Pregnancy as a risk factor for severe influenza infection: an individual participant data meta-analysis

被引：68

作者：

Mertz, Dominik ^{[1
,2
,3
,4
,5
]}

Lo, Calvin Ka-Fung ^{[3
,4
]}

Lytvyn, Lyubov ^{[2
]}

Ortiz, Justin R. ^{[6
]}

Loeb, Mark ^{[2
,3
,4
,5
]}

Ang, Li Wei ^{[7
]}

Anlikumar, Mehta Asmita ^{[8
]}

Bonmarin, Isabelle ^{[9
]}

Hugo Borja-Aburto, Victor ^{[10
]}

Burgmann, Heinz ^{[11
]}

Carratala, Jordi ^{[12
,13
,14
]}

Chowell, Gerardo ^{[15
,16
]}

Cilloniz, Catia ^{[17
]}

Cohen, Jessica ^{[18
]}

Cutter, Jeffery ^{[7
]}

Filleul, Laurent ^{[19
]}

Garg, Shikha ^{[20
]}

Geis, Steffen ^{[21
,22
]}

Helferty, Melissa ^{[23
]}

Huang, Wan-Ting ^{[24
]}

Jain, Seema ^{[25
]}

Sevic, Biljana Joves ^{[26
]}

Kelly, Paul ^{[27
,28
]}

Kusznierz, Gabriela ^{[29
]}

Lehners, Nicola ^{[30
]}

Lenzi, Luana ^{[31
]}

Ling, Ivan T. ^{[32
]}

Mitchell, Robyn ^{[33
]}

Mulrennan, Siobhain A. ^{[34
,35
]}

Nishioka, Sergio A. ^{[36
]}

Norton, Robert ^{[37
]}

Oh, Won Sup ^{[38
]}

Orellano, Pablo ^{[39
]}

Poeppl, Wolfgang ^{[40
]}

Pontarolo, Roberto ^{[31
]}

Popovici, Odette ^{[41
]}

Rodriquez, Alejandro ^{[42
]}

Schlehe, Bettina ^{[43
]}

Schnitzler, Paul ^{[44
]}

Sertogullarindan, Bunyamin ^{[45
]}

Shu, Yuelong ^{[46
]}

Taylor, Geoffrey ^{[47
]}

Thompson, Deborah L. ^{[48
,49
]}

Torres, Antoni ^{[17
]}

van Gageldonk-Lafeber, Arianne B. ^{[50
]}

Viasus, Diego ^{[51
,52
]}

Wang, Quanyi ^{[53
]}

Xu, Cuiling ^{[46
]}

机构：

[1] McMaster Univ, Dept Med, Hamilton, ON, Canada

[2] McMaster Univ, Dept Hlth Res Methods Evidence & Impact, Hamilton, ON, Canada

[3] McMaster Univ, Dept Pathol & Mol Med, MDCL 3203,1200 Main St W, Hamilton, ON L8N 3Z5, Canada

[4] McMaster Univ, Dept Clin Epidemiol & Biostat, MDCL 3203,1200 Main St W, Hamilton, ON L8N 3Z5, Canada

[5] McMaster Univ, Michael G DeGroote Inst Infect Dis Res, Hamilton, ON, Canada

[6] WHO, Initiat Vaccine Res, Geneva, Switzerland

[7] Minist Hlth, Singapore, Singapore

[8] Amrita VishwaVidyapeetham, Amrita Inst Med Sci, Dept Pulm Med, Vallikavu, Kerala, India

[9] Sante Publ France, St Denis, Reunion, France

[10] Inst Mexicano Seguro Social, Primary Hlth Care Unit, Mexico City, DF, Mexico

[11] Med Univ Vienna, Div Infect Dis & Trop Med, Dept Internal Med 1, Vienna, Austria

[12] Hosp Univ Bellvitge IDIBELL, Barcelona, Spain

[13] Spanish Network Res Infect Dis REIPI, Barcelona, Spain

[14] Univ Barcelona, Barcelona, Spain

[15] Georgia State Univ, Sch Publ Hlth, Atlanta, GA 30303 USA

[16] NIH, Div Int Epidemiol & Populat Studies, Fogarty Int Ctr, Bldg 10, Bethesda, MD 20892 USA

[17] Univ Barcelona, IDIBAPS, Hosp Clin, Dept Pneumol,Inst Torax, Barcelona, Spain

[18] Ctr Dis Control & Prevent, Atlanta Res & Educ Fdn, Influenza Div, Atlanta, GA USA

[19] French Natl Publ Hlth Agcy, Sante Publ France, Reg Unit Cire Ocean Indien, St Denis, Reunion, France

[20] Ctr Dis Control & Prevent, Influenza Div, Atlanta, GA USA

[21] London Sch Hyg & Trop Med, Dept Infect Dis Epidemiol, London, England

[22] MEIRU, Lilongwe, Malawi

[23] Publ Hlth Agcy Canada, Ottawa, ON, Canada

[24] Taiwan Ctr Dis Control, Off Prevent Med, Taipei, Taiwan

[25] Ctr Dis Control & Prevent, Influenza Div, Atlanta, GA USA

[26] Inst Pulm Dis Vojvodina, Sremska Kamen, Serbia

[27] Australian Capital Terr Hlth Directorate, Canberra, ACT, Australia

[28] Australian Natl Univ, Med Sch, Canberra, ACT, Australia

[29] ANLIS Dr C Malbran, Inst Nacl Enfermedades Resp Dr Emilio Coni, Buenos Aires, DF, Argentina

[30] Univ Hosp Heidelberg, Dept Med 5, Heidelberg, Germany

[31] Univ Fed Parana, Curitiba, Parana, Brazil

[32] Sir Charles Gairdner Hosp, Dept Resp Med, Perth, WA, Australia

[33] Publ Hlth Agcy Canada, Ottawa, ON, Canada

[34] Univ Western Australia, Sir Charles Gairdner Hosp, Dept Resp Med, Perth, WA, Australia

[35] Univ Western Australia, Sch Med & Pharmacol, Perth, WA, Australia

[36] Minist Hlth, Rio De Janeiro, Brazil

[37] Townsville Hosp, Microbiol & Pathol, Townsville, Qld, Australia

[38] Kangwon Natl Univ, Sch Med, Dept Internal Med, Chunchon, South Korea

[39] Consejo Nacl Invest Cient & Tecn CONICET, Buenos Aires, DF, Argentina

[40] Mil Hosp Vienna, Dept Dermatol & Trop Med, Vienna, Austria

[41] Natl Inst Publ Hlth, Natl Ctr Surveillance & Control Communicable Dis, Bucharest, Romania

[42] Hosp Univ Joan XXIII, IISPV, CIBERES, SEMICYUC Spanish Soc Intens Care Med,URV, Tarragona, Spain

[43] Heidelberg Univ, Dept Obstet & Gynecol, Heidelberg, Germany

[44] Univ Hosp Heidelberg, Ctr Infect Dis, Heidelberg, Germany

[45] Izmir Katip Celebi Univ, Med Fac, Izmir, Turkey

[46] Chinese Ctr Dis Control & Prevent, Natl Inst Viral Dis Control & Prevent, Natl Hlth & Family Planning Commiss, Key Lab Med Virol, Beijing, Peoples R China

[47] Univ Alberta, Edmonton, AB, Canada

[48] New Mexico Dept Hlth, Santa Fe, NM USA

[49] Presbyterian Healthcare Serv, Albuquerque, NM USA

[50] Natl Inst Publ Hlth & Environm RIVM, Bilthoven, Netherlands

来源：

BMC INFECTIOUS DISEASES | 2019年 / 19卷 / 01期

关键词：

Influenza; Vaccine; Pregnancy; Severity; Meta-analysis; A H1N1 VIRUS; HOSPITALIZED-PATIENTS; A(H1N1)PDM09 INFECTION; SEVERE OUTCOMES; UNITED-STATES; WOMEN; SURVEILLANCE; PNEUMONIA; FEATURES; SEASONS;

D O I：

10.1186/s12879-019-4318-3

中图分类号：

R51 [传染病];

学科分类号：

100401 ;

摘要：

Background WHO identifies pregnant women to be at increased risk for severe outcomes from influenza virus infections and recommends that they be prioritized for influenza vaccination. The evidence supporting this, however, is inconsistent. Ecologic studies in particular suggest more severe outcomes from influenza infection during pregnancy than studies based on individual patient data. Individual studies however may be underpowered and, as reported in a previous systematic review, confounding factors could not be adjusted for. We therefore conducted an individual participant data meta-analysis to assess the risk for severe outcomes of influenza infection in pregnant women while adjusting for other prognostic factors. Methods We contacted authors of studies included in a recently published systematic review. We pooled the individual participant data of women of reproductive age and laboratory confirmation of influenza virus infection. We used a generalized linear mixed model and reported odds ratios (OR) and 95% confidence intervals (CI). Results A total of 33 datasets with data on 186,656 individuals were available, including 36,498 eligible women of reproductive age and known pregnancy status. In the multivariable model, pregnancy was associated with a 7 times higher risk of hospital admission (OR 6.80, 95%CI 6.02-7.68), among patients receiving medical care as in- or outpatients, pregnancy was associated with a lower risk of admission to intensive care units (ICU; OR 0.57, 95%CI 0.48-0.69), and was not significantly associated with death (OR 1.00, 95%CI 0.75-1.34). Conclusions Our study found a higher risk of influenza associated hospitalization among pregnant women as compared to non-pregnant women. We did not find a higher mortality rate or higher likelihood of ICU admission among pregnant women who sought medical care. However, this study did not address whether a true community based cohort of pregnant women is at higher risk of influenza associated complications.

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