Discussion thread: USA - Texas: H1N1pdm09 December 17, 2013+

[alert]

Re: Discussion thread: USA - Texas: Unknown ILI flu type illness December 17, 2013

Re: Discussion thread: USA - Texas: Unknown ILI flu type illness December 17, 2013

I'm pretty sure the medical center is in Conroe, mixin, from the media location references.

Here's another question I have for the Montgomery Health Department:

Has E. coli been ruled out? One patient got sick at Thanksgiving and that is a notorious time for food-borne illness outbreaks.

The symptoms don't really match E. coli. E. coli doesn't really cause pneumonia.

The fact that it now appears there is no contact between the patients (and no HCW are ill) seems to me to rule out severe contagious illnesses such as MERS, plague, etc. That leaves two possibilities:

1. These are the most severe cases of a much wider illness, possibly even seasonal flu.

2. This illness is not spreading H2H, but rather something only these few individuals came in contact with.

At this point, given the high ILI levels in the area, I am leaning toward the first option.

 

[Emily]

Re: Discussion thread: USA - Texas: Unknown ILI flu type illness December 17, 2013

Re: Discussion thread: USA - Texas: Unknown ILI flu type illness December 17, 2013

The symptoms don't really match E. coli. E. coli doesn't really cause pneumonia.

http://www.ncbi.nlm.nih.gov/pubmed/11864280

Clin Microbiol Infect. 1998 Feb;4(12):717-723.
Community-acquired pneumonia due to Escherichia coli.
Marrie TJ, Fine MJ, Obrosky DS, Coley C, Singer DE, Kapoor WN.

http://www.washington.edu/news/2013/12/18/single-bacterial-super-clone-behind-world-epidemic-of-drug-resistant-e-coli/

December 18, 2013
Single bacterial super-clone behind world epidemic of drug-resistant E. coli
Michael McCarthy

UW Health Sciences and UW Medicine

Posted under: Health and Medicine, News Releases, Research, Science

Virulent, drug-resistant forms of E. coli that have recently spread around the world emerged from a single strain of the bacteria ? not many different strains, as has been widely supposed. This is the finding of a study reported today, Dec. 17, in mBio. The strain causes millions of urinary, kidney and bloodstream infections a year. It could have a far greater clinical and economic impact than any other strain of bacteria, including the so-called MRSA superbug.

Read the mBio scientific paper....

Salmonella can cause pneumonia outbreaks, too.

http://archinte.jamanetwork.com/article.aspx?articleid=553137

PNEUMONIA ASSOCIATED WITH ACUTE SALMONELLOSISReport of a Case of Salmonella Bronchopneumonia and Fourteen Cases of Interstitial Pneumonia
ALFRED P. INGEGNO, M.D.; JOHN B. D'ALBORA, M.D.; JOHN N. EDSON, M.D.; PETER J. GIANQUINTO, M.D.
Arch Intern Med (Chic). 1948;81(4):476-484. doi:10.1001/archinte.1948.00220220047003.

 

[sharon sanders]

Re: Discussion thread: USA - Texas: Unknown ILI flu type illness December 17, 2013

Re: Discussion thread: USA - Texas: Unknown ILI flu type illness December 17, 2013

I think we still know very little about this event.

It appears these are the concrete facts as of this time:

1) 8 people were hospitalized in this event. 4 are dead.

2) 1 alive person tested positive for H1N1pdm09 after initially testing negative previous to this afternoon. There is no information about any co-morbidities, co-infections, or vaccine status in regard to this patient.

3) 2 alive persons tested negative at least twice for some collection of flu strains.

4) The flu re-test results are still pending for 1 alive person.

5) There is very little information provided about the 4 deceased persons. There is a reference that none of these people had been vaccinated with this year's seasonal flu vaccine.

6) There are no patient histories or epidemiological data available/confirmed from any government source. Onset, hospitalization, death dates are missing.

7) All patients tested negative at least once for novel coronavirus.


From the currently available information it is impossible to draw any firm conclusions about this event.



Sources:

https://www.facebook.com/mctxpublichealth

http://www.mchd-tx.org/

 

[gsgs]

Re: Discussion thread: USA - Texas: Unknown ILI flu type illness December 17, 2013

Re: Discussion thread: USA - Texas: Unknown ILI flu type illness December 17, 2013

they said "positive for H1N1" but they didn't say what segments
they tested, presumably just the HA.
And they didn't say where they tested, did they do lung-samples ?

We know D225G preferrably goes into the lungs and there might be
fewer viruses in the upper tract after some days/weeks.

They should know about D225G from PCR meanwhile, would they
have mentioned it, if it was found ?

Anyway, CDC is on it now, we should know it in a few days.

And there is no spreading

All the deaths were male, what sex were the other 4 ?

 

[Giuseppe]

Re: Discussion thread: USA - Texas: Unknown ILI flu type illness December 17, 2013

Re: Discussion thread: USA - Texas: Unknown ILI flu type illness December 17, 2013

Extremely ridiculous information management from local and state health authorities at least.

I do not attempt to wonder if this is an Alabama cluster replica, where unneeded alarm was sounded after a series of 'regular' respiratory infections, complicated by other common bacteria.

What is the point for these outbreak of alarm?

Or, if there is a point at all.

 

[gsgs]

Re: Discussion thread: USA - Texas: Unknown ILI flu type illness December 17, 2013

Re: Discussion thread: USA - Texas: Unknown ILI flu type illness December 17, 2013

I missed Alabama ...
but here we have 4 deaths, 4 critical, flu tests negative
then one H1N1, all unrelated
2 negative for all flus
sounds like D225G


middle age
4:0 male deaths


Alabama was this from May ?
http://www.flutrackers.com/forum/showthread.php?t=206377


>KF648129,A/Texas/13/2013,2013/07/21,USA,H1N1,Human,4
>KF648085,A/Nevada/06/2013,2013/07/23,USA,H1N1,Human,4
>KF648120,A/Nevada/06/2013,2013/07/23,USA,H1N1,Human,4
>KF648080,A/North Carolina/08/2013,2013/07/24,USA,H1N1,Human,4
>KF648032,A/Delaware/09/2013,2013/08/02,USA,H1N1,Human,4
>KF648118,A/Wisconsin/12/2013,2013/08/04,USA,H1N1,Human,4
>KF648128,A/Wisconsin/12/2013,2013/08/04,USA,H1N1,Human,4
>KF648169,A/California/24/2013,2013/08/08,USA,H1N1,Human,4
>KF648170,A/Indiana/22/2013,2013/08/13,USA,H1N1,Human,4
>KF648172,A/Texas/15/2013,2013/08/15,USA,H1N1,Human,4

 

[tetano]

Re: Discussion thread: USA - Texas: Unknown ILI flu type illness December 17, 2013

Re: Discussion thread: USA - Texas: Unknown ILI flu type illness December 17, 2013

Let us not forget that the H1N1 virus-09 remains a pandemic virus and, like his predecessors, can cause new waves up to 5 years at a distance of the first one (see the lesson of 1957), keeping the characteristic to cause mortality in the younger age groups

 

[tetano]

Re: Discussion thread: USA - Texas: Unknown ILI flu type illness December 17, 2013

Re: Discussion thread: USA - Texas: Unknown ILI flu type illness December 17, 2013

 

[alert]

Re: Discussion thread: USA - Texas: Unknown ILI flu type illness December 17, 2013

Re: Discussion thread: USA - Texas: Unknown ILI flu type illness December 17, 2013

Extremely ridiculous information management from local and state health authorities at least.

I do not attempt to wonder if this is an Alabama cluster replica, where unneeded alarm was sounded after a series of 'regular' respiratory infections, complicated by other common bacteria.

What is the point for these outbreak of alarm?

Or, if there is a point at all.

It certainly could be an Alabama rerun, with other common pathogens being detected in other patients in the next couple days.

Alternatively, it could just be an H1N1 outbreak, with several more cases being confirmed by more careful testing.

Or it could be something else, such as a Legionella outbreak in the hospital (at least one of the fatalties appears to have taken ill in the hospital after heart surgery), and the one H1N1 case could be a background detection or a co-infection.

 

[curiosity]

Re: Discussion thread: USA - Texas: Unknown ILI flu type illness December 17, 2013

Re: Discussion thread: USA - Texas: Unknown ILI flu type illness December 17, 2013

http://www.dshs.state.tx.us/idcu/disease/influenza/surveillance/2013/



Note: 1 Pediatric death with un-subtyped influenza virus reported in September

The first round of H1N1pdm09 was significant for the pediatric population as well - three times as many deaths during that flu season compared to past seasons.

I am encouraging all of my friends and family to get vaccinated. There isn't much time before the rest of the U.S. begins to see high influenza rates and it can take up to two weeks (or longer for children) for the vaccination to be most effective.

 

[sharon sanders]

Re: Discussion thread: USA - Texas: Unknown ILI flu type illness December 17, 2013

Re: Discussion thread: USA - Texas: Unknown ILI flu type illness December 17, 2013

FluTrackers does not offer medical advice and our vaccine policy - for all vaccines - is for people to consult their medical practitioners.

 

[curiosity]

Re: Discussion thread: USA - Texas: Unknown ILI flu type illness December 17, 2013

Re: Discussion thread: USA - Texas: Unknown ILI flu type illness December 17, 2013

Wikipedia: 2009 flu pandemic in the United States by state (Texas)

2009/10 Flu Season -

Montgomery County = 1 death
Harris County (Houston Metropolis) = 26 deaths
spanning the main pandemic event - April 2009 - Nov/Dec 2009

Fast Forward to December 2013 -

Initial reports of 4 deaths in one facility (may be from other counties transferred in to the "Regional Hospital")

Current reports of 6 deaths in "Houston Area"

deaths spanning over an approximate 3 weeks?

Significant number of deaths in a much shorter amount of time.


Media accounts characterize the disease profile as affecting middle age individuals, most healthy prior to becoming ill, with a short duration of illness progressing from cold/flu symptoms to pneumonia to multiple organ failure and/or kidney failure.

Is this an isolated event or the start of a bigger event?

Media reports from various medical care providers are confusing -

Some indicate the numbers they are seeing in the facilities are normal and "expected" while others indicate the numbers are increasing significantly and the flu is aggressive.

Google Flu Trends, though not a science, has some interesting data in the cities view.

Conversely, the new Flu View by CDC doesn't really show any "worrisome" indicators ...

I am interested in your perspectives and analysis ...

 

[gsgs]

Re: Discussion thread: USA - Texas: Unknown ILI flu type illness December 17, 2013

Re: Discussion thread: USA - Texas: Unknown ILI flu type illness December 17, 2013

reminds to the D225G=D239G cases in 2009
what triggers it ? just random ?


total excess mortality should be low this season with H1 vs. H3 last season
although shifted towards younger ages

-----------------------------------------------
number of genbank ****** HAs by year and amino-acids D,E,G,N at 239:
2009:7887,664,121,24
2010:1631,32,43,16
2011,1347,1,33,22
2012,435,1,7,4
2013(Sep.),203,1,6,2

1.5%,2.6%,2.4%,1.6%,3.0%

 

[Ronan Kelly]

Re: Discussion thread: USA - Texas: Unknown ILI flu type illness December 17, 2013

Re: Discussion thread: USA - Texas: Unknown ILI flu type illness December 17, 2013

I think that it's important not to read too much into this yet.

With an average 24,000 influenza associated deaths annually [in the US] ( Estimates of Deaths Associated with Seasonal Influenza --- United States, 1976--2007 ) Texas would have approximately 1,800 flu associated deaths, mostly unreported, each season. We might just be seeing an increase in detections due to heightened surveillance due to MERS and Novel Avian Influenza associated anxiety.

 

[Gert van der Hoek]

Re: Discussion thread: USA - Texas: Unknown ILI flu type illness December 17, 2013

Re: Discussion thread: USA - Texas: Unknown ILI flu type illness December 17, 2013

Some - including a moderator of ProMED-mail - speculate there could circulate a more virulent influenza virus in Texas. There is no proof?

Personally I would be more interested in clinical data of the deceased or seriously affected influenza patients.

Patients can stated to be "healthy" , even with for instance low vit D status, high BMI, high blood sugar (below diabetes level), high triglycerides or being a smoker.

Exclude host factors first, before considering other factors?

 

[tetano]

Re: Discussion thread: USA - Texas: Unknown ILI flu type illness December 17, 2013

Re: Discussion thread: USA - Texas: Unknown ILI flu type illness December 17, 2013

We might just be seeing an increase in detections due to heightened surveillance due to MERS and Novel Avian Influenza associated anxiety.

Why only in Texas ?

 

[Ronan Kelly]

Re: Discussion thread: USA - Texas: Unknown ILI flu type illness December 17, 2013

Re: Discussion thread: USA - Texas: Unknown ILI flu type illness December 17, 2013

Why only in Texas ?

But it's not just Texas.

Flu activity is high in Texas, Louisiana, Mississippi and Alabama. Texas has twice the population (26 million) of the other three states put together so you would expect more reported fatalities. Just from doing a quick google search, there has been at least two deaths in Mississippi (3 million) (http://www.msdh.state.ms.us/msdhsite/_static/23,14656,341.html) . Georgia (10 million) reported a pair of fatalities (http://vaccinenewsdaily.com/medical...ports-first-flu-related-deaths-of-the-season/). North Carolina (Pop 10 million) had 3 deaths in the week ending Dec 3 (http://www.northcarolinahealthnews.org/2013/12/03/early-flu-deaths-portend-active-flu-season/) .

So there is evidence for flu activity & fatalities across the southern portion of the US. I think this story gained legs mostly because of the tardiness in identifying the pathogen. The whole "mystery illness" idea attracted lots of attention with the possibility for MERS or avian influenza and may have led to testing of fatal cases that may otherwise have remained untested.

That being said, it still bears watching. And questions need to be asked as to why this was so difficult to identify? Is there some drift going on? Is an adaptation to deeper lung tissue underway? etc. All worth examining.

 

[sharon sanders]

Re: Discussion thread: USA - Texas: Unknown ILI flu type illness December 17, 2013

Re: Discussion thread: USA - Texas: Unknown ILI flu type illness December 17, 2013

The state reports posted by Mixin are about 2 weeks ahead of the national CDC FluView reports and they are showing that the predominate flu strain this year is H1N1pdm09.

 

[tetano]

Re: Discussion thread: USA - Texas: Unknown ILI flu type illness December 17, 2013

Re: Discussion thread: USA - Texas: Unknown ILI flu type illness December 17, 2013

You are right, but the deaths of young and otherwise healthy people, with a dramatic evolution of the illness ( multi-organ insufficiency) is always worthy of consideration, expecially if cases are non limited to 1-2.
That sayd, I don' t believe in a super H1N1, these deaths are the signature of the ordinary H1N1 and its pandemic predecessors, as we saw in India or South America in the past season: many people who are sick with light illness and few cases of serious illness, probably in areas spared from earlier waves of the epidemic. It takes several years, even 5 or 6, before the virus loses its strength.

 

[sharon sanders]

Re: Discussion thread: USA - Texas: Unknown ILI flu type illness December 17, 2013

Re: Discussion thread: USA - Texas: Unknown ILI flu type illness December 17, 2013

I agree.