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Self evident … ***************** Begin forwarded message: From: "Kevin Gainer" <kgainer@xxxxxxxxxxxxxxx> Date: October 12, 2009 10:25:25 AM EDT To: <dave@xxxxxxxxxx>, <munsup.seoh@xxxxxxxxxx> Subject: Distribute to your entire
address book so people can protect themselves
last several days, we are starting to get an
avalanche of medical journal articles documenting early experience with the
virus. below are just a couple from this morning and the news is very bad. this is a very, very serious situation. the
epidemiology does have some marked differences compared
to "regular" flu including marked attack on lung tissue and
resulting oxygen deprivation. this is detailed in stories below. the bottom line is deaths in young ARE
ALREADY AT ABOUT THE LEVEL SEEN IN LAST SEASON FOR ENTIRE YOUNG COHORT AND
SEASON HASN'T EVEN STARTED YET. if the vaccine becomes available make sure
you get it and particularly any youth you know. H1N1 Critical Illness Can Occur Rapidly;
Predominantly Affects Young Patients
Newswise
— Critical illness among Canadian patients with 2009 influenza A(H1N1) occurred
rapidly after hospital admission, often in young adults, and was associated
with severely low levels of oxygen in the blood, multi-system organ failure, a
need for prolonged mechanical ventilation, and frequent use of rescue
therapies, according to a study to appear in the November 4 issue of JAMA. This study is being
published early online to coincide with its presentation at a meeting of the
European Society of Intensive Care Medicine. Infection
with the 2009 influenza A(H1N1) virus has been reported in virtually every
country in the world. The World Health Organization declared the first phase
six (phase indicating widespread human infection) global influenza pandemic of
the century on June 11, 2009. The largest number of confirmed cases occurred in
North America between March and July 2009, according to background information
in the article. Anand
Kumar, M.D., of the Health Sciences Centre and St. Boniface Hospital, Winnipeg,
Manitoba, Canada, and colleagues with the Canadian Critical Care Trials Group
H1N1 Collaborative conducted an observational study of critically ill patients
with 2009 influenza A(H1N1) in 38 adult and pediatric intensive care units
(ICUs) in Canada between April 16 and August 12, 2009. The study focused on the
death rate at 28 and 90 days, as well as the frequency and duration of
mechanical ventilation and the duration of ICU stay. The
researchers found that a total of 168 patients had confirmed or probable 2009 influenza
A(H1N1) infection and became critically ill during this time period, and 24
(14.3 percent) died within the first 28 days from the onset of critical
illness. Five more patients died within 90 days. The average age of the
patients with confirmed or probable 2009 influenza A(H1N1) was 32.3 years, 113
were female (67.3 percent), and 50 were children (29.8 percent). “Our
data suggest that severe disease and mortality in the current outbreak is
concentrated in relatively healthy adolescents and adults between the ages of
10 and 60 years, a pattern reminiscent of the W-shaped curve [rise and fall in
the population mortality rate for the disease, corresponding to age at death]
previously seen only during the 1918 H1N1 Spanish pandemic,” the authors write. Patients
with 2009 influenza A(H1N1) infection-related critical illness experienced
symptoms for a median (midpoint) of four days before entering the hospital, but
worsened rapidly and required care in the ICU within one or two days. Shock and
multi-system organ failure were common, and 136 patients (81 percent) received
mechanical ventilation, with the median duration being 12 days. The average ICU
stay was 12 days. Lung rescue therapies included neuromuscular blockade,
inhaled nitric oxide and high-frequency oscillatory ventilation. “In
conclusion, we have demonstrated that 2009 influenza A(H1N1) infection-related
critical illness predominantly affects young patients with few major
comorbidities and is associated with severe hypoxemic respiratory failure,
often requiring prolonged mechanical ventilation and rescue therapies,” the
authors write. “With such therapy, we found that most patients can be supported
through their critical illness.” (JAMA.
2009;302(17):doi:10.1001/jama.2009.1496). Available pre-embargo to the media at www.jamamedia.org) Editor’s
Note: Please see the article for additional information, including other
authors, author contributions and affiliations, financial disclosures, funding
and support, etc. Editorial:
Preparing for the Sickest Patients With 2009 Influenza A(H1N1) In
an accompanying editorial, Douglas B. White, M.D., M.A.S., and JAMA
Contributing Editor Derek C. Angus, M.D., M.P.H., of the University of
Pittsburgh School of Medicine, write that many U.S. hospitals may not have
adequate numbers of physicians or staffing structures to facilitate timely
treatment of the most seriously ill patients with 2009 influenza A(H1N1). “Hospitals
must develop explicit policies to equitably determine who will and will not
receive life support should absolute scarcity occur,” they write. “Any deaths
from 2009 influenza A(H1N1) will be regrettable, but those that result from
insufficient planning and inadequate preparation will be especially tragic,”
they conclude. (JAMA.
2009;302(17):doi:10.1001/jama.2009.1539). Available pre-embargo to the media at
www.jamamedia.org) Editor’s
Note: Please see the article for additional information, including financial disclosures,
funding and support, etc. Critical Illness From 2009 H1N1 in Mexico
Associated With High Fatality Rate
Newswise
— Critical illness from 2009 influenza A(H1N1) in Mexico occurred among young
patients, was associated with severe acute respiratory distress syndrome and
shock, and had a fatality rate of about 40 percent, according to a study to
appear in the November 4 issue of JAMA.
This study is being published early online to coincide with its presentation at
a meeting of the European Society of Intensive Care Medicine. Novel
2009 influenza A(H1N1) was first reported in the southwestern United States and
Mexico in March 2009. Between March 18 and June 1, 2009, 5,029 cases and 97
documented deaths occurred in Mexico. The population and health care system in
Mexico City experienced the first and greatest early burden of critical
illness, according to background information in the article. Guillermo
Domínguez-Cherit, M.D. of Instituto Nacional de Ciencias Médicas y Nutrición
“Salvador Zubirán,” Mexico City, and colleagues conducted an observational
study of critically ill patients at six hospitals in Mexico that treated the
majority of such patients with confirmed, probable, or suspected 2009 influenza
A(H1N1) between March 24 and June 1, 2009. The study focused on the death rate,
rate of critical illness and mechanical ventilation, and length of stay in the hospital
and the intensive care unit. Among
899 patients admitted to hospitals with confirmed, probable, or suspected 2009
influenza A(H1N1), 58 became critically ill. The critically ill patients had a
median (midpoint) age of 44 years. Most were treated with antibiotics, and 45
patients were treated with anti-influenza drugs known as neuraminidase
inhibitors, including oseltamivir and zanamivir. Fifty-four patients required
mechanical ventilation. “Our
analysis of critically ill patients with 2009 influenza A(H1N1) reveals that
this disease affected a young patient group,” the authors write. “Fever and
respiratory symptoms were harbingers of disease in almost all cases. There was
a relatively long period of illness prior to presentation to the hospital, followed
by a short period of acute and severe respiratory deterioration.” By
60 days, 24 of the critically ill patients (41.4 percent) died. Nineteen
patients died within the first two weeks after becoming critically ill. “Patients
who died had greater initial severity of illness, worse hypoxemia [abnormally
low levels of oxygen in the blood], higher creatinine kinase levels, higher
creatinine levels, and ongoing organ dysfunction,” the authors report. “Early
recognition of disease by the consistent symptoms of fever and a respiratory
illness during times of outbreak, with prompt medical attention including
neuraminidase inhibitors and aggressive support of oxygenation failure and
subsequent organ dysfunction, may provide opportunities to mitigate the
progression of illness and mortality observed in Mexico,” they conclude. (JAMA.
2009;302(17):doi:10.1001/jama.2009.1536). Available pre-embargo to the media at www.jamamedia.org) Editor’s
Note: Please see the article for additional information, including other
authors, author contributions and affiliations, financial disclosures, funding
and support, etc. Most H1N1 Patients With Respiratory Failure
Treated With Oxygenating System Survive Illness
Newswise
— Despite the severity of disease and the intensity of treatment, most patients
in Australia and New Zealand who experienced respiratory failure as a result of
2009 influenza A(H1N1) and were treated with a system that adds oxygen to the
patient’s blood survived the disease, according to a study to appear in the
November 4 issue of JAMA.
This study is being published early online because of its public health
importance. The
influenza A(H1N1) pandemic affected Australia and New Zealand during the 2009
southern hemisphere winter, causing an epidemic of critical illness. Some
patients developed severe acute respiratory distress syndrome (ARDS) and were
treated with extracorporeal membrane oxygenation (ECMO), according to
background information in the article. ARDS
is a lung condition that leads to respiratory failure due to the rapid
accumulation of fluid in the lungs. ECMO is a type of life support that
circulates blood through a system that adds oxygen. ECMO was used for the
patients in this study because they developed very low blood oxygen levels that
developed rapidly despite standard ventilator (or respirator) settings. ECMO is
generally used for a limited time because of the risks of bleeding, clotting, infection,
and organ failure. The
Australia and New Zealand Extracorporeal Membrane Oxygenation (ANZ ECMO)
Influenza Investigators in collaboration with the Australian and New Zealand
Intensive Care Research Centre at Monash University in Melbourne, conducted an
observational study of patients with 2009 influenza A(H1N1)-associated ARDS
treated with ECMO in 15 intensive care units (ICUs) in Australia and New
Zealand between June 1 and August 31, 2009. The researchers looked at
incidence, clinical features, the degree of lung dysfunction, technical
characteristics, the duration of ECMO, complications, and survival. The
study found that 68 patients with severe influenza-associated ARDS were treated
with ECMO, including 53 with confirmed 2009 influenza A(H1N1). An additional
133 patients with influenza A received mechanical ventilation, but not ECMO, in
the same ICUs. The 68 patients who received ECMO had a median (midpoint) age of
34.4 years and half were men. “Affected
patients were often young adults, pregnant or postpartum, obese, had severe
respiratory failure before ECMO, and received prolonged mechanical ventilation
and ECMO support,” the authors write. The
median duration of ECMO support was ten days. At the time of reporting, 54 of
the 68 patients had survived and 14 (21 percent) had died. Six patients
remained in ICU, including two who were still receiving ECMO. Sixteen patients
were still hospitalized, but out of ICU, and 32 had been discharged from the
hospital. “Despite
their illness severity and the prolonged use of life support, most of these
patients survived,” the authors conclude. “This information should facilitate
health care planning and clinical management for these complex patients during
the ongoing pandemic.” (JAMA.
2009;302(17):doi:10.1001/JAMA.2009.1535. Available pre-embargo to the media at www.jamamedia.org) Editor’s
Note: Please see the article for additional information, including other
authors, author contributions and affiliations, financial disclosures, funding
and support, etc. H1n1 Flu Sweeping U.S.: Ut Health Science
Center at Houston Experts Available
Newswise
— Waiting rooms are full, physician phone lines are overwhelmed and questions
are running rampant as federal health officials say the H1N1 flu virus is
spreading quickly. "Emergency
departments are experiencing increasing patient loads as the epidemic
progresses. Fortunately, most patients are not seriously ill, though many
certainly feel terrible,” said Brent King, M.D., professor and chair of the
Department of Emergency Medicine at The University of Texas Medical School at
Houston. “But, unfortunately, there is little we can do for these patients that
they cannot do for themselves. Resting, maintaining hydration and judiciously
using medications to treat fever are the mainstays of managing influenza.” However,
King added that a very small number of people have developed serious
respiratory symptoms in association with H1N1 influenza. “People who are
concerned that they might be seriously ill should contact their personal
physician and follow her or his advice regarding further treatment. As always,
emergency physicians are available to evaluate and treat those who are very
concerned about their symptoms,” King said. Pediatric
neurologists at the UT Medical School at Houston say they expect possible
neurological complications, including seizures, from the virus and clinicians
should look for H1N1-associated encephalopathy in children. “We expect to see
the same problems with H1N1 that we do with seasonal flu. We’re telling our
residents to look for meningitis, encephalitis, myositis and peripheral
neuritis,” said Ian Butler, M.D., professor and chief of the Division of Child
Neurology at the medical school. Health
officials are encouraging pregnant women—at any point in their pregnancy—to be
vaccinated for the seasonal flu and the H1N1 influenza. “The seasonal influenza
vaccine is already available, so pregnant women should receive it now. The H1N1
vaccine can be given as soon as it is available in your community,” said Pamela
Berens, M.D., associate professor of obstetrics and gynecology at the UT
Medical School at Houston. “If the expectant mother has not yet been
vaccinated, both vaccines can actually be given the same day but should be
given in different sites. The vaccine should also be given to women who have
recently delivered to reduce their chance of becoming ill and possibly passing
the illness on to their young child.” Berens
said changes during pregnancy may result in more severe complications for
pregnant women than for other groups. “During pregnancy there is an increase in
your heart rate and the amount of blood that your heart pumps. There is also an
increased consumption of oxygen and your lungs may not expand as well due to
the increasing size of the uterus and baby. Changes in your body's ability to
respond to infection also occur. All of these changes together likely play a
role in the risk of influenza in pregnancy,” Berens said. “Any pregnant women
who suspects that she has influenza symptoms should contact her OB to discuss
possible treatment and should notify them if they experience any difficulty
with breathing.” Robert
Emery, Dr.PH, associate professor of occupational health at The University of
Texas School of Public Health, says prevention needs to be the main focus.
“Although there is a lot of attention being focused on shots for the seasonal
and H1N1 flu, individuals and businesses need to remember the power of
prevention and adhere to the basic practices of frequent hand washing and cough
control to help prevent the spread of the virus,” Emery said. Experts
who are available for interviews to discuss H1N1 flu include: •Brent
King, M.D., can provide information about H1N1 flu, hospital plans for
responding to this infectious disease and how to best protect children. He is
chairman of the Department of Emergency Medicine at The University of Texas
Medical School at Houston and provides emergency medical care to both children
and adults at Memorial Hermann-Texas Medical Center, Children's Memorial
Hermann Hospital and Lyndon B. Johnson General Hospital. •Richard
N. Bradley, M.D., chief of the Division of EMS and Disaster Medicine at The
University of Texas Medical School at Houston, can discuss how Americans and
emergency departments are being affected. •Pamela
Berens, M.D., associate of obstetrics and gynecology at The University of Texas
Medical School at Houston, can answer questions about concerns facing women who
are pregnant. She is able to discuss questions about the vaccine and what
pregnant women should do if they think they are infected. •Ian
Butler, M.D., professor and chief of the Division of Child Neurology at The
University of Texas Medical School at Houston, can discuss neurological
complications in children that can result from H1N1 and seasonal flu. •Galit
Holzmann-Pazgal, M.D, assistant professor of pediatrics in the Division of
Pediatric Infectious Disease at The University of Texas Medical School at
Houston, is available for interviews to discuss prevention and treatment of the
swine flu as it related to children. Holzmann-Pazgal is also medical director
of infection control for Children’s Memorial Hermann Hospital. •Gloria
Heresi, M.D, professor and interim director of the Division of Pediatric
Infectious Disease at The University of Texas Medical School at Houston, is
available for interviews with Spanish-language media. She can discuss
prevention and treatment of H1N1 as it relates to children. •Richard
Castriotta, M.D., professor and director of the Division of Pulmonary, Critical
Care and Sleep Medicine at The University of Texas Medical School at Houston,
can discuss the flu's leading causes of death, which are respiratory failure
and/or pneumonia. Castriotta sees patients at Memorial Hermann-Texas Medical
Center, Lyndon B. Johnson General Hospital and the UT Pulmonary Medicine
clinic. •John
Halphen, M.D., assistant professor of medicine in the Division of Geriatric and
Palliative Medicine at The University of Texas Medical School at Houston, can
discuss how flu-like illnesses affect the elderly, including the danger of
dehydration, the risk of secondary bacterial infections and potential
complications for patients who may be on medications such as diuretics. He
coordinates geriatric services at Lyndon B. Johnson General Hospital, part of
the Harris County Hospital District. •Robert
Emery, Dr.PH, vice president of safety, health, environment and risk management
at The University of Texas Health Science Center at Houston, is available to
discuss flu prevention, as well as protective equipment for health care professionals.
Emery, who has a faculty appointment at The University of Texas School of
Public Health, also can discuss emergency preparedness and business continuity
plans in coordination with the U.S. Centers for Disease Control and Prevention
and the World Health Organization. •George
Delclos, M.D. is a professor of occupational medicine at The University of
Texas School of Public Health. Dr. Delclos is able to advise on H1N1
flu-related work life issues such as working from home if you feel ill or what
employers should look for in their employees. •Charles
Ericsson, M.D., can discuss H1N1 flu and measures to protect yourself during
travel. He is professor and head of clinical infectious disease at The
University of Texas Medical School at Houston. He also is the director of the
university's Travel Medicine clinic and sees patients at UT Physicians clinics,
Lyndon B. Johnson General Hospital and Memorial Hermann-Texas Medical Center. •Luis
Z. Ostrosky, M.D., can discuss the infectious nature of H1N1 flu and can
provide details on what patients can do to reduce their risk of becoming
infected or spreading it to others. He is available for interviews in both
English and Spanish. Ostrosky is associate professor of medicine and
epidemiology in the Division of Infectious Diseases at The University of Texas
Medical School at Houston. He also is medical director for epidemiology at
Memorial Hermann-Texas Medical Center. •Herbert
DuPont, M.D. is a professor of infectious disease and director of the Center
for Infectious Diseases at The University of Texas School of Public Health.
With over 30 years of experience in infectious disease and travel medicine,
DuPont can speak on the development of swine flu, symptoms, how to reduce the
risk of becoming infected and how to keep yourself safe if you are traveling. •Susan
P. Fisher-Hoch, M.D. is a professor of epidemiology at The University of Texas
School of Public Health Brownsville Regional Campus. Fisher-Hoch is one of the
world's leading virologists. She is able to discuss any topic related to the
H1N1 flu. •Kristy
Murray, D.V.M, Ph.D., a former Epidemic Intelligence Service Officer for the
Centers for Disease Control and Prevention, is assistant professor of
epidemiology at The University of Texas School of Public Health. She is able to
discuss transmission of the virus from animal to human and how to reduce your
risk of becoming infected or spreading it to others. •John
Herbold, D.V.M, Ph.D., is associate professor of epidemiology and director of
the Center for Biosecurity and Public Health Preparedness at The University of
Texas School of Public Health San Antonio Regional Campus. As a veterinarian,
Herbold can discuss the origin of influenza viruses in humans and the role of
animals in a flu outbreak. He can also discuss why H1N1 flu passed from human
to human unlike the bird/avian flu. In addition, Herbold can address the
importance of clinicians, veterinarians and public health workers joining
together to stabilize and fight the outbreak. •C.
Ed Hsu, Ph.D., MPH, is associate professor of public health informatics at The
University of Texas School of Health Information Sciences at Houston and
associate director of health informatics at the Center for Biosecurity and
Public Health Preparedness at The University of Texas School of Public Health.
In Hsu's Preventive Health Informatics and Spatial Analysis laboratory, he is
using public health informatics to address critical public health challenges,
including global health surveillance and emergency preparedness. •Elda
Ramirez, Ph.D., RN, is available to do interviews in both English and Spanish.
She can describe symptoms of H1N1 flu and discuss when it is appropriate to
consult a primary care provider or seek medical attention at an emergency room.
Ramirez is assistant professor in The University of Texas Health Science Center
at Houston School of Nursing and emergency medicine nurse practitioner in The
University of Texas Medical School at Houston. •Susan
Parnell, RN, a nursing instructor at The University of Texas Health Science
Center at Houston School of Nursing, is available to discuss infection control
and explain how cases of influenza or other outbreaks are investigated. •Victor
Cardenas, M.D., Ph.D., is an associate professor of epidemiology at The
University of Texas School of Public Health El Paso Regional Campus. He is able
to discuss first-hand experience in influenza A outbreaks in several countries,
including Mexico and Colombia. |
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