24 August 2009
As of the 24th August 2009, there have been 5118 laboratory-confirmed cases of pandemic influenza A H1N1 (2009) in South Africa. These include 18 fatal cases with laboratory confirmation at the National Institute for Communicable Diseases of the National Health Laboratory Service.
Nine of the deaths have been in pregnant women, with the majority in the third trimester of pregnancy. The third trimester of pregnancy has been identified as a particular risk factor for severe H1N1 illness in many other countries to date. It is critical that influenza H1N1 be highly considered in any pregnant woman with influenza-like illness (fever, muscle pain and/or dry cough).
In the earlier stages of pregnancy the decision to treat must be made by the doctor based on the clinical condition of the patient. In the third trimester of pregnancy treatment with the appropriate antiviral drugs must be given urgently particularly if there is any sign of pneumonia (shortness of breath) and prior to any laboratory testing and results being received.
Other risk factors for severe illness may include HIV/Aids, asthma, diabetes, any chronic heart and lung condition and any cause of depressed immunity. Early treatment may be indicated.
Currently there is a wide- spread community outbreak of pandemic influenza A H1N1 in South Africa. The majority of illness remains mild and self- limiting. Routine testing of all persons with influenza-like illness for H1N1 is not recommended, and laboratory focus has to be on identifying persons with more severe illness.
The likelihood of influenza –like illness being due to the pandemic influenza strain is very likely at this moment because of the widespread outbreak and a positive laboratory test is not necessary to guide treatment where indicated.
For further information please contact Nombuso Shabalala on 011 386 6462 or 082 886 4238
The National Institute for Communicable Diseases (NICD), a division of the National Health Laboratory Service,