FW: [IP] AMA -- H1N1 CrRapidly; Predominantly Affects Young Patientsitical Illness Can Occur

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Self evident …

 

*****************

 

Begin forwarded message:

 

From: "Kevin Gainer" <kgainer@xxxxxxxxxxxxxxx>

Date: October 12, 2009 10:25:25 AM EDT

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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