CDC: Calvert County Flu Typical Seasonal H3N2 Strain

 

 

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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.

McKenna On MRSA Pneumonia Cluster In Maryland

 

 

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

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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 | 

CIDRAP: MRSA Pneumonia Suspected In Calvert County Flu Cluster

 

Clumps of methicillin-resistant Staphylococcus aureus – Credit CDC PHIL

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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.

DHMH Update On Calvert County Flu Cases

 

 

 

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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

Calvert County: Health Department Update

 

 

Photo Credit- CCHD

 

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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.

Calvert County: Update On Fatal Cluster Of Respiratory Illness

 

 

 

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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.