<?xml version="1.0" encoding="utf-8"?>
<recommendedContent xmlns="http://api.mspoke.com">
    <recommendedItem id="20100101_19_414"
                     title="H1N1 Vaccination Still a Good Idea, CDC Says"
                     score="0.012"
                     href="http://www.medpagetoday.com/InfectiousDisease/SwineFlu/tb/18325?impressionId=1265762968223"
                     
      &lt;p&gt;Although pandemic H1N1 influenza activity appears to have leveled off, the CDC remains wary of what the future may hold.&lt;/p&gt;
&lt;p&gt;No states were reporting widespread influenza activity, and only six  --  Alabama, Georgia, Maine, New Jersey, New Mexico, and Virginia  --  were reporting regional activity, Anne Schuchat, MD, director of the CDC&apos;s National Center for Immunization and Respiratory Diseases, told reporters on a conference call today.&lt;/p&gt;
&lt;p&gt;Influenza-like activity remained below the baseline level for this time of year for the third straight week, Schuchat said.&lt;/p&gt;
&lt;p&gt;&quot;That&apos;s fairly similar to what we would normally see at this time of year with seasonal flu,&quot; she said.&lt;/p&gt;
&lt;p&gt;However, she said that the H1N1 virus continues to circulate, causing severe disease and death in some cases.&lt;/p&gt;
&lt;p&gt;Although total activity is down, Schuchat noted that the proportion of deaths attributed to either flu or pneumonia is higher than the epidemic threshold, and has been for the past three weeks. The reasons were unclear, but she said there are no indications that the virus has become more virulent.&lt;/p&gt;
&lt;p&gt;But, she said, &quot;H1N1 vaccination remains a good idea.&quot;&lt;/p&gt;
&lt;p&gt;The most recent results of the CDC&apos;s National H1N1 Flu Survey revealed that about 70 million people, or 23.4% of Americans, have been vaccinated so far. About 76 million doses of the vaccine have been used because of the requirement that children younger than 10 get two.&lt;/p&gt;
&lt;p&gt;About 37% of children up to age 18 have been vaccinated. For those younger than 10, 37% have received their second dose.&lt;/p&gt;
&lt;p&gt;Vaccine supply remains ample, Schuchat said, with about 124 million doses shipped around the country up to this point.&lt;/p&gt;
&lt;p&gt;Citing an &quot;unprecedented&quot; effort to monitor safety, she said there have not been any major safety concerns identified.&lt;/p&gt;
&lt;p&gt;&quot;So if safety was the reason that you were waiting, I think you can be reassured on that front.&quot;&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20100101_19_366"
                     title="Placental Infection Could Spur Asthma (CME/CE)"
                     score="0.01"
                     href="http://www.medpagetoday.com/Pediatrics/Asthma/tb/18252?impressionId=1265762968223"
                     
      Preterm birth complicated by chorioamnionitis may modestly increase a child&apos;s risk of later asthma, researchers found.&lt;br&gt;
&lt;br&gt;Children born preterm after a pregnancy complicated by the bacterial infection of placenta and amniotic fluid (chorioamnionitis) were significantly more likely to develop asthma by age eight than preemies without such exposure, according to Darios Getahun, MD, MPH, of Kaiser Permanente Department of Research and Evaluation in Pasadena.&lt;br&gt;
&lt;br&gt;Asthma diagnosis was nearly threefold more common among chorioamnionitis-exposed children who had been born preterm than those carried to term, they wrote in the February &lt;em&gt;Archives of Pediatrics &amp;amp; Adolescent Medicine&lt;/em&gt;.&lt;br&gt;
&lt;br&gt;Premature birth may not give an infant&apos;s lungs a chance to fully develop, leading to early infection and inflammation that elevate risk of chronic lung disease, such as asthma.&lt;p&gt;&lt;/p&gt;
&lt;p&gt;However, in utero exposures could be an important contributor as well, Getahun explained in an interview.&lt;/p&gt;
&lt;p&gt;Chorioamnionitis is thought to be associated with more than half of all preterm births.&lt;/p&gt;
&lt;p&gt;Fetal lungs stay in contact with the amniotic fluid which, when infected, may expose the developing lung to microorganisms, toxic substances, and inflammatory mediators, the researchers wrote.&lt;/p&gt;
&lt;p&gt;Animal model evidence suggests the condition may lead to scarring and fibrosis in the lung and damage to other fetal organs &quot;during a very critical time at preterm gestation,&quot; Getahun told &lt;em&gt;MedPage Today&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;So, his group retrospectively studied Kaiser&apos;s matched perinatal records on 510,216 singleton children born at the managed care group&apos;s hospitals in Southern California between 1991 and 2007.&lt;/p&gt;
&lt;p&gt;Physician-diagnosed asthma incidence by age 8 years, as expected, was significantly higher overall for preemies born at 23 to 36 weeks&apos; gestation than for those carried full-term (60.2 versus 40.0 per 1,000 person-years).&lt;/p&gt;
&lt;p&gt;But chorioamnionitis diagnosed during pregnancy substantially boosted this risk.&lt;/p&gt;
&lt;p&gt;Incidence of asthma rose to 100.7 per 1,000 person-years in exposed children born preterm, versus 39.6 per 1,000 among exposed, full-term children (IR 2.9, 95% CI 2.6 to 3.3).&lt;/p&gt;
&lt;p&gt;This association between chorioamnionitis and asthma in preemies persisted (HR 1.68, 95% CI 1.52 to 1.87) after adjustment for important confounding variables, including maternal age, race or ethnicity, smoking during pregnancy, prenatal care, and maternal asthma.&lt;/p&gt;
&lt;p&gt;Although the asthma risk appeared to rise with greater prematurity in exposed children, the elevated risk associated with chorioamnionitis exposure in utero was seen in every category of prematurity: &lt;ul&gt; &lt;li&gt; 1.23 times higher risk in children born at 23 to 28 weeks (95% CI 1.02 to 1.49)&lt;/li&gt; &lt;li&gt; 1.51 times higher risk in children born at 28 to 33 weeks (95% CI 1.26 to 1.80)&lt;/li&gt; &lt;li&gt; 1.20 times higher risk in children born at 34 to 36 weeks (95% CI 1.03 to 1.47)&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;Additional adjustment for bronchopulmonary dysplasia  --  &quot;one of the mechanisms through which preterm birth is presumably associated with respiratory problems in early childhood&quot;  --  had little impact on the findings.&lt;/p&gt;
&lt;p&gt;Thus, the bacterial infection appeared to be an independent risk factor for asthma in prematurely born children, the researchers concluded.&lt;/p&gt;
&lt;p&gt;The risks were particularly high for children born to African-American women who developed chorioamnionitis, suggesting this may be an at-risk group to single out for attention clinically, they suggested.&lt;/p&gt;
&lt;p&gt;Getahun cautioned, though, that his group&apos;s study could not prove causality. The researchers also noted that the study was limited by lack of data on parental atopy and smoking.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was supported by Kaiser Permanente Direct Community Benefit funds. The researchers reported no conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_302"
                     title="WHO Calls H1N1 Response Imperfect"
                     score="0.005"
                     href="http://www.medpagetoday.com/InfectiousDisease/SwineFlu/tb/18165?impressionId=1265762968223"
                     
      &lt;p&gt;The World Health Organization says its response to the H1N1 pandemic could have been better, but was not unduly swayed by drug manufacturers.&lt;/p&gt;
&lt;p&gt;&quot;We are under no illusions that this response was the perfect response,&quot; Keiji Fukuda, MD, the agency&apos;s top flu expert, told a hearing being held by the Council of Europe&apos;s health committee.&lt;/p&gt;
&lt;p&gt;But he added, &quot;The influenza pandemic policies and responses recommended and taken by WHO were not improperly influenced by the pharmaceutical industry.&quot;&lt;/p&gt;
&lt;p&gt;The council&apos;s hearing is a response to criticism by some European politicians, as well as elements of the media, that the danger of the H1N1 pandemic was exaggerated, perhaps to allow drug companies to score multimillion-dollar contracts for vaccines and antivirals.&lt;/p&gt;
&lt;p&gt;In North America, many experts defended the response to the outbreak, which WHO last April declared a phase six pandemic  --  the highest level. The phases reflect that an infectious agent is widely spread and causing disease in the community, but they say nothing about the severity of the disease.&lt;/p&gt;
&lt;p&gt;&quot;I do not believe that the record supports the claim that health officials in the U.S. or WHO exaggerated the threat,&quot; said Andy Pavia, MD, of the University of Utah in Salt Lake City.&lt;/p&gt;
&lt;p&gt;Pavia said in an e-mail that health officials had a choice  --  to assume the threat was minor or to react strongly.&lt;/p&gt;
&lt;p&gt;&quot;The choice is obvious,&quot; Pavia said, &quot;and I would not want to be in a position of explaining to the families of victims why we planned for the mildest outcome.&quot;&lt;/p&gt;
&lt;p&gt;For the most part, illness caused by the disease has been mild, although several thousand people have died around the world and many more were sick enough to require intensive care.&lt;/p&gt;
&lt;p&gt;But the relatively low number of deaths has prompted Wolfgang Wodarg, MD, a German member of the council&apos;s Parliamentary Assembly, to dub the outbreak a &quot;false pandemic&quot; and call for this week&apos;s hearing.&lt;/p&gt;
&lt;p&gt;&quot;What we have experienced now is that millions of people have been vaccinated unnecessarily,&quot; Wodarg said. &quot;This is damage done to people, in order to earn money.&quot;&lt;/p&gt;
&lt;p&gt;Fukuda, on the other hand, said today the pandemic &quot;is a scientifically well-documented event.&quot;&lt;/p&gt;
&lt;p&gt;&quot;The labeling of the pandemic as &quot;fake&quot; is to ignore recent history and science,&quot; he said, &quot;and to trivialize the deaths of over 14,000 people and the many additional serious illnesses experienced by others.&quot;&lt;/p&gt;
&lt;p&gt;Utah&apos;s Pavia echoed that sentiment. Ask any front-line doctor if the H1N1 flu was mild, he said, &quot;and prepare to get your head handed to you.&quot;&lt;/p&gt;
&lt;p&gt;One of them was Daniel Hinthorn, MD, of the University of Kansas Medical Center in Kansas City, Kan. &quot;As a physician who saw many patients with this disease, I believe it was very serious in many people,&quot; he wrote in an e-mail. &quot;The threat was not exaggerated, at least to my mind.&quot;&lt;/p&gt;
&lt;p&gt;Even last month, as flu activity in the U.S. declined, he said his hospital treated 11 inpatients for the flu, including six in intensive care, while &quot;lots of others&quot; were being seen in emergency wards and clinics.&lt;/p&gt;
&lt;p&gt;On the other hand, to say the threat was exaggerated &quot;is merely to say the obvious,&quot; argued Philip Alcabes, PhD, of City University of New York City. By the time a vaccine was available, &quot;this outbreak was far less serious than feared,&quot; he said in an e-mail.&lt;/p&gt;
&lt;p&gt;But &quot;reality-based skepticism about swine flu&quot; doesn&apos;t mean that people would refuse immunization  --  not if an outbreak was a real public danger, caused by a &quot;highly transmissible agent, likely to be virulent, highly preventable with reliably effective vaccine.&quot;&lt;/p&gt;
&lt;p&gt;He warned that public health professionals must avoid &quot;falling in love with the most dire forecast and then pushing high-tech precautions against the worst-case scenario.&quot;&lt;/p&gt;
&lt;p&gt;When that happens, &quot;people have to be excused for wondering whether the officials, the media, and the pharmaceutical companies were in cahoots on swine flu,&quot; he said.&lt;/p&gt;
&lt;p&gt;But several experts argued that preparing for a worst-case scenario was the responsible thing to do.&lt;/p&gt;
&lt;p&gt;Sometimes, &quot;mother nature throws us a break,&quot; argued Howard Markel, MD, PhD, of the University of Michigan in Ann Arbor.&lt;/p&gt;
&lt;p&gt;&quot;We responded to a threat without knowing the future,&quot; he said in an e-mail. &quot;A far worse outcome might have occurred if we did not take the threat seriously and H1N1 turned out to be worse than we initially predicted.&quot;&lt;/p&gt;
&lt;p&gt;The public health response should be compared to the use of seat belts or auto insurance, according to Gregory Poland, MD, of the Mayo Clinic in Rochester, Minn.&lt;/p&gt;
&lt;p&gt;Every day, he said in an e-mail, he puts on his seat belt before driving. &quot;I don&apos;t finish each day and say &apos;What a waste, I didn&apos;t have an accident,&apos;&quot; he said.&lt;/p&gt;
&lt;p&gt;&quot;It is (and remains) unpredictable as to whether this virus could further mutate or change in a manner such that it could literally turn deadly within weeks,&quot; he said. &quot;If this pandemic had been deadly (and you don&apos;t know until you are into it) and we weren&apos;t prepared, the criticism would have been overwhelming.&quot; Poland said.&lt;/p&gt;
&lt;p&gt;He and others also noted that the flu season isn&apos;t over yet.&lt;/p&gt;
&lt;p&gt;&quot;This argument should be taking place at the end of the flu season in late March, not now,&quot; said Peter Katona, MD, of the University of California Los Angeles. &quot;Flu is unpredictable, and this is the heart of the argument.&quot;&lt;/p&gt;
&lt;p&gt;&lt;em&gt;This article was developed in collaboration with ABC News. &lt;/em&gt;&lt;img src=&quot;http://www.medpagetoday.com/upload/2009/10/1/14357_1.jpg&quot; mce_src=&quot;http://www.medpagetoday.com/upload/2009/10/1/14357_1.jpg&quot; alt=&quot;&quot;&gt;&lt;/p&gt;
    </recommendedItem>
    <recommendedItem id="20090101_19_1912"
                     title="Anti-Flu Drugs Seem Safe in Pregnancy and Breastfeeding"
                     score="-0.005"
                     href="http://www.medpagetoday.com/InfectiousDisease/SwineFlu/tb/14710?impressionId=1265762968223"
                     
       TORONTO, June 15 -- The two antiviral drugs thought to be effective against the pandemic1N H1N1 influenza 
              virus are relatively safe in pregnant or lactating women, researchers here said.
              &lt;p&gt; 
              &lt;p&gt;Although the data are limited, a literature review suggests that both oseltamivir (Tamiflu) and zanamivir (Relenza) can be used if an H1N1 infection is suspected, according to Shinya Ito, M.D., of the Hospital for Sick Children here and colleagues.
              &lt;p&gt; 
              &lt;p&gt;The issue is important because -- as in seasonal flu -- pregnant women are at high risk for complications of the novel H1N1 strain, Dr. Ito and colleagues said online in the &lt;em&gt;Canadian Medical Association Journal&lt;/em&gt;.
              &lt;p&gt; 
              &lt;p&gt;&quot;Although the novel H1N1 influenza virus may not be as virulent as anticipated,&quot; the researchers argued, &quot;the increased risk of complications during pregnancy should be taken into account when caring for affected patients.&quot;
              &lt;p&gt; 
              &lt;p&gt;Oseltamivir and zanamivir belong to class of drugs known as neuraminidase inhibitors and -- based on molecular data -- the pandemic virus is susceptible to both.
              &lt;p&gt; 
              &lt;p&gt;However, the virus is not susceptible to the other major class of anti-flu drugs, the adamantanes rimantadine (Flumadine) and amantadine (Symmetrel).
              &lt;p&gt; 
              &lt;p&gt;To help clarify how the drugs should be used, Dr. Ito and colleagues conducted a literature search and also consulted records in Japan, where both oseltamivir and zanamivir were commonly used before the current pandemic.
              &lt;p&gt; 
              &lt;p&gt;In postmarketing surveillance, the maker of oseltamivir reported 61 women who were exposed to the drug during pregnancy, although the timing was not known. 
              &lt;p&gt; 
              &lt;p&gt;Among those pregnancies, Dr. Ito and colleagues said, there were 10 abortions, including six for therapeutic purposes, and one case each of trisomy 21 and anencephaly.
              &lt;p&gt; 
              &lt;p&gt;Those results are &quot;consistent,&quot; the researchers said, with data from the Toranomon Hospital and the Japan Drug Information Institute in Pregnancy, both in Tokyo, which prospectively followed a total of 90 pregnant women who took therapeutic doses of oseltamivir -- 75 milligrams twice a day for up to five days -- during the first trimester.
              &lt;p&gt; 
              &lt;p&gt;In those cases, there was one malformation (1.1%) -- a ventricular septal defect. The incidence of major malformations in the general population ranges from 1% to 3%, the researchers noted. 
              &lt;p&gt; 
              &lt;p&gt;When it comes to breast feeding, Dr. Ito and colleagues found, a single case report suggests that the dose passed on through breast milk is about 0.012 milligrams per kilogram of body weight per day, smaller than the approved pediatric dose of between two and four milligrams per kilogram of body weight daily. 
              &lt;p&gt; 
              &lt;p&gt;Information is even more limited concerning zanamivir, the researchers said.
              &lt;p&gt; 
              &lt;p&gt;Three pregnant women were accidentally exposed to zanamivir during clinical trials, and one pregnancy spontaneously miscarried, one was terminated, and one woman delivered a healthy baby.
              &lt;p&gt; 
              &lt;p&gt;The Japan Drug Information Institute in Pregnancy has information about one woman who took zanamivir at four weeks of gestation and delivered a healthy full-term baby.
              &lt;p&gt; 
              &lt;p&gt;Under reasonable assumptions about such things as milk intake, the researchers said, the amount of zanamivir that would be passed on through breast milk would be about 0.075 milligrams a day for a five kilogram infant.
              &lt;p&gt; 
              &lt;p&gt;As in the case of oseltamivir, that&apos;s lower than the recommended prophylactic dosage for children, of 10 milligrams a day by inhalation, they said.
              &lt;p&gt; 
              &lt;p&gt;If pregnant women need treatment or prophylaxis during the pandemic, &quot;oseltamivir appears to be the drug of choice because there are more data on its safety in pregnancy,&quot; Dr. Ito and colleagues said.
              &lt;p&gt; 
              &lt;p&gt;Both drugs appear to be &quot;compatible&quot; with breastfeeding and unlikely to lead to substantial drug exposure by the infant, they said. 
              &lt;p&gt; 
     &lt;table cellspacing=&quot;0&quot; hspace=&quot;1&quot; style=&quot;border-style:solid; border-width:1px; border-color:#8dabbc; font-family:arial; font-size:12px; background-color:#DBE9F2; padding:5px 5px 5px 5px;&quot;&gt;
&lt;tr&gt;&lt;td&gt;The study had support from the Japanese Ministry of Health, Labor and Welfare and the National Center for Child Health and Development-Motherisk Collaborative Research Fund. 
              &lt;p&gt;Dr. Ito reported no conflicts. 
      &lt;/td&gt;&lt;/tr&gt;&lt;/table&gt; &lt;p&gt;
    </recommendedItem>
    <recommendedItem id="20090101_19_2384"
                     title="Pregnancy Increases Risk of Severe H1N1 Disease"
                     score="-0.005"
                     href="http://www.medpagetoday.com/InfectiousDisease/SwineFlu/tb/15284?impressionId=1265762968223"
                     
      TORONTO, July 29 -- Pregnant women are at greater risk for severe disease and complications from H1N1 pandemic flu than the general public, researchers said. 
              &lt;br&gt;&lt;br&gt;They should be treated promptly with antiviral drugs if the pandemic flu strain is suspected, according to Denise Jamieson, MD, of the CDC, and colleagues. 
              &lt;br&gt;&lt;br&gt;The recommendation is based on an analysis of cases and deaths of pregnant women from the pandemic strain in the early weeks of the U.S. outbreak, Dr. Jamieson and colleagues reported online in &lt;em&gt;The Lancet&lt;/em&gt;. 
              &lt;br&gt;&lt;br&gt;The findings underscore the CDC recommendation that pregnant women with the flu should get swift antiviral treatment and may also have implications for the use of a vaccine against the pandemic. 
              &lt;p&gt;
              &lt;p&gt;&quot;If a pregnant woman feels like she may have influenza, she needs to call her healthcare provider right away,&quot; Dr. Jamieson said in a statement. 
              &lt;p&gt;
              &lt;p&gt;In addition, she said, doctors treating pregnant women need a triage system to screen for influenza-like symptoms &quot;and they should not delay in initiating appropriate antiviral therapy.&quot; 
              &lt;p&gt;
              &lt;p&gt;Dr. Jamieson said some doctors hesitate to use antiviral drugs in pregnant women &quot;because of concerns for the developing fetus, but this is the wrong approach. It is critical that pregnant women, in particular, be treated promptly.&quot; 
              &lt;p&gt;
              &lt;p&gt;During the first month of the outbreak -- from April 15 to May 18 -- 34 confirmed or probable cases of pandemic H1N1 in pregnant women were reported to the CDC from 13 states, the researchers found. 
              &lt;p&gt;
              &lt;p&gt;Confirmed cases were those with laboratory evidence of H1N1; probable cases were those in which the victim had an acute febrile respiratory illness and was positive for influenza A, but negative for H1 and H3, Dr. Jamieson and colleagues said. 
              &lt;p&gt;
              &lt;p&gt;Of the 34 cases, 11 -- or 32% -- required inpatient care, for an estimated hospital admission rate of 0.32 per 100,000 pregnant women, compared with 0.076 per 100,000 in the general population at risk, they said. 
              &lt;p&gt;
              &lt;p&gt;By June 16, six H1N1-related deaths in pregnant women had been reported to the CDC, all in women who had developed pneumonia and subsequent acute respiratory distress syndrome requiring mechanical ventilation.
              &lt;p&gt; 
              &lt;p&gt;That was 13% of the 45 deaths reported during that period, the researchers said. 
              &lt;p&gt;
              &lt;p&gt;Of the six who died, one was in the first trimester, one in the second trimester, and four were in the third trimester and all were &quot;fairly healthy&quot; before their illness, the researchers said. 
              &lt;p&gt;
              &lt;p&gt;All the women were treated with oseltamivir (Tamiflu) and the time from symptom onset to treatment ranged from six to 15 days, they said. 
              &lt;p&gt;
              &lt;p&gt;The five patients with viable pregnancies had cesarean sections and none of the infants were born with flu. Four have been discharged home in good health, while the fifth -- born at 27 weeks gestation -- remains in the hospital and is doing well, Dr. Jamieson and colleagues said. 
              &lt;p&gt;
              &lt;p&gt;Meanwhile, the issue seems likely to kindle debate over who should get the H1N1 vaccine when it becomes available. 
              &lt;p&gt;
              &lt;p&gt;&quot;There are two broad goals in using a vaccine,&quot; said Marc Lipsitch, DPhil, of Harvard University, &quot;to protect people who are likely to get severely ill if they are infected, and to slow down transmission by vaccinating the people who are most likely to get infected and pass the virus on.&quot; 
              &lt;p&gt;
              &lt;p&gt;But the second goal is going to be difficult to reach since current estimates show the vaccine arriving on the scene well after the second wave of the pandemic starts this fall, he said. 
              &lt;p&gt;
              &lt;p&gt;&quot;Therefore,&quot; Dr. Lipsitch said, &quot;it is very wise to plan to use vaccines mainly to protect those most vulnerable.&quot; 
              &lt;p&gt;
              &lt;p&gt;But he cautioned that it will be vital to monitor vaccine safety, since pregnant women -- and some other potentially high-risk groups -- are also at higher risk for other adverse events. 
              &lt;p&gt;
              &lt;p&gt;&quot;This means that even with a perfectly safe vaccine, there will be (by chance) people who receive the vaccine and then very shortly after experience adverse health events,&quot; he said. 
              &lt;p&gt;
              &lt;p&gt;To avoid a possible backlash, Dr. Lipsitch said, &quot;it is critical for the public and the health community to understand in advance that adverse events in vaccinated people are expected to happen, and their occurrence is not in itself an indication that the vaccine is unsafe.&quot; 
              &lt;p&gt;
              &lt;p&gt;Carlos del Rio, MD, of Emory University in Atlanta, concurred that safety is an important issue. &quot;The vaccine (as far as I can tell) has not yet been tested for safety in pregnancy,&quot; he said. 
              &lt;p&gt;
              &lt;p&gt;Dr. del Rio said it&apos;s not surprising that pregnancy appears to be a risk factor for severe H1N1 disease. &quot;Pregnancy is also a risk factor for other infectious diseases to be more severe,&quot; he said. &quot;Thus, it makes sense that (pregnant women) should be immunized.&quot; 
              &lt;p&gt;
              &lt;p&gt;On the other hand, he said, obesity also appears to be a risk factor for more severe disease, so the obese might also be considered as a priority group. 
              &lt;p&gt;
              &lt;p&gt;The principle that should guide vaccine use is that &quot;limited vaccine needs to go where it will do most good and prevent the most serious cases or deaths,&quot; according to Howard Markel, MD, PhD, of the University of Michigan in Ann Arbor. 
              &lt;p&gt;
              &lt;p&gt;Pregnant women, the obese, and those with asthma and diabetes appear to be such groups, he said, &quot;but we also need to think of first responders,&quot; including doctors, nurses, police, and fire personnel. 
              &lt;p&gt;
              &lt;p&gt;&quot;Even the people who keep our power lines, coal, water, electricity, and energy lines going -- we don&apos;t want any of these people out in time of a national crisis,&quot; Dr. Markel said. 
              &lt;p&gt;
              &lt;p&gt;The CDC&apos;s former director, Julie Gerberding, MD, said vaccinating pregnant women would have a double benefit. It &quot;protects mom and also likely protects newborns until they are old enough to be vaccinated or take antivirals, she said. 
              &lt;p&gt;
              &lt;p&gt;The authors noted several limitations of the study including the fact that &quot;ascertainment of women infected with pandemic H1N1 influenza virus was dependent on surveillance and laboratory testing methods used by state public health authorities during the outbreak. These methods varied by state and by the timing during the outbreak.&quot;
              &lt;p&gt; 
              &lt;p&gt;Other limitations include the fact that that pregnant women might be less likely to be tested than were those who were not pregnant and that &quot;healthcare providers might be more likely to admit a pregnant woman than a nonpregnant person with similar findings, which could lead to an exaggerated admission rate in pregnant women.&quot; 
              &lt;p&gt;
              &lt;p&gt;&lt;table cellspacing=&quot;0&quot; hspace=&quot;1&quot; style=&quot;border-style:solid; border-width:1px; border-color:#8dabbc; font-family:arial; font-size:12px; background-color:#DBE9F2; padding:5px 5px 5px 5px;&quot;&gt;
&lt;tr&gt;&lt;td&gt;The study was supported by the CDC. Dr. Jamieson and several other authors are employees of the agency. No other potential conflicts were reported.&lt;/td&gt;&lt;/tr&gt;&lt;/table&gt;
              &lt;p&gt;
              &lt;p&gt;&lt;em&gt;This article was developed in collaboration with ABC News.   &lt;/em&gt;&lt;img src=&quot;http://www.medpagetoday.com/upload/2009/5/14/14212.jpg&quot;&gt;


        
    </recommendedItem>
</recommendedContent>
