H1N1 Notes: Some Cases Without Fever; Postexposure Prophylaxis in Pregnancy

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Pregnant women “in close contact” with those who have confirmed, probable, or suspected swine-origin influenza A (H1N1) infection should receive a 10-day course of zanamivir or oseltamivir, according to an MMWR Dispatch report on three pregnant women with H1N1, one of whom died.

The report also recommends that pregnant women with confirmed, probable, or suspected disease should receive antivirals for 5 days. Oseltamivir is “normally not recommended for use during pregnancy,” according to its label, but the CDC says the drug is the preferred treatment for pregnant women during this outbreak. Oseltamivir should be started within 48 hours of symptom onset.

In other flu-related news, the New York Times reports an “odd feature” of the H1N1 virus about one third of infected patients at two Mexican hospitals did not have fever when screened. Given that many experts consider fever “the most important sign of the disease,” the Times says, its absence “could increase the difficulty of controlling the epidemic.”

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