Feasibility and Performance of Self-Collected Nasal Swabs for Detection of Influenza Virus, Respiratory Syncytial Virus, and Human Metapneumovirus.

BACKGROUND: We assessed performance of participant-collected midturbinate nasal swabs compared to study staff-collected midturbinate nasal swabs for the detection of respiratory viruses among pregnant women in Bangkok, Thailand. METHODS: We enrolled pregnant women aged ≥18 years and followed them throughout the 2018 influenza season. Women with acute respiratory illness self-collected midturbinate nasal swabs at home for influenza viruses, respiratory syncytial viruses (RSV), and human metapneumoviruses (hMPV) real-time RT-PCR testing and the study nurse collected a second midturbinate nasal swab during home visits. Paired specimens were processed and tested on the same day. RESULTS: The majority (109, 60%) of 182 participants were 20-30 years old. All 200 paired swabs had optimal specimen quality. The median time from symptom onsets to participant-collected swabs was 2 days and to staff-collected swabs was also 2 days. The median time interval between the 2 swabs was 2 hours. Compared to staff-collected swabs, the participant-collected swabs were 93% sensitive and 99% specific for influenza virus detection, 94% sensitive and 99% specific for RSV detection, and 100% sensitive and 100% specific for hMPV detection. CONCLUSIONS: Participant-collected midturbinate nasal swabs were a valid alternative approach for laboratory confirmation of influenza-, RSV-, and hMPV-associated illnesses among pregnant women in a community setting.

Comparison of influenza antibody titers among women who were vaccinated in the 2nd and the 3rd trimesters of pregnancy.

BACKGROUND: We compared cord blood antibody titers in unvaccinated pregnant women to those vaccinated with seasonal influenza vaccine during the 2nd and the 3rd trimesters. METHODS: Pregnant women had cord blood collected at delivery for hemagglutination inhibition assay against vaccine reference viruses: A/California/07/2009 (H1N1)pdm09, A/Switzerland/9715293/2013 (H3N2), and B/Phuket/3073/2013 (Yamagata lineage). Geometric mean titer (GMT) ratios were calculated comparing vaccinated versus unvaccinated pregnant women, and women vaccinated in the 2nd and the 3rd trimesters. Proportions of women achieving defined titers were compared using the χ2 test. RESULTS: Of 307 women, 190 (62%) were unvaccinated. Fifty and 67 were vaccinated during the 2nd and the 3rd trimesters, respectively. Median enrollment age was 29 years (interquartile range 24-34). Sixteen (5%) women had pre-existing conditions, but none were immunocompromised. GMT ratios comparing vaccinated and unvaccinated women were 5.90 (95% confidence interval [CI] 5.06-6.96) for influenza A/California, 5.39 (95% CI 4.18-6.08) for influenza A/Switzerland, and 5.05 (95% CI 4.43-5.85) for influenza B/Phuket. Similarly, the GMT ratios comparing the 3rd and the 2nd trimester vaccinated women were 2.90 (95% CI 2.54-3.39), 2.82 (95% CI 2.56-3.13), and 2.83 (95% CI 2.56-3.14), respectively. The proportions of women with defined titers for the three vaccine reference viruses did not differ between 2nd and 3rd trimester vaccinated women (titers ≥40: 68-92% versus 70-93%; ≥110: 32% versus 33-63%; and ≥330: 4-10% versus 3-21%). CONCLUSIONS: Pregnant women vaccinated against influenza had more placental transfer of influenza antibodies to their infants than unvaccinated women. Placental transfer of antibodies was higher among those vaccinated in the 3rd trimester than in the 2nd trimester. There was no difference in the proportions of women achieving antibody titers corresponding to protection against influenza in children. Findings support the current World Health Organization's recommendation that pregnant women may be vaccinated in either 2nd or 3rd trimester of pregnancy.

Predictors for influenza vaccination among Thai pregnant woman: The role of physicians in increasing vaccine uptake.

BACKGROUND: Physician recommendation and attitudes and beliefs of pregnant women toward influenza and vaccination may influence vaccine uptake during pregnancy. We examined how physician recommendation and health beliefs of pregnant women may jointly affect influenza vaccination during pregnancy. METHODS: Thai pregnant women aged ≥18 years and >13 gestational weeks attending antenatal care (ANC) clinics, and ANC physicians were recruited during May-August 2015. Women and physicians, linked using unique identifiers, provided data on demographic, health and work history, knowledge, attitudes, and beliefs toward influenza and vaccination, based on Health Belief Model constructs. Physicians also provided data on their practices in recommending influenza vaccination during pregnancy. Prevalence ratios for the association between knowledge, attitudes and beliefs of pregnant women, physician recommendation and documented receipt of vaccination within 30 days of the visit were calculated. RESULTS: Among 610 women, the median age was 27 years; 266 (44%) and 344 (56%) were in the second and third trimesters, respectively. Twenty-one (3%) had pre-existing conditions. Of 60 physicians with the median years of practice of 5; 17 (28%) reported frequently/usually/always recommending influenza vaccine to their pregnant patients, while 43 (72%) reported never/rarely/sometimes recommending the vaccine. Controlling for the pregnant women's knowledge and beliefs, pregnant women whose physician recommended influenza vaccination were 2.3 times (95% confidence interval 1.4-3.8) more likely to get vaccinated. CONCLUSIONS: In this study, physician recommendation was the only significant factor associated with influenza vaccine uptake among Thai pregnant women. Understanding physicians' motivation/barrier to recommending influenza vaccination to pregnant women may increase coverage.

Tolerability of trivalent inactivated influenza vaccine among pregnant women, 2015.

BACKGROUND: Thailand recommends influenza vaccination among pregnant women. We conducted a cohort study to determine if the prevalence of adverse events following immunization (AEFIs) with influenza vaccine among Thai pregnant women was similar to that often cited among healthy adults. METHODS: Women who were ≥17 gestational weeks and ≥18 years of age were recruited. Demographic and health history data were collected using structured questionnaires. Women were provided with symptom diary, ruler to measure local reaction(s), and thermometer to measure body temperature. AEFIs were defined as any new symptom/abnormality occurring within four weeks after vaccination. The diaries were abstracted for frequency, duration, and level of discomfort/inconvenience of the AEFIs. Serious adverse events (SAEs) and the likelihood of AEFIs being associated with vaccination were determined using standard definitions. RESULTS: Among 305 women enrolled between July-November 2015, median age was 29 years. Of these, 223 (73%) were in their third trimester, 271 (89%) had completed secondary school or higher, and 20 (7%) reported ≥1 pre-existing conditions. AEFIs were reported in 134 women (44%; 95% confidence interval [CI] 38-50%). Soreness at the injection site (74, 24%; CI 19-29%), general weakness (50, 16%; CI 12-21%), muscle ache (49, 16%; CI 12-21%), and headache (45, 15%; CI 1-19%) were most common. Of those with AEFIs, 120 (89%) reported symptom/abnormality occurred on day 0 or day 1 following vaccination. Ten women (7%) reported the AEFIs affected daily activities. The AEFIs generally spontaneously resolved within 24 h of onset. There were two vaccine-unrelated SAEs. Of 294 women with complete follow-up, 279 (95%) had term deliveries, 12 (4%) had preterm deliveries, and 3 (1%) had miscarriage or stillbirth. CONCLUSION: In our cohort, AEFIs with influenza vaccine occurred with similar frequency to those reported among healthy adults in other studies, and were generally mild and self-limited. No influenza vaccine-associated SAEs were identified.

Fetal long QT syndrome manifested as atrioventricular block and ventricular tachycardia: a case report and a review of the literature.

Fetal onset of congenital long QT syndrome (LQTS) is a rare manifestation, and prenatal diagnosis is difficult. This report describes a boy who presented with both atrioventricular (AV) block and ventricular tachycardia during the antenatal period. The early postnatal electrocardiogram showed prolongation of the QT interval and AV block, subsequently leading to a polymorphic ventricular tachycardia torsade de pointes. This unique feature of congenital LQTS has a poor outcome, but the boy was successfully treated with beta-blockers and implantation of an automated cardioverter-defibrillator. The intrauterine manifestation of fetal AV block and ventricular tachycardia should raise a high suspicion of congenital LQTS, and the strong association with a malignant clinical course should warrant special evaluation. The literature on the prenatal diagnosis, fetal therapy, and neonatal outcome of this condition also are reviewed.

Pregnancy outcomes of Southeast Asian immigrant pregnant women compared with Thai pregnant women in Rajavithi Hospital.

OBJECTIVE: To determine the pregnancy outcomes of Southeast Asian immigrant women compared to native Thai women in Rajavithi Hospital. MATERIAL AND METHOD: A retrospective cohort study was conducted on singleton Southeast Asian immigrant pregnant women in Thailand between January 2007 and December 2008. RESULTS: One thousand two hundred sixty immigrant pregnant women and 5040 controls were included. After adjusting the odds ratio, the cesarean section rate, postpartum hemorrhage, preterm birth, and neonatal intensive care unit admission of immigrant women are not different from native-born women. The incidence of low Apgar score at 5 minutes and perinatal death were significantly lower in the study group with an odds ratio of 0.506 (95% CI 0.29-0.89) and 0.295 (95% CI 0.10-0.83), respectively. Low birth weight was higher in the study group with an odds ratio of 1.707 (95% CI 1.45-2.01). CONCLUSION: In Thailand, the cesarean section rate, postpartum hemorrhage, preterm birth, and neonatal intensive care unit admission of immigrant women are not different from native-born women. Foreign-born status confers a protective effect for low Apgar score at 5 minutes and perinatal death. However, the incidence of low birth weight in foreign-born women is higher than native-born women.

Is there any clinical advantage in separating CIN 2 from CIN 3 in the current two-tiered cytological classification?

AIM: To investigate the practical use of description for CIN 2 or CIN 3 in HSIL cytology, the objective of the present study is to compare the prevalence of histologic CIN 2/3 or cancer (CIN 2+) between women with cytologic CIN 2 and CIN 3. METHODS: The medical records of women with high-grade squamous intraepithelial lesion (HSIL) on cytology who underwent colposcopy at Rajavithi hospital between January 2001 and March 2005 were reviewed. RESULTS: Of 152 women with HSIL, 70 and 82 had cytologic change compatible with CIN 2 and CIN 3, respectively. Women from HSIL-CIN 3 were significantly more likely to have CIN 2/3 or cancer than those from HSIL-CIN 2. Histology-proved CIN 2+ was confirmed in 64.3% and 85.4% in HSIL-CIN 2 and HSIL-CIN 3, respectively (p<0.05). Invasive cancer was found in 5.7% in HSIL-CIN 2 and 9.8% HSIL-CIN 3. CONCLUSION: The histologic outcome is obviously different between women with cytologic CIN 2 and CIN 3. However, both groups should be managed similarly because of the high prevalence of high-grade cervical lesion including invasive cancer.

Fractional thigh volume by three-dimensional ultrasonography for birth weight prediction.

OBJECTIVE: To determine the correlation between actual birthweight (BW) and fetal weight calculated from fractional thigh volume (ThiV). MATERIAL AND METHOD: The authors have conducted a prospective, cross-sectional study of normal Thai fetal thigh volume. There were 176 eligible pregnant women who met the criteria of singleton with no fetal anomaly were recruited into the present study. Prior to the present study, 3 operators had been trained and standardized for fractional ThiV measurement by an expert for the first 20 cases. To generate the fetal weight calculating formula, fetal ThiV data from the first 100 cases were employed Then, the authors' new prediction formula was compared and validated with the Hadlock's and the Tongsong formula in 56 normal late-third-trimester fetuses. All patients were assessed for 2D fetal biometry and 3D fractional ThiV within one week before delivery. RESULTS: A total of 176 fetuses underwent ultrasound at the gestational age of 38.5 +/- 2.1 weeks. The reproducibility of fractional ThiV measurement technique showned very good correlation in both inter- and intra-observer reliability as observed by the high intraclass correlation (0.971-0.994). By using the regression model, fractional ThiV presents a superior correlation to actual BW (r = 0.965). The fitting formula is characterized by predicted fetal BW (g) = 774.744 + 32.658 x fractional ThiV (ml). The presented new formula shows the smallest absolute percentage error (APE) for BW estimation when compared to that of Hadlock's and Tongsong's. CONCLUSION: Fetal 3D-fractional ThiV is consistent with actual BW The measurement of fractional ThiV can improve the accuracy of fetal weight prediction especially in some eventful conditions.