Dozens Of Ways To Spell `I-L-I’

 

Credit CDC

 

# 6613

ILIs  . . .  or  Influenza-like Illnesses  . . . are among the most common reasons for doctor’s visits each year. While often attributed to `flu’ - there are actually hundreds of `flu-like’ viruses vying for temporary residence in your upper respiratory tract.

 

Symptoms generally include fever, cough, and body aches  -  but may also commonly include rhinitis, sneezing, headache, fatigue, sore throat, nausea & vomiting, and diarrhea. 

 

Most of these symptoms are not caused by the invading virus - but are part of the body’s immune response to infection - so theses illnesses often tend to look alike. 

 

Influenza A & B, which can produce serous illness, are only responsible for a fraction of these cases.  By some estimates, 90% of ILIs reported each year are due to non-influenza viruses.

 

In October of 2009, during the height of the fall wave of the H1N1 pandemic, I posted the following graphic on my blog.

 

Of the more than 10,000 samples submitted for testing during the 1st week of October 2009, more than 72% – almost 3/4ths –  came back negative for influenza.

 

 

According to the CDC, each year adults (on average) experience 1 to 3 bouts with an ILI, while children may see 3 to 6 flu-like illnesses (cite MMWR)

 

For the layperson, respiratory infections are pretty much divided up into three broad categories; colds, Flu, or pneumonia.

 

But the reality is, there are myriad causes of influenza-like illnesses, with contributions from viral strains that include:

 

metapneumovirus

parainfluenzavirus

coronaviruses

respiratory syncytial virus (RSV)

adenoviruses

enteroviruses

Rhinoviruses (Common cold)

 

The Rhinovirus group alone consists of more than 100 varieties, and so by the time you add in all of the others you are talking about hundreds of different causes of ILI.

 

And more are being identified every year.

 

Less commonly - bacterial pneumonias (e.g. Legionella spp., Chlamydia pneumoniae, Mycoplasma pneumoniae & Streptococcus pneumoniae) – and illnesses like West Nile Virus, Dengue, and Q fever can produce ILI symptoms.

 

Most viral infections are mild, self-limiting, and are almost never identified since testing (beyond, perhaps, a rapid influenza test) is rarely warranted. 

 

Which is why doctors generally refer to ILIs, or Influenza-like Illnesses (or sometimes ARI Acute Respiratory Infection), when making a clinical diagnosis.

 

Your first line of defense against this yearly onslaught of respiratory viruses is the seasonal flu shot, which most years provides decent levels of protection against three flu strains. This year’s shot is formulated against:

 

• A/California/7/2009 (H1N1)pdm09-like virus
• A/Victoria/361/2011 (H3N2)-like virus
• B/Wisconsin/1/2010-like virus

 

Two of these strains are new in this year’s vaccine A/Victoria/H3N2 & B/Wisconsin) and community levels of immunity against these strains are likely low, making getting the shot this year doubly important.

 

Flu Vaccines have an excellent safety record, and are now recommended for nearly everyone over the age of 6 months. 

 

To protect against viruses not in the seasonal flu vaccine, your next line of defense is practicing good flu hygiene. Frequent hand washing, covering coughs and sneezes, and staying home if you are sick are key, even if you got the flu shot this year.

 

Of course, even if you are vigilant, you or someone in your family may get tagged by a respiratory virus this winter. 

 

With that prospect in mind, the CDC has prepared an excellent 24-page PDF guide for the home-care of influenza, which you can download.

 

 

 

 

And finally, a few years back I was hit by a very nasty virus that laid me up, delirious and unable to move, for 24 hours. I described the experience HERE, and since I live alone, it inspired me to take steps in case it ever happens again.

 

First, and perhaps most important, I’ve moved my cell phone charger to my beside table.  My phone now goes with me when I retire at night, that way I can call for help if ever the need arises. 

 

A sensible precaution for anyone of my years.

 

Second, I made a simple under-the-bed flu kit. 

In a small plastic box, I keep:

 

A couple of pouch Sports drinks (rehydration)

A bottle of acetaminophen

A bottle of expectorant pills

Imodium pills

A thermometer

Throat lozenges

Surgical masks for me to wear in case I have to call for help or have visitors.

 

Putting together this little flu kit may seem like too small of of a prep to bother with - but believe me - I wish I’d thought of it before I needed it.

»» Read More

CDC: Calvert County Flu Typical Seasonal H3N2 Strain

 

 

# 6228

 

 

Earlier this month three members of a family (out of five who fell ill) died from a respiratory infection in Calvert County, Maryland (see Calvert County: Update On Fatal Cluster Of Respiratory Illness) sparking national headlines and a good deal of online speculation.

 

While early reports seemed to lay most of the blame for the severity of these cases on a bacterial pneumonia co-infection on top of flu, there has been an understandable degree of curiosity regarding the exact flu strain that was involved.

 

Tonight, the CDC has published a report that indicates a plain vanilla version of seasonal H3N2 was involved.  

 

CDC Confirms Typical Human Influenza A H3N2 Virus in Maryland Cluster

 

March 16, 2012 -- CDC has confirmed that the influenza viruses isolated from the cluster of severe respiratory illness in one family in Maryland are seasonal influenza A H3N2 viruses. Genetic sequencing has confirmed that this is a typical human seasonal H3N2 virus that is more than 99% similar to other H3N2 influenza viruses submitted by the state of Maryland this season. While full antigenic testing is pending, based on genetic sequencing of some of the samples, these viruses are close to the H3N2 component of the 2011-2012 seasonal vaccine such that vaccination should offer protection against these viruses. Testing on the Methicillin-resistant staphylococcus aureus, (MRSA) isolates is ongoing, but preliminary results indicate that some of the MRSA isolates from Maryland are pulsed-field types USA300. Strains from the USA300 MRSA pulsed-field type can cause community MRSA infections including outbreaks of skin infections.

 

In early March 2012, Maryland reported a cluster of severe respiratory illness in four adults in the same immediate family. Three of the four family members died. The state of Maryland reported that all four people were confirmed to be positive for seasonal influenza A (H3N2) infection by the state Laboratories Administration. MRSA bacterial co-infections are reported to have occurred in at least two of the four patients. More information about the cases in Maryland is available at http://www.dhmh.maryland.gov/publicrelations/pr.

Bacterial infections can occur as co-infections with influenza or occur after influenza infection. Staphylococcus aureus (staph) is one such bacterial co-infection. Concurrent infection (co-infection) with staph – which is what seems to have occurred in the cluster in Maryland – is a potentially catastrophic complication of influenza that can progress rapidly to serious illness and death.

 

No formal surveillance is conducted for influenza with bacterial co-infections, however, these are well documented in the literature going back to the 1918 influenza pandemic. While not common, these co-infections have been reported in both children and adults.

 

The best way to prevent influenza and its complications is an annual influenza vaccine. The United States is experiencing a late influenza season. Activity has only recently begun to increase and may continue for some time. This week’s FluView is reporting 15 states with widespread influenza activity and 5 states with high influenza-like-illness activity. Nationally, the percent of respiratory specimens testing positive for flu is 23 percent. People who have not gotten vaccinated yet this season should get vaccinated now.

 

 

While perhaps a little anticlimactic for those who were expecting some sort of mutated flu strain, this does illustrate that even ordinary seasonal flu can induce serious, sometimes fatal, illness.

»» Read More

McKenna On MRSA Pneumonia Cluster In Maryland

 

 

Clumps of methicillin-resistant Staphylococcus aureus Magnified 2390x. – Credit CDC PHIL

# 6211

 

Author, journalist, and blogger Maryn McKenna is Flublogia’s resident expert on everything antimicrobial resistant, and is the author of Superbug: The Fatal Menace of MRSA.

 

This morning she has written about the cluster of flu-related deaths in Calvert County Maryland that has captured out attention this week.

 

Yesterday, new details emerged that suggest that a form of MRSA (or necrotizing) pneumonia served as a deadly co-infection in these deaths (see CIDRAP: MRSA Pneumonia Suspected In Calvert County Flu Cluster).

 

While we await further lab and autopsy results on this unusual and tragic story, Maryn gives us the short course in this emerging, and often lethal, complication of flu.

 

 

 

Flu Infections And MRSA Deaths In Maryland

• By Maryn McKenna March 9, 2012 | 

»» Read More

CIDRAP: MRSA Pneumonia Suspected In Calvert County Flu Cluster

 

Clumps of methicillin-resistant Staphylococcus aureus – Credit CDC PHIL

# 6210

 

 

Although we haven’t seen any official updates since late yesterday afternoon, reports have been trickling in through various media outlets suggesting that the fatal flu cluster in Lusby, Md.  involved the seasonal H3N2 virus and an aggressive form of MRSA pneumonia.

 

Lisa Schnirring of CIDRAP News  brings us up to date this evening with this report.  Follow the link to read her report in its entirety.

 

 

MRSA pneumonia suspected in fatal flu cluster

Lisa Schnirring Staff Writer

Mar 8, 2012 (CIDRAP News) – Another family member linked to a fatal flu cluster in Calvert County, Md., has been hospitalized, as suspicion grew that an aggressive drug-resistant form of pneumonia may have played a role in the severe illnesses, according to media reports.

 

Maryland and Calvert County health officials didn't report any new details about the cases, but the Washington Post reported yesterday that the sister of the 81-year-old woman who died has been hospitalized at MedStar Washington Hospital Center with fever but no other flu symptoms.

(Continue . . . )

 

 

Tissues taken during autopsies from two of the victims have reportedly been sent to the CDC for further analysis, which can take a day or two to complete.

»» Read More

DHMH Update On Calvert County Flu Cases

 

 

 

# 6206

 

Maryland’s Department of Health and Mental Hygiene has issued a press release this afternoon confirming earlier media reports that two of the Lusby, Md fatalities we’ve been following were infected with Influenza H3.

 

Perhaps not the most precise description of the flu strain we could ask for, but laboratory testing is ongoing, and I expect that more exact details (including analysis of suspected bacterial co-infection) will be released in the days ahead.

 

Meanwhile, the investigation continues, and so far, no signs of any other clusters of suspicious respiratory illness have been reported.

 

 

March 07

Update on Calvert County Respiratory Illness Investigation

Category: DHMH

Influenza Confirmed in Two Calvert County Cases

BALTIMORE (March 7, 2012) – The Maryland Department of Health and Mental Hygiene (DHMH) is working with the Calvert County Health Department to investigate four cases of severe respiratory illnesses in the same immediate family. Three have died. Testing by the DHMH Laboratories Administration has confirmed that two of the cases had Influenza H3, a strain of Influenza A that has been circulating this season. These cases were complicated by bacterial co-infections, a known complication of influenza infection.

 

Additional laboratory evaluation and investigation are ongoing. At this time, there is no indication of any other clusters of severe respiratory illness in the state. DHMH continues to coordinate with the Maryland Emergency Management Administration (MEMA) to update the Governor and local health and Emergency Medical Services (EMS) partners.

 

The 'flu' season typically can last as late as May. Vaccination is the best way to prevent influenza and its related complications that can lead to hospitalization and even death. DHMH recommends all individuals over the age of six months get vaccinated. In addition, DHMH reminds Marylanders to take other precautionary measures, such as hand washing and staying home if sick. Individuals with influenza-like illness (fever and sore throat or cough) should consult their healthcare providers for evaluation.

 

More information regarding the Calvert County investigation will be provided as it become

»» Read More

Calvert County: Health Department Update

 

 

Photo Credit- CCHD

 

# 6204

 

I’m impressed at how well the Calvert County Health Department has responded over the past 24 hours to the public’s interest in this story, updating their website numerous times with the latest information on the cluster of respiratory illness/deaths among a family in Lusby, Md.

 

They’ve published a new update today, with the following statement on their website.

 

 

Update on Calvert County Respiratory Illness Investigation
PRESS RELEASE

FROM: David L. Rogers, MD MPH
Health Officer
DATE: March 7, 2012, 8:45 am

Initial testing of two of four family members in Lusby, three of whom have died, suggests that that the serious lung infection suffered by all four was a complication of seasonal flu. A fourth family member remains hospitalized at Washington Hospital Center and is improving.

 

Samples have been sent to the Centers for Disease Control and Prevention in Atlanta for further testing.

 

These cases of serious lung infection were isolated to a single family and there are currently no other affected individuals. Local healthcare providers are not reporting any significant increase in patients with flu-like symptoms

 

The illnesses in these family members began with an 81-year-old Lusby woman who developed respiratory symptoms at her home beginning on or about February 23, 2012. She was cared for at home by three of her children, a son and two daughters. The caregivers developed similar respiratory symptoms on or about February 28, 2012. The mother died at home on March 1, 2012. Following her death the three children were hospitalized. Subsequently the 58-year-old son and a 56-year-old daughter died

 

As always, we recommend that everyone take routine precautions to prevent the spread of respiratory infections including hand washing and limiting contact with sick individuals. Those with flu-like symptoms, who develop cough, fever or sore throat, should be evaluated by their healthcare provider. Residents who have not received a seasonal flu vaccine are urged to get one from their healthcare provider or by calling Calvert County health department at 410-535-5400, ext. 349.

---end of press release---

 

Although there has been a good deal of unbridled speculation about these cases across the internet, so far I haven’t seen anything here to suggest a wider public health threat.

 

Whether the cause turns out to be viral, bacterial (or likely a combination of the two), fungal, or even environmental . . . based on what we know so far, this appears to be an isolated incident.

 

No additional cases have turned up in the community.

We’ll obvious watch this story for future updates, but for now, the local health department seems to have things well in hand.

»» Read More

Calvert County: Update On Fatal Cluster Of Respiratory Illness

 

 

 

# 6201

 

The Calvert County Health Department (CCHD) has posted a new update as of 8pm EST, March 6th on their website giving us the latest information on the cluster of 3 deaths in one family from a respiratory infection.

While preliminary testing indicates that the son and daughter were infected with an unspecified influenza A virus, a bacterial co-infection is mentioned as a complicating factor (some media outlets are calling it staph).

 

Update on Calvert County Respiratory Illness Investigation

Preliminary Testing Indicates Influenza

Dori Henry
Director of Communications
Maryland Department of Health and Mental Hygiene

BALTIMORE (March 6, 2012) – The Maryland Department of Health and Mental Hygiene (DHMH) is working in conjunction with the Calvert County Health Department to investigate a cluster of respiratory illnesses in Calvert County. As the Calvert County Health Department has reported, DHMH is aware of four cases in adults from a single family with severe respiratory illness; three have died. At this time, no other similar clusters have been reported from Calvert County or elsewhere in the state.

 

The cause for these illnesses is under investigation and testing is being conducted by the DHMH Laboratories Administration. Preliminary testing at the DHMH Laboratories Administration indicates that two of the fatal cases had influenza, and these cases may have been complicated by bacterial co-infections. Bacterial co-infection is a known complication of influenza infection. Additional testing is being conducted for all cases.

 

DHMH recommends all individuals continue to take the following precautions during influenza season: hand washing, staying home if sick, and staying up to date with influenza vaccinations. DHMH also reminds Maryland residents with influenza-like illness (fever and sore throat or cough) to consult their healthcare providers for evaluation. DHMH is not recommending any additional measures at this time. The Department will provide additional updates as more information becomes available.

There have been no new cases reported as of 8:00 p.m.

 

 

While three deaths in one family is the sort of thing that is bound to attract a lot of media attention, so far there is nothing here to suggest that anything exotic or particularly alarming is going on.

 

We will, of course, be watching for more definitive test results over the coming days.

 

But if nothing else, this is a sober reminder that even during a relatively quiet flu season, that influenza can pose a serious threat.

»» Read More

Calvert County Update

 UPDATED: 1710hrs EST Mar 6th.

According to WTOP news, in Washington D.C., the son  and daughter died from an influenza A infection (strain not disclosed).  A h/t to Crof for the link.

 

UPDATE: Cluster of respiratory-related deaths under investigation in Md.

Medstar Washington Hospital Center reports the son and daughter who died in the hospital had Influenza A. They also had other medical conditions, officials say.

The 81-year-old mother's cause of death is still under investigation.

The health of the other daughter (and fourth victim) is improving, hospital officials say.

 

# 6200

 

 

Earlier today we learned of a cluster of unusual deaths in a family in Calvert County, Maryland, from some type of unidentified `respiratory infection’ (see Maryland: Conflicting Reports On Cluster of Respiratory Deaths).

The Calvert County Health Department has updated their press release to state that there are no new cases as of 3:15 pm EST today.

 

The Washington Post has an article by Lena H. Sun that adds a little to the story, including that samples will be sent to the CDC for testing.  It now appears that there are 3 known deaths, and a fourth person appears to be recovering in the hospital.

 

Three dead from cluster of respiratory illnesses in Calvert County, Md.

 By Lena H. Sun, Tuesday, March 6, 3:32 PM

 

As far as what the cause of this illness might be, there are a lot of possibilities, and it will probably take several days to sort them out.

 

Stories like these often take on a life of their own, sometimes with a good deal of embellishment.

 

In that regard, I’m seeing a number of dubious looking comments left on local news sites, by readers purporting to have some kind of `insider knowledge’ of the situation. 

 

The old adage that A rumor can make it half way around the world before truth has got its boots on has never been truer since the advent of the internet.

 

With anonymous comments left on websites,  Caveat Lector should definitely be your guide.

»» Read More

Maryland: Conflicting Reports On Cluster of Respiratory Deaths

Note: There are now several updates to this story (here & here), and future updates can be found by searching HERE.

 

 

# 6199

 

Occasionally we see strange reports of illness that sound ominous or unusual crossing the news wires, but most of the time the causative agent turns out to be something fairly mundane.

 

`Mystery Fevers’ in Asia usually end up due to some kind of arbovirus, and mass illnesses in schools or cruise ships usually turn out to be norovirus.

 

But of course, every once in awhile, something unique will turn up, as did the novel H1N1 virus in Mexico three years ago

 

Today, we’ve multiple (and conflicting) reports coming out of Calvert County Maryland on a family where either 4 or 5 members contracted some sort of respiratory illness, and (depending on the source) subsequently 2, 3, or 4 of them have died.

 

We’ve a couple of news reports, a brief press release from the Calvert County Health Department, and a brief phone call by Sharon Sanders of FluTrackers to the CCHD trying to get details.

 

First, the press release, which suggests four illnesses and 2 deaths.

 

PRESS RELEASE FOR IMMEDIATE RELEASE CALVERT COUNTY HEALTH DEPARTMENT

DAVID L. ROGERS, MD MPH HEALTH OFFICER

CONTACT INFORMATION: 410-535-5400

March 6, 2012

This is a case of an elderly woman living in a rural setting in the Lusby area. She became sick on or about February 23, 2012, with upper respiratory symptoms, at her home. She was cared for at home by three of her children, a son and two daughters. They developed similar upper respiratory symptoms on or about February 28, 2012.

 

They were all hospitalized and became critically ill and two have subsequently died. One caregiver is currently at the Washington Hospital Center. This appears to be confined to a single family and there is no reason to believe, at this time, that others have been infected with this illness.

 

 

Sharon Sanders of FluTrackers placed a call to the CCHD (who are being swamped by inquiries), and talked to someone who stated the index case (the mother) also died, making 3 deaths. You can follow their tracking of this story on this thread.

 

Two news reports say there were five people stricken by this illness, and four died.  You can view those reports at the following links.

 

Health Alert: Four Deaths Reported in Calvert County

March 6, 2012

Calvert County Health Department (CCHD) is aware of a cluster of severe respiratory illnesses in five (Lusby area), including four members of a Calvert County family, residing approximately a mile south of the power plant. All five were hospitalized over the last two weeks. Four of the five have died of their illnesses.

(Continue . . .)

 

 

The first story we saw (h/t Carol@SC on the Flu Wiki) came from the local NBC TV affiliate. It too cites 5 illnesses and 4 fatalities.

 

 

Cluster of Deaths Following Flu-Like Symptoms in Calvert County

Cause of illness not immediately determined

Tuesday, Mar 6, 2012  |  Updated 11:29 AM EST

 

 

Multiple deaths in a single household from a respiratory illness are unusual enough to make health officials take notice. These are, however,`early days’, and testing and epidemiological investigations take time. 

If we get some more definitive information on this cluster, I’ll pass it along.

 

In the meantime, regardless of what this turns out to be, getting a seasonal flu shot and practicing good `flu hygiene’ (covering coughs, washing hands, staying home when sick), are your best protections against winter respiratory illnesses.

»» Read More

Study: Respiratory Viruses & Air Re-Circulation In Cars

 

 

 

# 5460

 

 

Two weeks ago a neighbor with a raging upper respiratory infection called me from the hospital Emergency Room and asked if I’d pick him up and take him home. 

 

A reasonable enough request, so I agreed.  But I did take a couple of precautions.

 

I brought a surgical mask for my coughing passenger to wear, and I drove him the five miles home with the windows rolled down.

 

Turns out, not only did I not catch whatever bug my neighbor had, according from a new study out of Australia, my instincts were right as well.

 

We don’t have a published study (one may show up eventually), but we do have a news report from 9NEWS on a presentation made to the Thoracic Society of Australia and New Zealand Annual Scientific Meeting in Perth this week.

 

The study compared the air flow and recirculation of viruses between a late model automobile and an `old clunker’ from 1989, and concluded that the `air-tightness’ of new cars could increase the risks of contracting a respiratory virus from a fellow occupant.

Dr. Scott Bell, Director of Thoracic Medicine at the Prince Charles Hospital in Brisbane is quoted as saying:

 

"Put simply, if you are travelling for around 90 minutes in a relatively modern car with air circulation on low, you are almost certain to catch influenza from another infected passenger.

 

The key message is that high risk people should be cautious of who they travel with in passenger cars during outbreaks of influenza."

 

 

Running a newer automobile’s air conditioner with it’s ventilation set to high (not re-circulating) was the functional equivalent of driving with a window partly down, which sucked a large number of viral particle out of the vehicle.

 

While lacking somewhat in scientific detail, you can read the entire article at:

 

Old cars safer than new to avoid the flu

17:47 AEST Mon Apr 4 2011

Travelling in old "clunkers" rather than late-model cars could protect people from catching the flu, new medical research shows.

 

But of course, you don’t have to buy an old clunker for car pooling during flu season.  You can reduce your risks by simply remembering to roll down a window, or run the a/c or heat on high ventilation.

Turns out, your Mother was right, after all.

 

A little bit of fresh air is good for you.

»» Read More

Resource: World Lung Foundation Atlas

 

 

# 5040

 

The WLF (World Lung Foundation) states their mission as:

 

To improve the lives of individuals across the world by strengthening community capacity to prevent and manage lung disease.

 

Today we’ve a press release announcing their Acute Respiratory Infections Atlas, along with their research that claims that more than 4 million lives are lost each year due to lung infections.

 

 

Four Million Deaths Each Year Caused by Acute Respiratory Infections – New Atlas Details Pandemic

Tuesday, November 9, 2010

(New York, NY) -Acute respiratory infections (ARIs), a disease group that includes pneumonia, influenza, and respiratory syncytial virus (RSV), are responsible for 4.25 million deaths each year, according to the first-ever Acute Respiratory Infections Atlas (ARIAtlas.org), published today by World Lung Foundation. ARIs are the third largest cause of mortality in the world and the top killer in low- and middle-income countries. Compared to the illness and mortality they cause, ARIs receive a fraction of government, donor agency, and philanthropic support.

 

"We know that at least four million people die from ARIs, yet the global health community does not even recognize them as a distinct disease group,” said Peter Baldini, Chief Executive Officer, World Lung Foundation. “The goal of the Acute Respiratory Infections Atlas is to demonstrate in vivid detail the scale of this problem and to kick-start a serious conversation about addressing it. With relatively modest resources, the means are available to save millions of lives. We simply need commitment, sound policy, and strategic investment."

A Forgotten Pandemic

Collectively, ARIs cause at least 6% of the world’s disability and death, according to the Atlas. These deaths occur overwhelmingly in the world’s poorest countries, where the drivers of ARIs, including malnutrition, pollution, overcrowding, and tobacco use are most prevalent. In countries such as Mali, Afghanistan, Sierra Leone, and Niger, the death rate from ARIs alone is ten times higher than the global median death rate from all causes.

 

(Continue . . . )

 

The WLF has also released a short video introduction on Youtube.

 

 

 

 

Of particular interest to myself, and hopefully to some of my readers, are the resources available on the WLF website, including an image and video library, campaign resources, along with interactive maps available from the www.ariatlas.org site.

 

I’ve only just begun to explore some of these resources, but they look very promising.

 

Sample map

 

 

Since I’m running late for an appointment, I’ll send you to a Reuters story, which has more on today’s report.

 

Lung infections kill 4.25 million a year: report

»» Read More