Fatal avian influenza A(H5N1) infection in a 36‐week pregnant woman survived by her newborn in Sóc Trăng Province, Vietnam, 2012

Abstract

Background Reports of pregnant women infected with avian influenza are rare. Studies showed that A/H5N1 virus can penetrate the placental barrier and infect the fetus. Of six documented cases, four died and two survivors had a spontaneous abortion. Objectives We report a clinical, outcome and epidemiological characteristics of a 36‐week pregnant woman infected with A/H5N1 and her newborn in Soc Trang province of Vietnam in 2012. Methods Epidemiological and laboratory investigations were conducted. Clinical manifestations, progress, treatment and outcome of the case‐patient and her newborn were collected. Human tracheal aspirate, throat swab and serum specimens were tested for influenza A/H5N1, A/H3N1, A/H1N1pdm09 and B by real‐time RT ‐ PCR and genome sequencing. Poultry throat and rectal swabs were tested by PCR and virus isolation. Results Case‐patient hospitalized with high fever and cough, and died after onset 6 days. She continuously slaughtered sick poultry 5 days before illness onset. Clinical manifestation showed rapid progressive severe pneumonia. Her tracheal aspirate sample was positive influenza A/H5N1 virus. Her new‐born was delivered by caesarean section with low birth weight and early onset pneumonia, however fully recovered after 16 days treatment. Neonate's throat swabs and paired serum samples tested negative for influenza A/H5N1. Clade 1.1 A/H5N1 virus was detected in poultry samples, was same clade and highly homogenous with the virus was detected in the mother. Conclusions This was the first documented a live birth from a pregnant woman infected with influenza A/H5N1 virus. Intensive studies are needed to better understand mother‐to‐child transmission of influenza A/H5N1 virus.

Antibodies to Highly Pathogenic A/H5Nx (Clade 2.3.4.4) Influenza Viruses in the Sera of Vietnamese Residents

“…The Global Influenza Surveillance and Response System (GISRS) tracks the emergence of viruses with pandemic potential. Within the framework of GISRS, this work is being carried out at the WHO Reference Laboratory for H5 on the basis of the State Research Center of VB “Vector” of Rospotrebnadzor [ 27 ] and in the Socialist Republic of Vietnam [ 28 , 29 , 30 ].…”

Infections in Pregnancy With COVID-19 and Other Respiratory RNA Virus Diseases Are Rarely, If Ever, Transmitted to the Fetus: Experiences With Coronaviruses, Parainfluenza, Metapneumovirus Respiratory Syncytial Virus, and Influenza

“…97 In 2012 a pregnant woman in the Soc Trang province of Vietnam died from complications of influenza H5N1 at 36 weeks gestation. 98 Her newborn was delivered by cesarean section and developed early-onset neonatal pneumonia; throat swabs and paired serum samples from the infant were negative for the virus.…”

“…Common in unvaccinated pregnant women 4 suspected cases of (H1N1) [94][95][96][97] 1 suspicious case of (H5N1) 98 Fetal tissues [90][91][92] Suspected placental infection 93 Yes 89…”

Serological Responses to Influenza Vaccination during Pregnancy

“…Maternal H5N1 influenza infection has also been shown to be detrimental to the developing fetus. Highly pathogenic strains of the influenza virus, such as H5N1, can trespass the placental barrier due to the cleavability of the H5 HA by furin resulting in increased cellular tropism, systemic spread, and enhanced pathogenicity [17,62]. The authors evaluated the levels of detectable virus in the fetal compartment.…”

“…Mortality rates were also highest among pregnant women (as high as 45%) during major influenza pandemics (1918, 1957, 1968, and 2009) [5,6,9,10]. In addition, the infection-related complications extend to the offspring, with a well-known increased risk of miscarriage, stillbirth, neonatal death, preterm birth, and low birth weight neonates [5,[10][11][12][13][14][15][16][17][18]. Given the myriad of adverse outcomes that can result from influenza infection, prevention through vaccination is the best control strategy [19].…”