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Prevention of Novel Influenza Infection in Newborns in Hospital Settings: Considerations and Strategies During the 2009 H1N1 Pandemic

  • Lauren B. Zapata, Juliette S. Kendrick, Denise J. Jamieson, Kitty MacFarlane, Katherine Shealy and Wanda D. Barfield...


During the 2009 influenza A (H1N1) pandemic, many pregnant women experienced severe illness and some gave birth while ill with suspected or confirmed pandemic (H1N1) 2009 influenza. Because of concerns about possible transmission of this novel virus to immunologically naïve newborns, and the absence of definitive studies regarding this risk, the Centers for Disease Control and Prevention (CDC) reviewed relevant literature to understand the potential burden of disease and routes of transmission affecting newborns. This report describes the issues considered during the 2009 H1N1 pandemic as CDC developed guidance to protect newborns in hospital settings. Also presented is a framework of protection efforts to prevent novel influenza infection in fetuses/newborns before birth and in hospital settings. Although developed specifically for the pandemic, the framework may be useful during future novel influenza outbreaks.

(Disaster Med Public Health Preparedness. 2012;6:97-103)


Corresponding author

Correspondence: Lauren B. Zapata, PhD, 4770 Buford Hwy NE, Mailstop K34, Atlanta, GA 30341 (


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1.Bautista, E, Chotpitayasunondh, T, Gao, Z, et alWriting Committee of the WHO Consultation on Clinical Aspects of Pandemic (H1N1) 2009 Influenza. Clinical aspects of pandemic 2009 influenza A (H1N1) virus infection. N Engl J Med. 2010;362 (18):17081719.
2.Siston, AM, Rasmussen, SA, Honein, MA, et alPandemic H1N1 Influenza in Pregnancy Working Group. Pandemic 2009 influenza A(H1N1) virus illness among pregnant women in the United States. JAMA. 2010;303 (15):15171525.
3.Fonseca, VP, Davis, M, Wing, R, et alCenters for Disease Control and Prevention (CDC). Novel influenza A (H1N1) virus infections in three pregnant women - United States, April-May 2009. MMWR Morb Mortal Wkly Rep. 2009;58 (18):497500.
4.Jamieson, DJ, Honein, MA, Rasmussen, SA, et alNovel Influenza A (H1N1) Pregnancy Working Group. H1N1 2009 influenza virus infection during pregnancy in the USA. Lancet. 2009;374 (9688):451458.
5.Louie, JK, Acosta, M, Jamieson, DJ, Honein, MACalifornia Pandemic (H1N1) Working Group. Severe 2009 H1N1 influenza in pregnant and postpartum women in California. N Engl J Med. 2010;362 (1):2735.
6.Creanga, AA, Johnson, TF, Graitcer, SB, et alSeverity of 2009 pandemic influenza A (H1N1) virus infection in pregnant women. Obstet Gynecol. 2010;115 (4):717726.
7.ANZIC Influenza Investigators and Australasian Maternity Outcomes Surveillance System. Critical illness due to 2009 A/H1N1 influenza in pregnant and postpartum women: population based cohort study. BMJ. 2010;340:c1279.
8.Han, K, Zhu, X, He, F, et alLack of airborne transmission during outbreak of pandemic (H1N1) 2009 among tour group members, China, June 2009. Emerg Infect Dis. 2009;15 (10):15781581.
9.Cauchemez, S, Donnelly, CA, Reed, C, et alHousehold transmission of 2009 pandemic influenza A (H1N1) virus in the United States. N Engl J Med. 2009;361 (27):26192627.
10.Thacker, E, Janke, B.Swine influenza virus: zoonotic potential and vaccination strategies for the control of avian and swine influenzas. J Infect Dis. 2008;197(suppl 1)S19S24.
11.Witkop, CT, Duffy, MR, Macias, EA, et alNovel influenza A (H1N1) outbreak at the U.S. Air Force Academy: epidemiology and viral shedding duration. Am J Prev Med. 2010;38 (2):121126.
12.Cao, B, Li, XW, Mao, Y, et alNational Influenza A Pandemic (H1N1) 2009 Clinical Investigation Group of China. Clinical features of the initial cases of 2009 pandemic influenza A (H1N1) virus infection in China. N Engl J Med. 2009;361 (26):25072517.
13.Lewis, D, Wilson, CDevelopmental immunology and the role of host defenses in neonatal susceptibility to infection. In: Remington J, Klein J, eds. Infectious Diseases of the Fetus and Newborn Infant. Philadelphia, Pennsylvania: WB Saunders; 2001:25-38.
14.Brady, MT.Health care-associated infections in the neonatal intensive care unit. Am J Infect Control. 2005;33 (5):268275.
15.Garvy, B.Host defense against pulmonary infection in neonates. Clin Appl Immunol Rev. 2003;4:205223.
16.Potter, RC, Gonik, B.Prevention of influenza in mothers and infants. Expert Rev Vaccines. 2009;8 (2):149152.
17.Centers for Disease Control and Prevention. Updated Interim Recommendations for the Use of Antiviral Medications in the Treatment and Prevention of Influenza for the 2009-2010 Season. Published 2009. Accessed September 11, 2009.
18.Bhat, N, Wright, JG, Broder, KR, et alInfluenza Special Investigations Team. Influenza-associated deaths among children in the United States, 2003-2004. N Engl J Med. 2005;353 (24):25592567.
19.Coffin, SE, Zaoutis, TE, Rosenquist, AB, et alIncidence, complications, and risk factors for prolonged stay in children hospitalized with community-acquired influenza. Pediatrics. 2007;119 (4):740748.
20.Iwane, MK, Edwards, KM, Szilagyi, PG, et alNew Vaccine Surveillance Network. Population-based surveillance for hospitalizations associated with respiratory syncytial virus, influenza virus, and parainfluenza viruses among young children. Pediatrics. 2004;113 (6):17581764.
21.Izurieta, HS, Thompson, WW, Kramarz, P, et alInfluenza and the rates of hospitalization for respiratory disease among infants and young children. N Engl J Med. 2000;342 (4):232239.
22.Neuzil, KM, Mellen, BG, Wright, PF, Mitchel, EF Jr, Griffin, MR.The effect of influenza on hospitalizations, outpatient visits, and courses of antibiotics in children. N Engl J Med. 2000;342 (4):225231.
23.O’Brien, MA, Uyeki, TM, Shay, DK, et alIncidence of outpatient visits and hospitalizations related to influenza in infants and young children. Pediatrics. 2004;113 (3, pt 1):585593.
24.Poehling, KA, Edwards, KM, Weinberg, GA, et alNew Vaccine Surveillance Network. The underrecognized burden of influenza in young children. N Engl J Med. 2006;355 (1):3140.
25.Centers for Disease Control and Prevention (CDC). Update: influenza activity - United States, August 30, 2009-March 27, 2010, and composition of the 2010-11 influenza vaccine. MMWR Morb Mortal Wkly Rep. 2010;59 (14):423430.
26.Libster, R, Bugna, J, Coviello, S, et alPediatric hospitalizations associated with 2009 pandemic influenza A (H1N1) in Argentina. N Engl J Med. 2010;362 (1):4555.
27.van 't Klooster, TM, Wielders, CC, Donker, T, et alSurveillance of hospitalisations for 2009 pandemic influenza A(H1N1) in the Netherlands, 5 June - 31 December 2009. Euro Surveill. 2010;15 2.
28.Irving, WL, James, DK, Stephenson, T, et alInfluenza virus infection in the second and third trimesters of pregnancy: a clinical and seroepidemiological study. BJOG. 2000;107 (10):12821289.
29. McGregor, JA, Burns, JC, Levin, MJ, Burlington, B, Meiklejohn, G.Transplacental passage of influenza A/Bangkok (H3N2) mimicking amniotic fluid infection syndrome. Am J Obstet Gynecol. 1984;149 (8):856859.
30.Zou, S.Potential impact of pandemic influenza on blood safety and availability. Transfus Med Rev. 2006;20 (3):181189.
31.Gu, J, Xie, Z, Gao, Z, et alH5N1 infection of the respiratory tract and beyond: a molecular pathology study. Lancet. 2007;370 (9593):11371145.
32.Yawn, DH, Pyeatte, JC, Joseph, JM, Eichler, SL, Garcia-Bunuel, R.Transplacental transfer of influenza virus. JAMA. 1971;216 (6):10221023.
33.Rasmussen, SA, Hayes, EB, Jamieson, DJ, O’Leary, DR.Emerging infections and pregnancy: assessing the impact on the embryo or fetus. Am J Med Genet A. 2007;143A (24):28962903.
34.Dulyachai, W, Makkoch, J, Rianthavorn, P, et alPerinatal pandemic (H1N1) 2009 infection, Thailand. Emerg Infect Dis. 2010;16 (2):343344.
35.Glezen, WP, Taber, LH, Frank, AL, Gruber, WC, Piedra, PA.Influenza virus infections in infants. Pediatr Infect Dis J. 1997;16 (11):10651068.
36.van den Dungen, FA, van Furth, AM, Fetter, WP, Zaaijer, HL, van Elburg, RM.Fatal case of influenza B virus pneumonia in a preterm neonate. Pediatr Infect Dis J. 2001;20 (1):8284.
37.Yusuf, K, Soraisham, AS, Fonseca, K.Fatal influenza B virus pneumonia in a preterm neonate: case report and review of the literature. J Perinatol. 2007;27 (10):623625.
38.Cunha, BA, Thekkel, V, Krilov, L.Nosocomial swine influenza (H1N1) pneumonia: lessons learned from an illustrative case. J Hosp Infect. 2010;74 (3):278281.
39.Verboon-Maciolek, MA, Krediet, TG, Gerards, LJ, Fleer, A, van Loon, TM.Clinical and epidemiologic characteristics of viral infections in a neonatal intensive care unit during a 12-year period. Pediatr Infect Dis J. 2005;24 (10):901904.
40.Ravenscroft, JL, Weisman, LENosocomial viral infections in the neonate. In: Basow DS, ed. UpToDate. Waltham, Massachusetts: UpToDate; 2009.
41.Cunney, RJ, Bialachowski, A, Thornley, D, Smaill, FM, Pennie, RA.An outbreak of influenza A in a neonatal intensive care unit. Infect Control Hosp Epidemiol. 2000;21 (7):449454.
42.Munoz, FM, Campbell, JR, Atmar, RL, et alInfluenza A virus outbreak in a neonatal intensive care unit. Pediatr Infect Dis J. 1999;18 (9):811815.
43.Sagrera, X, Ginovart, G, Raspall, F, et alOutbreaks of influenza A virus infection in neonatal intensive care units. Pediatr Infect Dis J. 2002;21 (3):196200.
44.National Center for Immunization and Respiratory Diseases, CDC; Centers for Disease Control and Prevention (CDC). Use of influenza A (H1N1) 2009 monovalent vaccine: recommendations of the Advisory Committee on Immunization Practices (ACIP), 2009. MMWR Recomm Rep. 2009;58 (RR-10):18.
45.Centers for Disease Control and Prevention. Interim results: Influenza A (H1N1) 2009 monovalent vaccination coverage–United States, October-December 2009. MMWR Morb Mortal Wkly Rep. 2010;59:15.
46.Centers for Disease Control and Prevention (CDC). Influenza vaccination in pregnancy: practices among obstetrician-gynecologists--United States, 2003-04 influenza season. MMWR Morb Mortal Wkly Rep. 2005;54 (41):10501052.
47.Tamma, PD, Ault, KA, del Rio, C, Steinhoff, MC, Halsey, NA, Omer, SB.Safety of influenza vaccination during pregnancy. Am J Obstet Gynecol. 2009;201 (6):547552.
48.Zaman, K, Roy, E, Arifeen, SE, et alEffectiveness of maternal influenza immunization in mothers and infants. N Engl J Med. 2008;359 (15):15551564.
49.Eick, AA, Uyeki, TM, Klimov, A, et alMaternal influenza vaccination and effect on influenza virus infection in young infants. Arch Pediatr Adolesc Med. 2011;165 (2):104111.
50.Arifeen, S, Black, RE, Antelman, G, Baqui, A, Caulfield, L, Becker, S.Exclusive breastfeeding reduces acute respiratory infection and diarrhea deaths among infants in Dhaka slums. Pediatrics. 2001;108 (4):E67.
51.Chantry, CJ, Howard, CR, Auinger, P.Full breastfeeding duration and associated decrease in respiratory tract infection in US children. Pediatrics. 2006;117 (2):425432.
52.Howie, PW, Forsyth, JS, Ogston, SA, Clark, A, Florey, CD.Protective effect of breast feeding against infection. BMJ. 1990;300 (6716):1116.
53.Quigley, MA, Kelly, YJ, Sacker, A.Breastfeeding and hospitalization for diarrheal and respiratory infection in the United Kingdom Millennium Cohort Study. Pediatrics. 2007;119 (4):e837e842.
54.Ip, S, Chung, M, Raman, G, Trikalinos, TA, Lau, J.A summary of the Agency for Healthcare Research and Quality's evidence report on breastfeeding in developed countries. Breastfeed Med. 2009;4(suppl 1)S17S30.
55.Bahl, R, Frost, C, Kirkwood, BR, et alInfant feeding patterns and risks of death and hospitalization in the first half of infancy: multicentre cohort study. Bull World Health Organ. 2005;83 (6):418426.
56.Hanson, L.Immunobiology of Human Milk: How Breastfeeding Protects Babies. Amarillo, Texas: Pharmasoft Publishing; 2004.
57.Tanaka, T, Nakajima, K, Murashima, A, Garcia-Bournissen, F, Koren, G, Ito, S.Safety of neuraminidase inhibitors against novel influenza A (H1N1) in pregnant and breastfeeding women. CMAJ. 2009;181 (1-2):5558.
58.Committee on Health Care for Underserved Women, American College of Obstetricians and Gynecologists. ACOG Committee Opinion No. 361: Breastfeeding: maternal and infant aspects. Obstet Gynecol. 2007;1092, pt 1479480.
59.U.S. Preventive Services Task Force. Primary care interventions to promote breastfeeding: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2008;149 (8):560564.
60.Gartner, LM, Morton, J, Lawrence, RA, et alAmerican Academy of Pediatrics Section on Breastfeeding. Breastfeeding and the use of human milk. Pediatrics. 2005;115 (2):496506.
61.To, KK, Hung, IF, Li, IW, et alDelayed clearance of viral load and marked cytokine activation in severe cases of pandemic H1N1 2009 influenza virus infection. Clin Infect Dis. 2010;50 (6):850859.
62.Centers for Disease Control and Prevention. Interim Guidance: Considerations Regarding 2009 H1N1 Influenza in Intrapartum and Postpartum Hospital Settings. Published 2009. Accessed December 29, 2009.
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