virus had an increasing effect on mortality from the respiratory system- and sepsis-related complications (level change 4¢7 and 1¢6/100,000 live births respectively), reversing after the outbreak. No effect was found on MMR from hypertensive disorders, haemorrhage, abortive outcomes, other direct obstetric causes, and indirect non-respiratory comorbidities. Interpretation The Argentinian maternal death registry appears sensitive to detect different effects of emerging infectious epidemics on maternal health. In a population-based natural experiment, pandemic H1N1 virus impacted maternal mortality almost exclusively from the respiratory system- and sepsis-related complications. Supplementary material associated with this article can be found, in the online version, at doi:10.1016/j.lana.2021.100116 Resumen: Antecedentes: Los virus pandémicos emergentes pueden tener múltiples efectos nocivos sobre la salud materna. Este estudio examina los efectos de un virus de influenza pandémica mediante series de tiempo ininterrumpidas de mortalidad materna por causas específicas, utilizando estadísticas vitales argentinas. Métodos: Realizamos un experimento natural con base poblacional a partir de registros vitales nacionales de muertes maternas entre 1980 y 2017. Se utilizaron modelos de regresión con punto de unión para modelar series de tiempo de la razón de mortalidad materna (RMM). La sensibilidad del registro para detectar los efectos del virus de la influenza pandémica A H1N1 2009 sobre las causas específicas de la RMM se analizó mediante un panel de series de tiempo interrumpidas (STI). Hallazgos: Durante este estudio de 38 años, la RMM disminuyó en un 58·6% (69·5 a 28·8 muertes/100.000 nacidos vivos), pasando de causas obstétricas directas (67·0 a 21·1/100.000 nacidos vivos; 68·4% de disminución) a causas indirectas (2·6 a 7·7/100.000 nacidos vivos; 196·2% de aumento). El análisis de regresión mostró una reducción promedio de -2·2%/año (IC 95%: -2·9 a -1·4) con 2 puntos de inflexión en la tendencia total (1998 y 2009). Los análisis de STI revelaron que el virus pandémico A H1N1 tuvo un efecto creciente sobre la mortalidad por complicaciones del sistema respiratorio y relacionadas con la sepsis (cambio de nivel 4·7 y 1·6/100.000 nacidos vivos, respectivamente), revirtiéndose después del brote. No se encontró ningún efecto sobre la RMM por trastornos hipertensivos, hemorragia, desenlace abortivo, otras causas obstétricas directas y comorbilidades indirectas no respiratorias. Interpretación: El registro de defunciones maternas de Argentina parece sensible para detectar diferentes efectos de las epidemias infecciosas emergentes sobre la salud materna. En el experimento natural poblacional, el virus pandémico A H1N1 afectó la mortalidad materna casi exclusivamente por complicaciones relacionadas con el sistema respiratorio y la sepsis.

Chemical examination of the EtOAc extract of the sponge-associated fungus Truncatella angustata in solid culture led to the isolation of eight undescribed isoprenylated cyclohexanols, namely truncateols O-V together with 14 known analogues. Their structures were determined on the basis of extensive spectroscopic analyses, including the modified Mosher's method and ECD data for the assignment of their absolute configurations. Truncateol O exhibited significant inhibition toward both HIV-1 and H1N1 virus, while truncateol P exerted inhibitory effect against HIV-1 virus.

The type A influenza viruses are the most virulent and variable human pathogens with epidemic or even pandemic threat. The development of sensitive, specific and safe field testing methods is in particular need and quite challenging. We report here the selection and practical utilization of the inactivated influenza virus-specific aptamers. The DNA aptamers against inactivated intact H1N1 virus particles were identified through the systematic evolution of ligands by exponential enrichment (SELEX) procedure. The discriminative aptamers and their truncated sequences showed selectively high affinity to inactive H1N1 virus and H3N2 virus with the Kd in the low nanomolar range and collective binding properties. The truncated sequences were first applied in a sandwich enzyme-linked oligonucleotide assay (ELONA) with a H1N1 detection limit (LOD, S/N = 3) of 0.3 ng/μL and then in an electrochemical impedance (EIS) aptasensor with more than 300 times improved LOD (0.9 pg/μL) and the excellent selectivity over other viruses (> 100 times). Therefore the developed aptasensors represent the safer, simpler, and possibly better virus-variation adaptable means of virus diagnostics.

OBJECTIVE To present and analyze treatments and clinical outcomes of Chinese patients with influenza-like illness. METHODS We conducted a multi-site observational study from December 2009 to April 2010. Patients with influenza-like illness from 45 hospitals were enrolled. Patients received Chinese herbal medicine (CHM), conventional treatments, or CHM plus conventional treatments (combination treatment) according to the guidelines for influenza A/H1N1 2009 in China. The primary outcomes were the time to alleviation of symptoms and the incidence of complications. The secondary outcomes were the time until becoming afebrile, incidence of severe illness, testing negative on an influenza A viral test, and total medical fees. RESULTS In total, 5967 patients were enrolled. The percentages of patients prescribed CHM alone, conventional treatment, and combination treatment were 27.8%, 5.1%, and 67.7%, respectively. There were no significant differences in the time to alleviation of symptoms, incidence of complications, time to becoming afebrile, or rate of severe illness among the CHM, conventional, and combination treatment groups. The rates of testing negative on the influenza virus A rapid test and H1N1 virus test were 90.3% and 76.3%, respectively. However, significant differences were found in the total medical fees among the three groups: CHM treatments were more economical than the other two treatments. CONCLUSION The efficacy of CHM for influenza-like illness was not different from that of conventional treatments, but it was more economical.

A simple, convenient, easy-to-use, and low-cost platform for rapid molecular detection of H1N1 virus is designed and implemented based on convective polymerase chain reaction (CPCR) and dipstick assay at the point of care (POC) settings. A fully disposable chemically-heated thermal processor is developed to heat the capillary tube from the bottom at a fixed temperature for amplification without the need for electrical power. Amplification is achieved when reagents in the capillary tube are spontaneously and repeatedly transported through different temperature zones, which significantly shortens the amplification time by eliminating the need for controlled time-domain temperature cycling. A rapid one-step nucleic acid dipstick assay is adopted to facilitate the detection of amplification products with the eye instead of instrumentation. The utility of our POC diagnostic system was demonstrated by detecting H1N1 virus with sensitivity of 1.0 TCID50/mL within 35 min. The developed system is particularly desired for resource poor settings, for example, developing countries, outside centralized laboratories, doctor’s offices and homes, to relieve the requirements for laboratory facilities and trained personnel.

Fourteen new isoprenylated cyclohexanols namely truncateols A–N (1–14) were isolated from the solid culture of the sponge-associated fungus Truncatella angustata. Their structures were determined on the basis of extensive spectroscopic analyses, including the modified Mosher's method and ECD, as well as X-ray diffraction for the assignment of absolute configurations. The structures of truncateols are characterized by the presence of unique alkynyl or allenyl groups. Truncateol M (13) exerted potent inhibitory effect against influenza-A viral infection by targeting virion assembly/release step.

Resume Afin de contribuer a la prevention de la grippe et diminuer les risques de survenue d’une pandemie, le pharmacien doit rappeler l’extreme contagiosite de cette maladie saisonniere, ainsi que l’importance de la vaccination, notamment dans certaines populations. Lorsque la maladie est declaree, il est amene a dispenser des traitements symptomatiques, voire specifiques chez les personnes fragilisees.

ObjectivesThe present study aimed to investigate the prevalence of and factors associated with H1N1 preventive behaviors in a community-based population.MethodsA cross-sectional study was conducted in three urban and two rural communities in Korea. Interviews were conducted with 3462 individuals (1608 men and 1854 women) aged ≥ 19 years during February–March 2010. Influenza-related information including anxiety, preventive behaviors and their perceived effectiveness, vaccination status, past influenza-like illness symptoms, and sources of and trust in information was obtained.ResultsAmong 3462 participants, 173 reported experiencing influenza-like illness symptoms within the past 12 months. The mean H1N1 preventive behavior score was 25.5 ± 5.5 (out of a possible 40). The percent of participants reporting high perceived effectiveness and high anxiety was 46.2% and 21.4%, respectively. After controlling for potential confounders, H1N1 preventive behavior scores were predicted by a high (β = 3.577, p

Objectives The aim of this study was to develop an immunochromatographic assay (ICA) for the detection of influenza A (H1N1) pdm09 virus infection. Materials and methods Several monoclonal antibodies against influenza A (H1N1) pdm09 virus were generated and an ICA (pdm09-ICA) was developed for the rapid and specific detection of influenza A (H1N1) pdm09 virus infection. The specificity and sensitivity of the developed assay were compared with that of hemagglutination assay and real-time reverse-transcription polymerase chain reaction (rRT-PCR). Results The detection limit was estimated to be 1/2 (8) hemagglutinating unit; the sensitivity and specificity rates of pdm09-ICA were 75.86% (110/145) and 100% (43/43), respectively, compared with rRT-PCR. The cross-reactivity for 20 influenza viruses, including seasonal H1N1 viruses, was found to be negative except for the H1N1 virus (A/Swine/Korea/GC0503/2005). Conclusion These results indicate that the proposed method can be easily used for rapid and specific detection of the pdm09 infection. The assay developed in this study would be a useful tool for distinguishing the pdm09 infection from seasonal influenza A and B infections.

During the H1N1 pandemic in 2009-10, the vaccination behavior of parents played a critical role in preventing and containing the spread of the disease and the subsequent health outcomes among children. Several studies have examined the relationship between parents' health communication behaviors and vaccinations for children in general. Little is known, however, about the link between parents' health communication behaviors and the vaccination of their children against the H1N1 virus, and their level of vaccine-related knowledge. We drew on a national survey among parents with at least one child less than 18 years of age (n=639) to investigate Parents' H1N1-related health communication behaviors including sources of information, media exposure, information-seeking behaviors, H1N1-related knowledge, and neighborhood social capital, as well as the H1N1 vaccination rates of their children. Findings showed that there is a significant association between the degree at which parents obtained H1N1 vaccination for their children and health communication variables: watching the national television news and actively seeking H1N1 information. And this association was moderated by the extent of the parents' H1N1-related knowledge. In addition, the parents' degree of neighborhood social capital mediated the association between H1N1 knowledge of the parents and H1N1 vaccination acceptance for their children. We found, compared to those with a low-level of neighborhood social capital, parents who have a high-level of neighborhood social capital are more likely to vaccinate their children. These findings suggest that it is necessary to design a strategic health communication campaign segmented by parent health communication behaviors.

A series of novel cycloalkylthiophene–imine derivatives containing benzothiazole unit were designed, synthesized and evaluated for their anti-viral activities. The bio-evaluation results indicated that some of the target compounds (such as 5g , 5i , 5u ) exhibited good to moderate antiviral effect on CVB5, ADV7 and EV71 viruses, however, these compounds did not have inhibition activity against H1N1 virus. Especially, the compounds 4c and 4d also exhibited high antiviral activities, which provide a new and efficient approach to evolve novel multi-functional antiviral agents by rational integration of active pharmacophores.

Despite being at highest risk for 2009 H1N1 virus morbidity and mortality, many children were not immunized with the vaccine. Identification of factors that put certain children at higher risk for under-immunization could reveal populations who may need to be specifically targeted for vaccination interventions in future pandemics. Little is known about the prevalence of, or factors associated with, 2009 H1N1 vaccine coverage in low-income, urban pediatric populations. This study evaluated 2009 H1N1 vaccination coverage in 19,643 children aged 6months to 18years receiving care at one of five community clinics associated with an academic medical center in a low-income community. Any (≥1 dose) and full coverage (1 dose for children ≥10years old, 2 doses for those10years) was determined as of December 1, 2009 and the end of vaccination period (June 30, 2010). Multivariable analyses were used to assess the impact of race/ethnicity, age, insurance, gender, and language on vaccine coverage and timeliness. By December 1, only 16.6% of children had received one dose, and 5.3% had full coverage. By the end of the vaccination period, 36.2% had received at least one H1N1 dose and 23.6% had full coverage. On multivariable analysis, older age, minority race/ethnicity, and private insurance were negatively associated with vaccination by December 1 and end of vaccination period, even after accounting for attendance at a clinic visit. In future pandemics, when timely receipt of a new vaccine in large populations may be imperative, general vaccination programs as well as special targeted education and vaccine reminders for these at risk groups may be warranted.

Aim To elucidate the inhibitory mechanism of baicalein on influenza A/FM1/1/47 (H1N1) virus in cell culture.

Background Transmission dynamics modeling provides a practical method for virtual evaluation of the impact of public health interventions in response to prospective influenza pandemics and also may help determine the relative contribution of different modes of transmission to overall infection rates. Accurate estimates of longevity for all forms of viral particles are needed for such models to be useful. Methods We conducted a time course study to determine the viability and longevity of H1N1 virus on naturally contaminated hands and household surfaces of 20 individuals with laboratory-confirmed infection. Participants coughed or sneezed into their hands, which were sampled immediately and again after 5, 10, and 30 minutes. Samples also were obtained from household surfaces handled by the participants immediately after coughing/sneezing. Clinically obtained H1N1 isolates were used to assess the viability and longevity of the virus on various artificially inoculated common household surfaces and human hands in a controlled laboratory setting. Viral detection was achieved by culture and real-time reverse-transcriptase polymerase chain reaction. Results The results suggest that H1N1 does not survive long on naturally contaminated skin and fomites, and that secretions deposited on hands by coughing or sneezing have a concentration of 50 /mL. Conclusions These data can be used to estimate the relative contribution of direct and indirect contact transmission on overall infection rates.

Summary: Objectives: The 2009 pandemic influenza A (H1N1) virus is a public health challenge. Notably, laboratory-confirmed cases do not represent the age group most susceptible to infection. To characterize the age distribution of all cases of H1N1 influenza, we studied the personal contacts of confirmed cases to identify the age group at the highest risk. Methods: We investigated the family members of 162 laboratory-confirmed cases of 2009 H1N1 in Yazd, Iran. Family members were retrospectively asked whether they had ≥2 respiratory symptoms within 7 days of the last contact with the associated index cases. The ages and symptoms of the patients as well as the interval between diagnosis and the onset of symptoms among household contacts were determined using a questionnaire. Results: We identified 596 family members of index cases, 83 (13.9%) of whom developed acute respiratory illness. No acute respiratory illness was found in 104 families (64%); however, there were 2 cases in 15 families (9.3%) and ≥3 cases in 4 families (24%). Household contacts from 5 to 18 years old were more susceptible to acute respiratory illness than those who were ≥51 years old (RR = 3.174, 95% CI 1.313–7.675 P-value = 0.01). Conclusion: Individuals ≤18 years old were most susceptible to infection by the H1N1 virus. Therefore, in low-income populations, prevention of the spread of H1N1 to this age group should be emphasized. Keywords: Household transmission, 2009 Influenza A (H1N1) virus

A selective cyclooxygenase-2 (COX-2) inhibitor has been previously shown to suppress the hyper-induced pro-inflammatory responses in H5N1 infected primary human cells. Here, we demonstrate that COX-2 inhibitors suppress H5N1 virus replication in human macrophages suggesting that H5N1 virus replication (more so than seasonal H1N1 virus) is dependent on activation of COX-2 dependent signaling pathways in host cells. COX-2 and its downstream signaling pathways deserve detailed investigation as a novel therapeutic target for treatment of H5N1 disease.

Although previous publications suggest the 2009 pandemic influenza A (H1N1) virus was reassorted from swine viruses of North America and Eurasia, the immediate ancestry still remains elusive due to the big evolutionary distance between the 2009 H1N1 virus and the previously isolated strains. Since the unveiling of the 2009 H1N1 influenza, great deal of interest has been drawn to influenza, consequently a large number of influenza virus sequences have been deposited into the public sequence databases. Blast analysis demonstrated that the recently submitted 2007 South Dakota avian influenza virus strains and other North American avian strains contained genetic segments very closely related to the 2009 H1N1 virus, which suggests these avian influenza viruses are very close relatives of the 2009 H1N1 virus. Phylogenetic analyses also indicate that the 2009 H1N1 viruses are associated with both avian and swine influenza viruses circulating in North America. Since the migrating wild birds are preferable to pigs as the carrier to spread the influenza viruses across vast distances, it is very likely that birds played an important role in the inter-continental evolution of the 2009 H1N1 virus. It is essential to understand the evolutionary route of the emerging influenza virus in order to find a way to prevent further emerging cases. This study suggests the close relationship between 2009 pandemic virus and the North America avian viruses and underscores enhanced surveillance of influenza in birds for understanding the evolution of the 2009 pandemic influenza.

The Spanish Society of Rheumatology (SER), through a multidiscipline task force, has elaborated a document with specific recommendations for specialists in Rheumatology, emphasizing the special needs of patients with rheumatic diseases, with the objective of informing and orienting health professionals about the current influenza A/H1N1 virus pandemic. All of the recommendations are based on prior documents elaborated by the Ministry of Health and Social Policy task forces, as well as those from the autonomous communities, which are themselves based on the guidelines and documents routinely published by the Centers for Disease Control (CDC) in the US, this being the center designated by WHO for the coordination of efforts against the pandemic. All rheumatologists and potential users of these recommendations are encouraged to consult the original documents, as well as the general guidelines established at each health center.

An assay for the detection of H1N1 virus was established using Reflectometric Interference Spectroscopy (RIfS), a label-free optical detection method. A direct assay format was used to detect the virus by the corresponding antibody immobilized on the chip surface. The used surface chemistry showed low non-specific binding of the virions and gave reproducible signals. The binding of H1N1 virus was monitored in RIfS and verified by atomic force microscopy (AFM) measurements. The proposed assay has the potential to be integrated in portable and miniaturized devices based on RIfS, which can be used in point of care testing at e.g. airports to improve homeland security.

The neuraminidase (NA) of influenza virus is the target of anti-flu drugs oseltamivir and zanamivir. Clinical practices showed that oseltamivir was effective to treat the 2009-H1N1 influenza but failed to the 2006-H5N1 avian influenza. To perform an in-depth analysis on such a drug-resistance problem, the 2009-H1N1-NA structure was developed. To compare it with the crystal 2006-H5N1-NA structure as well as the 1918 influenza virus H1N1-NA structure, the multiple sequential and structural alignments were performed. It has been revealed that the hydrophobic residue Try347 in H5N1-NA does not match with the hydrophilic carboxyl group of oseltamivir as in the case of H1N1-NA. This may be the reason why H5N1 avian influenza virus is drug-resistant to oseltamivir. The finding provides useful insights for how to modify the existing drugs, such as oseltamivir and zanamivir, making them not only become more effective against H1N1 virus but also effective against H5N1 virus.

Classical swine and avian-like H1N1 influenza viruses were reported widely in swine population worldwide, but human-like H1N1 swine viruses were reported occasionally. In 2006, a human-like H1N1 swine virus (A/swine/Guangdong/96/06) was isolated from pigs in Guangdong province, which was reported in China for the first time. To get further evidence for infection of pigs with human-like H1N1 influenza viruses, we analyzed eight gene segments of three human-like swine H1N1 viruses (A/swine/Guangdong/96/06, A/swine/Tianjin/01/04 and A/swine/Henan/01/06) isolated in China. All the eight genes of the three viruses are highly homologous to recent (about 2000) and early (1980s) human H1N1 influenza viruses, respectively. Phylogenetic analyses revealed that A/Swine/Guangdong/96/06 was directly derived from about 2000 human H1N1 influenza viruses, while A/swine/Tianjin/01/04 and A/swine/Henan/01/06 seemed to be descendants of human H1N1 viruses circulating in 1980s. Seroprevalence of our isolate (A/swine/Guangdong/96/06) confirmed the presence of human-like H1N1 virus in pigs in China. Existence of these influenza viruses, especially older viruses (A/swine/Tianjin/01/04 and A/swine/Henan/01/06), indicates that human-like H1N1 influenza viruses may remain invariant for long periods in pigs and provides the evidence that pigs serve as reservoirs of older influenza viruses for human pandemics.

Objective College students were at high risk for contracting the 2009 H1N1 virus. Many universities implemented campaigns to encourage use of non-pharmaceutical interventions (NPIs) to reduce the spread of the virus. The purpose of this study was to determine factors related to student adoption of NPIs. Methods Online surveys were conducted at two universities prior to the availability of the H1N1 vaccine. In total, 909 students participated. Results More than 80% of students adopted at least one action to reduce the likelihood of contracting the flu. Perception of the public health threat was associated with use of each of the NPIs. Perceived susceptibility, previous seasonal flu vaccination, and symptom knowledge were associated with four of the five NPIs. Conclusion Increasing college student understanding of the threat posed by a pandemic, as well as their susceptibility to that threat, could encourage the use of NPIs prior to availability of a vaccine.

Live attenuated cold-adapted influenza vaccines (CAIVs) have been developed over the past two decades by taking advantage of the segmented RNA genome of influenza and creating attenuated reassortants containing contemporary hemagglutinin (HA) and neuraminidase (NA) genes. These vaccines have been shown to be easily administered, safe and immunogenic in adults and children. Recent trials of a trivalent live attenuated CAIV (CAIV-T, tradename FluMist, Aviron, Mt. View, CA) in children have demonstrated greater than 85% efficacy against culture positive H3N2 and B influenza illness and complications, such as otitis media. CAIV-T also prevented shedding of H1N1 virus in 83% of vaccinated subjects after a monovalent CAIV challenge. Nasal IgA and serum HA inhibition (HAI) antibody produced by these vaccines have been associated with protection against infection, but protection may exist even in the absence of identifiable antibody response. Work to date documenting phenotypic and genetic stability, low likelihood of reactogenicity, infrequent transmissibility and attenuating properties of reassortants heralds promise for the broad use of this vaccine. Targeting children to receive this vaccine may now prove practical and may serve to reduce overall influenza morbidity, given the significant contribution of the pediatric age group of children to influenza illness burden and community spread. Studies of vaccine use in community settings will aid in determining the public health future of this approach.

a m d c 2 h So much has changed since May 4, 2009, when the second documented death from 2009 pandemic influenza A (2009 H1N1) virus infection in the United States occurred in a previously healthy pregnant woman. Since that time, our knowldge about influenza in pregnancy has expanded dramatically, nd much more attention has been focused on pregnancy isues. Before the emergence of the 2009 H1N1 virus, much of hat we knew about influenza in pregnancy was based on inirect evidence, such as studies that used acute respiratory hositalizations during influenza season as a proxy for influenza llness and observations from previous pandemics of case series of pregnant women with uncertain representativeness. In a very short time, our knowledge of 2009 H1N1 in regnancy has expanded greatly; with better diagnostic and reatment information, the increased severity of 2009 H1N1 mong pregnant women compared with the general populaion has been documented carefully and consistently in a wide ariety of clinical settings. We are pleased to bring you this pecial issue in the American Journal of Obstetrics and Gynecolgy entitled “Emerging Issues in the Prevention, Detection, and reatment of Influenza among Pregnant Women in the United tates,” which contains a wide variety of articles that summaize some of what we have learned about influenza in pregancy from the recent pandemic. This special issue begins with ersonal reflections on past and present pandemics written by ear Admiral Anne Schuchat, MD, who, as the Chief Health fficer during the pandemic and the Director of the National

The first case of pandemic influenza A/H1N1/2009 infection was reported in Mexico in mid-April, 2009, and to date the new H1N1 virus has spread to over 160 countries. Therefore, it is important to obtain reliable epidemiological data on the spread of this virus by novel molecular methods can be developed in detection of this new infectious agent. A new method was developed for detection of the pandemic influenza A/H1N1/2009 using real-time reverse transcription polymerase chain reaction (RT-PCR). Direct comparison with the specific primers and probes recommended by the World Health Organization (WHO) demonstrates that the new method has a much greater sensitivity, and may thus be employed as a rapid, alternative method in detecting of the pandemic influenza A/H1N1/2009 virus.