Posted on 06/24/2009 8:04:24 AM PDT by metmom
Within minutes, six-year-old Rubjit Thindal went from happily chatting in the back seat of the car to collapsing and dying in her father's arms.
"If we had known it was so serious, we would have called 911,'' Kuldip Thindal, Rubjit's distraught mother, said in Punjabi yesterday. "She just had a stomach ache -- she wasn't even crying.''
Rubjit was pronounced dead at hospital barely 24 hours after showing signs of a fever. Later, doctors told her parents she had the H1N1 influenza virus. She is believed to be the youngest person in Canada with the virus to have died.
(Excerpt) Read more at news.guelphmercury.com ...
interesting post , thanks !
Commentary
Tennessee School Closings Raise Pandemic Concerns Recombinomics
Commentary 11:13
September 2, 2009
http://www.recombinomics.com/News/09020901/H1N1_TN.html
Mounting illnesses have forced the Alcoa City Schools to close through Labor Day.
The 1,800-student system decided Tuesday to extend the holiday for its elementary school, middle school and high school after the absentee rate hit 30 percent. Normally it’s around 5 percent.
According to Director of Schools Tom Shamblin, some of the illnesses are confirmed flu cases. Other illnesses included stomach viruses, fevers and upper respiratory infections. Shamblin said middle schoolers were impacted the most, with a nearly 30% absentee rate.
The above comments describe a large pandemic H1N1 outbreak in schools in Alcoa, TN, which is just south of Knoxville (see zoomed map). Although other schools in the area also have high absenteeism rates (see broader view), they have followed the CDC recommendations on keep schools open. These other schools also cite a wide range of symptoms, as noted above. All of these symptoms have been previously reported for swine flu, and it is likely that the vast majority of these students are H1N1 infected. The number of infected students is much high than confirmed cases, due to limited testing of patients who meet the CDC case definition, as well as the high frequency of infections which not not develop a fever (and therefore do not meet the H1N1 case definition).
The absence of fever has been reported previously in Mexico and Chile, but a fever is included in the CDC case definition, so the symptoms listed for hospitalized H1N1 confirmed cases is 93%, leading many to assume the lack of a fever signals the lack of infection. Consequently, a runny nose is frequently diagnoses as allergies, and gastro-intestinal problems are called “stomach flu”, and other flu-like symptoms are called “upper respiratory infections” and in some cases an influenza A positive result is interpreted as seasonal or “normal” flu, even though 99% of influenza A positive patients at this time are swine flu because the traditional flu season has not begun.
Thus, the swine flu cases are easily noticed, even though the diagnosis, as seen above, is incorrect. These mis-diagnosis, especially those which attribute symptoms to allergies, lead to more H1N1 infections because students come to school, and remain in school because they have no fever. Moreover, the lack of testing leads to misconceptions about the H1N1 frequency in the area.
This lack of testing has been prevalent for months, so confirmed cases suggest that H1N1 levels in the region are low, and the explosion of cases creates “sticker shock” for returning students and parents. The high level of infections cited above is not limited to Tennessee. H1N1 is widespread throughout the south because the school year began in early August. However, high levels are being reported elsewhere. Almost 30% of students are also absent in Iowa, were there were large outbreaks last spring and around Marshalltown (see map). However, the limited number of swine flu testing kits shipped by the CDC precluded testing of the hundreds of symptomatic patients at the local clinic. Therefore these patients were not confirmed, even though attending physicians were certain that the patients were H1N1 infected.
This, the limited testing of H1N1 coupled with a case definition that includes fever has led to a significant under-reporting of cases, even in schools were absenteeism is approaching 30%. Moreover, students without fever continue to attend school, leading to massive outbreaks as described above. Therefore the explosion of cases in the south is likely to spread throughout the northern hemisphere as a new flu season begins in the absence of an effective vaccine and growing concerns of antiviral resistance.
Makes sense. This flu will be unavoidable once all the schools get going.
“Beijing to punish school officials over swine flu
12:09pm, Sep 02, 2009
http://tinyurl.com/nw2v7s SouthChinaMorningPost
School officials in Henan found responsible for a swine flu outbreak at a provincial high school that led to 109 students being infected
will be severely punished, a local official said.
Classes have been suspended for students at the No. 3 Senior High School in Xinan County in Henan province since last Thursday when the first swine flu patient from the school was reported, the official Xinhua News Agency said late Tuesday night.
An initial investigation showed that school officials failed to test students temperatures before the first classes of the fall term started,
as is required at all schools in the province, Xinhua cited Jiang Duyun, director of the provinces education department, as saying.
Beijing has acted aggressively to detect and contain swine flu cases after being accused of failing to move quickly enough to stop the 2003 outbreak of SARS. “...
Schools remain open this week in Scottsboro and Jackson County, Alabama despite rising abesentees and the death of a student.
http://wdef.com/news/scottsboro_schools_remain_open_after_flu_death_another_child_dies_in_tennessee/09/2009
September 2, 2009 7:01pm
Schools remain open this week in Scottsboro and Jackson County, Alabama despite rising abesentees and the death of a student.
The decision comes following the death of 12-year old Alex Garcia.
He was a student at Collins Elementary.
The boy appears to have been infected with the swine flu.
The state department of public health made the call to keep the schools open...
And administrators want parents to know they’re taking every precaution possible.
Judith Berry\Scottsboro City School District:
“I know they’re scared. I’m a grandparent, and I have three grandchildren in the schools here and its not something you take lightly, but they’re in school today and we’re doing everything we can to keep them safe.”
And another child has also died this week.
The five year old live in the Nashville area.
Health officials can confirm that he died from swine flu.
Lungs of fatal swine flu patients badly damaged
http://www.ctv.ca/servlet/ArticleNews/story/CTVNews/20090903/h1n1_lungs_090903/20090903
Sep. 3 2009
The lungs of people who have died from swine flu look more like those of the victims of H5N1 avian influenza than those of people who succumb to regular flu, the chief of infectious diseases pathology at the U.S. Centers for Disease Control says.
Study of about 70 fatal H1N1 cases so far also reveals there may be more incidences of co-infections with bacteria than was earlier thought, Dr. Sherif Zaki told The Canadian Press in an interview.
The damage to lung tissue is consistent with that inflicted by ARDS or acute respiratory distress symptom, Zaki says, referring to an often-fatal, difficult-to-treat syndrome that can have a number of causes. The U.S. National Heart, Lung and Blood Institute estimates about 30 per cent of people who develop ARDS die.
“In terms of the disease, yes, it (H1N1) is remarkably different than seasonal flu,” Zaki says. “The pathology looks very similar to H5(N1).”
The dangerous avian flu virus has killed 60 per cent of the 440 people known to have been infected with it. To date, though, the virus hasn’t acquired the capacity to spread easily from person to person.
The swine flu patients who went on to die suffered lung damage and changes in the lungs that would have made it difficult to deliver enough oxygen into their bloodstreams, Zaki says.
That reflects the observation of intensive care doctors who’ve struggled to save these profoundly ill patients.
“That’s what they saw in Winnipeg,” Dr. Paul Hebert, an intensive care physician and editor of the Canadian Medical Association Journal, said recently of how hard it is to oxygenate swine flu patients who become gravely ill.
“They have everybody on experimental ventilators and techniques. They can barely keep them alive.”
A number of doctors who have treated novel H1N1 patients — and colleagues who haven’t yet — were meeting in Winnipeg this week discussing what steps hospitals and ICUs need to take to get ready for an expected increase in pandemic flu cases this fall and winter.
Zaki says finding ways to prevent cases from progressing to severe illness should be the goal, “because once it happens in these patients . . . it’s very difficult to treat.”
Strikingly high levels of virus were spotted in the lungs of people who died rapidly from swine flu, he says, though less is seen in those who die after a longer battle with the virus.
“Some people die very quickly of it, within days. And some have more protracted illness, maybe two, three weeks,” he says.
“It’s surprising the amounts (of virus) that you see.... But it’s not unheard of,” he adds, pointing to what was seen with SARS.
Earlier studies conducted in tissue culture and in ferrets — the best animal model for human flu — found the new virus is drawn to tissue found deep in the lung. That’s a penchant it shares with H5N1. Seasonal flu viruses attack the upper airways.
Zaki says about a third of the fatal cases his team has reviewed involved co-infection with a bacterium, though the culprit varies.
Sometimes it is Staphylococcus aureus — the drug-resistant kind, known by the nickname MRSA and antibiotic-sensitive varieties as well. Some cases have involved group A Streptococcus. And some have been co-infection with Streptococcus pneumoniae.
“Those are the main three that we found.”
“It was not very clear initially,” Zaki adds of the frequency with which co-infection seems to occur in these cases. “But the more we studied, the more we realized that these do happen.”
He suggests pneumococcal vaccine, used in the elderly to lower the risk of pneumonia, could be a useful tool if given to younger people. The highest numbers of deaths so far have been in people in their late 30s and 40s.
Some of the cases of co-infection have been in people who were hospitalized for an extended period, which wouldn’t be all that surprising. But some were seen in people who weren’t hospitalized.
With the new virus causing severe disease in only a small portion of cases, public health authorities have been criticized for overreacting and overhyping the threat swine flu poses. Some critics have suggested the new flu isn’t really much worse than seasonal influenza.
From Zaki’s vantage point, however, this is not regular flu.
“This is a new virus. It causes a different disease than what we’re used to,” he says. “So I don’t think anybody can predict exactly, but it would be foolish not to be trying to study the disease more.”
Thanks for the ping!
thanks, bfl
http://www.cbsnews.com/stories/2009/09/02/cbsnews_investigates/main5282979.shtml
CDC Not Immune to H1N1
NEW YORK, Sept. 2, 2009
There Are at Least 6 Suspected Cases of H1N1 at the CDC and Nearby FacilitiesBy Michael Rey
(CBS) CBS News has learned that there have been at least six suspected cases of the H1N1 flu among employees at the headquarters of the Centers for Disease Control in Atlanta and nearby facilities. Among the cases, workers in the National Center for Chronic Disease Prevention and Health Promotion were notified by email from a supervisor on August 18th that one of their colleagues had a suspected but “not laboratory confirmed” case of the novel H1N1 flu. There were two other cases of possible swine flu in the emergency operations center at the Atlanta headquarters.
Scale of anticipated flu pandemic ‘frightening’: Doctor
http://www.ottawacitizen.com/health/Scale+anticipated+pandemic+frightening+Doctor/1958388/story.html
September 3, 2009 9:35 AM
An intensive care doctor speaking Wednesday at a conference on the H1N1 pandemic said the virus is the “most frightening” thing he has seen in his career and other experts here warned that hospitals are not yet ready for a surge of severely sick patients.
In an interview just prior to his address, Dr. Anand Kumar said he wanted to give the audience “the flavour” of what hospitals can expect to see when the second wave of the pandemic is expected to come this fall and winter.
“I think it’s an absolutely massive onslaught of incredibly sick young people that I had never imagined I would see in my life,” Kumar said of his experience treating patients in Winnipeg’s intensive care units. “It’s startling, and more than a little frightening, especially when you don’t know what the ceiling of this is going to be.”
The two-day conference, which has drawn together about 150 health-care professionals and experts from across the country and around the world, is focused on how to manage severe cases of the swine flu and prevent them from deteriorating. Also on the agenda are discussions about Canada’s vaccine strategy under attack this week from the Canadian Medical Association Journal the use of antivirals, medical ethics and clinical care guidelines. The sessions are closed to media.
Most cases of swine flu in Canada have been mild, but there is a subset of patients who are getting very sick. At least 72 deaths have been linked to H1N1 and more than 1,366 people have been hospitalized. Of those patients, more than 240 have spent time in intensive care units.
The virus’s behaviour differs from that of other flu bugs in that it attacks younger people at disproportionately higher rates, rather than the very old and very young who are normally more susceptible to flu. Researchers still don’t know why it is hitting some people so hard, particularly when they have no underlying health conditions or risk factors such as pregnancy.
Kumar said that, of the patients who were hospitalized in Winnipeg, two-thirds were young and healthy people who were “essentially struck down in the prime of their life” and that hospitals were filled with “rows and rows” of young patients in their 20s, 30s and 40s. He called it a “bizarre experience.”
“I’ve been doing this for 28 years and it’s probably the most frightening thing I’ve ever seen professionally,” he said.
Some of the people who got “spectacularly ill” could barely get any oxygen from a ventilator into their lungs because they were so filled with fluid, said Kumar, and some patients had lungs so damaged that a ventilator didn’t work.
Despite the rather ominous description offered by Kumar, he said young and healthy people shouldn’t be scared and that the vast majority of people who contract the virus recover well.
Hospitals, however, know they need to prepare for an onslaught of critically ill patients in the event the pandemic worsens.
Dr. Robert Fowler, a critical care specialist and associate professor at the University of Toronto, said the second wave is not going to hit every city at the same time and jurisdictions should be able to share resources, such as ventilators and personnel. Those plans are not yet ready to be activated, said Fowler, and hospitals in general are not ready for high numbers of swine flu patients to walk through their doors.
“Are we ready? I think lots of work has been done, but we’re not ready,” said Fowler. “There’s still lots more work to be done over the next weeks to months.”
Some hospitals are already pushed to their limits when caring for critically ill patients, and the possibility of being pushed beyond those limits is causing a lot of worry, he said.
Dr. Gerald Evans, an expert from Queen’s University who will address the conference Thursday, echoed those concerns.
“Canadian health care is sort of premised on the idea that we run at near 100 per cent capacity, so the lack of a surge capacity, the ability to take a big huge surge of people, is a significant problem,” he said.
More hospital beds are needed, more advanced ventilators are required, as well as the people trained to operate them, and strategies are needed to prevent serious cases from turning deadly, the experts said. Those strategies will be discussed in detail during the second day of the conference.
ping
Southeast Sees Rise in Swine Flu
Vanessa Ruffes 1 hr ago
http://www.13wmaz.com/news/local/story.aspx?storyid=68672&catid=153
The Centers for Disease Control reports that while flu activity stayed the same or declined in most part of the U.S., it seems to be increasing in the Southeast.
This trend was seen during the week of Aug. 16 to 22.
During that week, the CDC reported 8,843 hospitalizations and 556 deaths related to swine flu in the nation. That number is up from 7,983 hospitalizations and 522 deaths the week before.
For the Southeast, 4,429 hospitalizations and 10 pediatric deaths from swine flu were reported to date. Nationwide, 110 child deaths were reported.
“Widespread” influenza activity was reported in Georgia, according to the CDC.
The CDC knows of 110 swine flu-related pediatric deaths so far.
Up One Thousand hospitalizations in one Week.
Macon mom Lakeshia Dennis says when her 8-month old son started a fever and a cough, she immediately made a doctor’s appointment.
“The fever started, and the first thing that came to my mind was flu,” said Dennis.
Dennis says her biggest fear is swine flu. With a 4-year old son who just started pre-school, she says more germs may be coming into her home.
Sixteen-year old Dorian Hall says a few classmates are already out with the flu. His mother Valerie Baute immediately recognized the symptoms and brought him to the doctor.
“He was shaking uncontrollably. Headaches, backaches. He just came in and layed on me, and said he just didn’t feel good,” said Baute.
Flu in Georgia, is now “widespread,” according to the CDC.
Dr. Jason Smith says his workload has more than doubled, to about 75 patients a day. He says about 40 percent have flu symptoms.
Dr. Smith says over the past couple weeks, about 30 patients have tested positive for the flu each day. He says a typical number for this time of year is zero.
“Flu season really peaks around January or February, sometimes as early as March, and for it to be peaking in early September, that’s really early,” Dr. Smith said.
New CDC guidelines say a person must be hospitalized before they will test for swine flu. That’s to keep from overwhelming state health departments, and because testing is so expensive.
A quick flu test costs about $10, a swine flu test runs about $200-300.
But Lakeshia Dennis says she is more concerned about not knowing.
“He could have it and I wouldn’t even know. My other son could have a little cold, and I wouldn’t even know he has swine flu. And that worries me,” said Dennis.
Notice not as many are claiming this is the same or less deadly than the average flu.
Yes I did notice that . Also it’s hard to know the real number of deaths because of lack of reporting . New York state public stated it wasn’t counting anymore swineflu deaths .
And here’s where CDC halts death tallies from H1N1 swine flu virus
http://www.digitaljournal.com/article/276444?tp=1
an unlicensed intravenous form of the antiviral drug Relenza saved the life of a woman with a severe illness resulting from infection by the pandemic H1N1 influenza virus,
Could intravenous antivirals be a last-ditch treatment for swine flu?
September 3, 2009 | 5:41 pm
— Thomas H. Maugh II
ACHA Pandemic Influenza Surveillance
Influenza Like Illness (ILI) in Colleges and Universities
http://www.acha.org/ILI_Surveillance.cfm
With preliminary epidemiologic data on novel H1N1 flu suggesting significant risk among those in the college setting, ACHA deems it epidemiologically valuable to identify disease burden and population based attack rates of influenza like illnesses (ILI) [ICD-CM Diagnosis 487.1] on college campuses. ACHA has thus undertaken an effort to enlist (on a voluntary basis) interested institutions of higher education to submit data on a weekly basis regarding the number of new cases of ILI.
Project Description
New ILI cases reported include those seen in the student health service, those triaged over the phone by a health care professional but simply told to self-isolate and not be seen in the health service, and those known by the health service to have been seen in a local emergency department or urgent care center.
2 Westmont High students diagnosed with swine flu
Jim Jaworski Chicago Breaking News
September 3, 2009
2 Westmont High students diagnosed with swine flu
http://www.wgntv.com/news/wgntv-2-westmont-high-students-swine-flu-sept3,0,4437361.story
CHICAGO - Community Unit School District 201 officials are reporting that two Westmont High School students have been diagnosed with the H1N1 virus, also known as the swine flu.
According to a release from the district, an increased amount of WHS students have reported flu-like symptoms. Two students reported being diagnosed with H1N1 by their respective physicians.
Some students who reported symptoms were screened for fever by the school nurse and were cleared to return to class.
The district is working with the DuPage County Health Department, which is recommending that anyone with the flu should stay home and out of the public until at least 24 hours after the fever subsides.
For more information, go to www.dupagehealth.org or call 630-682-7400.
Thanks for the ping!
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