Sudden deaths and influenza

[tetano]

Into Italian subforum we are collecting a number of cases of 'sudden death', cases that have not received a full diagnosis or remained unexplained at the time of press attention. These 'sudden deaths' happened in the last two months. My suspect is that behind these unexplained fatalities there could be the influenza H1N1 2009. This because the overall number of cases seems to be elevated than the average figures expected for this kind of condition (the sudden death). In Italy, under the 35 year old class of age, there are in average around 200 cases per year of 'sudden death'. This year, only for the period comprised between the second half of January and the start of February I have had counted at least eleven of these cases. Since some of the usual symptoms may be overlooked or because an atypical presentation of the illness - the final diagnosis could have been mislabelled as heart failure, fulminant pneumonia o severe encephalitis. In the past pandemics, similar misdiagnosis happened, for example in the 1957 pandemic. It would be interesting to see if in all other countries covered by FluTrackers.com contributors a similar pattern of unexplained illness has materialized during the winter epidemic season. Further information will be welcomed.

 

[JimO]

Re: Sudden deaths and influenza

There were two tragic cases in the UK that caught my attention - a young woman (21-yo Katie Roach) who was a dance instructor and incredibly fit who died within four days of first having symptoms. Then there was the case of Craig Sweaton, a 27-yo body builder and fitness instructor who hadn't been sick "a day in his life" who died 3-4 days after onset.

With all the studies out there on the importance of Vitamin D in moderating the immune response, I just cannot understand why public health officials are not urging doctors to recommend testing their patients for Vitamin D deficiency and urging them to take supplements as needed.

Also, has any research been done regarding Vitamin D levels in patients who contract severe cases or who have died and seen any correlation?

 

[kiwibird]

Re: Sudden deaths and influenza

I have a Malaysian doctors blog I sometimes read. He has recently moved to Melbourne but his family is still in Malaysia.

ust before I decided to call it a night, I checked my Facebook one last time to see if there were any messages. There was one from my wife:

?Hubby, my brother has passed away?

A short sentence with six short words that sent a shiver down my spine.

My heart skipped a beat. I felt a cold shiver. The hair on the back of my neck stood erect. I felt as if some one has suddenly caught hold of my heart and was starting to squeeze the life out of it.

I knew my wife was not one to joke about such things.

I logged into Skype immediately and even before the video feed could connect, the audio told me that on the other end my wife and kids were crying tears of anguish!

It was for real.

Apparently, my brother-in-law, Ian, went to take a nap that afternoon and never woke up again. By the time his father went to wake him for dinner, his body was already cold.

The next few days were a blur.

We don?t know how he passed away and because a postmortem was not performed on his body, we will never know.

http://jimbocyberdoc.wordpress.com/page/3/

 

[kiwibird]

Re: Sudden deaths and influenza

Man sing the last song
Sudden death suspected heart attack

The deceased Mrs. yellow as gold reached remain on the Paida husband, hoping to wake him.
(18 Kuantan News), a billiard center managers choose to sing "Happy Here" song, burst suspected heart attack, fall to the ground, the Lantern, became the last of his life to celebrate a holiday!

The victim was 61-year-old Chinese man, Zhang Yuliang

He said that at first, I thought the dead "hair sheep hanging," the deceased had been clenched fist to open later and found the deceased has shown a black fingernails, I discovered that the deceased passed away

Perhaps this only made the news because he was singing - but I don't know if you normally have black nails from a heart attack.
http://chinapress.com.my/content_new.asp?dt=2011-02-19&sec=malaysia&art=0219mb90.txt

 

[tetano]

Re: Sudden deaths and influenza

For my research I use keywords like 'sudden death' 'death autopsy'
'Died young' 'dead baby'.
I would appreciate it if you can do a search in your countries and report these deaths from December 2010

 

[tetano]

Re: Sudden deaths and influenza

Italian student died in Grenoble


He created a lot of surprise and pain the news of the untimely and unexpected death of Desiree Ciapanna, 25, a student died in recent days in the French city of Grenoble, where he was studying. The girl, who grew up in the country of Gazzada, was found dead in his bed already, and death occurred during the night between 7 and 8 febbraio.Per the chief of police in Grenoble the girl "had been dead for about ten hours at the time of discovery, "and" on the body were not found signs of violence. " An autopsy has been conducted and the results have ruled out the use of drugs. The police in Grenoble has contacted the Italian authorities and the police have tracked down the family who reside in the district of Saint Ambrose in Varese. The parents, with his brother, are currently in France for the identification procedures. Most likely cause of death there is a sudden illness. Last night some friends of the family gathered to pray a rosary in his memory


http://www.ininsubria.it/studentessa-di-varese-morta-a-grenoble~A5666

 

[sharon sanders]

Re: Sudden deaths and influenza

Lake Luzerne, New York



Precious life, sudden death

Family, friends, schoolmates recall kind-hearted girl who died of still-unknown reason

By LEIGH HORNBECK Staff Writer

Updated 12:17 p.m., Friday, February 18, 2011


Hadley


At work, Patricia Burns is surrounded by death and dying. As a nurse's assistant at a hospice, her job is to care for the sick. Now, she is grappling with the sudden death of her 15-year-old daughter, a loss made worse because there was no explanation for her passing.
Christalin Canavan's death Dec. 27 is a medical mystery, unexplained by autopsy and toxicology. It was among the 1 to 2 percent of deaths each year that have no explanation.

Read more: http://www.timesunion.com/local/article/Precious-life-sudden-death-1019248.php#ixzz1EOtbW3wl
​

 

[sharon sanders]

Re: Sudden deaths and influenza

Los Angeles, California

By Lindsay William-Ross in News on <abbr class="published" title="2011-02-18T10:30:05-08:00">February 18, 2011 10:30 AM</abbr>
County Officials Speak About Employee's Death at Her Desk


Officials from Los Angeles County have finally issued a statement about the sudden death of Internal Services Department Rebecca Wells, who was discovered dead in a cubicle in Downey on Saturday morning.
County officials say an autopsy on Wells is pending.


http://laist.com/2011/02/18/county_officials_speak_about_employ.php

 

[sharon sanders]

Re: Sudden deaths and influenza

Palo Alto, California

Sudden Death Of Palo Alto Teacher Shocks School



Posted: 11:00 pm PST January 31, 2011

Updated: 9:49 am PST February 1, 2011


PALO ALTO, Calif. -- Students and staff at a Palo Alto elementary school received devastating news Monday when they learned a popular long-time teacher had died suddenly over the weekend.It appeared 43-year-old George Flath may have died from meningitis, a contagious disease that can kill in a matter of hours.A

http://www.foxreno.com/news/26686676/detail.html

 

[Tonka]

Re: Sudden deaths and influenza

Spanish to English translation

http://www.abc.es/agencias/noticia.asp?noticia=681854
Balearic recorded 8 cases of sudden death in young athletes in 5 years
07.02.2011 / 16:50 h
Palma, Feb. 7 (EFE) .- A study of the Cardiology Service of the Hospital are Ll?tzer indicates that in the past five years have occurred in the Balearic Islands at least 8 cases of sudden death in athletes under 35 years

A military Salamanca 30 years died of sudden death while doing sports
The incident took place around 09.15 am
02/03/1911 - 14:39 -IZQUIERDO FRANCISCO | SALAMANCA

A soldier of 30 years, RHM, died this morning in the city of Salamanca, in an episode of sudden death while doing sport with colleagues in the Plaza de Burgos, located near the headquarters of General Arroquia Engineers.
The incident took place around 09:15 hours in the morning. The military was playing a game of football with other colleagues in the barracks when he fell on the asphalt....

http://www.europapress.es/andalucia...me-muerte-subita-cardiaca-20110209174627.html

IT AFFECTS ONE IN 2,500 PEOPLE
UGR researchers determine the disease gene responsible for sudden cardiac death syndrome

DirectoryUnited StatesSpainRDResearch group

Photo: EP / PLANNERMEDIA
MADRID, 9 Feb. (EUROPA PRESS) -

Scientists at the Hospital Universitario Virgen de las Nieves and the University of Granada (UGR) have determined which called KCNH2 mutations are more frequent in the long QT syndrome (LQTS), a disorder of cardiac ion channels that affects approximately one in 2,500 people and can cause sudden death from ventricular arrhythmias.

This disease, experts say, often affects children and adolescents and sometimes confused with convulsions, mistakenly diagnosed as epilepsy.

However, until now, there are hundreds of mutations in twelve genes of sodium and potassium channels primarily. Thus, approximately 75 percent of the mutations described in LQTS are found in three genes, KCNQ1, the most frequent in other populations (potassium channel), KCNH2 (potassium channel), and SCN5A (sodium channel .)

To carry out this study, the researchers from Granada worked with nine patients with diagnostic criteria for long QT syndrome and 4 patients with idiopathic ventricular fibrillation (patients recovered from cardiac arrest in which the diagnosis is not the disease responsible).

The scientists found mutations in seven patients with long QT syndrome in two patients with idiopathic ventricular fibrillation. 71.4 percent of the mutations were in KCNH2 and 28.6 percent in SCN5A. However, found no mutation in KCNQ1.

Only two of these mutations were previously described. In fact, one of them has been studied in vitro in a cell vector definitely showing their involvement in the etiology of the disease, which is a major contribution to this field of research, in the words of the authors of the study.

"The great interest of the genetic test in the approach to these diseases lies in the possibility of identifying affected individuals but showing little phenotypic expression, that is, that the disease is not so clearly manifested in the electrocardiogram or evidence of image ", they say.

FAMILY CARRIER SCREENING

In his opinion, this increases the chances of detecting a family carrying the same disease but with inconclusive results in other tests, what they believe is a major breakthrough, since these genetic diseases can be hereditary.

Despite the significance of these findings, the researchers caution that their work is "a preliminary and initial experience" in Spain to describe the genotypic profile of a small sample of patients. "Multicentre collaboration is needed for larger groups and conclusions extrapolated to the general population," they conclude.

 

[tetano]

Re: Sudden deaths and influenza

Long QT syndrome (LQTS) is only one of multiple cause of sudden deaths

Myocatditis is an important cause of sudden death and may be due to viral infections, as influenza




What causes sudden death in young adults and children?

A sudden death in a young person can be caused by:

*

heart disease, including cardiomyopathy, congenital heart disease, myocarditis, genetic connective tissue disorders, mitral valve prolapse or conduction disease
*

medication-related causes, or
*

other causes.

We explain these below.

Heart disease
Heart disease is the most common cause of an unexpected sudden death in all age groups. In people aged 30 or over, the heart disease is usually due to 'furring' or 'blockages' of the blood vessels that supply the heart, i.e. coronary artery disease. But in younger people and in children the cause is much more often something other than coronary artery disease. The main causes are listed below. Some of these are inherited conditions. Some are detected easily while the person is alive, while others may go unnoticed until a tragic sudden death occurs.

Cardiomyopathies
These are abnormalities of the heart muscle and are usually inheritable.

*

Hypertrophic cardiomyopathy (HCM) The walls of the heart become abnormally thick without any other cause being identifiable. Even if there is not any thickening, the arrangement of the heart's muscle cells (myocytes) are disorganised and disrupted.
*

Arrhythmogenic right ventricular cardiomyopathy (ARVC) This condition causes the heart's muscle to become thin, because of an abnormal amount of fat and scar tissue in its wall. It affects mainly the right side of the heart.
*

Dilated cardiomyopathy (DCM) The left and right sides of the heart become enlarged and pump less efficiently, sometimes progressing to heart failure when the heart cannot meet the body's requirements.

Congenital heart disease
This group includes abnormalities of the structure of the heart which have been present since birth. Some of them may be inherited conditions. They include:

*

Valvular and more complex disease Abnormality of the heart's valves that can be associated with other abnormalities of the heart's structures such as 'a hole in the heart' (for example, Fallot's Tetralogy).
*

Anomalous coronary arteries When there is an abnormal arrangement of the arteries that supply blood to the heart muscle.

Myocarditis
Myocarditis is inflammation of the heart's muscle. It is usually due to a viral infection although it can be a complication of other medical conditions or exposure to drugs. It is not inheritable.

Genetic connective tissue disease
These are inheritable conditions affecting the structures that give support, strength and elasticity to the walls of the major blood vessels and, to a lesser extent, the heart muscle - for example Marfan's Syndrome and Ehler-Danlos. These can cause sudden death by arrhythmias or due to the sudden rupture of a major blood vessel such as the aorta (the major blood vessel that leaves the left side of the heart and supplies blood to the body).

Mitral valve prolapse
The mitral valve can sometimes be 'floppy' in appearance. This will show up on an echocardiogram (see cardiac tests). This is very common and affects around 1 or 2 in every 20 people. It is usually an asymptomatic and benign condition. In some rare cases mitral valve prolapse can be inherited in a family and can then be associated with arrhythmias and sudden death.

Conduction disease
This includes abnormalities in the way that the electrical impulses are conducted through the AV node due to disease (for example as in myotonic dystrophy), or because there are additional or 'accessory' pathways as in Wolff-Parkinson-White (WPW) Syndrome.

Medication-related causes
Prescription, over-the-counter and illegal drugs can have potentially dangerous but usually rare side effects, particularly if too much is taken (an overdose). These effects include arrhythmias (disturbance in the heart's rhythm) and sometimes a sudden death.

Other causes
Research suggests that sudden death may be caused infrequently by conditions such as fits (epilepsy) and severe asthma attacks. Pulmonary embolus (a clot to the lungs), has become better known recently due to its association with staying immobile for long periods during air travel. It can cause a sudden collapse and a rapid death (for more on this go to technical terms).

Sudden Arrhythmic Death Syndrome (SADS)
In around 1 in every 20 cases of sudden cardiac death - up to 500 every year in the UK - no cause can be found, despite examination of the heart by an expert cardiac pathologist. The cause of death is therefore described as 'unascertainable'. This is called Sudden Arrhythmic Death Syndrome, or SADS.

http://www.sads.org.uk/sudden_death.htm

 

[JimO]

Re: Sudden deaths and influenza

http://www.dailypress.net/page/content.detail/id/528703/David-John--Dud--Jolly.html?nav=5004

GLADSTONE - David John "Dud" Jolly, 52, of 518 Michigan Ave., Gladstone, passed away unexpectedly Sunday morning, Feb. 20, 2011, at the St. Francis Hospital in Escanaba from complications of pneumonia.

 

[tetano]

Re: Sudden deaths and influenza

Man died in swine flu outbreak


A MAN died after complaining of cold-like symptoms in one of the area’s first swine flu cases, an inquest heard.

Richard David Dooley, 24, was found dead in bed by his father in their Cae Coed Erw home, Bridgend, at around 8am on December 6, 2010, Aberdare Coroners’ Court heard.

Richard had gone to work as normal the day before, and went to bed at around 9.45pm saying he felt unwell. When his father Winston Dooley found him the next morning, he called an ambulance and Richard was pronounced dead.

Deputy Coroner Wayne Griffiths said Richard’s death was one of the first known swine flu cases in the area, and that a narrowing of his arteries meant he was not able to fight the virus in the way a man of his age normally could.

“The police were happy there were no suspicious circumstances or third party involvement, but that there had been a sudden onset of illness leading up to the day of his death.

“As a consequence of the circumstances tests were taken. This 24-year-old man had complained of a cough and a cold-like illness and a post-mortem examination revealed acute lung injury consistent with pneumonia.”

He added that this could be caused by various different things, but in this case had resulted from an influenza virus. Richard’s mother, present at the inquest, asked whether this meant swine flu, and Mr Griffiths confirmed it did.

He said: “There was a serious outbreak of this kind of substantial flu-like virus last year. This young man had a decreased ability to take in oxygen and had trouble breathing, and his heart was not as good as it should be.”

Mr Griffiths recorded a verdict of death by natural causes and extended his sympathies to Richard’s family.

He said: “This was a virus which attacked many people and, as a tragic consequence of what appeared to be another flu problem, Richard passed away.

“This was a direct cause of the epidemic, made worse by a narrowing in the arteries meaning he could not respond as well as he should.

“My condolences to you and the family. You must be devastated and I can’t say any more than that. I hope this brings some closure to you today.”

http://www.walesonline.co.uk/news/w...an-died-in-swine-flu-outbreak-91466-28474473/

 

[tetano]

Re: Sudden deaths and influenza

From late December until March 31 in this year I have monitored all deaths, reported by sources of information online in Italy, who had the feature to occur in unclear circumstances, those that in common parlance are called "natural dead' or that followed episodes of fever or simple discomfort, however that does not presage a fatal outcome.
For my research I used the google search engine and I used words like 'sudden death' 'death illness' 'death autopsy'
'Died young' 'death fever'.
I dwelt particularly on deaths involving young people, below the age of 35, which are also those that receive more attention from the media, but I tried to evaluate the deaths of people under the age of 65, with these characteristics.
I excluded the deaths that occurred in the course of sports or people suffering from significant diseases.
Also included are children under 1 year, whose sudden death occurred as a result of infectious episodes (ie, excluding cases of SIDS).

Many of these have been reported in italian section of the forum, some of them I recognized at different times and have not been published.


I believe that the number of deaths that I discovered greatly exceed what normally occurs during the winter seasons and that the spread of the new pandemic virus may be the source of this increase, in the absence of plausible alternative explanations, despite simplistic assessment that was given in Italy.
These deaths were numerous throughout all the period of time, but especially in the period from mid January to mid-February, coinciding with the moment of maximum circulation of the pandemic virus.

With regard to individuals under the age of 35 I found the following:

From 23 -12 to 13-01:

17

From 14-01 to 15-02

44

From 15-02 to 28-02

8

From 01-03 to 31-03

16

A total of 85 deaths in 99 days, an average of 0.85 per day
In the period between mid January and mid-February the average is 1.33.

I went to check how many deaths have occurred with these features in different months of the last and previous years, including winter, and I found no more than 6-7 per month.

With regard to individuals under the age of 65, only using the search key 'morte malore' you will be impressed by the large number of deaths that occurred during the period between mid January and mid February: I counted 125, a number that is 4 times higher than that recorded in other months of 2010.

I want to emphasize not the absolute number of deaths that I have found, that may not seem particularly high, but the 'significant increase, up to 5-6 times compared to previous periods.

 

[tetano]

Re: Sudden deaths and influenza

UCSF Study Explores Stroke in Children


Last year a four-year-old arrived at UCSF Medical Center from the emergency room of another hospital with pneumonia ? and worse. Infected with H1N1 influenza virus, the child had developed a blood clot.

The clot had dislodged and gotten stuck in one of the big vessels supplying much of the oxygen-rich blood to the child's brain. It was a stroke, and if the UCSF medical team had not responded in time, the child could have died.

The lessons of that day are part of a new retrospective study by interventional neuroradiologist, James Tatum, MD, and colleagues at UCSF looking at the effectiveness of treating children having stokes with a technique known as "mechanical embolectomy," a standard treatment for stroke in adults.


http://www.ucsf.edu/news/2011/04/9728/ucsf-study-explores-stroke-children

 

[tetano]

Re: Sudden deaths and influenza

Coroner: Old Mill Student Died of Respiratory Infection

The Marin County Coroner?s Office said Friday that an Old Mill School kindergartner who died March 4 succumbed to an acute respiratory infection.

But a series of tests that were conducted in the weeks following the 5-year-old boy?s death did not determine conclusively if the cause was Influenza A (H1N1), for which the boy had tested positive, or another virus.

According to Sheriff?s Lt. Keith Boyd, the Coroner?s Office conducted a forensic examination, toxicology, histology and culture studies, as well as a review of the circumstances surrounding the death of the boy.

Marin County Public Health Officer Jason Eberhart-Phillips said the tests were able to rule out a bacterial infection in the boy?s death, but not the exact viral cause. Influenza A (H1N1), widely known as swine flu, and cardiac hypertrophy, which is a thickening of the heart that results in a decrease in size of the chamber of the heart, were also listed as ?significant conditions? in the boy?s death by natural causes.

?We know from experience that the flu can kill and the H1N1 has and continues to cause death in a number of very unfortunate cases,? Eberhart-Phillips said. ?But apparently there weren?t willing to ascribe the death exclusively to H1N1. What can commonly happen when someone is infected with flu is that they are infected with something else at the same time and the double whammy can result in an even more serious infection.?

?He either died of Influenza A (H1N1) or he may have had another virus,? he continued. ?It may have been that another virus was taking the opportunity to infect him at the same time he was infected with the flu.?

The boy?s parents informed Old Mill officials on the night of March 3 that he was experiencing flu-like symptoms and would be kept at home the next day, according to the Sheriff's Office. Mill Valley Police and Mill Valley Fire personnel were called to the family?s home at around 8:30 a.m. the next morning, and the boy was rushed to Marin General Hospital.

The boy died at 9:45 a.m. at Marin General after testing positive for influenza, sending shockwaves throughout the Mill Valley School District community.

http://millvalley.patch.com/articles/coroner-old-mill-student-died-of-respiratory-infection

 

[tetano]

Re: Sudden deaths and influenza

"I STILL can't believe he's gone." Those are the words of a young Bristol mother whose son died of swine flu.

Stephanie Wiltshire's world was shattered when she found 16-month old Kevin dead in his cot just nine days before Christmas.

His young life had been cut short by a combination of acute bronchitis and swine flu.

"It shocked me and I still can't believe he's no longer here especially as I'd checked on him in his cot a few hours earlier," she said.

"He hadn't shown any signs of swine flu but after the post mortem examination I was told he had acute bronchitis and swine flu," said Stephanie, of Bishport Avenue, Hartcliffe.

She has another son, George, five, and now the Bridge Learning Campus Primary School where he is a pupil have presented a cheque to Stephanie to go towards research into the virus.

"He was my wonderful little boy and George's best friend," said Stephanie, who has set up a memorial website for Kevin.

She added: "Kevin is the most special little boy I have known, so smart and funny and sadly was taken from us in the night.

"I don't know what form of swine flu it was but I've given the doctors permission to use some of Kevin's organs for research," she added.

A medical report records Kevin's death as a "sudden death of a toddler with acute bronchitis. Virus A HINI contributed to the bronchitis."

http://www.thisisbristol.co.uk/news/T-BELIEVE-SON-S-GONE/article-3582859-detail/article.html

 

[tetano]

Re: Sudden deaths and influenza

Emerging infectious diseases

Pandemic (H1N1) 2009?associated Deaths Detected by Unexplained Death and Medical Examiner Surveillance


The emergence of pandemic (H1N1) 2009 influenza illustrated the need for improved surveillance to identify deaths resulting from emerging pathogens. Common methods for identifying infectious cause?related deaths include reports by health care providers and review of death certificates. These methods have limitations for identifying deaths caused by emerging pathogens because the disease may not be fully defined or death certificates may not indicate an infectious cause. During an emerging pathogen epidemic, it is important to investigate deaths occurring outside of traditional settings to determine if sudden deaths occurring in the community are a result of the novel pathogen.

In 1995, the Centers for Disease Control and Prevention (CDC) Emerging Infections Program (EIP) Unexplained Deaths Program (UNEX) began in 4 states (1). Under UNEX, deaths likely resulting from an infection, but for which routine testing did not identify a pathogen, are investigated. State and CDC Infectious Diseases Pathology Branch researchers partner with medical examiners and hospital pathologists to review cases and autopsy reports. Expanded resources for specimen testing are provided, which increases the likelihood of a pathogen-specific diagnosis.

...



During the spread of pandemic (H1N1) 2009, UNEX cases were reported to the Minnesota and Oregon health departments by physicians, infection preventionists, and hospital pathologists (Figure 1). Both states also conducted statewide surveillance by using Med-X. New Mexico detected cases through the New Mexico Office of the Medical Investigator and its Med-X system. Medical examiners investigated all decedents for influenza-like illness (ILI) based on pre- or postmortem findings as well as sudden deaths in previously healthy persons <50 years of age. Each state expanded its EIP Influenza Surveillance statewide during the pandemic (H1N1) 2009 pandemic. In addition, hospitalized persons with ILI, including decedents, were reported to the state health department by physicians, infection preventionists, and hospital pathologists.

...


A total of 194 pandemic (H1N1) 2009?associated deaths were detected in this analysis, 160 (82%) through hospital surveillance and 34 (18%) through UNEX/Med-X. The additional surveillance resulted in the detection of 21% more total cases than hospital surveillance alone. Minnesota had the highest proportion of UNEX/Med-X?detected cases with 24% (16/50); Oregon had the lowest with 11% (8/68) (Table 1). Decedents detected by using UNEX/Med-X were more frequently of a nonwhite race (48% vs. 22%); an increased percentage of deaths of American Indians/Alaska Natives was detected through UNEX/Med-X versus hospital surveillance (21% vs. 4%).

...

UNEX/Med-X decedents were more likely to have had an autopsy performed (85% vs. 17%) and were more likely to have died in their residences (53% vs. 8%) than decedents detected by hospital surveillance. The median age of UNEX/Med-X decedents was 37.5 years, compared with 51.0 years for hospital surveillance decedents (p<0.001) (Table 1). The proportion of UNEX/Med-X decedents among age groups decreased with increasing age (62% among those 0?4 years of age compared with 2.6% among those >65 years of age; Figure 2).

More hospital surveillance than UNEX/Med-X decedents (89% vs. 68%) were determined to have >1 underlying condition. Specific underlying conditions were more frequently identified among hospital surveillance than UNEX/Med-X decedents, except for obesity (Table 2). Pneumonia, including viral pneumonia, was frequently reported among decedents. Acute respiratory distress syndrome was documented for 37% of hospital and 15% of UNEX/Med-X decedents. Two previously healthy children with nasopharyngeal swabs positive for influenza had evidence at autopsy of viral myocarditis.

UNEX/Med-X surveillance captured 11%?24% of pandemic (H1N1) 2009?associated deaths in the 3 states. Other estimates of deaths resulting from pandemic (H1N1) 2009 may be increased with better data on nonhospitalized and sudden unexplained deaths (7,8). Estimates from surveillance in New York, New York, which included medical examiner and unexplained respiratory cause?related death surveillance, indicate 17% of decedents died at home and 6% had not sought any prior medical care

...

Even with an emphasis on deaths among those <50 years of age, UNEX and Med-X programs are critical for detecting severe illnesses that rapidly progress to death and could otherwise go undetected. Partnering with medical examiners and pathologists to identify infectious cause?related deaths among persons who were previously healthy is important to give a clear picture of the entire mortality spectrum.

Although it is important to accurately measure the impact of a disease, it is perhaps more important to quickly identify new serious disease threats. Approximately one tenth to one quarter of the influenza deaths detected in this study, and particularly those in younger, healthier persons, were not detected by hospital surveillance when influenza awareness was at its peak. This finding argues for surveillance systems like UNEX and Med-X as a means of quickly detecting emerging, severe infectious disease threats. Because pathogens are likely to emerge over broad geographic areas, we recommend a standardized approach to death investigations to fully understand the epidemiologic and clinical features of illness caused by a particular pathogen.

http://www.cdc.gov/eid/content/17/8/101914.htm

 

[tetano]

Re: Sudden deaths and influenza

THE parents of a man who died from swine flu just hours after complaining of a sore throat and headache are hoping to organise an annual football tournament in his memory.
Kind-hearted Garry Irvine, who lived with his parents Ian, 73, and Mary, 75, in Mayfield, Midlothian, was rushed to hospital after collapsing at home in January, but could not be saved.

The 49-year-old's sudden death sent shockwaves through the local community as he had apparently been in good health almost to the day he died.

Ian and Mary - a retired home help, who said Garry had "never been ill" prior to his death - had a shield made in their son's memory and had hoped local teams Arniston Rangers, of which Garry was a big fan, and Newtongrange Star would play a match to win it.

...

Garry went to bed one afternoon in January because he wasn't feeling well. The next morning, after collapsing while being attended to by the doctor, he was rushed to the Royal Infirmary, where he was put on a life-support machine.

However, there was nothing doctors could do and the machine was switched off that night.


http://edinburghnews.scotsman.com/ed...for.6818967.jp

 

[tetano]

Re: Sudden deaths and influenza

Aborted sudden cardiac sudden death associated with influenza A(H1N1) infection

Theofilos M. Kolettis, Associate Professor in Cardiology
Anna P. Kotsia, Eleni Sourla, Theofilos M. Kolettis, John A. Goudevenos

University of Ioannina, Greece

Since the 2009 pandemic, the novel influenza A(H1N1) viral infection has been associated with a substantial mortality worldwide. The main cause of death has been acute respiratory distress syndrome, mostly in cases with severe concomitant underlying disease or in immunocompromised patients (1). We read with great interest the article by Komai et al (2), describing a case of fatal fulminant myocarditis associated with influenza A (H1N1) infection in an immunocompetent 51-year-old male patient. We would like to share our recent experience with influenza A (H1N1)-related myocarditis in a young man, presenting with out-of-hospital cardiac arrest. A previously healthy 27-year-old male had cardiac arrest at his home. The patient had a 2-day history of malaise, cough and fever for 2 days prior to clinical presentation. Basic cardiopulmonary resuscitation was initiated promptly and ventricular fibrillation was recorded by the emergency medical services after approximately 10 minutes. He was successfully defibrillated, intubated and mechanically ventilated. On admission, he was hemodynamically stable and ECG showed sinus tachycardia, without signs of ischemia/infarction. Laboratory data showed WBC of 13000/?L with 85% of neutrophil, creatine phosphokinase of 6600U/L and troponin I of 1.53 ng/mL. Transthoracic echocardiography revealed moderately reduced left ventricular function with diffuse hypokinesis and ejection fraction of 40%. No complications were noted and he was extubated 24 hours after admission. Chest X-ray was normal and coronary angiography revealed normal coronary arteries. Nasopharyngeal smear samples were positive for influenza A(H1N1) virus. Treatment included ?-blockade, ACE inhibitor, low molecular weight heparin and oseltamivir. During hospital stay, serial echocardiography showed gradual improvement of left ventricular function, which normalized 3 weeks after admission. He was discharged on day 21st in good medical condition, without neurological sequelae. While viral myocarditis is a well recognized complication of seasonal influenza A infection (3), limited information exists with respect to myocardial involvement and presentation in cases with influenza A(H1N1) infection. We report a case of aborted sudden cardiac death due to ventricular fibrillation, caused by myocarditis associated with influenza A(H1N1) infection. In addition to the case reported by Komai et al (2), two additional cases similar to ours have been reported, namely one resuscitated cardiac arrest(4) and a case of sudden cardiac death in a 18- year-old female (5). We conclude that ventricular fibrillation secondary to myocarditis is a rare but devastating complication of influenza A(H1N1) infection in otherwise healthy individuals. More epidemiological data are awaited.

http://eurheartj.oxfordjournals.org/content/32/3/283/reply