- Swine flu [influenza pandemic (H1N1) 2009 virus infection]
is most dangerous when it causes the lungs to become inflamed, flood
with fluid, and fail to function, doctors in Australia and New Zealand
have found. While a majority of people infected with the virus have
a mild illness, a small number develop life-threatening disease,
intensive care specialists Steven Webb and Ian Seppelt said. They
described the most common of 3 main complications from the pandemic
2009 strain as "flu A-associated acute respiratory disease syndrome",
or "FLAARDS."
-
- "FLAARDS -- sometimes with associated multiple organ
failure -- is the most common syndrome and has the highest attributable
mortality," Webb and Seppelt wrote in an editorial in the September
[2009] issue of the medical journal Critical Care and Resuscitation
[text and abstract not yet available. - Mod.CP]
-
- The new pandemic (H1N1) 2009 influenza strain has killed
at least 3917 people and spread to 191 countries and territories
since its discovery in Mexico and the US in April 2009. Hospitals
in the Northern Hemisphere are bracing for a surge in flu cases in
coming weeks, spurred by colder weather that promotes its spread.
In Australia, flu patients occupied a quarter of beds in intensive
care units last winter [2009] and 178 died.
-
- Cases may be peaking in Hong Kong. Average daily attendance
at the city's accident and emergency departments rose from 6354 in
the last week of August [2009] to 7086 last week [week of 21 Sep
2009], according to a government statement on 25 Sep 2009. The virus
has killed at least 23 people in Hong Kong.
-
- Intensive care doctors in Australia and New Zealand are
pooling data on more than 400 swine flu cases to describe disease
patterns and treatment strategies, and inform the Northern Hemisphere
countries about what to expect this winter [2009-10]. "ICUs
[intensive care units] are the 'canary in the coal mine'," Webb
and Seppelt wrote in the editorial. "It is only by documenting
the severe cases requiring intensive care that it is possible to
get an idea of the overall impact of this new disease."
-
- In Victoria, Australia's 2nd most-populous state, the
pandemic virus sickened about 5 per cent of the population, with
0.3 per cent of infected patients being hospitalized, health officials
said in a study yesterday [28 Sep 2009] in the Medical Journal of
Australia. One in 5 people admitted to the hospital were transferred
to an ICU, mostly because of severe respiratory failure. 85 per cent
of critically ill patients survived after staying an average of 9
days in ICU. Almost 3/4 of these patients required mechanical ventilation
to breathe and 7 per cent needed to have their blood pumped through
an artificial lung in a procedure known as extracorporeal membrane
oxygenation, or ECMO.
-
- In most cases, flu remains in the nose, throat and bronchi,
where it causes a runny nose, sore throat, and cough until the body's
immune systems eliminates it, usually within a week. The new pandemic
(H1N1) 2009 strain may be at least 1000 times more adept than seasonal
flu at infiltrating the lower branches of the airway, said Yoshihiro
Kawaoka, a virologist at the University of Tokyo, who has studied
the viruses in non-human primates.
-
-
- In severe cases, influenza can damage the capillaries
surrounding the tiny grape-like sacs, known as alveoli, where gas
is exchanged through the blood. Damaged alveoli can bleed, causing
pulmonary hemorrhage and blood clots. Inflammatory substances are
produced by the immune system to fight the infection and repair the
damage. An over-exuberant response can worsen the effect by filling
the lungs with fluid and cause permanent scarring that restricts
lung function.
-
- Besides FLAARDS, the other predominant disease patterns
associated with the pandemic flu virus are community-acquired bacterial
pneumonia and an exacerbation by the virus of airflow limitation,
Webb and Seppelt said. Life-threatening infection may be more common
in people with underlying health conditions, including morbid obesity,
type-2 diabetes, cancer, a weakened immune system, and chronic lung
disease, they said. Pregnant women and those who recently gave birth
also appear at higher risk.
-
- Still, "many patients with FLAARDS are young and
previously well," they said. In Australia, the median age of
people dying from seasonal flu is 83. In the case of the novel pandemic
(H1N1) 2009 virus, it is 51 years, the health department said in
a report last week [week of 21 Sep 2009].
-
- http://www.bloomberg.com/apps/news?pid=20601081&sid=aPd3JODa5N08
-
-
- Communicated by ProMED-mail rapporteur Mary Marshall
-
- These observations reinforce those described in the preceding
ProMED-mail report [Influenza pandemic (H1N1) 2009 (60): bacterial
coinfection 20090930.3410] that bacterial coinfection was observed
frequently in lung tissue specimens from fatal cases of influenza
pandemic (H1N1) virus infection in the USA. - Mod.CP
-
-
- INFLUENZA PANDEMIC (H1N1) 2009 - TAIWAN HOSPITALIZED
CASES
-
-
- Date: 1 Oct 2009 Source: Taiwan Epidemiology Bulletin,
Taiwan Centers for Disease Control
-
- http://teb.cdc.gov.tw/main_e/news_list.aspx?id=2344
-
- Early release: the first 100 hospitalized severe complicated
influenza cases caused by 2009 pandemic influenza A (H1N1) in Taiwan
2009/09/25
-
- Abstract
-
-
- To understand the features of the severe complicated
influenza patients caused by 2009 pandemic influenza A (H1N1), we
retrospectively reviewed the medical records of the 1st 100 laboratory-confirmed
cases (by date of onset), analyzed all clinical variables and described
their clinical and epidemiologic characteristics.
-
-
- The cases had onset dates from [2 Jul 2009 to 29
Aug 2009];
-
- half of them were adults and the other half were children.
The median age was 16.5 years. 38 had preexisting medical conditions; 6
of the 50 adults were morbidly obese; 8 of the 50 children were obese,
and 2 women were pregnant. The most common initial presentations
were fever (99 per cent) and cough (93 per cent). 89 patients had
viral pneumonia; 23 were complicated with respiratory failure requiring
mechanical ventilation, and 9 were treated with concomitant support
by extra-corporeal membrane oxygenation.
-
-
- By [18 Sep 2009], 82 patients recovered and were discharged
from the hospitals; 9 were still hospitalized, and the remaining 9 patients
(including 2 obese patients and one pregnant woman) died. The median time
between onset of symptoms and 1st doctor visit was one day, and the median
hospital stay for those who had been discharged was 6 days. The average
duration from onset of symptoms to the date of rapid testing, admission,
or prescription of oseltamivir for patients with onset after [15
Aug 2009] was shorter than those with onset before [15 Aug 2009].
-
-
- In conclusion, most of the severe complicated influenza
patients caused by
-
- 2009 pandemic influenza A (H1N1) were children and
young to middle-aged adults; overweight and pregnancy posed higher
risk to these patients. The preventive and control measures conducted
by the public health sector have effectively accelerated diagnosis
and treatment. However, quality of medical care remains to be improved
to further reduce the number of severe complicated influenza cases
and mortality.
-
- Centers for Disease Control, Department of Health, Executive
Yuan, Taiwan, R.O.C. Copyright: All rights reserved. 2007 No. 6,
Linshen South Road, Taipei, Taiwan 10050, R.O.C. Communicable Disease
Reporting and Consultation Hotline: 1922
-
- The full article is presently only available in Chinese
and can be found at http://teb.cdc.gov.tw/upload/doc/23452_
- 25-10-%E7%B6%B2%E8%B7%
- AF%E9%A0%90%E5%A0%B1-%E4%B8%AD.pdf.
-
-
- An English translation of the full article should be
available by about 25 Oct 2009.
-
- Communicated by Angela Song-En Huang, MD MPH Field Epidemiology
Training Program Taiwan Centers for Disease Control <mailto:huang.songen@gmail.com>huang.songen@gmail.com
-
-
- Jen-Hsiang Chuang, MD MS PhD Epidemic Intelligence Center
Taiwan Centers for Disease Control <mailto:jhchuang@cdc.gov.tw>jhchuang@cdc.gov.tw
-
- ProMED-mail would like to thank Dr Angela Song-En Huang
and Dr Jen-Hsiang Chuang for alerting us to this document. As with
other reports on hospitalized/severe cases of influenza pandemic
(H1N1) 2009 virus infection, the high risk groups appear to include
younger ages, pregnant women, and obese individuals (see ProMED-mail
postings below). Of concern is the stated figure that 89 (89 per
cent) of the severe cases had viral pneumonia, a significantly higher
percentage than reported elsewhere (see ProMED-mail postings below).
-
-
- The recent ProMED-mail posting on FLAARDS [flu A-associated
acute respiratory
-
- disease syndrome] described in Australia and New
Zealand mentions that
-
- 20 per cent of hospitalized patients had severe respiratory
disease with FLAARDS
-
- requiring intensive care unit management of the
cases [Influenza pandemic (H1N1)
-
- 2009 (61): FLAARDS 20091001.3419].
-
-
- Of note is the recent description of 29 per cent of severe
cases in the USA with secondary bacterial pneumonia Influenza pandemic
(H1N1) 2009 (60): bacterial coinfection 20090930.3410.
-
- For a map of Taiwan, see http://www.lib.utexas.edu/maps/middle_east_and_asia/taiwan_pol92.jpg.
-
-
- For the interactive HealthMap/ProMED map of Taiwan,
see <http://healthmap.org/r/00DX>http://healthmap.org/r/00DX.
- Mod.MPP
-
-
-
- Patricia A. Doyle DVM, PhD Bus Admin, Tropical Agricultural
Economics Univ of West Indies Please visit my "Emerging Diseases"
message board at: http://www.emergingdisease.org/phpbb/index.php Also my
new website: http://drpdoyle.tripod.com/ Zhan le Devlesa tai sastimasa
Go with God and in Good Health
-
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