1. Influenza A H1N1 Hospital Universitário Oswaldo Cruz Faculdade de Ciências Médicas Universidade de pernambuco Vicente Vaz abril/2010

4. Pandemias de Influenza no século 20 1957: “ Gripe Asi á tica ” A(H2N2) 1968: “ Gripe de Hong Kong ” A (H3N2) 25 a 100 milhões de mortes Credit: US National Museum of Health and Medicine 1-4 milhões de mortes 1-4 milhões de mortes 1918: “ Gripe espanhola ” A(H1N1) 2009:Gripe A confirmados 16.455 óbito s

14. Hospitalizações em 2010

16. Óbitos em 2010

25. According to WHO, the majority of 2009 H1N1 influenza isolates tested worldwide remain sensitive to oseltamivir, an antiviral medicine used to treat influenza disease. Worldwide, 220 2009 H1N1 isolates tested have been found to be resistant to oseltamivir – 54 of these isolates were detected in the United States. Resistência ao Oseltamivir

26. Vacina

27. Cronograma

28. Three Studies Demonstrate the Safety and Efficacy of Pandemic H1N1 Flu Vaccine Summary and Comment by Bruce Soloway, MD Published in Journal Watch General Medicine January 21, 2010 Results are in from studies in the U.S., China, and Hungary. Copyright © 2010. Massachusetts Medical Society . All rights reserved.

37. Incidence and Case Fatality Rates of Novel 2009 Pandemic A/H1N1 Influenza in England Summary and Comment by Paul S. Mueller, MD, MPH, FACP Published in Journal Watch General Medicine January 14, 2010 H1N1 influenza incidence was highest among children, but H1N1-associated mortality was highest among elders. Copyright © 2010. Massachusetts Medical Society . All rights reserved.

43. Steroids Might Benefit Critically Ill Patients with Suspected H1N1 Influenza Summary and Comment by Kristi L. Koenig, MD, FACEP Published in Journal Watch Emergency Medicine January 8, 2010 Combined treatment with antiviral agents and steroids led to significant improvements in organ function within 1 week. Copyright © 2010. Massachusetts Medical Society . All rights reserved.

49. Gestantes e a nova gripe

54. Obstet Gynecol. 2010 Apr;115(4):711-6. Maternal and neonatal outcomes after antepartum treatment of influenza with antiviral medications. Greer LG, Sheffield JS, Rogers VL, Roberts SW, McIntire DD, Wendel GD Jr. University of Texas Southwestern Medical Center, Department of Obstetrics and Gynecology, Parkland Health and Hospital System, Dallas, Texas 75235-9032, USA. laura.greer@utsouthwestern.edu Abstract OBJECTIVE: To review the maternal and neonatal outcomes after antepartum exposure to M2 ion channel inhibitors or oseltamivir to provide some guidance on the risk, if any, of antiviral medication during pregnancy. METHODS: This was a retrospective cohort study examining maternal and neonatal outcomes after antepartum exposure to antiviral therapy for influenza. We evaluated maternal characteristics, pregnancy outcomes, and fetal outcomes and compared them with our overall obstetric population.

55. RESULTS: Exposure to antiviral therapies (M2 ion channel inhibitors [n=104] compared with oseltamivir [n=135] compared with the control group [n=82,097]) during pregnancy was not associated with increased rates of preterm birth (7% compared with 10% compared with 6%, P=.190), premature rupture of membranes (23% compared with 16% compared with 22%, P=.154), gestational diabetes (4% compared with 8% compared with 6%, P=.388), or preeclampsia (6% compared with 1% compared with 4%, P=.209). Exposure was not associated with increased duration of hospital stay for mother or neonate. There were no differences in the incidence of minor malformations (19% compared with 15% compared with 22%, P=.101). Liveborn singletons without major malformations did not have differences in fetal weight (3,238+/-586 g compared with 3,281+/-642 g compared with 3,336+/-571 g, P=.186), need for intubation (2% compared with 0.8% compared with 1%, P=.552), intensive care nursery admission (3% compared with 3% compared with 2%, P=.418), or hyperbilirubinemia (12% compared with 9% compared with 8%, P=.282). Liveborn singletons had no grade 3 or 4 intraventricular hemorrhages, seizures, or neonatal deaths. Two preterm neonates exposed to different classes of medications had necrotizing enterocolitis (1.0% compared with 0.8% compared with 0.02%, P<.001). CONCLUSION: We found no evidence of an association between antepartum antiviral exposure and adverse outcomes. LEVEL OF EVIDENCE: II. PMID: 20308829 [PubMed - in process] Obstet Gynecol. 2010 Apr;115(4):711-6. Maternal and neonatal outcomes after antepartum treatment of influenza with antiviral medications .

58. Obrigado [email_address]