H1N1 flu victim collapsed on way to hospital [Latest H1N1 updates downthread]

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.

The Queen’s Medical Center confirms swine flu cases among employees
Posted: Jun 30, 2009 9:54 PM MDT Updated: Jun 30, 2009 9:55 PM MDT
By Leland Kim - bio | email

http://www.khnl.com/global/story.asp?s=10623160

HONOLULU (KHNL) - The Queen’s Medical Center confirmed Tuesday several employees have been infected with swine flu. They work in different departments at the main hospital and are recovering at home.

Sources tell KHNL/K5 employees who tested positive for the H-1-N-1 virus include two doctors and at least one nurse. Hospital officials say the situation is under control, and they’re doing the best they can to prevent the virus from spreading.

The Queen’s Medical Center is the state’s highest level trauma hospital. It sees more than 260,000 patients every year. The news of several employees coming down with swine flu has some in the community concerned.

“Oh my God,” said Torlen Shinjo, a Waipahu resident. “That’s shocking because we need those doctors and nurses to take care of those very sick patients at the hospital and that is my hospital, too.”

The H-1-N-1 virus has spread globally. The World Health Organization classified it as a “pandemic” on June 11. Hawaii had its first confirmed case of swine flu on May 5, and now it’s reached the Queen’s Medical Center.

“I really wasn’t surprised,” said an anonymous registered nurse who works at Queen’s. “It’s global and it was time to come to Hawaii and with nurses, there’s a lot of us and it was only a matter of time someone in the healthcare field would come down with it.”

About 3,000 people work at the main hospital, so this swine flu outbreak represents only a small fraction of the total number of employees.

“At this time we have no plan to testing on all of our employees,” said Cindy Kamikawa, vice president of nursing and chief nursing officer for The Queen’s Medical Center. “We are taking precautions that we take all the time to assure that employees are not coming to work sick.”

According to sources, earlier in the month, 23 staff members at the trauma ICU unit were out sick because of flu like symptoms. That’s when backup had to be called in.

The hospital has a float pool and part-time nurses to cover shifts.

“We’ll always evaluate that on a day-to-day, shift-to-shift basis to assure that we have adequate staffing in all of our different departments to care for our patients,” said Kamikawa.

At this time, the outbreak has not spread to other employees, and no patients have been infected from contact with hospital staff.

“As with any communicable disease, we follow our CDC, the centers for disease control, guidelines and precautions,” said Kamikawa.

Despite this recent outbreak, patients still have confidence in The Queen’s Medical Center.

“That’s my hospital,” said Shinjo. “I was born there and I would still go to that hospital no matter what.”

Since May, almost 550 people have come down with swine flu statewide, including an outbreak infecting about 20 Moloka’i firefighters. Monday, the first swine-flu related death was reported in Hawaii. A woman in her late 60’s died June 19 at Tripler Army Medical Center.

Massachusetts:

MetroWest towns holding pneumonia clinics
By Charlie Breitrose/Daily News staff
The MetroWest Daily News
Posted Jun 30, 2009 @ 11:56 PM

http://www.metrowestdailynews.com/news/x726977744/MetroWest-towns-holding-pneumonia-clinics

MetroWest health officials, concerned that the H1N1 (swine flu) virus pandemic still lacks a suitable vaccine, are offering a vaccine for one of the most serious flu complications - pneumonia.

Public health departments in a number of area towns will hold free vaccination clinics for pneumonia this month to protect those most vulnerable to the potentially deadly illness.

According to the state Department of Public Health, pneumonia played a lead role in many of the deaths during the influenza epidemic of 1918 and 1919 - 7 to 20 percent of flu cases developed pneumonia, and 20 to 36 percent of those died.

Natick held its first summer pneumonia clinic last week, and more are planned, said Public Health Nurse Leila Mercer. Normally, residents receive flu vaccinations in the fall.

“This is in response to the declared pandemic (of swine flu),” Mercer said. “People have been thinking about the swine flu, and even though we don’t have a swine flu vaccine, we do have the bacterial pneumonia vaccine.”

State officials recently increased the list of people to whom towns can provide free pneumonia shots. Among the most vulnerable are people over 65, and 19- to 64-year-olds who smoke or have asthma. People who have had pneumonia in the past or those who have a reduced ability to fight infections, including those with leukemia, HIV, AIDS, or spleen problems, are encouraged to get a vaccine.

Vaccines are also recommended for people with heart disease, lung disease, sickle cell, diabetes, alcoholism, have a cochlear implant, had an organ transplant, take radiation drugs or are on a longterm steroid regimen.

Last week’s clinic drew 20 people, Mercer said. Others are scheduled for July 8 at Town Hall from 4 p.m. to 6 p.m., and on July 20 at the Kennedy Senior Center from 1 p.m. to 2:30 p.m. The clinic in Natick is open to anyone.

Marlborough will hold some clinics, including one at the Senior Center, said Public Health Nurse Nancy Cleary, but the dates have yet to be determined. People can still stop by the Public Health Department’s office in the Walker Building any Tuesday from 2 p.m to 4 p.m. to get a shot, Cleary said.

“Before we get into all the clinics for the swine flu and regular flu season, I think this is a good interim period to address this so people understand why it is important to get the pneumonia vaccine,” Cleary said.

While the vaccine will help prevent a serious side effect of the flu, it won’t prevent it, said Kitty Mahoney, Framingham’s chief public health nurse.

“The new state guidelines say to target anyone at risk of pneumonia because that’s the one serious complication we are seeing with H1N1,” Mahoney said. “But people should know it is not a protection against H1N1. We will give out that shot when the CDC makes it available, probably in the fall.”

Framingham will hold a clinic for people who are in at-risk categories on July 14, from 4 p.m. to 7 p.m., in the Memorial Building, said Mahoney, who is also president of the Massachusetts Public Health Nurses Association.

The vaccine clinics in Milford and Franklin are run by the Visiting Nurses Association. Paul Mazzuchelli, health officer for the Milford Board of Health, said they will not have pneumonia shots this summer.

“The next vaccine clinic we have scheduled is in the fall right around flu season, probably mid-September or early October,” Mazzuchelli said. “What we usually do is we offer pnuemococcal with our flu clinics. Usually, over recent years, the responses been very low.”

(Charlie Breitrose can be reached at 508-626-3964 or cbreitro@cnc.com.)

Hospital: Man treated for flu before diagnosis

Doctors suspected H1N1 strain from start

By PAUL HARASIM
LAS VEGAS REVIEW-JOURNAL
Swine Flu / H1N1 virus
The chief nursing officer at MountainView Hospital said Tuesday that the 33-year-old man who died last weekend as a result of the H1N1 virus was treated as though he had the disease from the day he was admitted, despite the fact that he was not diagnosed until well into his 13-day hospitalization.

According to registered nurse Helen Vos, John Talley told hospital officials he had been ill “for more than a week” before he turned up at the hospital’s emergency room for treatment of flulike symptoms on June 15.

She said doctors suspected the H1N1 virus, also known as swine flu, but a so-called “rapid” test came back negative.

Though the anti-viral drug Tamiflu is largely effective only when given in the first 48 hours after an individual shows symptoms, Vos said doctors working on Talley quickly gave him the drug in hopes it could still help fight off the virus.

“We had all the specialists available immediately working on the case,” she said. “He was seriously ill.”

Nothing, Vos said, stopped Talley’s feverish body from shutting down.

“He was critically ill almost from the first day,” said Vos, who noted that the hospital followed the isolation protocols recommended by the Centers for Disease Control and Prevention in treating Talley. “He was supported by equipment for breathing.”

Talley’s family, who held a memorial service for him Tuesday at Palm Mortuary-Summerlin, was unavailable for comment. Physicians said that Talley had no underlying medical conditions prior to contracting H1N1.

It wasn’t until a couple of days before Talley died that doctors found through a sophisticated Polymerase Chain Reaction test that what they first suspected was correct: He had the H1N1 virus.

The state’s chief health officer, Dr. Mary Guinan, told the Review-Journal on Monday that she wants physicians to immediately give the more sophisticated test to patients hospitalized with flulike symptoms. Too often medical officials have found, she said, that “rapid tests” register a false negative.
The diagnosis of H1N1 could be critical, given that the best treatment, Tamiflu or Relenza, is most effective in the first 48 hours after symptoms are seen.

Officials with the Southern Nevada Health District reported Tuesday that two of the hospitalized patients with H1N1 are in serious condition and the other is “improving.”

An emergency room physician who contacted the Review-Journal on Tuesday said he believes the health district, which for several weeks has followed the CDC recommendations by tracking only H1N1 cases requiring hospitalization, is doing the public a disservice by issuing a number of “confirmed cases” that make it appear that the Las Vegas Valley isn’t hard hit by the virus.

District health officials on Monday said Clark County has 80 confirmed cases, which the district’s chief health officer called “the tip of the iceberg.”

“You can bet the 80 number is really the tip of the iceberg,” said the emergency room physician, who asked for anonymity because he worried that his hospital might see his comments as negative and take a job action against him. “We passed 80 way back in March. That number is now meaningless. I don’t get swine flu cases on every shift, but almost.”

Most, he said, aren’t sick enough to require hospitalization.

The physician said every patient he sees who tests positive for a strain of influenza A receives Tamiflu, regardless of the outcome of another test H1N1.

“I’m treating all my patients who have flulike symptoms like they have the swine flu,” he said.

The physician said he understands the CDC’s reasoning in concentrating only on hospitalized cases. District officials have said it is established that the virus is everywhere in the county and precautions must be taken.

“Yes, the swine flu is really here,” the physician said. “That’s been established. And we have to act like it is. But it’s not helping people take it serious when we make it sound like we have just a few cases here.”

As of Friday, state officials said the rest of Nevada had 160 cases and Clark County 80.

The CDC now estimates that more than 1 million people in the United States have been infected with the H1N1 strain.

Contact reporter Paul Harasim at pharasim@reviewjournal.com or 702-387-2908.

http://www.lvrj.com/news/49591797.html

http://english.people.com.cn/90001/90782/90880/6691201.html

20:21, July 01, 2009

5 more A/H1N1 flu suspects hospitalized in Indonesia

Four foreigners in Bali and an Indonesian student, who was just came back to Jakarta from Australia, are suspected of being infected with Influenza A/H1N1, according to Antara news agency on Wednesday.

Gusti Lanang Suardhana, Bali’s Sanglah hospital head of medical services, said that they received four new foreigners with A H1N1 flu symptoms.

They were a German national Gerry O’Brien, 43, Argentine national Brian Schargorodsky, 22, and Australians Ryan Wood, 23, and Aaron Michael, 24.

“They’re all young tourists who just got here,” Gusti was quoted as saying on Tuesday.

With the incoming of the four A/H1N1 flu suspects, the hospitalis now treating nine flu suspects who all of them are foreigners.

Meanwhile in Jakarta at the same day, the head of the South Jakarta health agency Togi Aswan said that it is now examining a student who had juts arrived from Australia with A/H1N1 flu symptoms.

“I will not mention a name, but the student shows positive signs of A/H1N1 flu symptoms after he came back from Australia,” Togi said.

He said that the student resides in the suburb area of Pondok Indah, South Jakarta.

As of now, three Indonesians are treated in hospital as A H1N1 flu suspect patients.

Considering that the incubation period of A/H1N1 flu virus is at least three days, Indonesia on Monday last week asked people from A/H1N1 flu-affected area to use face masks for three days during their visit to Indonesia

The Viral Dynasty Of The Spanish Flu
Posted on: Tuesday, 30 June 2009, 13:20 CDT

The influenza virus that terrorized the world in 1918-19 founded a viral dynasty that lives on, according to a study published on Tuesday by the New England Journal of Medicine.

The authors of the study insist that we have been living in an influenza pandemic era since 1918. They believe that the 2009 “swine flu” virus that had people panicking across the globe was just another guise of the same old viral family.

“The 1918-1919 influenza pandemic was a defining event in the history of public health,” says director Dr. Fauci of the National Institutes of Allergy and Infectious Diseases and a co-author of the study.

“The legacy of that pandemic lives on in many ways, including the fact that the descendents of the 1918 virus have continued to circulate for nine decades.”

Influenza viruses have eight genes, two of which code for virus surface proteins hemagglutinin (H) and neuraminidase (N), which allow the virus to enter a host cell and spread from cell to cell. There are 16 H subtypes and 9 N subtypes, making 144 possible HN combinations.

But only H1N1, H2N2, and H3N2 are known to be fully adapted to infect humans. Other combinations such as the H5N1 bird flu virus have only occasionally infected small numbers of humans.

Since its debut in 1918, the virus “has drawn on a bag of evolutionary tricks to survive in one form or another — and to spawn a host of novel progeny viruses with novel gene constellations, through the periodic importation or exportation of viral genes,” the authors said.

Jeffrey Taubenberger, the senior investigator at NIAID’s Laboratory of Infectious Diseases, says that all of the influenza A viruses adapted for humans “are descendants, direct or indirect, of that founding virus.”

“The eight influenza genes can be thought of as players on a team: Certain combinations of players may arise through chance and endow the virus with new abilities, such as the ability to infect a new type of host,” said David Morens, an author of the study.

That is likely what caused the 1918 pandemic, he added.

It remains a mystery as to what factors determine whether infection in a new host yields a dead-end infection or sustained, human-to-human transmission, like the virus of 1918. Research on such topics is in high gear, but they have yet to find any definitive answers, notes Dr. Morens.

What is understood is that the human immune system rallies its defense against the influenza virus’s H and N proteins, mostly in the form of antibodies. But as people develop immunity to new variants of the flu, the virus reacts by making changes that will challenge the antibodies’ ability to recognize it.

For nearly a century, the immune system has been battling the 1918 influenza virus and its progeny, as it constantly attempts to outwit its enemy and anticipate its moves.

It is unlikely that the 1918 flu is anywhere near its end, however virologists remain optimistic. They note that the pandemics that have occurred repeatedly since 1918 have actually been gradually becoming less severe.

The Asian flu killed four million people in 1957, and then the Hong Kong flu of 1968 killed 2 million people. That is a stark contrast to the mere 311 reported deaths that have occurred from the swine flu pandemic at hand, according to the latest WHO figures released on Monday.

This trend is partly the result of advances in medicine and public health measures, but it may also be indicative of viral evolutionary pathways that cause increases in the virus’s ability to spread from host to host, along with a decrease in its tendency to kill those hosts. “Although we must be prepared to deal with the possibility of a new and clinically severe influenza pandemic caused by an entirely new virus, we must also understand in greater depth, and continue to explore, the determinants and dynamics of the pandemic era in which we live,” conclude the authors.

http://www.redorbit.com/news/health/1713405/the_viral_dynasty_of_the_spanish_flu/

Acquisition of H274Y Tamiflu Resistance in Pandemic H1N1
Recombinomics Commentary 02:09
July 1, 2009

In the context of tracing contacts of a cluster of 3 imported cases in Denmark, a female contact who initially tested negative on PCR, was given prophylaxis with oseltamivir (75 mg per day). Five days later, despite reportedly having complied with treatment, she developed flu-like symptoms and was tested positive for A(H1N1)v. Sequencing of the virus showed a single mutation H275Y (H274Y in N2 nomenclature) in the neuraminidase gene. The presence of the resistance marker and the phenotypic (in vitro) resistance was confirmed by a WHO collaborating Centre. The virus is not a re-assortant and is presumed to remain susceptible to zanamivir (another neuraminidase inhibitor). All other virus isolated as part of this cluster investigation, including the presumed source patient, did not show the mutation.

According to the available epidemiological and virological data, this reported event in Denmark is almost certainly secondary resistance acquired during post-exposure prophylaxis. This is supported by the time sequence and the absence of similar genotypic markers in viruses isolated in the other cases of the cluster.

There is no evidence in this case that the isolated resistant virus has transmitted to other persons, meaning that the risk of spread of a resistant virus is nearly zero.

Secondary resistance, arising due to treatment, must not be confused with more complex mutations including the H274Y substitution resulting from primary resistance. Such primary resistance was first observed in seasonal A(H1N1) influenza virus in the 2007-2008. It spread worldwide generally displacing other seasonal A(H1N1) viruses (98% resistance in EU in 2008-2009

The above risk assessment by the European Centre for Disease Control indicates the oseltamivir resistance identified in a female contact of a pandemic H1N1 confirmed traveler was due to the acquisition of H274Y. The report also indicates the sequence from the likely source of the pandemic H1N1 infection of the contact did not contain H274Y, supporting the acquisition during prophylactic treatment leading to a low risk assessment for spread.

However, there are alternate explanations for the failure to detect H274Y in the sequence from the traveling contact. If the contact was infected with two versions of H1N1, sample collection prior to oseltamivir treatment would generate the sequence of the dominant wild type species. The local contact, who developed symptoms five days after the start of treatment , would test positive for H274Y because the prophylactic treatment would lower the level of wild type RNA. Thus, potential spread of resistance would reside in patients in the originating country, who could travel to Denmark and re-introduce the H274Y.

Alternatively, the local contact could have been infected by another source in Denmark, since there were no symptoms during the first five days of prophylactic treatment. Although Denmark has reported a relatively low level of H1N1 in residents, like most countries in Europe, testing is focused on airport travelers and contacts, while testing for community spread is limited. However, since many passengers will be infected shortly before flight, many will be asymptomatic. Others will be asymptomatic because of an infection that does not produce a high fever, while others will have symptoms reduced because if medications. Thus, the number of passengers evading detection at airports will be large, leading to H1N1 spread in the community.

The evidence for H274Y acquisitions via recombination are linked to the recent patterns of spread in H1N1 seasonal flu. Although the report notes the dramatic primary spread of H274Y between 2007-2009, it simply calls such spread complex and fails to address the appearance of H274Y on multiple genetic backgrounds in the absence of Tamiflu treatment. It is the jumping of H274Y from one genetic background to another (recombination) that has raised concerns that such jumps will lead to acquisition of H274Y on a pandemic H1N1 background, because the H274Y level is near 100% in seasonal flu and pandemic H1N1 is accelerating its spread through the human population, increasing the frequency of dual infections involving swine and seasonal H1N1.

Thus, the acquisition of H274Y is expected and it is likely that there will be more examples of sequences like the resistance described in the above report. Release of the sequences from the cluster would be useful, as would the travel history of the traveler thought to have infected the contact who developed resistance via H274Y.

These data should launch more aggressive surveillance worldwide. Although countries have been promptly depositing sequences, the number of sequences remains low. Denmark has only deposited one sequence, which was from a patient infected in April.

The start of flu season in the southern hemisphere should lead to rapid evolution and the widespread acquisition of important polymorphisms, such as PB2 E627K, which was reported in Shanghai, but present only in the original sequence and the first clone, and NA H274Y, as found in the above patient from Denmark.

http://www.recombinomics.com/News/07010901/H274Y_Swine_Acquisition.html

Gwinnett Teen Diagnosed
with Swine Flu
Updated: Tuesday, 30 Jun 2009, 6:56 PM EDT
Published : Tuesday, 30 Jun 2009, 6:09 PM EDT

Stacey Elgin
Edited By: Leigha Baugham | myfoxatlanta.com
GWINNETT COUNTY, Ga. (MyFOX ATLANTA) - A Gwinnett County mother said Tuesday that she was trying to stop the spread of the swine flu. The woman’s 13-year-old son was diagnosed with the virus Monday night and she urged other parents to pay close attention to their children.

Amy Haynes said the thought that her son could catch swine flu crossed her mind before her son left for Camp Swamp in Green County a week before his diagnosis.
Haynes said she decided she was being overly concerned until she picked her son up from camp.

“He just kept complaining over and over, ‘I’m so tired, I feel so weak,’” said Haynes.

Doctors confirmed Haynes’ fears, her son Jonathan tested positive for the H1N1 virus.

“It doesn’t matter what camp they are going to, it could be any camp, there could be other kids at your camp,” said Haynes.

Haynes said for two days, her son was around other people, he went to church on Sunday and he was with his friends. Haynes said her son was supposed to go to a Braves game Tuesday night, but his diagnosis changed that.

The Camp Swamp director said there weren’t sure if Jonathan Haynes caught the virus while attending their camp, but the entire camp was cleaned thoroughly as a precaution.

Jonathon Haynes was recovering at his dad’s home, because Amy Haynes has a weakened immune system due to a blood disorder.

The Haynes family wears protective masks when they are around Jonathon, and Haynes said she spent hours cleaning her home to keep the virus from spreading.

According to the Centers for Disease Control, Georgia has 65 confirmed cases out of more than 27,000 in the U.S. alone and more cases are anticipated in the coming weeks and months.

http://www.myfoxatlanta.com/dpp/news/Gwinnett_Teen_Diagnosed_with_Swine_Flu_063009

China:

Recovering swine flu patient dies

http://www.shanghaidaily.com/article/?id=406118&type=National

A SWINE flu patient died yesterday in east China’s Zhejiang Province but the cause of her death was not yet known, local health authorities said late yesterday.

The 34-year-old woman was found dead at 7:35am in her ward lavatory at the No.1 People’s Hospital of Xiaoshan District in Hangzhou, the provincial capital, according to the Hangzhou municipal health bureau.

The patient was recovering as her temperature had been normal for a week. She coughed occasionally, but other flu symptoms had disappeared. She was admitted to the hospital on June 23.

If she is found to have died from the disease, it would be China’s first death from it.

Liang Wannian, vice director of the Health Ministry’s emergency office, warned on Monday that China is “very likely” to have its first death from the H1N1 flu in the foreseeable future, as the number of the flu cases rises.

“The possibility of a wide spread of the virus in China in autumn and winter is also becoming more likely,” the official said.

The Chinese mainland confirmed 57 new H1N1 cases yesterday, with the total number hitting 867.

China:

Recovering swine flu patient dies

http://www.shanghaidaily.com/article/?id=406118&type=National

A SWINE flu patient died yesterday in east China’s Zhejiang Province but the cause of her death was not yet known, local health authorities said late yesterday.

The patient was recovering as her temperature had been normal for a week. She coughed occasionally, but other flu symptoms had disappeared. She was admitted to the hospital on June 23.

If she is found to have died from the disease, it would be China’s first death from it.

“The possibility of a wide spread of the virus in China in autumn and winter is also becoming more likely,” the official said.

The Chinese mainland confirmed 57 new H1N1 cases yesterday, with the total number hitting 867.

Jackson Township NJ elementary school student dies from H1N1 virus

July 1, 2009 by Jackson NJ Online Staff Writer

http://www.jacksonnjonline.com/2009/07/01/breaking-news-jackson-township-nj-elementary-school-student-dies-from-h1n1-virus/

Jackson, NJ – Today, the Jackson Township School District announced on their website that a child from the Lucy N. Holman Elementary School has died from the H1N1 (Swine Flu) virus. The age and grade of the child have not yet been released. The announcement was made earlier this morning on New Jersey 101.5 radio.

Three weeks ago, several students in Goetz Middle School, in the Jackson Township School District had been confirmed with the H1N1 virus which prompted the district to send a letter home to all parents stating the outbreak at the middle school was under control and warned parents of the syptoms of the H1N1 virus and precaustionary measures to take to avoid the spread of the virus.

At the June 16th Jackson Township Boar of Education meeting, there was no mention of the virus within the district to the public in attendance. Just moments ago, Lucy N. Holman principal Theresa Lictra’s autmotated phone message was sent to all Holman parents. The message told parents to visit the Lucy N. Holman website, but did not say why. The website in reference (www.jacksonsd.org) had information posted concerning the death and counseling options for students and parents.

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