Outcomes of Pandemic Influenza in Pregnancy
Outcomes of Pandemic Influenza in Pregnancy: an Observational Cohort Study
We propose to follow a cohort of pregnant and post-partum Canadian women through the fall and winter of 2009/2010 and the anticipated second and third waves of the current pandemic in order to better understand the incidence, complications and risk factors for severe disease due to H1N1 influenza in pregnant women, and to contribute data on the safety and effectiveness of antivirals and vaccines in this population.
The primary hypotheses to be tested are:
(i) pandemic influenza infection in the second and third trimester of pregnancy is associated with an increase in adverse fetal outcomes (fetal loss, stillbirth, neonatal mortality, significant neonatal morbidity, prematurity) (ii) close contact with young children (<2 yrs) at home or work is the most important risk factor for influenza in pregnant women (iii) higher scores on a scale of community infection prevention (a combination of self-reported hand hygiene adherence, avoidance of ill persons and avoidance of crowds) are protective against influenza (iv) receipt of seasonal influenza vaccine from 2007 to 2009 will increase the risk of illness due to influenza A(H1N1)v in the second and third waves of the pandemic.
(v) pandemic influenza vaccine is effective in preventing symptomatic influenza in pregnant women.
(vi) vaccination of pregnant women against a particular strain of influenza protects their infants against influenza infection in the first six months of life.
調査の概要
状態
条件
詳細な説明
Subjects will be consented to participate in the study. They will complete a web-based baseline questionnaire. Participants will be given a nasal swab kit with instructions for obtaining swabs. Baseline blood (10mls) will be drawn for influenza serology and for measurement of total IgG and IgG subtypes. An email will be sent to each participant within 24 hours of their enrolment to welcome them to the study.
Participants will be asked to complete a weekly diary using web-based data entry. An email will be sent to each participant every Monday during the study reminding the participant to complete their weekly diary and to report and submit a nasal swab if they have any symptoms of an acute respiratory illness. Reminder emails will be sent 48 hours later if the weekly form remains incomplete. Participants will be telephoned if forms remain incomplete for three weeks. Weekly emails will also be used to update participants about vaccine availability, current vaccine recommendations, and any changes in expert recommendations for pregnant women.
Once every four weeks additional questions will be asked on the weekly survey. If any participant develops symptoms compatible with an acute viral respiratory illness they will be asked to collect and submit a nasal swab as soon as possible after the onset of symptoms and to complete an illness starting the day of symptom onset and ending when all symptoms are either absent or mild, or for 3 days, whichever is longer. Subjects will be notified if results are positive for influenza along with the local Medical Officer of Health. Treatment for influenza will be discussed with each infected participant by a physician investigator.
Repeat serology and blood for total IgG and IgG subtype will be drawn at the time of delivery to the six week post partum. Women will notify the study when they are admitted for delivery or termination of pregnancy and will be interviewed either in person at the hospital, or over the telephone within 3 weeks of delivery. A chart review will be performed to identify any complications at delivery or termination, and to record neonatal outcomes. Post-partum, mothers will continue their own weekly and illness diaries and weekly diaries for their infants will be added.
Pregnant women requiring hospital admission for influenza in hospitals participating in surveillance for the Toronto Invasive Bacterial Diseases Network (TIBDN) and Serious Outcomes Surveillance (SOS) for the PHAC/CIHR Influenza Research Network (PCIRN), as well as pregnant women with influenza admitted to intensive care units as part of the Canadian Critical Care Clinical Trials Group Influenza Surveillance System (ICU-Flu) will be approached. Risk factor data from the baseline and weekly questionnaires will be collected retrospectively from these women. With consent, women will be followed to delivery/termination, and the same information collected regarding neonatal outcomes as was collected for other women in the cohort.
An email will be sent to all participating women requesting their consideration of three additional parts of the study:
- A questionnaire of development (the 8 month Ages and Stages® Questionnaire; see attached) to be completed by the parent
- An assessment with a physical examination at 7-9 months of age by a trained physician or a nurse practitioner
- Permission for the study to contact parents in the future about further follow-up.
Mothers will also be asked to book an appointment for the 7-9 month assessment. Mothers who do not wish to have a pediatrician assessment will be asked over the telephone if they have any questions they wish to have answered about the study or the Ages and Stages® questionnaire, and if they consent to contact for future long term follow-up studies. If the child's score on the Ages and Stages® questionnaire raises a concern, mothers will be offered the chance to discuss this with a study physician, to have the results shared with her child's physician and/or to be referred to a pediatrician.
Participants may choose to withdraw from the study at any time. When they do so, they will be asked if the data and blood samples that have been provided can be kept and used for study purposes. If a patient withdraws and cannot be contacted data that has been obtained will be retained, and blood will be used for the immediate study purpose, but will not be used for future studies.
研究の種類
入学 (実際)
連絡先と場所
研究場所
-
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Alberta
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Calgary、Alberta、カナダ
- University Of Calgary
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Edmonton、Alberta、カナダ
- University of Edmonton
-
-
British Columbia
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Vancouver、British Columbia、カナダ
- British Columbia's Women's and Children's Hospital
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-
Nova Scotia
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Halifax、Nova Scotia、カナダ、B3K 6R8
- Queen Elizabeth Ii Health Sciences Centre
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Ontario
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Hamilton、Ontario、カナダ
- McMaster University
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Ottawa、Ontario、カナダ
- Public Health Agency of Canada
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Toronto、Ontario、カナダ
- Mount Sinai Hospital
-
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Quebec
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Montreal、Quebec、カナダ
- Laval University
-
-
参加基準
適格基準
就学可能な年齢
- 子
- 大人
- 高齢者
健康ボランティアの受け入れ
受講資格のある性別
サンプリング方法
調査対象母集団
説明
Inclusion Criteria:
Participants must:
- be and pregnant, and, at the time of enrolment, not more than 30 weeks gestation.
- be greater than or equal to 16 years of age
- give written informed consent prior to entry
- be available for follow-up during the study period
- have convenient access to a computer with internet access
- know basic skills for use of the internet
- have the ability to complete questionnaires in either English or French
Exclusion Criteria:
- None
研究計画
研究はどのように設計されていますか？
デザインの詳細
この研究は何を測定していますか？
主要な結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
|---|---|---|
|
Influenza A(H1N1)v infection: will be as diagnosed by polymerase chain reaction(PCR) from nasal or nasopharyngeal (NP) swabs, and/or seroconversion to influenza A(H1H1)v.
時間枠：October 2009 to June 2010
|
Primary analysis for risk factors for infection will consider only symptomatic infection, defined as acute respiratory illness/ influenza like illness (fever (at least one measured T>=38°C) and cough and one other local or systemic symptom compatible with influenza) during the pregnancy with seroconversion to A(H1N1)v not explained by vaccination. Seroconversion defined as a 4 fold increase in hemagglutination inhibition titer from 1st to 2nd serum sample. Symptoms compatible with influenza defined as fever, cough, coryza, generalized myalgias, sore throat, headache, severe fatigue. |
October 2009 to June 2010
|
二次結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
|---|---|---|
|
Adverse fetal/neonatal outcome.
時間枠：October 2009-June 2010
|
Fetal loss >12 weeks, stillbirth, neonatal mortality, significant neonatal morbidity, prematurity, or low birth weight, stillbirth, neonatal mortality, prematurity, live birth at less than 37 weeks gestational age, low birth weight, significant neonatal morbidity, severe congenital malformation, complicated influenza infection.
|
October 2009-June 2010
|
協力者と研究者
スポンサー
捜査官
- 主任研究者：Shelly McNeil, MD FRCPC、Dalhousie University, Halifax, NS
- 主任研究者：Emmanuel Bujold, MD、Laval University, Montreal, Quebec
- 主任研究者：Allison McGeer, MD FRCPC、University of Toronto, Toronto, Ontario
- 主任研究者：Mark Loeb, MD、McMaster University, Hamiton, Ontario
- 主任研究者：Marie Louie, MD、University of Calgary, Calgary, Alberta
- 主任研究者：George Zahariadis, MD、University of Alberta, Edmonton, Alberta
- 主任研究者：Deborah Money, MDFRCSC、University of British Columbia, Vancouver, British Columbia
- 主任研究者：Rachel Rodin, MD、Public Health Agency of Canada, Ottawa, Ontario
研究記録日
主要日程の研究
研究開始
研究の完了 (予想される)
試験登録日
最初に提出
QC基準を満たした最初の提出物
最初の投稿 (見積もり)
学習記録の更新
投稿された最後の更新 (見積もり)
QC基準を満たした最後の更新が送信されました
最終確認日
詳しくは
本研究に関する用語
追加の関連 MeSH 用語
その他の研究ID番号
- 114231
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