CDC To Monitor Children's Flu Complications: Drug-Resistant Staph A New Wrinkle

SFgate ^ | 12-8-2003 | Daniel Yee

[torstars]

There havebeen some school closings:


Schools in Trousdale County, 35 miles northeast of Nashville, are closed until Monday because so many of their 1,300 students have the flu, said Kim Karesh, spokeswoman for the Tennessee Department of Education.

Trousdale is the only school system in Tennessee to have closed because of the flu, Karesh said.

Memphis and Shelby County has had 653 flu-like illnesses reported, which is high for this time of year, said Brenda Ward, spokeswoman for the local health department.

http://www.theleafchronicle.com/news/stories/20031209/localnews/2284.html

[torstars]

Here's a report suggesting the outbreak is now beginning to take off in Northern California. Kaiser is well established there, and uses its network of hospitals to monitor the outbreak. Some there are using "epidemic" to describe the recent rise. I would assume that most of these are Fujian:

"Health giant Kaiser Permanente, which conducts influenza surveillance for the state health department, reported Monday that 390 patients in its Northern California region tested positive for the flu virus in the week ending Dec. 6.

``I have never seen anything like this,'' said Dr. Roger Baxter, a consultant who for the last eight years has overseen Kaiser's flu vaccine program in Northern California, where the health company serves 3.2 million patients. ``We're in an epidemic situation.''

The 390 cases last week represented a dramatic bump from the same week last year when Kaiser doctors reported only one case of the flu. Baxter said there has been an upswing in the number of flu cases at doctors' offices and Kaiser hospitals in San Jose, Santa Clara, San Francisco, Alameda and other areas. The week ending Nov. 29 there were 229 flu cases reported.

And it's still early in the flu season, which typically tapers off in March.

Baxter added that an abnormally high 30 percent of those people with flu-like symptoms who were tested for influenza last week received positive results for the virus. Typically, a 10 percent result indicates an outbreak."


http://www.bayarea.com/mld/mercurynews/living/health/7448956.htm

[Judith Anne]

Thanks for all your work, bringing this information to the thread.

[riri]

Do you know, off hand, what the prevalent strain was last year?

[mewzilla]

So when do the kids pick up the staph, before or after they enter the hospital? If it's after, then some hospitals need to do a better job of infection control.

[riri]

The Fujian strain started in China last year and was widespread in New Zealand and Australia this summer (southern hemisphere's winter)

Am I to assume it wasn't as brutal in the SH because they have had more exposure the strain?

[Judith Anne]

Staph is ubiquitous. I kid you not. And children aren't sterilized on admission to the hospital. I am positive that you have staph organisms on your body right now.

Seriously, staph and other infections attack when the resistance is low, due to other illness.

[torstars]

In the US the prevalent H3N2 strain was Panama-like last year. Fujian began last year in China. There was some Fujian in the US last season, but most was Panama.

[torstars]

Am I to assume it wasn't as brutal in the SH because they have had more exposure the strain?

No, it was quite severe in Australia and New Zealand (although I'm not sure about children's deaths). I think that Fujian just emerged in China at the end of 2002.

[torstars]

Today's CDC press conference pretty much verified what I suspected happened in the selection of this year's vaccine strains. I think the sequence goes something like this.

Last year Fujian emerged from Fujian Province in China. The virus was detected in several locations in mainland China and also made an appearance in the US in early 2003.

In the spring the components of the current vaccine were chosen. Fujian was on the radar screen, but the initial isolate, A/Fujian/411/2002, did not grow well in eggs, which is how flu virus in killed vaccines is produced. A/Wyoming/3/2003 had just been isolated and there was little data on its stability in eggs. Therefore, the current vaccine used the tried and true A/Panama/2007/99 to represent H3N2 strains.

This summer Fujian was the dominant strain in Australia and New Zealand. It was one of their worst flu seasons and a Fujian-like virus was selected to replace Panama-like for the upcoming flu season in the southern hemisphere.

Thus, the vaccine under development will be ready for the flu season in the southern hemisphere, but it will be too late for the current season on the northern hemisphere.

[torstars]

More on flu deaths in otherwise healthy (and in some cases immunized) children:

"DES MOINES (AP) -- A 1-year-old child in Iowa has died of the flu, state health officials confirmed Monday.

Iowa Department of Public Health spokesman Kevin Teale said the child died from Type A influenza.

No further information was released because of patient confidentiality, Teale said. He would not confirm when the child died, the child's name or hometown.

Between 800 and 1,000 Iowans die each year from the flu and pneumonia, he said. Most are elderly or people who have had chronic health problems.

"For an otherwise healthy child, it is unusual," Teale said.

State health officials also didn't know if the child had previously received a flu shot, he said.

He said the flu vaccine is a dead virus and doesn't cause the flu, nor should it compound existing illnesses, such as bronchitis or pneumonia.

Over the weekend, a Council Bluffs family said their 20-month old daughter had died from the flu. Caitlin Mouw died Dec. 2.

Her parents, Dan and Erin Mouw, said the child and three older brothers had been given flu shots. The child's doctor suspects a combination of pneumonia and the flu caused the girl's death, the Mouw family said."

[mewzilla]

I wasn't aware that MDR staph was that prevalent outside hospital settings.

[calawah98]

Thanks for all the information, it has answered a lot of questions I had.

[TXFireman]

ping

[Judith Anne]

In a recent study in the UK, 8 of 1000 people in the general population were found to have it colonized in the front of the nose.

Now, just imagine a little old lady taking her purchase to the clerk, and while paying, takes a cloth handkerchief out of her coat pocket to blow her nose, then puts the hanky back in the pocket.

Does she wash her hands? No, she hasn't gone to the bathroom, she's just blown her nose.

Then she visits her friend in the hospital and gives her the nice gift she just bought.

Her friend in the hospital has the flu, for example. She takes the contaminated gift into her hands (lotion, for example) opens it, and smells the lotion. Nice. She also transfers the bug, hypothetically, to her own hands. She gets a fit of coughing, covers her mouth with her hands, and inhales the MRSA from her friend's nose.

Bingo! MRSA pneumonia! She acquired it IN the hospital, but not FROM the hospital.

[Judith Anne]

Here's the link to the article about the study:

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=115211

[riri]

So, in your opinion, how much (if any) protection does the immunization that was given out this year protect against this strain? The two strains are somewhat related aren't they? What I can't seem to get a straight answer on is if the shot does indeed provide protection against this Fujian strain.

So, glad to know we have the CDC looking out for us?! Criminy.

[torstars]

The Fujian-like viruses are H3N2 as are the Panama-like (I just got a shot and I think it contained Moscow-like, but its still in the same ballpark - the current vaccine has an H3N2 strain that first appeared around 1999).

Animal data indicated that immunization with Panama gave titers of >40 (protective) in 75% of the animals. Thus, in the animal studies, there was clearly some cross-protection.

However, the virus has continued to mutate, and the virus from Australia had already changed somewhat from Fujian, and I suspect the latest version of Fujian has changed even more, so you could have good antibody levels to Panama and still get the flu.

Theoretically, the cross reacting antibodies would help, but as noted in some of the fatal cases in children, the vaccine didn't help enough.

One thing I didn't know was that for children under 9, a second shot is recommended a month later, so it seems that some of the fatalities were in children who had only received one of the two shots.

[torstars]

The titers of >40 in the previous post were against Fujian, so immunization with Panama does give some protection against Fijian (at least against the Fujian virus isolated in 2002).

[torstars]

Here is the sequence of A/Kumamoto/102/02, which is pretty close to A/Wyoming/03/2003. Thus, the two viruses which are candidates for A/Fujian/411/2002 substitutes are close to each other. One was isolated in late 2002 and the other in early 2003. I think Kumamoto is in Japan, while Wyoming of course is in the US. Ideally, the new vaccine would have a virus that killed this season in Colorado, but there is a lag between the time a virus is isolated and it is deemed suitable for use in large scale vaccine production.