Takahiko Kubo

Relationship of Th1/Th2 cell balance with the immune response to influenza vaccine during pregnancy

To determine the optimal timing for influenza vaccination in pregnant women, we measured alterations in the types 1 and 2 T helper cell (Th1/Th2) balance during pregnancy, monitored specific immunity to inoculated antigens after vaccination with inactivated influenza vaccine, evaluated the relevance of the Th1/Th2 ratio and immune responses to the vaccination, monitored the maintenance of high antibody titers until delivery and measured the transplacental antibody transfer rate. No significant alterations of the Th1/Th2 balance were noted in the 65% of pregnant women among whom the Th1/Th2 ratio was lower than 9.9% in the first trimester. In those groups with a ratio higher than 10% in the first trimester, there was a tendency for the ratio to decrease as gestation advanced. The efficiency of immunization was not influenced by the Th1/Th2 status or by the stage of gestation. The antibody titer decreased steadily with time from 1 month after vaccination to the time of delivery. Conversely, the transfer rate of antibodies from maternal to fetal blood at the time of delivery increased with the duration of gestation after vaccination. Nevertheless, the antibody titers in both maternal and fetal blood were sufficient to afford protection against infection. Thus, efficient influenza vaccination can be undertaken at any stage of pregnancy. J. Med. Virol. 81:1923–1928, 2009.

Outcomes of infants exposed to oseltamivir or zanamivir in utero during pandemic (H1N1) 2009

OBJECTIVE To assess adverse fetal outcomes and short-term prognoses of infants exposed to oseltamivir or zanamivir in utero during pandemic (H1N1) 2009 in Japan. STUDY DESIGN Case series study. We asked the 2611 obstetric facilities in Japan that are members of the Japan Society of Obstetrics and Gynecology to participate, and data were provided from 157 facilities. We evaluated the numbers of pregnancy complications and neonatal abnormalities. RESULTS We evaluated 624 infants born to 619 women given oseltamivir and 50 infants born to 50 women given zanamivir. Of patients given oseltamivir before gestational week 22, 3 experienced miscarriage and 1 experienced induced abortion. The overall rate of congenital malformations was 2.1% (14/670). In infants exposed during the first trimester, the rate of malformations was 1.3% (2/156) with oseltamivir and 0.0% (0/15) with zanamivir, although in infants exposed during the second and third trimesters, this rate was 2.6% (12/464) with oseltamivir and 0.0% (0/35) with zanamivir. Increased rates of miscarriage in women given antiviral drugs before gestational week 22 (0.9% [3/322]), preterm delivery in women given antiviral drugs before gestational week 37 (5.5% [33/600]), stillbirth (0% [0/670]), neonatal death (0.15% [1/670]), birthweight <2500 g (8.7% [58/670]), small-for-gestational-age infants (8.4% [56/670]), necrotizing enterocolitis (0.0%), intraventricular hemorrhage (0.0%), seizures (0.15% [1/670]), and other transient abnormalities in the neonatal period (4.3% [29/670]) were not observed in those exposed to antiviral drugs before the corresponding episodes or complications. CONCLUSION Short-term prognoses of infants exposed to oseltamivir or zanamivir in utero were not adversely affected.

National survey of fibrinogen concentrate usage for post‐partum hemorrhage in Japan: Investigated by the Perinatology Committee, Japan Society of Obstetrics and Gynecology

The aim of this study was to provide basic documents applicable to studying the usefulness of administering fibrinogen concentrate to patients with massive post‐partum hemorrhage. We investigated the usage of fibrinogen concentrate at training institutions for specialist physicians of the Japan Society of Obstetrics and Gynecology.

Review of the pandemic (H1N1) 2009 among pregnant Japanese women

Pregnant women are prone to serious complications when they contract influenza, and a considerable number of pregnant women died from the pandemic (H1N1) 2009 worldwide; however, no maternal mortality occurred in Japan during this pandemic. This review explores the reasons why maternal mortality did not occur in Japan. Two studies conducted during and soon after the pandemic (H1N1) 2009 in Japan suggested the following: 40 000–50 000 pregnant Japanese women took antiviral medicines for prophylaxis after close contact with an infected person; 40% of them (16 000–20 000) contracted the novel influenza and accounted for a half of all 30 000–40 000 pregnant patients with the novel influenza; at least 181 of them required hospitalization; and at least 17 of them developed pneumonitis. Hospitalized women had a 2.5 times higher risk of preterm delivery (at <37 weeks) compared with the general population. The two studies suggested that the following may have contributed to the lack of maternal mortality in Japan: (i) more than 60% of candidates were vaccinated within 1.5 months after the availability of a vaccine against the novel virus; (ii) vaccination reduced the infection rate by 89%; (iii) a large number of women took antiviral drugs before symptom onset after close contact with an infected person; and (iv) approximately 90% of hospitalized pregnant patients took antiviral drugs within 48 hours after symptom onset.

Effect of the Fukushima nuclear power plant accident on radioiodine (131I) content in human breast milk

Background:  Environmental pollution with radioiodine (iodine‐131, 131I) occurred after an accident at the Fukushima nuclear power plant (FNP) on March 11, 2011, in Japan. Whether environmental pollution with 131I can contaminate human breast milk has not been documented.

Experience with recombinant activated factor VII for severe post-partum hemorrhage in Japan, investigated by Perinatology Committee, Japan Society of Obstetrics and Gynecology.

To investigate the utility of recombinant activated Factor VII (rFVIIa) for severe post‐partum hemorrhage (PPH) in Japan.

Pregnancy outcomes of women exposed to laninamivir during pregnancy

The purpose of this study is to assess pregnancy outcomes of women treated with a novel neuraminidase inhibitor, laninamivir, during pregnancy.

Low titers of measles antibodies in Japanese pregnant women: A single‐center study

Aim:  Measles during pregnancy has deleterious effects on both perinatal and maternal outcomes. In Japan, local epidemics of measles and cases of measles during pregnancy are still being reported; therefore, the seroprevalence of antibodies to measles is suspected to be still not sufficient. The aim of this study was to analyze the seroprevalence of antibodies to measles in Japanese pregnant women and estimate the percentage of these women who require vaccination or revaccination against measles.

Discrepancy between human T‐cell lymphotropic virus type I screening test and confirmatory tests in non‐endemic areas

Aim:  The purpose of this study was to examine the seroprevalence of human T‐lymphotropic virus (HTLV)‐I among pregnant women at our institution in Tokyo, Japan, which is a non‐endemic area, and to investigate the results of Western blotting among pregnant women who had obtained positive results from a screening test.

Interventional radiology for critical hemorrhage in obstetrics: Japanese Society of Interventional Radiology (JSIR) procedural guidelines

AbstractThere has been an increasing demand for interventional radiology (IR) procedures for the treatment of severe postpartum hemorrhage (PPH) (also called critical hemorrhage in obstetrics). The Japanese Society of Interventional Radiology Guideline Committee developed the practical guidelines for IR procedures for severe PPH using evidence-based methodology. This article aimed to describe the rationale for developing these guidelines and to provide the answers for clinical questions about IR procedures consisting of current available evidence and the consensus among experts.