Swine Flu similar to Spanish flu

More evidence of the similarity.
It is actually obvious if you study the Spanish flu epidemic case
fatality rate for New York in 1918.

The 1918 Spanish Flu has low case fatality rates for summer but became
worse in winter.

Now we have Tamilfu so fatality rates should be much lower and yet
they are not. The clue is presented in this article.

Many pregnant women refuse to take Tamilflu, supported by their
doctors.

Evidence of swine flu risk to pregnant women rises; experts urge early
treatment

By Helen Branswell – 10 hours ago

TORONTO — There are mounting and troubling signs that swine flu and
pregnancy don't mix well.

Six pregnant women in Manitoba are reportedly on ventilators because
they are severely ill with the virus. And at least two pregnant women
in the United States have died of swine flu complications after
delivering babies by C-section.

A pregnant teenager in the Dominican Republic died, as did a pregnant
woman in Scotland. A woman in St. Theresa Point, a First Nations
community in Manitoba, miscarried after contracting swine flu.

Humankind's relationship with the new swine H1N1 virus is still in its
infancy. But people who've studied the issue of pregnancy during flu
pandemics don't like the signs they are seeing.

Dr. Denise Jamieson, an obstetrician-gynecologist with the U.S.
Centers for Disease Control's division of reproductive health, says
she finds the evidence to date "very unsettling."

"I am concerned about this," Jamieson said in an interview from
Atlanta.

"There does seem to be increased severity in pregnancy. We don't have
hard and fast numbers but there are enough reports that are
concerning."

Data released by the CDC last month said at that point, 17 per cent of
Americans hospitalized for severe swine flu infections were pregnant
women.

A report a couple of weeks back in the World Health Organization's
journal, Weekly Epidemiologic Record, noted of 30 swine flu patients
hospitalized in California, five were pregnant women. Of those, two
developed severe complications - spontaneous abortion and premature
rupture of membranes.

Jamieson said the numbers are still small but seem to be pointing to a
pattern seen in previous pandemics, when pregnant women were
disproportionately harder hit than non-pregnant peers.

Dr. Danuta Skowronski, a flu expert with the British Columbia Centre
for Disease Control, recently published a review article on influenza
immunization in early pregnancy in the journal Vaccine.

In looking at the evidence about the impact of influenza on pregnancy,
she and co-author Dr. Gaston De Serres of Laval University noted that
the fatality rate was higher in pregnant women during the 1918 and
1957 pandemics, though not the milder pandemic of 1968.

Skowronski said that given the fact that younger adults don't appear
to have antibodies to the new swine flu virus, similar results may be
on the cards during a swine flu pandemic.

"If we base it on what we know of the 1918, 1957 pandemics, what we
know about pre-existing antibody levels to swine influenza in the
population, based on that I would say for this particular virus,
pregnant women may suffer more serious consequences, especially in the
third trimester," she said.

"And they should probably seek care early if they have influenza-like
illness."

Studies done after the disastrous 1918 Spanish flu - which took its
heaviest toll on young adults - showed astonishing death rates among
pregnant women, said Dr. Michael Osterholm, an infectious diseases
expert at the University of Minnesota.

Skowronski's review paper suggests there were also very high rates of
spontaneous abortions during that pandemic - 26 per cent in pregnant
women who became infected and 52 per cent among those who went on to
develop pneumonia from their infection.

Osterholm explained pregnancy is a precarious state for a woman from
an immunological point of view. In order that the mother's body does
not reject the fetus, part of the immune system has to be effectively
dialled down.

Other factors are also believed to come into play, including reduced
lung capacity, Jamieson added.

She said that while the CDC doesn't yet have firm numbers, they are
hearing that some pregnant women are reluctant to take antiviral drugs
when they are diagnosed with swine flu. In some cases, their
physicians share the reluctance.

Jamieson said given the risk swine flu poses to pregnant women, any
who feel they may have contracted it should seek care quickly and
should tell their doctor about potential exposures to people who had
the virus. And they should take the antiviral drugs, she said.

"The message we're trying to get out is: 'Don't delay. If you suspect
influenza, initiate antiviral therapy appropriately even before you
get the testing back," Jamieson said.

"We definitely feel like in a situation like this, the benefits
outweigh the risks of giving antiviral medication."

Follow Canadian Press Medical Writer Helen Branswell's flu updates on
Twitter at CP-Branswell

Copyright © 2009 The Canadian Press. All rights reserved.