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 ...
conjunctivitis & H1N1 Flu
NJ Dept of Health wanted to test people that presented with conjunctivitis:
http://www.nj.gov/health/er/swineflu/documents/school_guidance_042709.pdf
Here’s a study that shows % of people showing each of the symptoms, including conjunctivitis. [Page 4]
http://hospitals.unm.edu/h1n1/documents/Jamieson_2009_The-Lancet.pdf
Pinellas confirms 4th swine flu death - FL
Updated: Tuesday, 15 Sep 2009, 9:16 AM EDT
Published : Tuesday, 15 Sep 2009, 9:13 AM EDT
ST. PETERSBURG - The Pinellas County Health Department has confirmed the county’s fourth swine flu death.
Health officials said the 51-year-old man had underlying health conditions.
There were 77 swine flu fatalities reported in Florida as of September 9.
Health officials are warning Floridians to take precautions to protect themselves.
For more information, call the Florida Department of Health at (877) 352-3581 or log onto www.MyFluSafety.com .
http://www.myfoxtampabay.com/dpp/health/swine_flu/pinellas_swine_flu_death_091509
Date:15/09/2009 URL: http://www.thehindu.com/2009/09/15/stories/2009091554730100.htm
Back
Front Page
H1N1 gets more virulent
‘Virus not giving any chance to doctors to treat patient’
HYDERABAD: The H1N1 virus, imported to Hyderabad from overseas, is showing signs of getting ‘mutated’ into a more virulent form. Clinical observation of experts in the State capital indicate that the genetic make up of H1N1 virus has ‘changed’ and is now more ‘potent’ after coming into contact with the local existing viral forms.
This is the ‘second wave’ of swine flu virus, coinciding with the rainy season, which is still active. There is a possibility of onset of a third and more virulent form in the upcoming winter season. The virus is getting more ‘time’ to stay in the atmosphere because of low temperatures, experts opine. A pattern, among the fatalities has been detected. “Patients are dying within 24 to 48 hours after getting infected with H1N1. The virus is not giving any chance to the doctors to treat the patient. That’s why we are losing patients who have good immunity,” said Gandhi Hospital Superintendent E.A. Ashok Kumar.
Between May and August, when H1N1 virus was imported from other countries, it did not cause severe illness to patients. “These days, the patient’s condition is deteriorating within 24 hours. There is a definite shift in the genetic make up of the virus. It might have genetically changed after coming into contact with local influenza virus,” Superintendent of Chest Hospital S.V. Prasad.
© Copyright 2000 - 2009 The Hindu
Video: Caller Blows Whistle: Alleges Bird Flu Virus Transported in Trucks
The caller claims to have been in touch with a truck driver, working on contract for the Department of Homeland Security. He was getting paid $ 5,000 a load for trucking bird flu vials to various destinations within the US. All of the deliveries were allegedly made at night, and the trucks were all escorted by armed undercover ex-cops/private security. Many of the loads allegedly were either picked up or dropped of at underground missile silos.
This truck driver further claims he was paid at a Bank of America branch in a back room. He anonymously gave a number to the bank and was paid in cash on the spot. Many of the truck driver’s deliveries were extremely mysterious in nature. He was often told to drive an empty truck from one location to another and then was stopped at a random site and led down a private road to a drop off point (many of which were underground missile silos) so if interrogated he could not divulge sensitive information.
http://www.grandforksherald.com/event/article/id/133445/
September 14 2009
GF student back in school after H1N1
A Grand Forks high school student was back in school Monday after a brief bout with the H1N1 virus, the first confirmed student case of the so-called swine flu locally since classes resumed Aug. 27.
By: Chuck Haga, Grand Forks Herald
A Grand Forks high school student was back in school Monday after a brief bout with the H1N1 virus, the first confirmed student case of the so-called swine flu locally since classes resumed Aug. 27.
Assistant Supt. Jody Thompson said the unidentified student became ill last week with flu-like symptoms.
“Fortunately, the parents did all that we ask in such a situation,” Thompson said. “They kept the student out until 24 hours after the fever subsided.
“The mom reported that it was not a severe case. She said the symptoms were less than what (the student) normally has with seasonal flu.”
Thompson said the student’s case “is the only one I’m aware of” involving H1N1 in the district this fall, though other students who have left school or been held out at some point in the past three weeks may have included some infected with the H1N1 virus.
All illnesses with flu-like symptoms are considered potential cases of swine flu, but not all are tested specifically for the virus, he said. In the case of the high school student, a test was done and submitted to health officials in Bismarck, who confirmed the presence of the H1N1 virus.
The short duration and lack of severity in that case was reassuring, Thompson said.
“The reality is that we know adults and children in Grand Forks have had H1N1 this summer,” he said. Now, with school starting and kids getting together in large numbers, “we know we have to monitor the situation closely.”
In consultation with local health officials and with guidance from the Centers for Disease Control in Atlanta, the school district has taken steps to minimize the impact of the disease, he said. That includes a new computer tracking system meant to provide early warning of spikes in absenteeism that could indicate H1N1 outbreaks at individual schools.
Reach Haga at (701) 780-1102; (800) 477-6572, ext. 102; or send e-mail to chaga@gfherald.com.
~
Swine Flu That Resists Tamiflu Is Harder to Spread, WHO Says
http://www.bloomberg.com/apps/news?pid=20601124&sid=aG.qKHeqAsi4
~
H1N1 patients may be infectious 10-plus days
http://www.usatoday.com/news/health/2009-09-14-H1N1-swine-flu_N.htm
Thanks for all the pings, having to catch up as went to swine central = Austin Tx today.
The article about it being infectious for 10 days is scary to say the least.
Scotland:
Swine flu victim speaks of ordeal
Page last updated at 23:37 GMT, Tuesday, 15 September 2009 00:37 UK
http://news.bbc.co.uk/2/hi/uk_news/8257686.stm
A pregnant Scottish woman who had to be flown to Sweden for life-saving treatment for swine flu has spoken for the first time of her ordeal.
WA:
New death in Washington:
The Washington State Department of Health has updated its total of H1N1 deaths from 14 to 16.
http://www.doh.wa.gov/h1n1/h1n1_newsroom.htm
Going by typical H1N1 symptoms in kids not enough: Lancet
Posted: Wednesday, Aug 26, 2009 at 0233 hrs
A study in the British medical journal Lancet has found that children suffering from swine flu may not show signs typical of the virus but report other symptoms which doctors must watch out for.
The observations have been made by doctors in Birmingham, UK, after studying the first wave of paediatric admissions for H1N1.
The study suggests that instead of looking for the typical symtoms of swine flu like fever, cough and a running nose before recommending a test, doctors could go in for the same if a child has complaints like an earache and swollen eyes and suffers from underlying illnesses.
The Birmingham doctors found that besides cough, fever and running nose, many children who were later diagnosed with H1N1 came with symptoms like ear ache, photophobia, chest pain, swollen eyes and blood in vomit.
The doctors reviewed 78 of 89 children who tested positive and were admitted to hospitals between June 5 and July 4, 2009, at paediatric hospitals in Birmingham and London. The data showed that 29 of 71 patients did not fulfil the H1N1 influenza case definition as described by the UK’s Health Protection Agency (HPA) and other agencies. This includes a temperature of at least 38°C or a history of fever and cough, sore throat, limb or joint pain, headache, vomiting or diarrhoea, or a life-threatening illness.
http://uk.reuters.com/article/idUKTRE58E7Q220090915?rpc=401&;
Swine flu deaths show this flu is different - experts
Tue Sep 15, 2009 10:40pm BST
By Maggie Fox, Health and Science Editor
WASHINGTON (Reuters) - Autopsies on people who have died from the new pandemic H1N1 flu show this virus is different from seasonal influenza, even if it has not yet caused more deaths, experts told a meeting on Tuesday.
Americans who died from swine flu had infections deep in their lungs, Dr. Sherif Zaki of the U.S. Centres for Disease Control and Prevention told a meeting of flu experts, including damage to the alveoli — the structures in the lung that deliver oxygen to the blood.
This in turn caused what is known as acute respiratory distress syndrome — an often fatal development that leaves patients gasping for breath.
The World Health Organisation has confirmed 3,205 deaths globally from swine flu but experts agree all estimates of the extent of the pandemic are grossly understated because so few patients are ever actually tested.
Seasonal flu kills, too — about 250,000 to 500,000 cases a year globally, according to the WHO. But not in the same way as swine flu, which unlike seasonal flu frequently causes severe disease in young adults and children.
“It is very rarely you see what we call diffuse alveolar damage in fatal seasonal influenza,” Zaki told a meeting sponsored by the U.S. Institute of Medicine, which advises government on health matters.
Seasonal flu causes bronchitis and other upper respiratory disease. But Zaki, the chief infectious disease pathologist at CDC, said the new virus had burrowed into the lungs of the 90 or so people he examined after they died, and they had huge amounts of the virus in their blood.
“This is almost exactly what we see with avian flu,” Zaki said. “This looks like avian flu on steroids.”
EXPERIMENTAL DRUGS
Dr. Yoshi Kawaoka of the University of Wisconsin said tests in monkeys showed the virus lives and replicates 1,000-fold better in the lungs than does seasonal flu.
He said the No. 1 drug of choice against H1N1 — Roche’s and Gilead Sciences Inc’s Tamiflu — lowered the so-called viral load of virus in the lungs just enough to help the body fight back.
Experimental flu drugs lower it even more, notably Daiichi Sankyo’s CS 8958 and another drug called T-705 or favipiravir, made by Fujifilm Holdings unit Toyama Chemical, Kawaoka said.
Zaki said 90 percent of the fatalities he looked at had some condition that would predispose them to serious disease. They had a median age of 38 and one victim was a two-month-old infant who died within a day of getting sick.
Nearly half — 46 percent — were obese, many had fatty liver disease, 27 percent had heart disease and 22 percent had asthma, he said.
Dr. Guillermo Ruiz-Palacios of Mexico’s National Institute of Medical Sciences and Nutrition said many Mexican patients with severe disease were also obese. In addition, patients came in late for treatment and many were infected with a second common virus, called parainfluenza virus.
Fewer than a third of the U.S. deaths, 29 percent, had a so-called secondary bacterial infection, usually Streptococcus pneumoniae, Zaki said.
Ruiz-Palacios also said the new virus can be found in the urine and faeces of patients, something that may affect how it spreads.
bump
So 54% were not obese, 73% did not have heart disease and 78% did not have asthma. One wonders what the overlap of the three sets above were. My guess is that most of those with heart disease and asthma are in the obese category. Although, I certainly don't mean to suggest ALL people with heart disease or asthma are obese.
They are excellent pathogen exchange programs, too.
(Thanks, by the way, for the stellar job you do keeping us all up to date!)
THE CANADIAN PRESS:
Low levels of key antibodies may lead to severe disease, study suggests
By Helen Branswell Medical Reporter (CP) – 5 hours ago
TORONTO — Australian researchers may have uncovered a clue as to why some people who catch swine flu suffer life-threatening illness. And if they are right, there is an existing weapon in the treatment arsenal that could help reduce the pandemic death toll.
The group found that pregnant women who became severely ill with the new H1N1 virus had low levels of a particular antibody that is known to fight off viruses and help the body respond to vaccine. Moderately ill women were much less likely to have significantly suppressed levels of the antibody, the researchers reported.
“We all believe we may have stumbled onto something very interesting,” said Dr. Lindsay Grayson, director of infectious disease at Austin Health, a network of three hospitals in Melbourne.
“To our knowledge it’s the first time that a correlation or an association is being noted between severe influenza of any sort and a subtle but potentially important immune deficiency.”
The team made the discovery when Grayson ordered a test that looked at antibody levels - not just by class, but looking at individual subtypes within those classes. The call was made in the case of a very sick patient whose decline was particularly rapid, and the team was debating whether immune globulin - a blood product containing antibodies harvested from donated blood - might help.
The testing showed the patient had low levels of an antibody called IgG2, which Grayson admitted came as a surprise. They started ordering tests on all their swine flu patients in ICU.
“What we found was almost everyone, all the patients who needed ICU were IgG2 deficient,” he said in an interview from San Francisco, where the data were presented at ICAAC, the annual meeting of the American Society for Microbiology.
Severe cases had IgG2 levels that were about one-third of those detected in people who were moderately ill.
While the work was only done in pregnant women, Grayson and others said it would be useful to look to see if this deficiency might explain why a small subset of swine flu cases become gravely ill while most people only suffer through a bout of the flu. It’s known that between two and 20 per cent of people have some antibody deficiency, he said, though not all of those people would be IgG2 deficient.
Three of four critically ill patients treated with immune globulin survived, defying predictions of those caring for them.
Dr. Donald Low, chief microbiologist at Toronto’s Mount Sinai, said the findings are exciting, if preliminary, and might explain why aboriginals seem to be at greater risk of developing severe disease if they contract swine flu.
He suggested the hypothesis should be studied further. “It would be a fishing expedition, but obviously worthwhile.”
“I think the bottom line is that this is obviously something that has to be looked into. And it may have therapeutic implication. ... It could be a marker for women at higher risk if they get infected to get more severe disease.”
But Dr. Anand Kumar, an intensive care specialist from Winnipeg who treated a lot of severely ill swine flu patients in the spring and early summer, was not as optimistic.
“The results are just what I’d expect in any group of critically ill,” he said by email.
Kumar, who is also an infectious diseases specialist, said it is not uncommon for all antibody levels to drop with critical illness and the more severe the sickness, the steeper the drop.
But he does think the notion of treating pandemic flu patients with antibodies harvested from other people makes sense, though he believes the immune globulin should be from people who’ve recovered from swine flu and have antibodies specific to the virus.
Grayson admitted they can’t say at this point whether there is a cause-and-effect relationship at work here, meaning low IgG2 levels in the patients predisposed them to suffering from more severe disease once they caught the virus. But he doesn’t believe the reverse is at play, that the infection caused the low IgG2 levels.
“We don’t think that influenza is causing this deficiency. We think that instead the influenza is picking out those people who have the deficiency,” he said.
The numbers are admittedly small and will require further study, likely in the Northern Hemisphere. Swine flu rates are dropping in Melbourne, Grayson said. Still, 16 of 19 severely ill patients had very low IgG2 levels, compared to three of 20 with moderate illness.
The team looked at healthy pregnant women and found that about 60 per cent of them were mildly deficient in IgG2 levels, which leads them to believe this may be one of the immune system changes that occurs to allow a pregnant woman to carry a foreign body - a fetus - without rejecting it. But Grayson said the group needs to follow women after they deliver to see if their IgG2 levels rise to normal levels.
Grayson said while the group’s work hasn’t proven their hypothesis, Northern Hemisphere doctors caring for the sickest of swine flu patients in the weeks and months to come should consider checking IgG2 levels and using immune globulin, which is often given to people seriously ill with some bacterial infections.
“In many ways, this is applying a general principle that we apply to bacteria diseases to now say well, ‘Gee, we’ve made this interesting observation. This might work for influenza,”’ he said.
http://www.google.com/hostednews/canadianpress/article/ALeqM5icleN_u1gqVocAlyuj48dD91QwKA
Ping to post 1,256 for an interesting development about swine flu.
Canada:
Story of toddler stricken with swine flu has happy ending
(((((((After being turned away from the emergency ward three times in the late spring, Rhea Myers ended up in the pediatric Intensive Care Unit at the Winnipeg Health Sciences Centre in June. ))))))
By Carol Sanders, Winnipeg Free Press
September 16, 2009 5:03 AM
http://www.ottawacitizen.com/health/Story+toddler+stricken+with+swine+happy+ending/1999471/story.html
WINNIPEG — The H1N1 virus is expected to surge when the fall flu season begins, hitting younger victims harder than regular flu. It has already taken several Canadian lives.
But it’s spared many more. And it may have actually helped one very sick but strong toddler whose photo appeared in the Winnipeg Free Press on June 28.
After being turned away from the emergency ward three times in the late spring, Rhea Myers ended up in the pediatric Intensive Care Unit at the Winnipeg Health Sciences Centre in June.
She was placed in a sterile isolation room, hooked up to a breathing machine and was in a coma for weeks. At that traumatic time, her parents agreed to an interview and to have her photo taken, but didn’t want their names made public.
Today, the toddler with long blond curls is back in the pink, at home with her family and enjoying the swing sets.
“She’s doing fabulous,” said her dad, Scott Myers.
He and Rhea’s mom, Michelle, are so grateful that their H1N1 story had a happy ending, they agreed to share it.
“The reality is that the outcome . . . could’ve been tragic,” she said. “If there is a silver lining to a child being that sick, perhaps being in the coma gave her body the rest it needed to heal, and she has somehow beaten H1N1 and is now healthier than ever.”
In June, Rhea was one of 20 suspected or confirmed H1N1 cases in the pediatric ICU.
Rhea already had serious medical challenges: the 16-month-old already had respiratory problems and needed supplemental oxygen to help her breathe. Still, she was a busy, happy toddler. When she became totally listless, her parents became alarmed.
After she was admitted to hospital, she tested positive for the H1N1 virus that was virtually shutting down her lungs.
A ventilator pumped 300 shallow breaths a minute into her lungs. The quick, little breaths pumped in oxygen without inflating — and further damaging — her injured little lungs, giving them time to heal.
“Lungs can make a remarkable recovery,” a pediatric ICU doctor said at the time.
Rhea’s did.
“They thought the ventilator could possibly cause more damage to her lungs,” said her mom, Michelle. “But . . . after over a year of requiring oxygen on a daily basis, she hasn’t needed any for over a month.
“It’s so great to go to the park or even just to our backyard without carrying an oxygen tank with us, or worry that her oxygen levels are dropping too low.”
Michelle said Rhea was a little weaker and lost some muscle tone after lying in a coma for so long, so she underwent physiotherapy.
She still has some lung damage and a weak immune system, her mother said.
Rhea takes a protective antibiotic, and needs to be a little stronger before she’s able to go to daycare.
The little girl, who’s always had a happy nature, is glad to be home. Her big brother, Alex, is also relieved.
“When Alex wakes up in the morning, he says, ‘Rhea’s awake, let’s go get her,’ “ said Michelle.
When Rhea was able to breathe without oxygen tubes, he was overjoyed, she said.
“Alex jumped up with his arms in the air yelling, ‘No more tubes, hurray for Rhea!’ “
Swine Flu Might Be Even More Contagious
Tests Show People ‘Shed’ the Swine Flu Virus for Days Longer Than First Thought
By MICHAEL SMITH
MedPage Today Staff Writer
Sept. 16, 2009—
http://abcnews.go.com/Health/SwineFluNews/people-shed-swine-flu-virus-longer-thought/story?id=8584596
SAN FRANCISCO — People infected with the swine flu (or H1N1 pandemic flu) strain continue to shed virus after the point where current recommendations say they can go back to work or school, two studies suggested Tuesday.
The question, experts said, is whether those people are still contagious and whether a longer stay-at-home period would prevent enough additional infections outweigh the cost.
The U.S. Centers for Disease Control currently says people should wait at least a day after their fever subsides — usually three or four days after the onset of symptoms — before resuming normal activities.
But patients can continue to shed virus for several days after that, according to data presented at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy in San Francisco.
Even so, detection of virus doesn’t necessarily mean contagion, said Dr. Gaston De Serres, of Laval University in Quebec City.
“We detected live virus,” he told reporters. “We cannot say (patients are) contagious but they have the potential to be.”
De Serres and colleagues studied 43 people with confirmed H1N1 pandemic flu, as well as members of their households, using polymerase chain reaction technology to detect the virus and culture methods to find live influenza.
Eight days after their symptoms started, De Serres said eight of the 43 (or 19 percent) were still shedding live virus, detected by culture methods.
Meanwhile, in a similar study, Dr. David Chien Lye, of Tan Tock Seng Hospital in Singapore reported that even after treatment with oseltamivir (Tamiflu), patients may still shed virus for several days.
Lye and colleagues studied 70 patients treated in the hospital after they showed signs of the pandemic flu. They found that 80 percent were still shedding virus after five days of illness, compared with 40 percent after seven days and 10 percent after 10 days.
The longest period during which a patient shed virus was 12 days from the start of symptoms, he said. Lye used a different method to detect the virus and wasn’t able to tell whether the virus given off by the patients was a “live virus,” he said. But he said a small sub-study in which both tests were used provided similar results in each instance.
De Serres said he and his colleagues are still trying to determine if any of their participants transmitted the virus after the first seven days.
For his part, Lye said his patients did not actually transmit the virus, since they were hospitalized and staff took full precautions against the flu.
Both researchers said more study is needed, but the findings suggest that people with the H1N1 flu shouldn’t rush to resume normal activities.
“If you only stay home a couple of days,” De Serres said, “it’s very likely you will still be contagious.”
The mere act of shedding virus may not mean much, according to Dr. Donald Low, of Toronto’s Mount Sinai Hospital, because modern tests are so sensitive they can find viruses long after they’re dead.
Shedding a Virus Doesn’t Always Mean Spreading Disease
For instance, he said, researchers tested a carpet several months after one of the first victims of Sudden Acute Respiratory Syndrome (SARS) had vomited on it.
“It was just chock-full of virus,” he said, “but it was all dead.”
He added that health policy-makers must balance the economic impact of telling people to stay home longer with the medical impact of some potential extra infections.
The current recommendation is intended to decrease the chance of transmitting the virus, rather than to stop it completely, said Dr. Daniel Jernigan, the deputy director of the CDC’s influenza division.
“Some people will continue to shed live virus after their fever stops, we know that,” he said, but it’s not clear that they remain contagious.
Also, keep up with other H1N1 update stories on this thread: H1N1 flu victim collapsed on way to hospital [Latest H1N1 updates downthread] thanks to DvdMom and others.
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