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Infectious Respiratory Disease Outbreaks and Pregnancy: Occupational Health and Safety Concerns of Canadian Nurses

  • Karen P. Phillips (a1) (a2), Tracey L. O'Sullivan (a1) (a3) (a4), Darcie Dow (a5) and Carol A. Amaratunga (a2) (a5) (a6)


Introduction: This paper is a report of a qualitative study of emergency and critical care nurses' perceptions of occupational response and preparedness during infectious respiratory disease outbreaks including severe acute respiratory syndrome (SARS) and influenza.

Problem: Healthcare workers, predominantly female, face occupational and personal challenges in their roles as first responders/first receivers. Exposure to SARS or other respiratory pathogens during pregnancy represents additional occupational risk for healthcare workers.

Methods: Perceptions of occupational reproductive risk during response to infectious respiratory disease outbreaks were assessed qualitatively by five focus groups comprised of 100 Canadian nurses conducted between 2005 and 2006.

Results: Occupational health and safety issues anticipated by Canadian nurses for future infectious respiratory disease outbreaks were grouped into four major themes: (1) apprehension about occupational risks to pregnant nurses; (2) unknown pregnancy risks of anti-infective therapy/prophylaxis; (3) occupational risk communication for pregnant nurses; and (4) human resource strategies required for pregnant nurses during outbreaks. The reproductive risk perceptions voiced by Canadian nurses generally were consistent with reported case reports of pregnant women infected with SARS or emerging influenza strains. Nurses' fears of fertility risks posed by exposure to infectious agents or anti-infective therapy and prophylaxis are not well supported by the literature, with the former not biologically plausible and the latter lacking sufficient data.

Conclusions: Reproductive risk assessments should be performed for each infectious respiratory disease outbreak to provide female healthcare workers and in particular pregnant women with guidelines regarding infection control and use of anti-infective therapy and prophylaxis.


Corresponding author

Correspondence: Karen Phillips, PhD, 43 Templeton Street, Room 215 Ottawa, Ontario K1N 6N5 Canada E-mail:


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Naylor, D, Basrur, S, Bergeron, Met al: Learning from SARS: Renewal of public health in Canada. Health Canada Ottawa, 2003.
World Health Organization: Summary of probable SARS cases with onset of illness from 1 November 2002 to 31 July 2003. Available at Accessed 16 December 2009.
Korteweg, C, Gu, J: Pathology, molecular biology, and pathogenesis of avian influenza A (H5N1) infection in humans. Am J Pathol 2008;172(5):11551170.
World Health Organization: Cumulative Number of Confirmed Human Cases of Avian Influenza A/(H5N1) Reported to WHO. Available at Accessed 16 December 2009.
World Health Organization: Swine influenza—Update 4 April 28, 2009. Available at Accessed 16 December 2009.
World Health Organization: Statement to the press by WHO Director-General Dr Margaret Chan. Available at Accessed 16 December 2009.
World Health Organization: Pandemic H1N1 2009 Update 78. Available at Accessed 16 December 2009.
Amaratunga, CA, O'sullivan, TL, Phillips, KPet al: Ready, aye ready? Support mechanisms for health care workers in emergency planning: A critical gap analysis of three hospital emergency plans. Am J Disaster Med. 2004;2(4):195210.
Shields, M, Wilkins, K: Findings from the 2005 National Survey of the Work and Health of Nurses: Statistics Canada Catalogue No.83-003-XPE. Ottawa: Minister of Industry; Canadian Institute for Health Information; Health Canada. Available at Accessed 16 December 2009.
Amaratunga, CA, Phillips, KP, O'sullivan, TLet al: Chapter 7: The need for healthcare worker sex and gender-sensitive supports during infectious disease outbreaks, In: Tyshenko, MG, Paterson, C. (eds), SARS Unmasked: Risk Communication of Pandemics and Influenza in Canada. Montreal, CA: McGill-Queen's University Press, 2010.
Advisory Committee on Immunization Practices, Smith, NM, Bresee, JSet al: Prevention and control of influenza: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 2006;55(RR-10):142.
Harris, JW: Influenza occurring in pregnant women. JAMA 1919;72:978983.
Greenberg, M, Jacobziner, H, Paketer, J, Weisel, BAG: Maternal mortality in the epidemic of Asian influenza New York City. Am J Obs Gynecol 1958;76:897902.
Freeman, DW, Barno, A: Deaths from Asian influenza associated with pregnancy. Am J Obs Gynecol 1959;78:11721175.
Centers for Disease Control: Pandemic Influenza Questions and Answers. Available at Accessed 16 December 2009.
St. Geme, JM Jr, Bradley, JG, Torrance, DJet al: Influenza 1968-A2/Hong Kong/68. West J Med 1970;112(6):2538.
Wells, DL, Hopfensperger, DJ, Arden, NHet al: Swine influenza virus infections. Transmission from ill pigs to humans at a Wisconsin agricultural fair and subsequent probable person-to-person transmission. JAMA 1991;265(4):478481.
Lam, CM, Wong, SF, Leung, TNet al: A case-controlled study comparing clinical course and outcomes of pregnant and non-pregnant women with severe acute respiratory syndrome. Br J Obst Gynecol 2004;111:771774.
Wong, SF, Chow, KM, Leung, TN, et al: Pregnancy and perinatal outcomes of women with severe acute respiratory syndrome. AmJ Obst Gynecol 2004;191:292297.
Shek, CC, Ng, PC, Fung, GP, et al: Infants born to mothers with severe acute respiratory syndrome. Pediatrics 2003;112(4):e254.
Lau, K-K, Yu, W-C, Chu, C-M, et al: Possible central nervous system infection by SARS coronavirus. Emerg Infect Dis 2004;10(2):342344.
Robertson, CA, Lowther, SA, Birch, T, et al: SARS and pregnancy: A case report. Emerg Infect Dis 2004;10(2):345348.
Yudin, MH, Steele, DM, Sgro, MDet al: Severe acute respiratory syndrome in pregnancy. Obst Gynecol 2005;105:124127.
Stockman, LJ, Lowther, SA, Coy, Ket al: SARS during Pregnancy, United States, Letter to the Editor. Emerg Infect Dis 2004;10(9):16891690.
Lange, JH: Respiratory protection and emerging infectious diseases:Lessons from severe acute respiratory syndrome. Chin Med J (Engl) 2005;118:6268.
Covello, V, Peters, R, Wojtecki, J, Hyde, R: Risk communication, the West Nile Virus epidemic, and bio-terrorism: Responding to the communication challenges posed by the intentional or unintentional release of a pathogen in an urban setting. J Urban Health 2001;78(2):382391.
Heaney, CA, Israel, B: Social networks and social support. In: Glanz, K, Rimer, BK, Lewis, FM, (eds). Health Behavior and Health Education: Theory, Research, and Practice. 3rd ed. San Francisco: Jossey-Bass, Inc., 2002.
O'sullivan, TL, Amaratunga, CA, Phillips, KPet al: If schools are closed, who will watch our kids? Family caregiving and other sources of role conflict among nurses during large scale outbreaks. Prehosp Disaster Med 2009;24(4):317321.
Kitzinger, J: Qualitative Research: Introducing focus groups. BMJ 1995;311:299302.
Morse, JM: Designing funded qualitative research. In: Denzin, NK, Lincoln, YS (eds.), Handbook of Qualitative Inquiry. Thousand Oaks, CA: Sage, 1994, pp. 220–235.
Morse, JM: The significance of saturation. Qualitative Health Research 1995;5:147149
Morse, JM: Determining sample size. Qualitative Health Research 2000;10(1):35.
Miles, MB, Huberman, AM: Qualitative Data Analysis: An Expanded Sourcebook. Thousand Oaks, CA: Sage, 1994.
Toma, JD: Approaching rigor in applied qualitative research. In: Conrad, CF, Serlin, RC (eds), The SAGE Handbook for Research in Education: Engaging Ideas and Enriching Inquiry. Thousand Oaks, CA: Sage, 2005.
O'Connor, E, O'sullivan, T, Amaratunga, Cet al: Risk Communication with nurses during infectious disease outbreaks: Learning from SARS. J Emerg Management 2009;7(5):4856.
Lee, DT, Sahota, D, Leung, TNet al: Psychological responses of pregnant women to an infectious outbreak: A case-control study of the 2003 SARS outbreak in Hong Kong. J PsychosomRes 2006;61(5):707713.
Glover, V, O'Connor, TG: Effects of antenatal stress and anxiety: Implications for development and psychiatry. Br J Psych 2002;180:389391.
Lederman, SA, Rauh, V, Weiss, L, et al: The effects of the World Trade Center event on birth outcomes among term deliveries at three lower Manhattan hospitals. Env Health Persp 2004;112(17):17721778.
Engel, SM, Berkowitz, GS, Wolff, MS, Yehuda, R: Psychological trauma associated with the World Trade Center attacks and its effect on pregnancy outcome. Paediatric Perinatal Epidemiology 2005;19(5):334341.
Ng, PC, Leung, CW, Chiu, WKet al: SARS in newborns and children. Biol Neonate 2004;85(4):293298
Rebmann, T: Severe acute respiratory syndrome: implications for perinatal and neonatal nurses. J Perinat Neonat Nurs 2005;19(4):332345.
Jiang, X, Gao, X, Zheng, H, et al: Specific immunoglobulin g antibody detected in umbilical blood and amniotic fluid from a pregnant woman infected by the coronavirus associated with severe acute respiratory syndrome. Clin Diagn Lab Immunol 2004;11:11821184.
Koren, G, King, S, Knowles, S, Phillips, E: Ribavirin in the treatment of SARS: A new trick for an old drug? CMAJ 2003;168(10):12891292.
Rezvani, M, Koren, G: Pregnancy outcome after exposure to injectable ribavirin during embryogenesis. Reprod Toxicol 2006;21(1):113115.
Ferm, VH, Willhite, C, Kilham, L: Teratogenic effects of ribavirin on hamster and rat embryos. Teratology 1978;17:93101.
Kochhar, DM, Penner, JD, Knudsen, TB: Embryotoxic, teratogenic, and metabolic effects of ribavirin in mice. Toxicol Applied Pharmacol 1980;52:99112.
Clark, DA, Banwatt, D, Croy, BA: Murine trophoblast failure and spontaneous abortion. Am J Reprod Immunol 1993;29:199205.
Lindsay, KL, Greene, MF, Jones, JKet al: Inadequate numbers. Can Family Phys 2007;53:401402.
Muller, MP, Dresser, L, Raboud, J, et al: Adverse events associated with high-dose ribavirin: evidence from the Toronto outbreak of severe acute respiratory syndrome. Pharmacotherapy 2007;27:494503.
Tai, DY: Pharmacologic treatment of SARS: Current knowledge and recommendations. Annals Acad Med Singapore 2007;36:438443.
Ward, P, Small, I, Smith, Jet al: Oseltamivir (Tamiflu) and its potential for use in the event of an influenza pandemic. J Antimicrob Chemo 2005;55 Suppl 1:i5i21.
Centers for Disease Control and Prevention: Pregnant Women and Novel Influenza A (H1N1) Virus: Considerations for Clinicians. Available at Accessed 16 December 2009.
Rasmussen, SA, Jamieson, DJ, Bresee, JS: Pandemic influenza and pregnant women. Emerg Infect Dis 2008;14;95100.
Tanaka, T, Nakajima, K, Murashima, Aet al: Safety of neuraminidase inhibitors against novel influenza A (H1N1) in pregnant and breastfeeding women. CMAJ 2009;181(1–2).
Wentges-van Holthe, N, van Eijkeren, M, van der Laan, JW: Oseltamivir and breastfeeding. Int J Infect Dis 2008;12(4):451.
World Health Organization: Pandemic influenza in pregnant women. Pandemic (H1N1) 2009 briefing note 5. Available at Accessed 16 December 2009.
Public Health Agence of Canada: Pregnant and Breastfeeding Women-H1N1 Flu Virus. Available at: Accessed 11 January 2010.
Centers for Disease Control and Prevention: H1N1 flu (swine flu) and feeding your baby: What parents should know. Atlanta (GA): Available at Accessed 16 December 2009.
Centers for Disease Control and Prevention: Novel influenza A (H1N1) virus infections in three pregnant women—United States, April–May 2009. MMWR: Recommendations and Reports. 2009; 58:13.
World Health Organization: Pandemic influenza in pregnant women. Pandemic (H1N1) 2009 briefing note 5. Available at Accessed 16 December 2009.
Jamieson, DJ, Honein, MA, Rasmussen, SA, et al: H1N1 2009 influenza virus infection during pregnancy in the USA. Lancet 2009;374(9688):451458.
World Health Organization: Ethical considerations in developing a public health response to pandemic influenza. WHO/CDS/EPR/GIP/2007.2 Available at Accessed 16 December 2009.
Ontario Ministry of Health and Long-Term Care: SARS Provincial Operations Centre Directive L03-04 May 13, 2003. Directive to all Ontario non-acute care facilities. Available at: Accessed 16 December 2009.
Centers for Disease Control and Prevention: Novel influenza A (H1N1) virus infections among health-care personnel—United States, April–May 2009. MMWR 2009;58(23):641645.


Infectious Respiratory Disease Outbreaks and Pregnancy: Occupational Health and Safety Concerns of Canadian Nurses

  • Karen P. Phillips (a1) (a2), Tracey L. O'Sullivan (a1) (a3) (a4), Darcie Dow (a5) and Carol A. Amaratunga (a2) (a5) (a6)


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