Legadillo
Resident
Most of us are aware of the symptoms of H1N1. The one symptom getting the most attention lately, especially with some of the new federal measures aimed at schools is FEVER. However, my concern is exactly how many cases present with fever?
There is an outbreak of Swine Flu here in my area (Bryan County, Georgia) and the school criteria for quarantine and being allowed to stay home is fever (I guess otherwise they won't be excused, who knows). Yet, I remembered that one of the unique features of H1N1 is that 1/3 of cases present with NO fever, according to the below New York Times article. Moreover, some of the people I am aware of that have been confirmed here had NO fever but had all the other symptoms, including diarrhea, malaise and vomiting and participated in many activities, such as church missions, trips to the mall, etc..... believing they DID NOT pose a threat.
I am curious to know what scientific studies support the below article because I think it is critical to develop a more effective and comprehensive screening tool for school nurses and doctors to use. Furthermore, I think if this is indeed the case, the federal criteria based primarily on fever could be problematic and exclude a huge number of spreaders in our schools.
http://www.nytimes.com/2009/08/08/health/08flu.html?em
Many Swine Flu Cases Have No Fever
Published: May 12, 2009
Many people suffering from swine influenza, even those who are severely ill, do not have fever, an odd feature of the new virus that could increase the difficulty of controlling the epidemic, said a leading American infectious-disease expert who examined cases in Mexico last week.
In April, medical workers at Taoyuan Airport, in northern Taiwan, checked passengers for fever.
Fever is a hallmark of influenza, often rising abruptly to 104 degrees at the onset of illness. Because many infectious-disease experts consider fever the most important sign of the disease, the presence of fever is a critical part of screening patients.
But about a third of the patients at two hospitals in Mexico City where the American expert, Dr. Richard P. Wenzel, consulted for four days last week had no fever when screened, he said.
“It surprised me and my Mexican colleagues, because the textbooks say that in an influenza outbreak the predictive value of fever and cough is 90 percent,” Dr. Wenzel said by telephone from Virginia Commonwealth University in Richmond, where he is chairman of the department of internal medicine.
While many people with severe cases went on to develop fever after they were admitted, about half of the milder cases did not; nearly all patients had coughing and malaise, Dr. Wenzel said.
Also, about 12 percent of patients at the two Mexican hospitals had severe diarrhea in addition to respiratory symptoms like coughing and breathing difficulty, said Dr. Wenzel, who is also a former president of the International Society for Infectious Diseases. He said many such patients had six bowel movements a day for three days.
Dr. Wenzel said he had urged his Mexican colleagues to test the stools for the presence of the swine virus, named A(H1N1). “If the A(H1N1) virus goes from person to person and there is virus in the stool, infection control will be much more difficult,” particularly if it spreads in poor countries, he said.
The doctor said he had also urged his Mexican colleagues to perform tests to determine whether some people without symptoms still carried the virus.
He also said he had examined patients and data at the invitation of Dr. Samuel Ponce de León, who directs Mexico’s national vaccination program.
Dr. Wenzel said that an unusual feature of the Mexican epidemic, which complicates the understanding of it, was that “in recent months five different influenza viruses have been circulating in Mexico simultaneously.”
Pneumonia rates at one of the hospitals Dr. Wenzel visited, the National Institute for Respiratory Diseases, reached 120 per week recently compared with 20 per week during the past two years, suggesting a possible relation to the swine flu.
The pneumonias that the flu patients developed did not resemble the staphylococcal lung infections that were believed to be a common complication in the 1918-1919 influenza pandemic, Dr. Wenzel said.
He said the two Mexican hospitals were well prepared for an outbreak of respiratory disease. Mexican doctors activated a program to allay anxiety among staff members, offering the staff information, a hot line, psychological support and medical examinations.
“This aspect of epidemic response is not well appreciated in the United States in my estimation, yet is critical for success,” Dr. Wenzel said. “We haven’t put nearly enough into managing fear among health workers.”
http://www.nytimes.com/2009/05/13/health/13fever.html
Is anyone aware of a recent study supporting this article?
Also: read what some of the new federal measures are concerning schools:
Swine Flu Should Not Close Most Schools, Federal Officials Say
Published: August 7, 2009
Most schools should be able to stay open even if swine flu outbreaks occur again this fall, government officials said Friday as they issued recommendations for dealing with the illness when the school year starts.
Decisions about whether to close schools should be made locally, the officials said, and “should balance the goal of reducing the number of people who become seriously ill or die from influenza with the goal of minimizing social disruption and safety risks to children,” which sometimes occur when schools close.
The nation has 130,000 schools, 55 million students and 7 million staff members. Closing schools may mean that parents have to stay home or find child care, which some cannot afford. People in essential jobs, like health care, may be stuck at home during outbreaks when they are most needed. In some cases, children may wind up being left home alone or going to the mall, where they can spread the H1N1 flu virus.
The secretaries of education, homeland security and health and human services described the guidelines for schools with grades kindergarten through 12 on Friday at a news briefing in Washington, along with the director of the Centers for Disease Control and Prevention. Guidelines for colleges and employers are set to be issued on Aug. 23.
“It’s now clear that closure of schools is rarely indicated, even if H1N1 is in the school,” said Dr. Thomas R. Frieden, director of the disease control centers, though he added that closings might be necessary if so many people were sick that the school could not function, or if parents persisted in sending sick children to school.
Education Secretary Arne Duncan said that some schools “will have to close,” and that administrators should be making plans to continue schooling at home, via telephones and the Internet.
Emphasizing that vaccination is the best way to prevent the spread of the flu, Health and Human Services Secretary Kathleen Sebelius said the vaccine against the H1N1 virus should be ready by October. People will probably need two shots of the new vaccine, in addition to one shot for seasonal flu. Children and young people ages 6 months to 24 years are to be given priority for the H1N1 vaccine, and vaccination clinics may be set up in some schools.
The advice to schools includes telling staff members and students to stay home when they are sick and not to return for at least 24 hours after the fever goes away. This differs from earlier guidelines, which advised staying home for seven days.
Schools are also urged to set up a separate room where students and staff members who do come to school sick can stay until they can be sent home. They should be given masks to wear, and so should the people looking after them.
Special schools for sick children or pregnant teenagers, both high-risk groups, may need to close, Dr. Frieden said.
The guidelines also say that if the flu becomes more severe, additional measures may be needed, like screening staff members and students daily, telling people at high risk and those with sick family members to stay home, and increasing the distance between people at school by moving the desks farther apart.
There is an outbreak of Swine Flu here in my area (Bryan County, Georgia) and the school criteria for quarantine and being allowed to stay home is fever (I guess otherwise they won't be excused, who knows). Yet, I remembered that one of the unique features of H1N1 is that 1/3 of cases present with NO fever, according to the below New York Times article. Moreover, some of the people I am aware of that have been confirmed here had NO fever but had all the other symptoms, including diarrhea, malaise and vomiting and participated in many activities, such as church missions, trips to the mall, etc..... believing they DID NOT pose a threat.
I am curious to know what scientific studies support the below article because I think it is critical to develop a more effective and comprehensive screening tool for school nurses and doctors to use. Furthermore, I think if this is indeed the case, the federal criteria based primarily on fever could be problematic and exclude a huge number of spreaders in our schools.
http://www.nytimes.com/2009/08/08/health/08flu.html?em
Many Swine Flu Cases Have No Fever
Published: May 12, 2009
Many people suffering from swine influenza, even those who are severely ill, do not have fever, an odd feature of the new virus that could increase the difficulty of controlling the epidemic, said a leading American infectious-disease expert who examined cases in Mexico last week.
In April, medical workers at Taoyuan Airport, in northern Taiwan, checked passengers for fever.
Fever is a hallmark of influenza, often rising abruptly to 104 degrees at the onset of illness. Because many infectious-disease experts consider fever the most important sign of the disease, the presence of fever is a critical part of screening patients.
But about a third of the patients at two hospitals in Mexico City where the American expert, Dr. Richard P. Wenzel, consulted for four days last week had no fever when screened, he said.
“It surprised me and my Mexican colleagues, because the textbooks say that in an influenza outbreak the predictive value of fever and cough is 90 percent,” Dr. Wenzel said by telephone from Virginia Commonwealth University in Richmond, where he is chairman of the department of internal medicine.
While many people with severe cases went on to develop fever after they were admitted, about half of the milder cases did not; nearly all patients had coughing and malaise, Dr. Wenzel said.
Also, about 12 percent of patients at the two Mexican hospitals had severe diarrhea in addition to respiratory symptoms like coughing and breathing difficulty, said Dr. Wenzel, who is also a former president of the International Society for Infectious Diseases. He said many such patients had six bowel movements a day for three days.
Dr. Wenzel said he had urged his Mexican colleagues to test the stools for the presence of the swine virus, named A(H1N1). “If the A(H1N1) virus goes from person to person and there is virus in the stool, infection control will be much more difficult,” particularly if it spreads in poor countries, he said.
The doctor said he had also urged his Mexican colleagues to perform tests to determine whether some people without symptoms still carried the virus.
He also said he had examined patients and data at the invitation of Dr. Samuel Ponce de León, who directs Mexico’s national vaccination program.
Dr. Wenzel said that an unusual feature of the Mexican epidemic, which complicates the understanding of it, was that “in recent months five different influenza viruses have been circulating in Mexico simultaneously.”
Pneumonia rates at one of the hospitals Dr. Wenzel visited, the National Institute for Respiratory Diseases, reached 120 per week recently compared with 20 per week during the past two years, suggesting a possible relation to the swine flu.
The pneumonias that the flu patients developed did not resemble the staphylococcal lung infections that were believed to be a common complication in the 1918-1919 influenza pandemic, Dr. Wenzel said.
He said the two Mexican hospitals were well prepared for an outbreak of respiratory disease. Mexican doctors activated a program to allay anxiety among staff members, offering the staff information, a hot line, psychological support and medical examinations.
“This aspect of epidemic response is not well appreciated in the United States in my estimation, yet is critical for success,” Dr. Wenzel said. “We haven’t put nearly enough into managing fear among health workers.”
http://www.nytimes.com/2009/05/13/health/13fever.html
Is anyone aware of a recent study supporting this article?
Also: read what some of the new federal measures are concerning schools:
Swine Flu Should Not Close Most Schools, Federal Officials Say
Published: August 7, 2009
Most schools should be able to stay open even if swine flu outbreaks occur again this fall, government officials said Friday as they issued recommendations for dealing with the illness when the school year starts.
Decisions about whether to close schools should be made locally, the officials said, and “should balance the goal of reducing the number of people who become seriously ill or die from influenza with the goal of minimizing social disruption and safety risks to children,” which sometimes occur when schools close.
The nation has 130,000 schools, 55 million students and 7 million staff members. Closing schools may mean that parents have to stay home or find child care, which some cannot afford. People in essential jobs, like health care, may be stuck at home during outbreaks when they are most needed. In some cases, children may wind up being left home alone or going to the mall, where they can spread the H1N1 flu virus.
The secretaries of education, homeland security and health and human services described the guidelines for schools with grades kindergarten through 12 on Friday at a news briefing in Washington, along with the director of the Centers for Disease Control and Prevention. Guidelines for colleges and employers are set to be issued on Aug. 23.
“It’s now clear that closure of schools is rarely indicated, even if H1N1 is in the school,” said Dr. Thomas R. Frieden, director of the disease control centers, though he added that closings might be necessary if so many people were sick that the school could not function, or if parents persisted in sending sick children to school.
Education Secretary Arne Duncan said that some schools “will have to close,” and that administrators should be making plans to continue schooling at home, via telephones and the Internet.
Emphasizing that vaccination is the best way to prevent the spread of the flu, Health and Human Services Secretary Kathleen Sebelius said the vaccine against the H1N1 virus should be ready by October. People will probably need two shots of the new vaccine, in addition to one shot for seasonal flu. Children and young people ages 6 months to 24 years are to be given priority for the H1N1 vaccine, and vaccination clinics may be set up in some schools.
The advice to schools includes telling staff members and students to stay home when they are sick and not to return for at least 24 hours after the fever goes away. This differs from earlier guidelines, which advised staying home for seven days.
Schools are also urged to set up a separate room where students and staff members who do come to school sick can stay until they can be sent home. They should be given masks to wear, and so should the people looking after them.
Special schools for sick children or pregnant teenagers, both high-risk groups, may need to close, Dr. Frieden said.
The guidelines also say that if the flu becomes more severe, additional measures may be needed, like screening staff members and students daily, telling people at high risk and those with sick family members to stay home, and increasing the distance between people at school by moving the desks farther apart.
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. It became obvious to me that the one person responsible for implementing protocols was unaware of the latest statistics and guidelines. So, I followed with the email from which I snipped my previous post. Needless to say, I am not confident about sending my children off to school in 8 days!
