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USA - Texas: Public Health department confirmed H1N1pdm09 outbreak - in Houston area media report of 13 fatalities - Montgomery county health says 2 confirmed H1N1pdm09

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  • #61
    Re: USA - Texas: Public Health department confirmed H1N1pdm09 outbreak - in Houston area media report of 6 fatalities, 14 more critically ill - Montgomery county health says 2 confirmed H1N1pdm09

    Published Date: 2013-12-24 13:18:26
    Subject: PRO/EDR> Influenza (70): USA (TX) H1N1
    Archive Number: 20131224.2134839

    INFLUENZA (70): USA (TEXAS) H1N1
    ********************************
    A ProMED-mail post
    http://www.promedmail.org
    ProMED-mail is a program of the
    International Society for Infectious Diseases
    http://www.isid.org

    Date: Fri 20 Dec 2013
    Source: CIDRAP News [edited]
    http://www.cidrap.umn.edu/ongoing-pr...blishing-staff


    Texas health investigators have now linked 2 infections in a severe influenza-like illness (ILI) cluster to the 2009 H1N1 virus, and a dramatic flu activity jump in the state has vaulted Texas and 3 other southern states into the "widespread" category for the 1st time this season [2013-14].

    Earlier this week, the Montgomery County Health District (MCHD), located near Houston, reported a severe ILI cluster that put 8 people in a local hospital, killing 4 of them. Initial tests were negative for flu, which raised speculation about what pathogen was fueling the outbreak. Local media outlets noted that patients in the cluster were middle-aged adults who were reportedly previously healthy, which also ramped up the level of concern. Yesterday [19 Dec 2013], however, the MCHD said further tests now show that 2 of the survivors were infected with the 2009 H1N1 virus [influenza H1N1 pdm9 virus] and that further tests were underway to pinpoint the cause of the other infections.

    The 2009 H1N1 cases in Montgomery County come at the time of a steep rise in flu in Texas, along with similar spikes in Louisiana, Mississippi, and Alabama, according to the latest update today [20 Dec 2013] from the US Centers for Disease Control and Prevention (CDC). Most of the flu activity in those states, and the nation as a whole, is linked to the former pandemic virus, which is now considered a seasonal flu strain and has been included in all formulations of flu vaccines since the 2009-10 flu season. Dominant activity from the H1N1 strain stands in stark contrast from last year [2012], when the H3N2 virus was most common and was marked by an early, moderately severe season.

    The Texas Department of State Health Services (TDSHS) said today [20 Dec 2013] in its latest flu surveillance update that flu activity is increasing steadily in the state, with all of its regions reporting cases, with widespread, high-intensity activity. Of respiratory samples that tested positive for flu, nearly all were influenza A, and of the subtyped influenza A samples, 96.1 percent were the 2009 H1N1 virus. Testing for other respiratory viruses in Texas last week also found high levels of rhinovirus and respiratory syncytial virus (RSV) [Neither of these observations have particular significance in relation to the type of influenza virus in circulation. - Mod.CP].

    The TDSHS said 2 clusters of ILI have been detected in hospitalized patients from the state's Houston region. Tests revealed the 2009 H1N1 virus from one cluster, and the cause in the 2nd one, is still undetermined. In a separate statement, the TDSHS said though recent spikes in flu activity aren't unusual, it issued flu testing and treatment today [20 Dec 2013] to doctors and encouraged the public to get vaccinated against influenza. It urged health providers to consider antiviral treatment, even if initial rapid tests are negative for flu. It added that a negative test does not rule out flu in a patient with suspected illness.

    Michael Jhung, MD, MPH, a medical epidemiologist in the CDC's influenza division, told CIDRAP News that the epidemiology of 2009 H1N1 infections is a little different than other seasonal strains and that for a variety of reasons it has a bigger impact on younger adults and older children. If the 2009 H1N1 virus continues as the dominant strain, it's possible that health providers will see more impact on those groups, but the situation wouldn't be similar to the pandemic months, because the virus is already included in the seasonal flu vaccine, he said. "It's not the start of another pandemic. The very young and elderly people, as well as those with underlying health conditions, are always at increased risk no matter what the flu strain," Jhung said.

    Last flu season [2012-13] the H3N2 strain dominated most of the season and exacted a heavy toll on older people. Jhung emphasized that it's too early in the season to predict the flu's pattern and impact. Overall, flu activity in the United States is low, but there are pockets of high activity, such as Texas, and the CDC expects activity to increase in other parts of the country in the coming weeks and months, he said. Jhung said the overall message remains the same, that influenza can be very serious, and there is still time to be vaccinated.

    Nationally, all flu markers rose last week, especially the percentage of respiratory specimens that tested positive for flu, which rose from 13.3 percent to 17.8 percent from the week before, according to the CDC. Like Texas, nearly all of the flu viruses tested so far are influenza A, and subtyping shows that 2009 H1N1 virus is the dominant strain. Two pediatric flu deaths were reported, one of which occurred during the 2012-13 season. The most recent death involved the 2009 H1N1 strain and raises the total so far this season [2013-14] to 4. Texas, Louisiana, Mississippi, and Alabama became the 1st states to report widespread geographic flu activity this season, and 20 states reported regional spread. The CDC's marker for visits to clinics for ILI also showed high activity for Texas, Louisiana, Mississippi, and Alabama.

    Canada's flu activity indicators also increased sharply last week, according to an update today [20 Dec 2013] from the Public Health Agency of Canada (PHAC). The areas of heaviest activity are in the Alberta region that includes Calgary, an area of Ontario that includes Ottawa and Toronto, and part of Quebec. As in the United States, the 2009 H1N1 virus is also the dominant strain in Canada, accounting for 88 percent of the subtyped influenza A samples. The PHAC also reported a sharp rise in positive samples for RSV.

    Elsewhere, flu activity in Europe remained low, though there are signs that activity is picking up in some countries, according to the latest report from the European Centre for Disease Prevention and Control (ECDC). Testing over the past several weeks shows that most of the flu viruses detected in European countries are influenza A, with about 56 percent of the subtyped samples being the H3N2 strain and about 44 percent the 2009 H1N1 strain.

    [Byline: Lisa Schnirring]

    --
    Communicated by:
    ProMED-mail
    <promed@promedmail.org>

    [The above review summarises the current influenza situation succinctly.

    The outbreak of an "undiagnosed severe respiratory illness" in Texas is not due to some strange, novel infection but is in fact the onset of the winter influenza season in the Americas. Indeed, the Texas authorities were rather slow to confirm this. Perhaps this was a consequence of the absence of seasonal influenza in the rest of the world, Europe, and Northern Asia in particular. - Mod.CP

    Comment


    • #62
      Re: USA - Texas: Public Health department confirmed H1N1pdm09 outbreak - in Houston area media report of 6 fatalities, 14 more critically ill - Montgomery county health says 2 confirmed H1N1pdm09

      [Source: US Centers for Disease Control and Prevention (CDC), full page: (LINK). Edited.]


      This is an official CDC HEALTH ADVISORY

      Distributed via the CDC Health Alert Network, December 24, 2013, 14:30 ET (2:30 PM ET), CDCHAN-00359

      Notice to Clinicians: Early Reports of pH1N1-Associated Illnesses for the 2013-14 Influenza Season


      Summary

      From November through December 2013, CDC has received a number of reports of severe respiratory illness among young and middle-aged adults, many of whom were infected with influenza A (H1N1) pdm09 (pH1N1) virus.

      Multiple pH1N1-associated hospitalizations, including many requiring intensive care unit (ICU) admission, and some fatalities have been reported.

      The pH1N1 virus that emerged in 2009 caused more illness in children and young adults, compared to older adults, although severe illness was seen in all age groups.

      While it is not possible to predict which influenza viruses will predominate during the entire 2013-14 influenza season, pH1N1 has been the predominant circulating virus so far.

      For the 2013-14 season, if pH1N1 virus continues to circulate widely, illness that disproportionately affects young and middle-aged adults may occur.

      Seasonal influenza contributes to substantial morbidity and mortality each year in the United States. In the 2012-13 influenza season, CDC estimates that there were approximately 380,000 influenza-associated hospitalizations [1]. Although influenza activity nationally is currently at low levels, some areas of the United States are already experiencing high activity, and influenza activity is expected to increase during the next few weeks.

      The spectrum of illness observed thus far in the 2013-14 season has ranged from mild to severe and is consistent with that of other influenza seasons. While CDC has not detected any significant changes in pH1N1 viruses that would suggest increased virulence or transmissibility, the agency is continuing to monitor for antigenic and genetic changes in circulating viruses, as well as watching morbidity and mortality surveillance systems that might indicate increased severity from pH1N1 virus infection. In addition, CDC is actively collaborating with state and local health departments in investigation and control efforts.

      CDC recommends annual influenza vaccination for everyone 6 months and older. Anyone who has not yet been vaccinated this season should get an influenza vaccine now. While annual vaccination is the best tool for prevention of influenza and its complications, treatment with antiviral drugs (oral oseltamivir and inhaled zanamivir) is an important second line of defense for those who become ill to reduce morbidity and mortality.

      Antiviral treatment is recommended as early as possible for any patient with confirmed or suspected influenza who is hospitalized; has severe, complicated, or progressive illness; or is at higher risk for influenza complications.


      Background

      The risk of severe disease and complications from influenza is higher among children younger than 5 years of age, adults aged 65 years and older, pregnant women, and those with underlying medical conditions. In most influenza seasons, the majority of influenza-associated hospitalizations and deaths are among adults aged 65 years and older [2, 3]. However, during the 2009 pandemic, pH1N1 caused more illness in children and young adults than in older adults [4]. This was likely due in part to protection in older adults provided by cross-reactive immunity to pH1N1 caused by prior infection with antigenically-related viruses. The pandemic also was notable for reports of severe illness among pregnant women infected with pH1N1 and adverse neonatal outcomes [5].

      Early observations from the 2013-14 influenza season indicate that some persons infected with pH1N1 virus have had severe illness. While most of these people with severe illness have had risk factors for influenza-associated complications, including pregnancy and morbid obesity, several have not.

      CDC recommends annual vaccination as the best tool for prevention. However, for persons with suspected or confirmed influenza, treatment with neuraminidase inhibitor antiviral drugs (oral oseltamivir and inhaled zanamivir) can be an important component of clinical care.

      Evidence from past influenza seasons and the 2009 H1N1 pandemic has consistently shown that treatment with antiviral medications reduces severe outcomes of influenza when initiated as soon as possible after illness onset.

      Clinical trials and observational data show that early antiviral treatment may (1) shorten the duration of fever and illness symptoms, (2) reduce the risk of complications from influenza (e.g., otitis media in young children, pneumonia, respiratory failure and death), and (3) shorten the duration of hospitalization.


      Recommendations for Health Care Providers
      • Clinicians should encourage all patients 6 months of age and older who have not yet received an influenza vaccine this season to be vaccinated against influenza. There are several flu vaccine options for the 2013-2014 flu season (see http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6207a1.htm?s_cid=rr6207a1_w#Tab1 ), and all available vaccine formulations this season contain a pH1N1 component; CDC does not recommend one flu vaccine formulation over another.
      • Clinicians should encourage all persons with influenza-like illness who are at high risk for influenza complications (see list below) to seek care promptly to determine if treatment with influenza antiviral medications is warranted.


      Summary of CDC Recommendations for Influenza Antiviral Medications for Health Care Providers for the 2013-2014 Influenza Season
      • CDC guidelines for influenza antiviral use during 2013-14 season are the same as during prior seasons. Clinical benefit is greatest when antiviral treatment is administered early. When indicated, antiviral treatment should be started as soon as possible after illness onset, ideally within 48 hours of symptom onset. However, antiviral treatment might still be beneficial in patients with severe, complicated, or progressive illness, and in hospitalized patients and in some outpatients when started after 48 hours of illness onset, as indicated by clinical and observational studies.
      • Antiviral treatment is recommended as early as possible for any patient with confirmed or suspected influenza who
        • is hospitalized;
        • has severe, complicated, or progressive illness; or
        • is at higher risk for influenza complications.
        • This list includes:
          • children aged younger than 2 years;
          • adults aged 65 years and older;
          • persons with chronic pulmonary (including asthma), cardiovascular (except hypertension alone), renal, hepatic, hematological (including sickle cell disease), metabolic disorders (including diabetes mellitus), or neurologic and neurodevelopment conditions (including disorders of the brain, spinal cord, peripheral nerve, and muscle such as cerebral palsy, epilepsy [seizure disorders], stroke, intellectual disability [mental retardation], moderate to severe developmental delay, muscular dystrophy, or spinal cord injury);
          • persons with immunosuppression, including that caused by medications or by HIV infection;
          • women who are pregnant or postpartum (within 2 weeks after delivery);
          • persons aged younger than 19 years who are receiving long-term aspirin therapy;
          • American Indians/Alaska Natives;
          • persons who are morbidly obese (i.e., body-mass index is equal to or greater than 40); and
          • residents of nursing homes and other chronic-care facilities.

        • Antiviral treatment can also be considered for suspected or confirmed influenza in previously healthy, symptomatic outpatients not at high risk on the basis of clinical judgment, especially if treatment can be initiated within 48 hours of illness onset.
        • Clinical judgment, on the basis of the patient’s disease severity and progression, age, underlying medical conditions, likelihood of influenza, and time since onset of symptoms, is important when making antiviral treatment decisions for outpatients.
        • Decisions about starting antiviral treatment should not wait for laboratory confirmation of influenza.
        • Rapid influenza diagnostic tests (RIDTs) have limited sensitivities and predictive values; negative results of RIDTs do not exclude influenza virus infection in patients with signs and symptoms suggestive of influenza. Therefore, antiviral treatment should not be withheld from patients with suspected influenza, even if they test negative.
        • While influenza vaccination is the best way to prevent influenza, a history of influenza vaccination does not rule out influenza virus infection in an ill patient with clinical signs and symptoms compatible with influenza.


      For more information


      Endnotes
      1. Centers for Disease, C. and Prevention, Estimated influenza illnesses and hospitalizations averted by influenza vaccination - United States, 2012-13 influenza season. MMWR Morb Mortal Wkly Rep, 2013. 62(49): p. 997-1000. (http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6249a2.htm?s_cid=mm6249a2_w )
      2. Mullooly, J.P., et al., Influenza- and RSV-associated hospitalizations among adults. Vaccine, 2007. 25(5): p. 846-55. (http://www.ncbi.nlm.nih.gov/pubmed/21342884 )
      3. Centers for Disease, C. and Prevention, Estimates of deaths associated with seasonal influenza --- United States, 1976-2007. MMWR Morb Mortal Wkly Rep, 2010. 59(33): p. 1057-62. (http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5933a1.htm )
      4. Jhung, M.A., et al., Epidemiology of 2009 pandemic influenza A (H1N1) in the United States. Clin Infect Dis, 2011. 52(5): p. S13-26. (http://www.ncbi.nlm.nih.gov/pubmed/21342884 )
      5. Creanga, A.A., et al., Severity of 2009 pandemic influenza A (H1N1) virus infection in pregnant women. Obstet Gynecol, 2010. 115(4): p. 717-26. (http://www.ncbi.nlm.nih.gov/pubmed/20308830 )


      -
      -------

      Comment


      • #63
        Re: USA - Texas: Public Health department confirmed H1N1pdm09 outbreak - in Houston area media report of 6 fatalities, 14 more critically ill - Montgomery county health says 2 confirmed H1N1pdm09

        Texas HA 225 Receptor Binding Variance Potential

        An examination of the potential for Receptor Binding Site (RBS) Polymorphisms in the Texas High-CFR cases, including detailed near-term and mid-term genetic probabilities and projections

        Comment


        • #64
          Re: USA - Texas: Public Health department confirmed H1N1pdm09 outbreak - in Houston area media report of 6 fatalities, 14 more critically ill - Montgomery county health says 2 confirmed H1N1pdm09

          http://www.kbtx.com/home/headlines/F...237683641.html

          Flu Cases Spike in Texas, 13 Dead in Houston Area

          Posted: Fri 7:55 PM, Dec 27, 2013

          EL PASO, Texas (AP) Officials are reporting a spike in flu cases in Texas with more than a dozen deaths in the Houston area, most of which were caused by the H1N1 strain that's also known as the swine flu.

          KHOU in Houston reports that 13 people have died in Houston so far, including a teenager. Kathy Barton, spokeswoman for the city's health department, says the teenager was infected with the H1N1 strain of the virus. About 95 percent of the influenza A cases in Texas are H1N1.

          [snip]

          Comment


          • #65
            Re: USA - Texas: Public Health department confirmed H1N1pdm09 outbreak - in Houston area media report of 13 fatalities - Montgomery county health says 2 confirmed H1N1pdm09

            A <a href="http://pf11.blogspot.com/2009/11/norway-sequence-with-225g-mixture-also.html" target="_blank">flashfire</a> occurs when a <a href="http://pf11.blogspot.com/2013/12/texas-ha-225-receptor-binding-variance.html" target="_blank">minority species</a> with <b><span style="color: #274e13;">Hemagglutinin</span></b> <b><span style="color: #660000;">Receptor Binding Variance</span></b> persists unacknowledged. *

            pH1N1 Texas Fatality by County

            * Quasi-species at key antigenic / receptor binding areas
            • Mixture HA 225D / HA 225G
            • Mixture HA 225D / HA 225N

            Comment


            • #66
              Re: USA - Texas: Public Health department confirmed H1N1pdm09 outbreak - in Houston area media report of 13 fatalities - Montgomery county health says 2 confirmed H1N1pdm09

              71 Fatalities in Texas
              by
              2014-01-05 *

              • pH1N1 Dominant Texas Fatality by County [Excel]
              • pH1N1 Dominant Texas Fatality by County [html/css]
              • Distribution of pH1N1 Influenza Fatalities in Texas [map by Al]



              * 2014-01-05 Updated Stats from Jim Oliveros

              Comment


              • #67
                Re: USA - Texas: Public Health department confirmed H1N1pdm09 outbreak - in Houston area media report of 13 fatalities - Montgomery county health says 2 confirmed H1N1pdm09

                pH1N1 Child Vaccine Escape
                CDC Early 2013


                <div style="text-align: center;">
                <hr style="width: 30%;" />41 Cases over 43 Sequences<hr style="width: 30%;" /></div>
                Introduction

                In the 30 days covering 2013-02-28 to 2013-03-29, the&nbsp;<span style="color: #783f04;"><b>United States CDC</b></span>&nbsp;released a total of 43&nbsp;<b><span style="color: #632423; font-family: &quot;Trebuchet MS&quot;;">pH1N1</span></b>&nbsp;sequences at&nbsp;<strong>GISAID&nbsp;</strong>on 41 human cases<strong>&nbsp;</strong>sampled from October 2012 to February 2013. Geographic surveillance includes&nbsp;<b>America,</b>&nbsp;<b>Africa, Asia </b>and<b> Russia.&nbsp;</b>Although&nbsp;<b><span style="color: #632423; font-family: &quot;Trebuchet MS&quot;;">pH1N1</span></b>&nbsp;in most locales during the&nbsp;2012-2013 season was the <b><span style="color: #783f04;">minority</span></b> serotype, the sequences in this Analytic Report describe a high level of human-infective diversity and an ease of avian genetic acquisition, including multiple instances demonstrating concentrated transport of <b><span style="color: #660000;">High-CFR</span></b>&nbsp;<b><span style="color: #632423; font-family: &quot;Trebuchet MS&quot;;">pH1N1&nbsp;</span><span style="color: #783f04;">Upsilon</span></b> polymorphisms onto single sequences.

                . . .

                Read the Open-Access, Full-Text
                Investigational Analytic
                including Genetic Details

                Comment


                • #68
                  Re: USA - Texas: Public Health department confirmed H1N1pdm09 outbreak - in Houston area media report of 13 fatalities - Montgomery county health says 2 confirmed H1N1pdm09

                  pH1N1 Drug Resistant Low Reactor
                  CDC Fall 2013


                  <div style="text-align: center;">
                  <hr style="width: 30%;" />46 Cases over 49 Sequences<hr style="width: 30%;" /></div>
                  Introduction

                  In the 32 days covering 2013-10-17 to 2013-11-19, the&nbsp;<span style="color: #783f04;"><b>United States CDC</b></span>&nbsp;released a total of 49&nbsp;<b><span style="color: #632423; font-family: &quot;Trebuchet MS&quot;;">pH1N1</span></b>&nbsp;sequences at&nbsp;<strong>GISAID&nbsp;</strong>on 46 human cases<strong>&nbsp;</strong>sampled from February 2013 to October 2013. Geographic surveillance includes&nbsp;<b>America,</b>&nbsp;<b>Africa, Asia, Brazil, Ecuador, Paraguay&nbsp;</b>and<b>&nbsp;Peru.&nbsp;</b>

                  The sequences in this Analytic Report describe a high level of genetic activity at the <b><span style="color: #274e13;">Hemagglutinin</span></b> <b><span style="color: #660000;">antigenic area</span></b> between <b><span style="color: blue;">aa155</span></b> and <b><span style="color: blue;">aa158</span></b> with <b>5</b> amino variations and <b>4</b> silent revisions. &nbsp; <b><span style="color: #274e13;">HA</span></b> <b><span style="color: blue;">225G</span></b> is present in <b><span style="color: #660000;">quasi-species</span></b> on <b>2</b>&nbsp;American samples and as dominant form in <b>2</b> tropical countries. The <b>Dominican Republic</b> <b><span style="color: #274e13;">HA</span></b> <b><span style="color: blue;">225G</span></b>&nbsp;<b><span style="color: #660000;">Low Reactor</span></b> appears on a <b><span style="color: #7f6000;">TamiFlu Resistant</span></b> strain. &nbsp;<b><span style="color: #7f6000;">Drug Resistance</span></b> is also found in <b>2</b> US sequences and <b>1</b> South American case.
                  . . .

                  Read the Open-Access, Full-Text
                  Investigational Analytic
                  including Genetic Details

                  Comment


                  • #69
                    Re: USA - Texas: Public Health department confirmed H1N1pdm09 outbreak - in Houston area media report of 13 fatalities - Montgomery county health says 2 confirmed H1N1pdm09

                    95 Fatalities in Texas
                    by
                    2014-01-07 *

                    • pH1N1 Dominant Texas Fatality by County [Excel]
                    • pH1N1 Dominant Texas Fatality by County [html/css]
                    • Distribution of pH1N1 Influenza Fatalities in Texas [map by Al]



                    * 2014-01-07 Updated Stats from Jim Oliveros

                    Comment


                    • #70
                      Re: USA - Texas: Public Health department confirmed H1N1pdm09 outbreak - in Houston area media report of 13 fatalities - Montgomery county health says 2 confirmed H1N1pdm09

                      pH1N1
                      TamiFlu Resistance

                      in
                      Texas

                      Texas communicated two TamiFlu Resistant cases in this week's Public Health report.

                      No sequences were deposited, nor locations stipulated.

                      Comment


                      • #71
                        Re: USA - Texas: Public Health department confirmed H1N1pdm09 outbreak - in Houston area media report of 13 fatalities - Montgomery county health says 2 confirmed H1N1pdm09

                        114 Fatalities in Texas
                        by
                        2014-01-12 *

                        • pH1N1 Dominant Texas Fatality by County [Excel]
                        • pH1N1 Dominant Texas Fatality by County [html/css]
                        • Distribution of pH1N1 Influenza Fatalities in Texas [map by Al]



                        * 2014-01-12 Updated Stats from Jim Oliveros

                        Comment


                        • #72
                          Re: USA - Texas: Public Health department confirmed H1N1pdm09 outbreak - in Houston area media report of 13 fatalities - Montgomery county health says 2 confirmed H1N1pdm09

                          141 Fatalities in Texas
                          by
                          2014-01-17 *

                          • pH1N1 Dominant Texas Fatality by County [Excel]
                          • pH1N1 Dominant Texas Fatality by County [html/css]
                          • Distribution of pH1N1 Influenza Fatalities in Texas [map by Al]



                          * 2014-01-18 Updated Stats from Jim Oliveros

                          Comment


                          • #73
                            Re: USA - Texas: Public Health department confirmed H1N1pdm09 outbreak - in Houston area media report of 13 fatalities - Montgomery county health says 2 confirmed H1N1pdm09

                            166 Fatalities in Texas
                            by
                            2014-01-25 *

                            * 2014-01-25 Updated US Deaths by State [FT#216453] from Jim Oliveros

                            Comment

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