Sudden deaths and influenza

[tetano]

Re: Sudden deaths and influenza

Sudden death of an immunocompetent young adult caused by novel (swine origin) influenza A/H1N1-associated myocarditis

Virchows Arch. 2011 Mar;458(3):371-6. Epub 2011 Jan 14.
Sudden death of an immunocompetent young adult caused by novel (swine origin) influenza A/H1N1-associated myocarditis.
Gdynia G, Schnitzler P, Brunner E, Kandolf R, Bl?ker H, Daum E, Schnabel P, Schirmacher P, Roth W.
Source

Institute of Pathology, University Hospital, Im Neuenheimer Feld 220/221, 69120, Heidelberg, Germany.
Abstract

The main cause of death from novel (swine origin) influenza A/H1N1 infection is acute respiratory distress syndrome. Most fatal cases are immunocompromised patients or patients with a severe underlying disease. Here, we report a fatal case of acute interstitial myocarditis associated with novel influenza A/H1N1 infection in an immunocompetent young woman. A previously healthy 18-year-old woman experienced malaise, diarrhea, and fever for several days prior to a sudden collapse at home. Autopsy revealed a predominantly lymphocytic myocarditis in the absence of a significant respiratory tract infection. Infection with novel (swine origin) influenza A/H1N1 was confirmed by PCR analysis of blood as well as myocardial tissue. Influenza-caused diarrhea with consecutive hypokalemia potentially contributed to the fatal outcome of the myocarditis, characterized by ventricular fibrillation. In conclusion, sudden death by myocarditis may be a rare complication of novel influenza A/H1N1 infection in otherwise healthy individuals, even in the absence of significant respiratory tract infection.

PMID:
21234762
[PubMed - indexed for MEDLINE]

http://www.ncbi.nlm.nih.gov/pubmed/21234762

 

[tetano]

Re: Sudden deaths and influenza

Four-year-old girl who died as she slept had swine flu


A distraught mother has told an inquest how she battled to save her daughter's life after she caught swine flu.

Prabhleen Sarao gave four-year-old Gian mouth-to-mouth resuscitation after family members found her unconscious in bed.

The youngster was taken by ambulance to Leicester Royal Infirmary, but doctors were unable to revive her and she died about half-an-hour later.

Mrs Sarao, of Mowmacre Hill, Leicester, told the inquest at Leicester Town Hall: "She would not wake up, so we carried her downstairs and put her on the sofa. I knew instantly something was wrong. I was so shocked.

"I got instructions over the phone from the ambulance service and tried giving her mouth-to-mouth, but I don't know if I did it correctly because I was panicking so much."

The inquest heard Gian and other family members had been suffering from "fever-like symptoms" in the week before her death on December 5 last year.

Mrs Sarao told the court her daughter had seemed to be getting better.

On the day of Gian's death, Mrs Sarao said the youngster had been "playing and jumping up and down on the bed" with one of her aunts.

Mrs Sarao put her daughter to bed at about midday, but when an aunt went to wake her up at about 4pm, she was unconscious and her lips and the tips of her fingers had turned blue.

Pathologist Dr Roger Malcomson told the hearing that Gian died from a lung infection caused by the swine flu virus.

He said this particular strain had been going around Leicester last winter and he recalled another child also catching the virus.

Dr Malcomson said Gian's death could not have been predicted because the symptoms of swine flu – a high temperature, coughing and tiredness – were similar to normal flu.

Coroner Catherine Mason recorded a verdict of death by natural causes


http://www.thisisleicestershire.co....pt-swine-flu/story-13298475-detail/story.html

 

[tetano]

Re: Sudden deaths and influenza

With the last increase to 4 the cases of sudden death in young healthy people in the United Kingdom.

Here 's list:

12/05/2010 child 4 years old from Leicester
12//06/2010 young man 24 years old in Wales
12/16/2010 child 16 months old at Bristol
01 / ?/2011 49 year old man in Scotland

These are 4 deaths in a single season in only one country.
How many similar deaths may be considered to have escaped the surveillance in the UK , in other European countries and in the world?

 

[tetano]

Re: Sudden deaths and influenza

Asthma contributed to Bath schoolboy's swine flu death



A schoolboy died of swine flu because of his underlying asthma just five days before Christmas, an inquest heard yesterday.

Ryan Hoe, 12, suffered a heart attack and died from the H1N1 strain of the disease after it struck his weak lungs.

Avon Coroner's Court heard Ryan had been fit and well but suffered mild asthma before he entered Royal United Hospital in Bath in December last year.

But Ryan, of Bathampton, suffered cardiac arrest and died at 3.30pm later that day. Deputy assistant Coroner Terrence Moore delivered a verdict of natural causes.

http://www.thisissomerset.co.uk/Ast...-s-swine-flu/story-13688112-detail/story.html

 

[tetano]

Re: Sudden deaths and influenza

Raise to 5 the cases of sudden death in young healthy people affected from swine flu in the United Kingdom.

Here 's list:

12/05/2010 child 4 years old from Leicester
12//06/2010 young man 24 years old in Wales
12/16/2010 child 16 months old at Bristol
12/20/2010 boy 12 years old in Bathampton
01 / ?/2011 49 year old man in Scotland

 

[tetano]

Re: Sudden deaths and influenza

Northam parents to sue over Andrew Allen's hospital death

December 18, 2010


THE parents of a schoolboy who died hours after being sent home from hospital with Panadol plan to sue after a damning report found a doctor was only metres away, but was never called by an inexperienced nurse to treat their son.

...

Andrew was taken to Northam Hospital on September 16 with a temperature of 40C. He was barely able to breathe or walk, his skin was mottled and he was sweating profusely.

Despite his condition, RN-A sent him home with junior-strength Panadol and a pamphlet on gastroenteritis.

Mrs Allan found her son dead in his bed early the next morning.

..

An autopsy report shows he had swine flu and staphylococcal pneumonia.



http://www.heraldsun.com.au/news/na...s-hospital-death/story-e6frf7l6-1225973342202

 

[tetano]

Re: Sudden deaths and influenza

In the italian forum I collected cases of children who died suddenly after a few hours or days of illness with gastrointestinal symptoms, as the australian boy who died in 2010.

In 2011 I counted 17 children, aged from 6 months to 7 years , in which an investigation was opened.
The causes of these as of others sudden deaths may be many, but what impressed me is the large number.

In the list there are also cases of 2010 and 2009 (including a child died with H1N1 flu)


The link to the thread:

http://www.flutrackers.com/forum/showthread.php?t=176002

 

[tetano]

Re: Sudden deaths and influenza

Scand J Infect Dis. 2011 Nov 10.
Fulminant myopericarditis in an immunocompetent adult due to pandemic 2009 (H1N1) influenza A virus infection.
Davoudi AR, Maleki AR, Beykmohammadi AR, Tayebi A.
Source

Department of Infectious Disease, Mazandaran University of Medical Sciences, North Iranian Research Centre for Infectious Disease , Sari.
Abstract

Abstract Acute myopericarditis is a well-recognized but rare complication of numerous viral infections. Here we report a case of fulminant myopericarditis presenting with acute heart failure and a state of shock in a previously healthy young woman. H1N1 influenza A virus sequences were identified in throat and pericardial fluid, suggesting a viral source of the infection.

PMID:
22074554
[PubMed - as supplied by publisher]

http://www.ncbi.nlm.nih.gov/pubmed/22074554

 

[tetano]

Re: Sudden deaths and influenza

Mike Coston wrote a good piece on gastrointestinal bird flu infections

http://afludiary.blogspot.com/2011/11/5969-gastrointestinal-h5n1-infection-in.html

Gastric symptoms, including diarrhea and vomiting, afflicts about one in five people with swine flu.
I wonder if the virus through the intestinal epithelium can go directly into the bloodstream and cause e.g. phenomenon of thrombosis or strokes that are the cause of sudden deaths

 

[tetano]

Re: Sudden deaths and influenza

From Emerging Infectious Diseases
Deaths Associated With Pandemic (H1N1) 2009 Among Children, Japan, 2009-2010

Akihisa Okumura, MD, PhD; Satoshi Nakagawa, MD, PhD; Hisashi Kawashima, MD, PhD; Takashi Muguruma, MD, PhD; Osamu Saito, MD; Jun-ichi Fujimoto, MD; Chiaki Toida, MD; Shuji Kuga, MD; Toshihiro Imamura, MD; Toshiaki Shimizu, MD, PhD; Naomi Kondo, MD, PhD; Tsuneo Morishima, MD, PhD

...
As of March 31, 2010, the Ministry of Health, Labour, and Welfare (MHLW) reported on its website (www.mhlw.go.jp/kinkyu/kenkou/influenza/houdou.html) that 198 patients in Japan with pandemic (H1N1) 2009 had died, of whom 41 were children <20 years of age.

..

For 34 (83%) children, a life-threatening event occurred within 2 days after influenza onset (Figure 2). Twenty-nine (71%) children died within 4 days after influenza onset (Figure 2)

..

Cause of death was categorized as unexpected cardiopulmonary arrest (CPA) for 15 patients, encephalopathy for 15, respiratory failure for 6, myocarditis for 2, viral sepsis for 2, and incidental for 1. Median age of patients who died of unexpected CPA was 43 months. Only 1 of these patients had a preexisting condition. For 13 patients, unexpected CPA occurred outside the hospital; most patients were presumed to have been found several hours after CPA. Two patients experienced unexpected CPA in the hospital, 1 in the outpatient clinic and 1 during hospitalization. Chest radiographs and CT scans of the head and chest were unremarkable for all children examined.

..

Encephalopathy was considered the cause of death for 15 patients (median age 62 months)

...

Six patients were judged to have died of respiratory failure

..

Two patients died of myocarditis; both were ≥12 years of age and previously healthy. One had unexpected circulatory collapse in a local pediatric clinic; the other was found lying on the floor at home without preceding respiratory or neurologic symptoms. At admission, both patients had markedly elevated creatine kinase (>9,000 IU/L) and markedly reduced cardiac output on cardiac ultrasonography; chest radiographs were unremarkable. In the clinic patient, intensive resuscitation, including intra-aortic balloon pumping and continuous hemodiafiltration, was performed but was ineffective.

...


Most life-threatening events occurred on the day of or 1 day after influenza onset.
..


Alanine transaminase and creatine kinase levels were significantly higher in patients with unexpected CPA than in those with respiratory failure.

...

Discussion


Most cases were in young, previously healthy children who died after a brief fulminant illness.Unexpected CPA and acute encephalopathy were the leading causes of death. Children who died of respiratory failure often had preexisting conditions, whereas unexpected CPA occurred among younger children without preexisting conditions.

..

Unexpected CPA was another leading cause of death associated with pandemic (H1N1) 2009 among children in Japan. Most cases of unexpected CPA occurred in previously healthy children <5 years of age. The elevated alanine transaminase and creatine kinase levels in these children could be attributable to postmortem changes. The direct cause of unexpected CPA is difficult to determine. One possible explanation is severe brain damage resulting in CPA; however, none of the patients in our study had obvious neurologic signs or symptoms until CPA, nor did they have any evidence of brain herniation. Abrupt onset of CPA suggests a cardiogenic origin such as fatal arrhythmia from undetected myocarditis.[29,30] Myocarditis associated with pandemic (H1N1) 2009 has been reported.[31,32] Gdynia et al. reported an unexpected death of a young adult caused by pandemic (H1N1) 2009–associated myocarditis.[31] The clinical course in this patient was characterized by sudden collapse at home followed by fatal arrhythmia. Viral sepsis may also be related to unexpected CPA. Clinical signs of viral sepsis are nonspecific and may be missed. Considering that most cases of unexpected CPA occurred outside the hospital, rapid progression of viral sepsis may have occurred. Unexpected CPA has also been reported in some case series.[5–7,24,33] Cardiac arrest outside the hospital was observed for 67 of 270 children who died in the United States.[24] In a report from England, 16 of 70 children who died were in CPA when seen in an emergency department.[7] Detailed postmortem examinations are necessary to clarify the mechanism of unexpected CPA.

http://wwwnc.cdc.gov/eid/article/17/11/pdfs/11-0649.pdf

 

[tetano]

Re: Sudden deaths and influenza

from the post above:

In a report from England, 16 of 70 children who died were in CPA when seen in an emergency department.

The original article is the following:

The Lancet, Volume 376, Issue 9755, Pages 1846 - 1852, 27 November 2010
doi:10.1016/S0140-6736(10)61195-6Cite or Link Using DOI
Published Online: 27 October 2010
Paediatric mortality related to pandemic influenza A H1N1 infection in England: an observational population-based study

from the abstract:

19 (27%) deaths occurred before inpatient admission. Children in this subgroup were significantly more likely to have been healthy or had only mild pre-existing disorders than those who died after admission (p=0?0109).

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)61195-6/abstract?_eventId=login

 

[tetano]

Re: Sudden deaths and influenza

In the northern hemisphere winter of 2003–04 antigenic variant strains (A/Fujian/411/02 –like and A/Korea/770/2002-like) of influenza A H3N2 emerged and had drifted antigenically from the A/Panama/2007/99 virus, the H3N2 component of the 2003–2004 influenza vaccine.
Circulation of these strains in the UK and in USA was accompanied by an unusually high number of laboratory confirmed influenza associated fatalities in children. Several indicators suggest that this season was more severe than the previous three seasons. These indicators included estimates of outpatient visits, pediatric hospitalizations, and influenza-related mortality.

One hundred fifty-three influenza-associated deaths among children from October 11, 2003, through April 13, 2004, were reported to the CDC by 40 state health departments.

Seventeen fatal cases of laboratory-confirmed influenza A in children under eighteen years were reported to HPA between September and December 2003.

The median age of the american children was 3 years (range, 2 weeks to 17 years).

The median age of british cases was two years, with a range from four months to seventeen years.

Among the 149 american children for whom information on underlying health status was available, 70 (47 percent) had previously been healthy.

Among the sixteen british cases for whom underlying health status information was available none was recorded as having a known risk factor for severe influenza.

Forty-five american children (29 percent) died within three days after the onset of illness, and eight (5 percent) died within one day. Sepsis or shock were diagnosed in 50 (34 percent). 47 (31 percent) died at home or in transit to a health care facility. 31 of the 47 children who died outside a hospital (66 percent) had a temperature of 38°C or higher, 35 (74 percent) had respiratory symptoms, and 18 (38 percent) had gastrointestinal symptoms. 6 died of myocarditis or pericarditis and 2 of myocardial infarction.
Among the causes of death there was fulminant progression to death after an initially mild illness. The mechanisms of these sudden deaths are unknown but could include an exaggerated inflammatory response to influenza-virus infection or complications of an unrecognized metabolic disorder.

Four (24%) british deaths were sudden with either no recognized antecedent illness or illness of less than 6 hours duration. A further four (24%) occurred within forty-eight hours of onset of symptoms.
Eight (47%) children died following hospitalization and nine (53%) died in the community. In the cases with recognized antecedent illness, eight (57%) had fever, eleven (79%) had respiratory symptoms (cough/chest infection/croup), three (21%) had vomiting and/or diarrhea, two (14%) had clinically recognized sepsis. Two (14%) children were markedly confused prior to collapse. Myocarditis was detected in two cases (12%).
The range of clinical complications in UK fatal cases can be grouped into categories including fulminant progression to death after an initially mild illness.

In the british case series over 40% of death certificates had no mention of influenza as a direct or indirect cause of death, and in over 70% of cases the diagnosis of influenza was not made until post mortem tissue was examined. The burden of influenza in young children is therefore under recognized, precisely because few influenza infections are recognized clinically.The number of deaths is not comprehensive and is likely to underestimate the number of fatal cases that occurred.



Influenza-Associated Deaths among Children in the United States, 2003–2004
Niranjan Bhat, M.D., Jennifer G. Wright,et al.
N Engl J Med 2005; 353:2559-2567December 15, 2005

http://www.nejm.org/doi/full/10.1056/NEJMoa051721#t=articleTop

Fatal Cases of Influenza A in Childhood.
Johnson BF, Wilson LE, Ellis J, Elliot AJ, Barclay WS, et al. (2009)
PLoS ONE 4(10): e7671. doi:10.1371/journal.pone.0007671

http://www.plosone.org/article/info:doi/10.1371/journal.pone.0007671

 

[tetano]

Re: Sudden deaths and influenza

Myocardial Injury and Bacterial Pneumonia Contribute to the Pathogenesis of Fatal Influenza B Virus Infection
J Infect Dis. (2012) doi: 10.1093/infdis/jir861

An autopsy study involving influenza B infections revealed how histologically similar the disease is to fatal influenza A and how quickly it can kill, challenging the notion that it is milder than influenza A.

Influenza B is more fatal in children, though the disease can cause a substantial number of seasonal flu infections in adults, including some deaths, according to the researchers.

Of 35 patients with available information, 24 (69%) died within 4 days of illness onset.

The group said the rapid progression from illness onset to death was a notable finding, with durations that were shorter than several other flu viruses, including the 1918 pandemic H1N1, 2009 H1N1, and seasonal H3N2. They added that reasons for the variations, which could relate to the disease itself or various biases, still need to be determined.

Myocardial injury was seen in 20 (69%) of 29 case-patients for whom samples were available. Investigators found that 17 patients had evidence of myocyte damage, including 10 with myocarditis. They didn't find viral antigens in any of the myocardial samples, though rRT-PCR testing found evidence of influenza B from one patient's myocardial tissue.

Regarding the cardiac findings, the authors said they were surprised about how frequent evidence of cardiac damage was found, even when tests didn't reveal myocarditis.

http://jid.oxfordjournals.org/content/early/2012/01/28/infdis.jir861.abstract

http://www.cidrap.umn.edu/cidrap/content/influenza/general/news/feb0112influenzab.html

 

[Tonka]

Re: Sudden deaths and influenza

http://ottawa.ctv.ca/servlet/an/loc...T_HOCKEYDEATH_120206/20120206/?hub=OttawaHome

CTV OTTAWA
Teen boy dies after collapsing during a hockey game

Tyler Kerr died after suffering a cardiac arrest at an Ottawa-area hockey arena on Feb. 6, 2012.


A 15-year-old boy is dead after collapsing at an arena in Carp during a hockey game Sunday, Feb. 5, 2012.
Updated: Mon Feb. 06 2012 5:43:40 PM

ctvottawa.ca

The family of 15-year-old Tyler Kerr is at a loss as they question how a healthy teen could have suffered a cardiac arrest and die unexpectedly.

His uncle, Curtis Kerr, told CTV his nephew did not have any known health issues and that they have no idea why his heart suddenly stopped....

...CTV has confirmed Kerr was not hurt during the game and that he did not complain about feeling sick leading up to the collapse.

Autopsy results are pending.

more from the source.

 

[tetano]

Re: Sudden deaths and influenza

In the course of the season just passed I renewed the work of monitoring deaths that have the characteristics of sudden deaths ( without previous symptoms) and fulminant (shorty after influenza like illnesses) as well as I did during the season 2010/11.

The interest of the comparison between the two seasons is given by the different epidemiological characteristics , since the first season was dominated by the virus H1N1 ( with a 26% of virus B) and the second by the virus H3N2.

In the period between mid December and the end of March, which coincides with the prevalent circulation of the influenza virus, I counted a total of 35 deaths, of which 23 in the period between 14/01 and 15/02.

Over the same periods last season the total deaths were 85 and 44 respectively.

Many of the deaths occurred in the period in which the circulation of the influenza virus is higher so it is reasonable to suspect that the virus is implicated, at least in a part of the cases, .

The number of deaths registered during the season 2010/11 is considerably higher ( more than double ) than those of the last season, indicating a possible greater impact linked to the pandemic virus.

 

[tetano]

Re: Sudden deaths and influenza

Vomiting toddler sent home from hospital with ibruprofen... and dies just 22 hours later

A two-year-old girl died just 22 hours after doctors sent her home from hospital with ibuprofen, an inquest heard.

Michelle Fernando began displaying flu-like symptoms one week after her mother Uthpala, 27, fell ill swine flu.

Her concerned father Rashid, 30, took her to Bristol Children?s Hospital but doctors sent her home with the painkiller and advised her parents to give her plenty of water.

Michelle suddenly stopped breathing the following day and she was rushed back to hospital by ambulance but pronounced dead on arrival.

Traces of the deadly swine flu virus were found in her nose and throat but a pathologist ruled that she died of pneumonia and septicaemia.
The inquest at Flax Bourton Coroner?s Court, near Bristol, heard how doctors examined the toddler but sent her home after diagnosing a viral infection on November 17, 2009. But the next night she started having difficulty breathing.



...

Read more: http://www.dailymail.co.uk/health/a...-hours-sent-home-ibuprofen.html#ixzz214tkRRBN

 

[tetano]

Re: Sudden deaths and influenza

Sudden and fulminant deaths of healthy children in Italy during the 2010-11 and 2011-12 seasons: results of an online study
Stefano Prandoni

Published: 2012-07-31 15:11:31 | DOI: 10.4081/jphr.2012.e29 | Abstract views: 37
Search for citations in Google Scholar
Related articles: Google Scholar

Abstract

The 2009 pandemic in Italy has been viewed as a false alarm, and it has not been properly understood based on historical precedents and more in-depth studies that have been conducted in other countries. Some of these studies have pointed to a phenomenon of sudden and fulminant death among healthy children, which is not the sole prerogative of pandemic influenza, but was, in 2009, a more frequent occurrence than in previous years. The purpose of this study is to gather such cases occurring during the 2010-11 and 2011-12 seasons. Google Search was used in order to find cases of children and teens with no reported preexisting conditions of relevance and who died suddenly and unexpectedly after exhibiting flu-like symptoms during the two seasons. During the 2010-11 season, 29 deaths were found to meet the above conditions, 18 of which were fulminant and 11 sudden. For the 2011-12 season, there were ten such cases: five fulminant and five sudden. Most of these cases occurred during the period of maximum circulation of the flu virus. Fulminant deaths were three times more frequent during the first of these seasons and involved children of a higher average age than the more recent season. It is not possible to come to any definite conclusions, but there is reason to suspect that the driver of this significant increase may be the A(H1N1)pdm09 virus. Regardless of how one wishes to interpret these results, it is advisable that the surveillance systems be strengthened and more recent study techniques be adopted in order to determine the causes of similar deaths in the future.

full article

http://www.jphres.org/index.php/jphres/article/view/jphr.2012.e29

 

[tetano]

Re: Sudden deaths and influenza

Pediatric studies show the flu's deadly danger, the benefits of school vaccinations


Findings among the research featured at first IDWeek conference


San Diego, CA (October 19, 2012) – New data being presented at IDWeek 2012TM shows the fatal risk that influenza poses even for children without underlying health conditions and the effectiveness of school-based vaccination programs in protecting student populations. Together, these findings support the crucial public health message that families should take the flu virus seriously every year.

One study viewed influenza from an epidemiological perspective, analyzing U.S. pediatric influenza-associated deaths over an eight-year period and finding that 43 percent of the deaths occurred in children with no health conditions, such as asthma or diabetes, that would have predisposed them to being at high risk of serious flu complications. Moreover, the study found that those young, previously healthy patients succumbed faster. The median duration of illness from onset of initial symptoms to death was four days in children with no underlying high-risk health conditions compared with seven days in children with at least one such condition.

"During the 2004-2012 influenza seasons, almost half the children who died had been previously healthy," said Karen K. Wong, MD, an Epidemic Intelligence Service officer with the Centers for Disease Control and Prevention (CDC) and the study's lead researcher. "The numbers demonstrate how important it is for all children, even children who are otherwise healthy, to get a flu vaccine every year, and underscore why all children with severe illness should get treated early with influenza antiviral medications."

The other study looked at influenza from a proactive perspective, assessing the impact of immunization programs in elementary schools in the Los Angeles area and finding lower rates of flu and higher rates of attendance. At one school where nearly half of the students received either a flu shot or the nasal spray, a "herd immunity" seemed to even safeguard the unvaccinated children.

"It's the school-aged children who spread the flu. They generally are contagious even when active, so they tend to be around other children, giving it to them and spreading it for longer periods of time," said lead researcher Pia Pannaraj, MD, an assistant professor of pediatrics at the University of Southern California and Children's Hospital Los Angeles. "It seems like the best place to prevent community spread of influenza is actually to go and prevent it at the school level."

This work is among the significant research being discussed at the inaugural IDWeek meeting, taking place through Sunday in San Diego. With the theme Advancing Science, Improving Care, IDWeek features the latest science and bench-to-bedside approaches in prevention, diagnosis, treatment, and epidemiology of infectious diseases, including HIV, across the lifespan. More than 1,500 abstracts from scientists in this country and internationally will be highlighted over the conference's five days.

...

http://www.eurekalert.org/pub_releases/2012-10/sfhe-pss101212.php

 

[tetano]

Re: Sudden deaths and influenza

Healthy Birmingham schoolgirl dies of swine flu day after 16th birthday




A healthy Birmingham schoolgirl died of swine flu the day after celebrating her 16th birthday.

Amie Prosser collapsed at the family home in Short Heath after complaining of stomach pains.

Her mum Julie Cooper broke down as she told an inquest of the moment she knew her daughter had died.

?I screamed for her brother Anthony and said something had happened to Amie,? she said.

?He phoned the ambulance while I tried to get her to breathe again. I knew straight away she was dead ? I knew it.?

Mrs Cooper said Amie had earlier been violently sick and had been sent home early from school.

She said the teenager?s lips turned blue as she collapsed in the lounge.

Amie died on December 10, 2009 ? the day after her birthday ? as a second wave of the deadly H1N1 virus swept the country.

An inquest at Sutton Coldfield Town Hall heard tests on her body returned positive results for swine flu.

The precise cause of death was given acute myocarditis ? an inflammation of the heart ? caused by H1N1 influenza.



http://www.birminghammail.co.uk/news/local-news/healthy-birmingham-schoolgirl-dies-swine-2995266

 

[tetano]

Re: Sudden deaths and influenza

During the last three seasons I implemented a monitoring of sudden deaths of people under the age of 65 years for 'malore' ( sudden illness), with no reports of pathologies and/or past predisposition and not related to physical activity. The research is based on the Google search engine, for the months of December, January, February and March, using the key words 'morte'(death) and 'malore' ( sudden illness), in chronological order from the first to the last day of each month. The goal of this survey is to use the Internet to gather news related to cases of unexplained sudden deaths among otherwise healthy adults during the 2010-11, 2011-12 and 2012-13 seasons, while taking account of the different epidemiological development, with the first and the last seasons being characterized by the A(H1N1)-pdm09 virus and the second by the A(H3N2) virus.
In the winter months there is a spike in mortality from respiratory and circulatory causes and various explanations of this phenomenon may be found.
Among the most credited there are climatic factors (low temperatures). Research suggests that EWM ( excess winter mortality) may be higher in countries with a warmer winter climate because people there tend to take fewer precautions against the cold. These countries tend to have homes with poorer thermal efficiency (for example, fewer homes have cavity wall insulation and double glazing), which makes it harder to keep homes warm during the winter. It has been shown that low indoor temperature is associated with higher EWM from cardiovascular disease in England. The Eurowinter group (1997) reported that compared with people living in countries with cold winters, those from warmer countries were less likely to wear warm protective clothing in cold weather.
Although EWM is associated with low temperatures, conditions directly relating to cold, such as hypothermia, are not the main cause of excess winter mortality. The majority of additional winter deaths are caused by cerebrovascular diseases, ischaemic heart disease and respiratory diseases (The Eurowinter group, 1997 and ONS, 2010). Although cancer causes more than a quarter of all deaths annually, previous research found that there was no clear seasonal pattern for these deaths.
The cold can have various physiological effects, which may lead to death in vulnerable people.
Woodhouse et al found that colder home temperature was associated with increased blood pressure in older people. The Eurowinter group (1997) noted that cold causes haemoconcentration, which leads to thrombosis, and that cold can also lower the immune system?s resistance to respiratory infections.
Another major cause of EWM can be linked to environmental factors: evidence of association between exposure to air pollution and overall cardiovascular morbidity and mortality is increasingly found in the literature. Exposure to higher than usual levels of air-borne air pollutants over a few hours to several days has been reported to contribute to increased risk of myocardial infarction, arrhythmia, stroke and heart failure in susceptible patients. In particular, the focus has been on fine particulate matter (PM) <2.5 ?m in aerodynamic diameter (PM2.5). More recently, ultrafine particles <0.1?m, nitrogen oxides, ozone, elemental carbon, organic carbon and other sources of air pollutants (eg traffic and accidental fires) have also been studied.
In recent years increasing evidence show a correlation between winter mortality and circulation of infectious agents, in particular of influenza virus.
The level of influenza circulating in the population increases in winter and in vulnerable groups, such as the elderly or those with pre-existing health problems influenza can lead to life-threatening complications, such as bronchitis or secondary bacterial pneumonia.Indeed most influenza related deaths are not due directly to the primary viral infection but are from complications such as secondary bacterial pneumonia or worsening of chronic health conditions such as congestive heart failure or pulmonary disease. As a result, most persons for whom influenza initiated the chain of events leading to death will not be tested for influenza at the time of death or even at the time of hospitalization and will no longer be shedding virus by the time they are brought to medical attention.
Most measures of influenza-related mortality are estimates based on calculating the number of deaths occurring above, or in excess of, the number expected for that time of year if influenza viruses were not circulating. Data are typically collected from death certificates and the outcomes most frequently used are pneumonia and influenza deaths, respiratory and circulatory deaths, or all cause deaths. Counting only pneumonia and influenza deaths produces a very conservative estimate of influenza associated mortality that likely underestimates the true impact of influenza, while using increases in deaths due to all causes attributes any seasonal increase in the number of deaths to influenza and likely overestimates the impact of influenza.

Influenza (and other upper respiratory infections) may trigger cardiovascular events by causing an acute and severe inflammatory state in the body which can lead to destabilization and rupture of atherosclerotic plaques.
The influenza attack rate in a typical year is 10?20% and, given the high burden of symptomatic and asymptomatic coronary artery disease, many of these cases occur in subjects with coronary heart disease (CHD). This attack rate (and in many cases, the severity of the subsequent disease) will be even higher during epidemics and pandemics. Accordingly, it has been noted that during influenza epidemics and pandemics (except for 1918 Spanish flu pandemic), roughly twice as many subjects die of cardiac causes rather than from influenza pneumonia.



Over the last three seasons in Italy, two years were marked by prevailing circulation of pandemic H1N1-09 virus (in 2010-11 and in 2012-13) and a year in which the seasonal H3N2 virus prevailed (2011-12). My working hypothesis is that the pandemic virus, targetting the population under 65 years, may have resulted in an excess of mortality from cardiovascular causes, including sudden deaths for ' malore ', in this population, unlike the seasonal virus, which mostly affects the elderly.
An unconventional research method has been adopted, one based on an examination of news found online using Google Search. Internet can be an innovative tool of great potential used along side, if not replacing, traditional monitoring systems in order to increase detection capabilities, particularly in countries where the monitoring tools have proven inadequate in documenting the true impact of epidemics related to traditional or emerging viruses.

At other times of the year, outside of the winter , the fatal sudden events with features that I have indicated range around 30 per month. Only in the last 15 days of August 2011, under a heatwave, the incidence was double.
During the last season (2012-2013) I recorded the following data:


December 39
January 65
February 65
March 51

By comparison, in the 2011-12 season, dominated by H3N2 virus and that has been characterized by very high levels of mortality in the elderly, the number of deaths recorded in January was 38 and in February 43 (coinciding with a wave of very low temperatures that hit Italy in the first half of the month). In December and March were 34 and 29 respectively.

In the period between mid-January and mid-February of the 2011 during the period of maximum circulation of the H1N1 flu virus, in the second year of circulation in Italy and without abnormal cold waves, such deaths were 125.

from 01/01 to 01/14 31
from 01/15 to 02/15 125
from 02/16 to 02/28 24
March 56


My survey did not pretend to prove a certain role of pandemic influenza in determining more of these events in individuals younger than 65 years, but wants to be a starting point for methodologically sound investigations to shed light on the association between influenza and cardiovascular diseases, expecially in a country like Italy which lacks rapid mortality indicators adopted by many western countries.