INFLUENZA WATCH

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Cluster of respiratory-related deaths under investigation in Md.
Tuesday - 3/6/2012, 5:08pm ET

The Calvert County Health Department is investigating a cluster of respiratory-related deaths.

UPDATE:

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.

Tuesday - 3/6/2012, 2:56pm ET

WASHINGTON - Three people in the Lusby, Md. area have died from a respiratory illness and the Calvert County Health Department is investigating the cluster of deaths.

The case appears to be confined to a single family and there are no other individuals affected, the health department says.

At this time, they are not recommending any protective actions for the general public.

Calvert County schools made automated phone calls home to dispel rumors, says Deputy Health Officer Dan Williams.

The first case of illness was reported in an 81-year-old woman who began showing symptoms around Feb. 23. Three of the woman's children took care of her in her home.

The three children, a son and two daughters, developed similar upper respiratory symptoms around Feb. 28.

All four of the family members were eventually hospitalized and became critically ill.

The elderly woman, a 58-year-old son and a 56-year-old daughter died.
The other daughter is currently hospitalized at the Washington Hospital Center.

The state Office of Chief Medical Examiner is working to determine a cause of the illness and the Centers for Disease Control and Prevention has been asked to evaluate tissue samples from the victims.

The health department is recommending that Calvert County residents take standard precautions to prevent the spread of illness, including washing their hands and limiting contact with sick individuals.
Those with flu-like symptoms should check with their healthcare provider to be evaluated.

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.

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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 MedStar 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---


Seasonal flu vaccinations are available at local pharmacies and grocery stores. The Calvert County health department will be administering flu vaccinations Monday through Friday 8:30 am – 4:00 pm on a walk-in basis at a cost of $20. Check, cash or credit cards are accepted.

www.calverthealth.org/

[dothedd]

Lone, here is the answer:

Flu Infections and MRSA Deaths in Maryland
By Maryn McKenna Email Author March 9, 2012 | 6:00 am |

Sad news out of Maryland, and a reminder of how devastating MRSA, methicillin-resistant Staphylococcus aureus, can be when it combines with flu infection. According to the Maryland Department of Health and Mental Hygiene, the Washington Post and ProMED, five members of a family have fallen ill and three have died from MRSA pneumonia that took hold in lungs inflamed by flu infection.

The dead are Ruth Blake, 81, and her children Lowell, 58, and Vanessa, 56. Another child, Elaine, also fell ill and was hospitalized, and Ruth Blake’s sister has been hospitalized also. They had all contracted one of the seasonal flu strains circulating this year: H3N2. According to the Post, Ruth Blake was vaccinated against flu this season; her children were not. The assumption is that both flu and MRSA spread from the mother to the children.

MRSA pneumonia is fast-acting and lethal; it is often called “necrotizing pneumonia” for the way it simply kills lung tissue. Exactly why it has that effect is still disputed — MRSA has so many cellular toxins at its disposal that there could be a number of culprits — but there is no dispute that it is a very serious disease.

MRSA post-flu pneumonia isn’t well-understood because it has been a concern only recently. The first cases to alert the United States that this might be a problem were in Baltimore in the flu season of 2003-2004. The four patients were all seen at Johns Hopkins University Medical Center, and physicians there wrote the cases up afterward. Over two months, there was a 31-year-old woman who was in the hospital for four weeks; MRSA ate holes in her lung, the largest of which was 1 by 1.5 inches. Two other women, 20 and 33 years old, were each hospitalized for three months. The 20-year-old’s heart stopped, and her blood clotting grew so disordered that doctors had to amputate one leg below her knee; the 33-year-old lost both lower legs. The fourth patient was a 52-year-old man, a two-pack-a-day smoker, who died.

Other reports came into the Centers for Disease Control and Prevention over the course of that flu season. When the CDC counted up the following summer, there had been 15 cases of severe MRSA pneumonia in nine states. Four of them died. CDC personnel wrote another article warning of the dangers of MRSA and flu two years later, after clusters of cases in Louisiana and Georgia during the 2006-2007 flu season. They said: “Secondary S. aureus pneumonia is a potentially catastrophic complication of influenza … MRSA [community-acquired pneumonia] often affects young, otherwise healthy persons and can be rapidly fatal.”

Pneumonia that follows on flu is a seriously under-appreciated danger of flu infection: An analysis from 2010 points out that, in 2007, there were 457 deaths from flu in the US and 52,847 deaths from post-flu pneumonia. There is no reliable way to protect yourself against MRSA, since there is no vaccine, and the bacterium can live on the skin undetected for an unpredictable period of time. Hypothetically, if you prevent flu infection you lessen the likelihood of this pneumonia occurring — but as the mother’s case illustrates, flu vaccine doesn’t confer perfect protection, especially not in the elderly whose immune systems are not robust enough to begin with.

It’s a very sad story, and another illustration of how perilous and destructive MRSA can be.

X-RAYS and info. Take a look:
www.wired.com/wiredscience/2012/03/flu-mrsa-pneumonia/

[dothedd]

Health News

U.S. flu levels rising, but still low

Published: March. 10, 2012 at 7:25 AM

ATLANTA, March 10 (UPI) -- Influenza continued to rise within the United States with more states reporting widespread activity, but flu-like illness stayed relatively low, officials said.

The Centers for Disease Control and Prevention in Atlanta, which tracks flu-like illness, said for the week ending March 3, doctor visits for flu-like illness stayed below the baseline, but levels were above regional baselines for much of the Midwest.

The percentage of respiratory specimens that tested positive for influenza rose to 21.3 percent, compared to 18.4 percent of the previous week, the CDC said.

The rate of hospitalizations for laboratory-tested confirmed influenza reached 2.1 per 100,000 people last week, an increase of 36 percent from the previous week, although levels are still lower than expected for this time of the year, the CDC said.

Almost 90 percent of the hospitalizations this flu season have involved influenza A strains and of 246 type A isolates that were sub-typed, 185 were H3N2 and 61 were 2009 H1N1, the Centers for Infectious Disease Research & Policy at the University of Minnesota reported.

Kansas, Missouri and Oklahoma reported high flu-like illness activity. California, Colorado, Illinois, Kansas, Missouri, Nevada, New Jersey, Oklahoma and Virginia report wide geographic spread of the flu.

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16/03/2012

European Medicines Agency issues recommendations for 2012/2013 seasonal flu vaccine composition

The European Medicines Agency has issued the European Union (EU) recommendations for the influenza virus strains that should be included in flu vaccines this year.

Trivalent vaccines for the 2012/2013 season should contain these virus strains:
an A/California/7/2009 (H1N1)pdm09-like virus;
an A/Victoria/361/2011 (H3N2)-like virus;
a B/Wisconsin/1/2010-like virus.

Quadrivalent vaccines containing two influenza B viruses should also include a B/Brisbane/60/2008-like virus.

The EU recommendation was issued by the Biologics Working Party's Ad-hoc Influenza Working Group on the basis of observations by the World Health Organization (WHO). The Agency's Committee for Medicinal Products for Human Use adopted the recommendation on 15 March 2012.

Further information on the suitable candidate vaccine virus strains for the A/Victoria/361/2011 (H3N2)-like and B/Wisconsin/1/2010-like viruses will be published in April 2012.

The Agency recommends that marketing-authorisation holder submit applications to change the composition of centrally authorised seasonal flu vaccines by 11 June 2012.

www.ema.europa.eu/ema/index.jsp?curl=pages/news_and_events/news/2012/03/news_detail_001467.jsp&mid=WC0b01ac058004d5c1&murl=menus/news_and_events/news_and_events.jsp&jsenabled=true

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European Medicines Agency, 2012. Reproduction is authorised provided the source is acknowledged.

15 March 2012
EMA/CHMP/BWP/140597/2012

Committee for Medicinal Products for Human use
BWP ad-hoc influenza Working Group
EU recommendations for the seasonal influenza vaccine composition for the season 2012/2013

The meeting of the Ad hoc Influenza Working Group of the BWP was convened in order to implement Part A of the Note for Guidance on harmonisation of requirements for influenza vaccine i.e. the selection of virus strains for the manufacture of seasonal influenza vaccine for 2012/2013.

Having considered the information on international surveillance by WHO presented by Dr John McCauley (WHO Collaborating Centre, NIMR, Mill Hill, UK), the CHMP BWP Ad hoc Influenza Working Group, consisting of experts on influenza from the Member States, considered that the WHO recommendation on the composition of vaccines for 2012/2013 should be followed:

Trivalent vaccine containing:
* an A/California/7/2009 (H1N1)pdm09-like virus
* an A/Victoria/361/2011 (H3N2)-like virus
* a B/Wisconsin/1/2010-like virus

The above recommendation is applicable also for live attenuated influenza vaccines.

For vaccine manufacturers considering the use of a B/Victoria/2/87 lineage vaccine virus in quadrivalent vaccines containing two influenza B viruses, a B/Brisbane/60/2008-like virus in addition to the strains mentioned above is considered appropriate.

On the basis of cross reactivity and growth in eggs, the group agreed that for the purpose of vaccine manufacture, the following strains be accepted:
* As A/California/7/2009 (H1N1)pdm09-like viruses:
reassortant virus NYMC X-179A, which is derived from A/California/7/2009
* reassortant virus NYMC X-181, which is derived from A/California/7/2009
* reassortant virus NIB-74, which is derived from A/Christchurch/16/2010

* reassortant virus NIB-74xp, which is derived from A/Christchurch/16/2010
* A/Brisbane/10/2010 (wild type)

www.ema.europa.eu/docs/en_GB/document_library/Other/2012/03/WC500124221.pdf