Self evident ?
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Begin forwarded message:
From: "Kevin Gainer" <kgainer(_at_)columbus(_dot_)rr(_dot_)com>
Date: October 12, 2009 10:25:25 AM EDT
To: <dave(_at_)farber(_dot_)net>, <munsup(_dot_)seoh(_at_)wright(_dot_)edu>
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;
<http://www.newswise.com/articles/h1n1-critical-illness-can-occur-rapidly-pr
edominantly-affects-young-patients> Predominantly Affects Young Patients
Source: American Medical <http://www.newswise.com/institutions/view/13/>
Association (AMA)
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 <http://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
<http://www.newswise.com/articles/critical-illness-from-2009-h1n1-in-mexico-
associated-with-high-fatality-rate> Associated With High Fatality Rate
Source: American Medical <http://www.newswise.com/institutions/view/13/>
Association (AMA)
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 <http://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
<http://www.newswise.com/articles/most-h1n1-patients-with-respiratory-failur
e-treated-with-oxygenating-system-survive-illness> Treated With Oxygenating
System Survive Illness
Source: American Medical <http://www.newswise.com/institutions/view/13/>
Association (AMA)
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 <http://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
<http://www.newswise.com/articles/h1n1-flu-sweeping-u-s-ut-health-science-ce
nter-at-houston-experts-available> Center at Houston Experts Available
Source: University of Texas <http://www.newswise.com/institutions/view/168/>
Health Science Center at Houston
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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