Australia: 3 children die from severe form of flu

[Treyfish]

Re: Australia: 3 children die from severe form of flu

Flu warning 'should have been issued earlier'

Posted Sat Jul 7, 2007 4:26pm AEST

• Map: Perth 6000

The Council of General Practitioners says the Western Australian Health Department should have issued its flu warning to parents earlier than yesterday afternoon to give hospitals and doctors a chance to cope with demand.
Three Perth children under the age of five have died in the past week and tests have shown they all carried the influenza A strain.
The Department issued a warning last night for parents to seek early medical attention if their child has flu-like symptoms.
The Council's Doctor Steve Wilson says Friday afternoon was too late to issue the warning as hospitals and practices were not able to rearrange rosters and add staff.
Dr Wilson says his Perth practice is at full capacity today and he is having to turn people away.
"Certainly if they had the heads up on this earlier in the week, an earlier notification would've been useful because we might've been able to change our rosters," he said.
"Maybe cancel some scheduled appointments and make sure we had adequate capacity to take emergencies which of course is always the issue with general practice."
The Health Department's director of communicable disease control Doctor Paul Van Buynder says further tests are expected to show a second bacterial infection caused the rapid progress of the illness resulting in the deaths.
He says warnings were sent out when virologists confirmed the virus was present.
"The public warning in fact went out before we had definitive data about the possible other organisms involved and it was certainly put out the same time as we sent a message to our health information lines and to all general practitioners and the emergency departments," Dr Van Buynder said.
Taryn Dickeson says she brought her two-year-old to Princess Margaret Hospital because she could not get an appointment with a GP until later today.
She says she was unnerved after hearing about the deaths of the three children, and wanted to get her son examined.
"Well I guess we've probably been concerned with what we've heard in the last 24 hours with other things going on, but I myself have been sick all week," she said.
"Jack came down with a bit of a temperature last night, had a restless night with him, and he was very lethargic and non-committal this morning." http://www.abc.net.au/news/stories/2...07/1972638.htm

[Treyfish]

Re: Australia: 3 children die from severe form of flu

Sick, elderly urged to vaccinate against flu

Posted Sat Jul 7, 2007 12:00pm AEST

• Map: Brisbane 4000

Queensland doctors are urging the elderly and those with weak immune systems to be vaccinated against the latest strains of the influenza virus.
The warning follows the deaths of three children from a suspected flu virus in Western Australia.
Dr Shaun Rudd, from the Australian Medical Association's Queensland branch, says the deaths are a reminder of how dangerous the flu virus can be.
"Flu knows no borders and it moves may move around the world each year," he said.
"I think that it just again confirms that we make sure we do the right thing and the most important thing is to immunise people who are more likely to run into problems with the flu then not."
Dr Rudd says anyone who contracts the virus should abandon the idea of soldiering on at work.
"Because all they're going to do is spread the virus around," he said.
"They're far, far better to stay at home and for people who want to prevent the virus, the other thing is just simple cleanliness, make sure you wash your hands before you eat - that sort of thing. That's really all you can do." http://www.abc.net.au/news/stories/2...07/1972580.htm

[vinny]

Re: Australia: 3 children die from severe form of flu

is it possible for the flu to kill this quickly i mean pnuemonia set in rather fast didnt it.

[Jonesie]

Re: Australia: 3 children die from severe form of flu

Is there a vaccine available in the USA to protect children from this Influenza AH3 strain?

[AlaskaDenise]

Re: Australia: 3 children die from severe form of flu

.......Would H3 pick up some virulent characteristics from another virus that would cause it to kill so quickly?

Good question.

Hopefully they'll test and release sequences of these cases.

.

[prepdeb]

Re: Australia: 3 children die from severe form of flu

Is there a vaccine available in the USA to protect children from this Influenza AH3 strain?

Looks like they plan to include H3 in the 2007 - 2008 seasonal vaccine, but it seems there are many strains.

Primary Changes and Updates in the Recommendations
The 2007 recommendations include six principal changes or updates:

ACIP reemphasizes the importance of administering 2 doses of vaccine to all children aged 6 months--8 years if they have not been vaccinated previously at any time with either LAIV (doses separated by >6 weeks) or TIV (doses separated by >4 weeks), on the basis of accumulating data indicating that 2 doses are required for protection in these children (see Vaccine Efficacy, Effectiveness, and Safety).
ACIP recommends that children aged 6 months--8 years who received only 1 dose in their first year of vaccination receive 2 doses the following year (see Vaccine Efficacy, Effectiveness, and Safety).
ACIP reiterates a previous recommendation that all persons, including school-aged children, who want to reduce the risk of becoming ill with influenza or of transmitting influenza to others should be vaccinated (see Box and Recommendations for Using TIV and LAIV During the 2007--08 Influenza Season).
ACIP emphasizes that immunization providers should offer influenza vaccine and schedule immunization clinics throughout the influenza season (see Timing of Vaccination).
ACIP recommends that health-care administrators consider the level of vaccination coverage among health-care personnel (HCP) to be one measure of a patient safety quality program and implement policies to encourage HCP vaccination (e.g., obtaining signed statements from HCP who decline influenza vaccination) (see Additional Information Regarding Vaccination of Specific Populations).
The 2007--2008 trivalent vaccine strains are A/Solomon Islands/3/2006 (H1N1)-like (new for this season), A/Wisconsin/67/2005 (H3N2)-like, and B/Malaysia/2506/2004-like viruses. (see Recommendations for Using TIV and LAIV During the 2007--08 Influenza Season).

from:

http://www.cdc.gov/mmwr/preview/mmwrhtml/rr56e629a1.htm

[LMonty]

Re: Australia: 3 children die from severe form of flu

--------------------------------------------------------------------------------

is it possible for the flu to kill this quickly i mean pnuemonia set in rather fast didnt it.

yes, and AFAIK it argues against the comments on bacterial pneumonia, they ususally set in after the acute flu symptoms have improved. It seems to point to viral pneumonia or ARDS from the flu itself.

I'll add a couple of caveats to my comment, though. We dont have enough info to be sure the severe illness started within a day of symptoms as the article suggests or not. Pediatric pts may also develop bacterial secondaries quicker than adults, anyone familiar with peds know if that is the case?

[Treyfish]

Re: Australia: 3 children die from severe form of flu

RECAP
INFLUENZA A DEATHS, CHILDREN - AUSTRALIA (WA)

[1]
Date: Fri 6 Jul 2007
Source: News.com.au, 6 Jul 2007 [edited]
<http://www.news.com.au/story/0,23599,22030064-2,00.html>


Deaths of children in Perth blamed on flu
-----------------------------------------------------
A total of 3 children under 5 years of age have died in Perth,
Australia, in the past few days from what is believed to be a severe
form of influenza, the Western Australian Health Department says. The
department is urging parents to quickly see a doctor if their
children show signs of respiratory illness.

Director of Communicable Disease Control, Dr. Paul Van Buynder, said
the speed at which the 3 children fell ill was a concern. "While we
do not want to create unnecessary panic, it is important for parents
to be aware that the disease can cause serious illness within 24
hours," Dr. Van Buynder said. "Parents whose children have cold or
flu-like symptoms, including a cough and a fever, should see their
general practitioner (GP)." The Health Department is advising all
parents of young children to see a doctor for flu vaccination if they
have not already done so.

Dr Van Buynder said one of the children had been identified with
having the influenza A virus, which is covered by this year's flu
vaccine, and it was likely all 3 children had that strain of the
virus. They had been well and became very sick within a day, he said.
"It's not about large numbers, it's about that we had 3 children who
got sick very quickly," he said.

Of the children who fell ill in Perth's Princess Margaret Hospital
for Children, tests revealed that 2 of them had developed a form of
pneumonia. "Samples taken from the 2 children who died in hospital
suggested they had secondary bacterial pneumonia. We'll be able to
confirm that over the next few days."

Dr. Van Buynder said the Department was advising parents to see a
doctor quickly if their children developed flu symptoms because
secondary chest infections could usually be stopped with antibiotics.
The 3rd child did not receive hospital treatment.

******
[2]
Date: Sat 7 Jul 2007
Source: The West.com.au, Sat 7 Jul 2007 [edited]
<http://www.thewest.com.au/default.aspx?MenuID=77&ContentID=33611>


Parents urged to be vigilant after flu deaths
--------------------------------------------------------
Health authorities are urging parents to be on alert following news
that 3 young children died after contracting the flu in the past few
days. Pathology tests are being undertaken over the weekend [7-8 Jul
2007] to determine the exact cause of the deaths, but Health
Department Director of Communicable Disease Control Paul Van Buynder
suspected the children had died of secondary bacterial infections
after their immune systems had been compromised by the flu virus.

It is understood at least 2 of the children had contracted pneumonia
as a result of the virus, which could have contributed to their
deaths. All the children were aged under 5 and each is believed to
have died within 24 hours of showing the first signs of flu. Two died
at their homes before their parents could seek medical attention and
the 3rd died before being admitted to hospital.

They all came from the metropolitan area but authorities are unaware
of any links between the 3 children. Some of the siblings of those
who died are also believed to be recovering in hospital.

PathWest clinical virologist David Smith said the virus was the
influenza A(H3) strain, which was not particularly virulent. It is
one of the strains covered by this year's flu vaccination.

Dr. Van Buynder warned parents that listlessness, cough and fever
were the key symptoms parents should look for and urged them to seek
medical advice immediately. "While we do not want to create
unnecessary panic, it is important for parents to be aware that the
disease can cause serious illness within 24 hours," he said. The
emergency departments at Fremantle, Joondalup, Swan District and
Princess Margaret hospitals [PMH] were available to see children
after hours if they could not see a GP.

Panicked parents flooded hospitals and jammed the Health Department's
hotline with hundreds of calls last night [6 Jul 2007] after news of
the children's deaths was revealed. Executive director of the Child
and Adolescent Health Service Robyn Lawrence said last night PMH had
a 60 percent increase in patient admissions, which she attributed to
the flu panic. "Parents are obviously concerned," she said. "Children
are being processed as quickly as we can." Dr. Lawrence said the
waiting time at the PMH Emergency Department was up to 3 hours. She
assured parents that the hospital had staff in reserve to deal with
the increased patient numbers.

The medical clinic at Joondalup Hospital was forced to close its
doors at 8:30 last night [6 Jul 2007] when it became unable to deal
with any more patients. Waiting times at hospital emergency
departments blew out by hours, after-hours GP clinics were swamped
across Perth and the flu hotline had 130 callers at one time.

Australian Medical Association State president Geoff Dobb said the
influenza A strain was one of the most common during winter and that
West Australians were particularly vulnerable because it had been
several years since the last flu epidemic. He said parents should not
be worried if their children simply had a runny nose and headache,
though they should look out for a fever above 38 deg C [100.4 deg F].
"The critical thing is the combination of a fever and a cough," he
said. "What we're talking about here is not just having a runny nose
and feeling unwell, often people refer to that loosely as having the
flu. "A true influenza will make you feel really unwell, more severe
with cough, fever and muscular aches and pain." He said that unlike
the flu, people with a cold may have a sore throat and runny nose,
followed by a cough, but without a significant fever.

Many hospital staff, who did not want to be named, were critical that
the alert was issued without more advice being made available to
parents and doctors, some of whom were not told that the flu warning
was to be issued yesterday.

Parents can call Health Direct on 1 800 020 080 [in Australia] for
advice and locations of their nearest after-hours clinic.

[Byline: Liam Phillips, Peta Rule and Debbie Guest]

--
Communicated by:
ProMED-mail Rapporteur Mary Marshall

[Death of unvaccinated children during outbreaks of seasonal
influenza virus infection, though distressing, is not an unusual
event and is usually a consequence of secondary infection. It is
probably a not infrequent accompaniment of the southern hemisphere
winter.

The influenza A virus responsible for these deaths is not considered
to be exceptionally virulent nor does it appear to differ
antigenically from the H3 component of the current seasonal vaccine
for use in the Southern hemisphere. Infants and the elderly are most
at risk and should be protected by vaccination. - Mod.CP]

http://www.promedmail.org/pls/promed/f?p=2400:1001:17193043570740359527::NO::F2400_P1001_BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,38248

[Richard McC]

Re: Australia: 3 children die from severe form of flu

Doctors in Perth say they have isolated the bacteria which, combined with the influenza A virus, has caused the death of three Perth children, but say they can not release the information until it hs been discussed with the state coroner.

All three children had the influenza A virus, but died from complications related to bacterial infections.

http://www.abc.net.au/news/stories/2007/07/08/1972925.htm

[Sally Furniss]

Re: Australia: 3 children die from severe form of flu

http://www.abc.net.au/news/stories/2007/07/08/1972950.htm

The ACT branch of the Australian Medical Association (AMA) says the local health system is prepared to deal with a deadly flu outbreak in Canberra.

Western Australian health authorities are investigating three deaths of children suffering influenza, although it has not been confirmed if the deaths were caused by the same virus.

ACT AMA president Doctor Andrew Foote says there is no cause for concern in Canberra at the moment.

He says if cases do come up, lessons have been learnt from a previous flu outbreak at the Jindalee Nursing Home.

"Certainly over the last 12 months there have been multiple meetings and scenario planning and I think the public can be reassured that we are prepared should the need arise," Dr Foote said.

[Sally Furniss]

Re: Australia: 3 children die from severe form of flu

Doctors in Perth say they have isolated the bacteria which, combined with the influenza A virus, has caused the death of three Perth children, but say they can not release the information until it hs been discussed with the state coroner.

All three children had the influenza A virus, but died from complications related to bacterial infections.


http://www.abc.net.au/news/stories/2...08/1972925.htm

more of the story

Parents whose children have flu-like symptoms are still being encouraged to see a doctor, while waiting times at Princess Margaret Hospital are up to three hours.

The WA Health Department's director of communicable diseases Doctor Paul van Buynder says all three children who died had showed signs of a similar bacterial infection.

"We believe that this has just been a tragic small cluster of illness that's led to this conclusion," Dr van Buynder said.

"It's unlikely that we would have been able to detect it earlier and it's unlikely that there was anything within the medical condition of the children that caused this illness in this case."

He says parents should keep looking for the warning signs and seek medical help if they are concerned.

"Doctors can test for this bacteria but we are advising general practitioners and the public that if their child is particularly ill and they are concerned, that they are transferred to a tertiary centre," he said.

[Johnny Yuma]

Re: Australia: 3 children die from severe form of flu

This does not explain why the children died so quickly, IMO.


Flu combo killed three kids: WA Health


July 8, 2007 - 3:09PM

Three Perth children who died within 24 hours of falling ill had contracted a combination of a flu strain and a pneumonia-causing bacterial infection, the West Australian Health Department says.

The department's Communicable Disease Control director Dr Paul Van Buynder said all three children were under the age of five.

"It's apparent that all three of the children who had tragic consequences had very similar illnesses that started with a mild Influenza A infection and gone on from there to develop secondary bacterial complications," Dr Van Buynder said.

"Most of the children who have a secondary bacterial infection will develop a full-blown pneumonia and that will be part of the cause of the tragic consequences."

Dr Van Buynder said an investigation by the health department had not discovered any links between the three dead children.

Worried parents have inundated emergency departments after the health authorities issued a warning on Friday urging parents to get children with fever and lethargy checked.

Double the number of patients normally seen were admitted to Princess Margaret Hospital's (PMH) emergency department, PMH Child and Adolescent Services executive director Dr Robyn Lawrence said.

Ten children an hour had been seen on Sunday, close to double the normal rate, with some parents waiting up to three hours to have their children checked by doctors.

About 21 children were admitted to the hospital on Saturday which was about normal, Dr Lawrence said.

The health warning is still in place but Dr Van Buynder said parents whose children had had coughs and sniffles for some time should keep their children away from emergency hospital departments.

Dr Van Buynder said it was unusual for the flu strain and the bacteria, which is not uncommon, to kill children.

"Most years, despite the circulation of both the virus and the bacteria, we've seen no children who have this course of illness," Dr Van Buynder said.

Meanwhile, Queensland Health is urging all parents to vaccinate their young children against flu, especially if they also suffered from a medical condition such as heart disease or diabetes.

Health officials in Victoria said the number of flu cases were below average so far, while in NSW an initial increase in the number of flu cases had been reported going into the season.

http://www.theage.com.au/news/National/Three-dead-WA-kids-had-flu-infection/2007/07/08/1183833327997.html

[Richard McC]

Re: Australia: 3 children die from severe form of flu

http://www.abc.net.au/news/stories/2...08/1972950.htm


ACT AMA president Doctor Andrew Foote says there is no cause for concern in Canberra at the moment.

He says if cases do come up, lessons have been learnt from a previous flu outbreak at the Jindalee Nursing Home.

"Certainly over the last 12 months there have been multiple meetings and scenario planning and I think the public can be reassured that we are prepared should the need arise," Dr Foote said.

I live in Canberra, and I am NOT reassured. The local hospital system is at 110% capacity at the best of times.

[Thornton]

Re: Australia: 3 children die from severe form of flu

Just a couple of months ago, the USA CDC issued this alert on the association of bacterial co-infection with influenza in rapidly progressive severe influenza in children.

http://www2a.cdc.gov/HAN/ArchiveSys/ViewMsgV.asp?AlertNum=00259

Distributed via Health Alert Network
Wednesday, May 09, 2007, 11:15 EDT (11:15 AM EDT)
CDCHAN-00259-2007-05-09-ADV-N

Influenza-Associated Pediatric Mortality and the Increase of Staphylococcus aureus co-infection
CDC is requesting that states report all cases of influenza-related pediatric mortality from the 2006-2007 influenza season.
Since 2004, the Influenza-Associated Pediatric Mortality Surveillance System, part of the Nationally Notifiable Disease Surveillance System, has collected information on deaths among children due to laboratory-confirmed influenza, including the presence of other medical conditions and bacterial infections at the time of death. From October 1, 2006 through May 7, 2007, 55 deaths from influenza in children have been reported to CDC from 23 state health departments and two city health departments. Data on bacterial co-infections were reported for 51 cases; 20 (39%) had a bacterial co-infection, and 16/20 were infected with Staphylococcus aureus. While the number of pediatric influenza associated deaths is similar to that reported during the two previous years, there has been an increase in the number of deaths in which both influenza and pneumonia or bacteremia due to S. aureus were identified. Only one influenza and S. aureus co-infection was identified in 2004-2005, and 3 were identified in 2005-2006. Of the 16 children reported with S. aureus so far in 2006-2007, 11children had methicillin-resistant (MRSA) isolated from a sterile site (9) or sputum (2), and 5 had methicillin-susceptible S.aureus isolated from a sterile site (3) or sputum (2). The median age of children with S. aureus co-infection was older than children without S.aureus co-infection (11 years versus 4 years, p<.01) Children with influenza and S. aureus co-infections were reported to be in good health before illness onset but progressed rapidly to severe illness. Influenza strains isolated from these children have not been different from common strains circulating in the community and the MRSA strains have been typical of those associated with MRSA skin infection outbreaks in the United States.
Healthcare providers should be alerted to the possibility of bacterial co-infection among children with influenza, and request bacterial cultures when bacterial co-infection is suspected. Clinicians, clinical agencies and medical examiners are asked to contact their local or state health department as soon as possible when deaths among children due to laboratory-confirmed influenza are identified. CDC requests that all cases of pediatric influenza-associated deaths be reported promptly by state health departments to CDC through http://sdn.cdc.gov and that information about bacterial pathogens isolated from sterile sites and/or from sputum or endotracheal aspirates be completed on the Influenza-Associated Pediatric Mortality Surveillance System case report form. If the influenza death was complicated by S. aureus infection, please contact the clinical agency to determine if the S. aureus isolate is available. CDC is interested in receiving S. aureus isolates to better characterize those from fatal cases of influenza in children
If you have any questions about this Health Advisory, please call the Influenza Division, Epidemiology and Prevention Branch at 404-639-3727.

[Jonesie]

Re: Australia: 3 children die from severe form of flu

Here's the 1st case isolated:

Vol. 130 No. 9, September 1976 Archives
? Online Features

Pneumonia and pleural effusion. Association with influenza A virus and Staphylococcus aureus
T. W. Mausbach and C. T. Cho

An 8-month-old infant with severe pneumonia and massive pleural effusions was found to have concurrent infections due to Staphylococcus aureus and influenza A virus. This was proved by the isolation of both agents from the pleural fluid. We believe this is the first case of isolation of an influenza virus from pleural effusions.

http://archpedi.ama-assn.org/cgi/con...act/130/9/1005