Rhinoviruses as an underestimated cause of influenza‐like illness in pregnancy during the 2009–2010 influenza pandemic

Abstract

During the 2009-2010 influenza pandemic, pregnant women were identified at high risk for severe infection. In case of influenza-like illness they were systematically treated with oseltamivir. When performed, virological diagnosis showed that some of these women were not influenza-infected. The objectives of the study were to identify viruses which could induce an influenza-like illness in pregnant women during the 2009-2010 pandemic, then to establish possible links between detected viruses and symptoms, and then characterize human rhinoviruses (HRV) strains detected in some samples. Nasal swabs from 78 pregnant women presenting with influenza-like illness and previously tested for influenza virus by RT-PCR in 2009-2010 were further assayed by multiplex RespiFinder assay and bocavirus PCR to search for 13 other viruses. Genotyping of HRV strains was carried out using partial genomic sequencing in the VP4/VP2 region. Influenza A virus infection was confirmed in 33 women (42%). Non-influenza viruses were detected in 18 additional cases (23%). Rhinoviruses were the most numerous (13%) and belonged to 9 different genotypes distributed between the 3 genogroups. When comparing symptoms observed in influenza-infected women and women infected by other viruses, shivers were more frequent in the former group (P=0.02), and expectorations in the latter (P=0.03). During the influenza pandemic 2009-2010, non-influenza viruses and mostly rhinoviruses were an underestimated cause of influenza-like illness in pregnant women. Viral diagnosis should help to stop empiric oseltamivir therapy in influenza-negative patients and antibiotic treatment in patients infected with a non-influenza virus.

Causes and consequences of fever during pregnancy: A retrospective study in a gynaecological emergency department

“…The influenza test was generally performed using specific PCR, but in five cases, multiplex PCR was performed, detecting two positive cases for rhinoviruses. Two retrospective studies conducted during the 2009–2010 flu pandemic found in pregnant women with influenza-like symptoms, non-influenza respiratory viruses rates of 23 %, and influenza H1N1 rates between 31 and 42 %, similar to our results [ 10 , 11 ]. The multiplex PCR was not used on a routine basis because it is expensive and time-consuming, although this strategy could possibly avoid use of antibiotics and hospitalizations.…”

Immunobiological aspects of vaccines in pregnancy: Maternal perspective

“…Rhinovirus, coronavirus, parainfluenza viruses 1-4, and human metapneumovirus have also recently been detected in cases of respiratory viral infections in pregnant women [21,22]. Rhinovirus is described as a cause of influenza-like illness in several studies in pregnant women, and Middle Eastern Respiratory Syndrome and Severe Acute Respiratory Syndrome coronaviruses have been shown in case reports to be associated with severe disease in pregnant women [23,24]. Other respiratory viruses were commonly detected in Nepal in women with fever and respiratory symptoms, with the most common being rhinovirus [22].…”

Sequencing human rhinoviruses: Direct sequencing versus plasmid cloning

“…However, recently researchers shifted to directly sequencing the cDNA product after purification. Most articles published within the last year that sequenced RV utilized this method (Daleno et al, 2013; Garcia et al, 2013; Miyaji et al, 2013; Pilorge et al, 2013). Others utilized direct sequencing in earlier studies as well (Blomqvist et al, 2009; Kneider et al, 2009; Wisdom et al, 2009; Mizuta et al, 2010; Watanabe et al, 2010).…”