To the Editor: The November2006 issue of Emerging InfectiousDiseases featured 2 perspectives (1,2)that highlighted the need for strate-gies to prevent and treat pregnantpatients during outbreaks of new oremerging diseases or during bioter-rorist attacks. However, neither arti-cle discussed implications for a sur-veillance strategy.Based on my previous experienceat the World Health Organization(WHO) with the severe acute respira-tory syndrome (SARS) outbreak, Ipropose several practical steps forsuch a strategy: l) systematic identifi-cation and reporting of cases in preg-nant women, 2) estimation of thenumber of cases in pregnant women,3) international clinical networks toshare treatment and infection controlexperience, and 4) standard protocolsfor sharing clinical and treatmentinformation between nations.First, cases in pregnant patientsshould be systematically identifiedand reported during outbreaks, byincluding information on pregnancystatus and duration of the pregnancyin case-report forms for new diseases.This is important for several reasons.First, case-patients that come to atten-tion in an ad hoc fashion may providea biased view of outcome, since thosewith a poor outcome are more likelyto draw attention. Second, althoughpregnancy is not rare, the number ofcases in pregnant women in outbreaksof new or emerging diseases in any 1location may be too small for mean-ingful analysis
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