NYC Health Dept Statement On Symptomatic HCW From Guinea

 

UPDATED:  Added a statement from Doctors without Borders (MSF).  16:50 hrs EDT

 

# 9240

 

Normally I don’t report on suspected cases of Ebola since most will turn out to be false alarms, but since it is already all over the media, and the New York City Department of Health has issued a statement, I’ve reproduced it here.

 

Statement on Patient at Bellevue Hospital

October 23rd, 3:05 pm

Today, EMS HAZ TAC Units transferred to Bellevue Hospital a patient who presented a fever and gastrointestinal symptoms.  

The patient is a health care worker who returned to the U.S. within the past 21 days from one of the three countries currently facing the outbreak of this virus.

The patient was transported by a specially trained HAZ TAC unit wearing Personal Protective Equipment (PPE).  After consulting with the hospital and the CDC, DOHMH has decided to conduct a test for the Ebola virus because of this patient’s recent travel history, pattern of symptoms, and past work. DOHMH and HHC are also evaluating the patient for other causes of illness, as these symptoms can also be consistent with salmonella, malaria, or the stomach flu.

Preliminary test results are expected in the next 12 hours.

Bellevue Hospital is designated for the isolation, identification and treatment of potential Ebola patients by the City and State.  New York City is taking all necessary precautions to ensure the health and safety of all New Yorkers.

As a further precaution, beginning today, the Health Department’s team of disease detectives immediately began to actively trace all of the patient’s contacts to identify anyone who may be at potential risk. The Health Department staff has established protocols to identify, notify, and, if necessary, quarantine any contacts of Ebola cases.

The Health Department is also working closely with HHC leadership, Bellevue's clinical team and the New York State Department of Health to ensure that all staff caring for the patient do so while following the utmost safety guidelines and protocols.

The chances of the average New Yorker contracting Ebola are extremely slim. Ebola is spread by directly touching the bodily fluids of an infected person. You cannot be infected simply by being near someone who has Ebola.

 

Via Pathfinder on FluTrackers, we have the following brief statement from Doctors without Borders regarding this case:

 

Statement on Returned Field Worker

October 23, 2014

Doctors Without Borders/Médecins Sans Frontières (MSF) statement:

A person in New York City, who recently worked with Doctors Without Borders in one of the Ebola affected countries in West Africa, notified our office this morning to report having developed a fever.  As per the specific guidelines that Doctors Without Borders provides its staff on their return from Ebola assignments, the individual engaged in regular health monitoring and reported this development immediately.  While at this stage there is no confirmation that the individual has contracted Ebola, Doctors Without Borders, in the interest of public safety and in accordance with its protocols, immediately notified the New York City Department of Health & Mental Hygiene, which is directly managing the individual’s care. 

At this stage Doctors Without Borders will not be providing any further details about its colleague.

 

You’ll find that FluTrackers is maintaining an extensive thread on media reports here.

The Global Reach Of Infectious Disease

Photo Credit- CDC

 

# 8303

 

This week we’ve seen two of the world’s most prestigious public health organizations (CDC & WHO) publicly express concerns over the increasing dangers of global disease spread – including, but certainly not limited to – pandemic influenza. 

 

On Wednesday, in WHO: IHR & Global Health Security, we looked at the large number of member states which have yet to meet the core surveillance and response requirements of the International Health Regulations that went into force in 2007.

WHO IHR Infographic

 

On Friday, in CIDRAP On The Global Health Security Agenda, we looked at a 26 nation initiative to improve global health surveillance & emergency response in an age of rising infectious diseases.  The rationale for which is explained on the CDC’s Global Health Website at:

 

Why Global Health Security Matters

Disease Threats Can Spread Faster and More Unpredictably Than Ever Before

(Excerpt)

A disease threat anywhere can mean a threat everywhere. It is defined by

• the emergence and spread of new microbes;
• globalization of travel and trade;
• rise of drug resistance; and
• potential use of laboratories to make and release—intentionally or not—dangerous microbes.

 (Continue . . .)

 

These are hardly new concerns for either agency, as both have worked for decades to prevent the spread of disease around the world. But over the past decade there has come a greater awareness of the ability of once rare, and geographically remote, infectious diseases to travel in a matter of hours to virtually any part of the globe.

A partial list of recent global health threats we’ve discussed previously includes:

 

• The  importation of West Nile Virus to North America in 1999 (see WNV: The Economic Costs Of An Invasive Arbovirus)
• The more recent arrival of Dengue Fever in Florida and Texas (see MMWR: Travel Associated Dengue Surveillance 2006-2008)
• Last fall’s Chikungunya outbreak in the Caribbean (see ECDC Update On The Spread Of Chikungunya In The Caribbean)
• The huge increase in antibiotic resistant bacteria (see NDM-1: A Matter Of Import)
• SARS in 2003 (see SARS & Remembrance)

 

To this short list you can add Pandemic H1N1 in 2009, the emergence of MERS-CoV from the Arabian Peninsula (see WHO MERS-CoV Summary Update #13, the continual spread of H7N9 and H5N1 avian flu viruses (see The Expanding Array Of Novel Flu Strains), Polio in the Middle East and Africa, contaminated food or drugs, XDR-TB, and of course the one(s) we don’t even know about yet . . .  Virus X.

 

This rationally paranoid listing of disease threats is backed up by a recent Assessment by the Director of National Security (see DNI: An Influenza Pandemic As A National Security Threat) that finds the global spread of infectious diseases – along with cyber attacks, terrorism, extreme weather events, WMDs, food and water insecurity, and global economic concerns.- constitutes a genuine threat to national security.

 

Although the specter of pandemic influenza and  bioterrorism get the most attention in the media, already each year thousands of people in the United States (and around the world) are sickened or die from `imported’ diseases like WNV, HIV/AIDS, Carbapenem-resistant  bacteria, and TB. 

 

History has shown, that once a disease takes flight, it is notoriously difficult to reign in.  Hence the need to tackle infectious diseases where they emerge, not once they arrive on our shores.

 

While you and I cannot do much about disease threats around the world (except for supporting elected representatives who vote to fund public health, and contributing to NGOs who fight the battles every day), there are things you can do to prepare for the day when – inevitably, and despite the best efforts of public health agencies to prevent it – the next pandemic threat emerges.

 

We’re not talking building a `doomsday bunker’, or stockpiling a 2-year supply of N95 masks and Tyvek suits, but rather taking reasonable steps to prepare your family, business, and community against what is perceived by many as being all but inevitable; another pandemic.

 

Pandemics, while rare, are just one of scores of possible disaster scenarios that one can find themselves suddenly thrust into. When you add in the risks from earthquakes, hurricanes, tornadoes, floods, blizzards, and other – even more common – emergencies, it makes sense to maintain a general level of preparedness against `all threats’.

 

Every family needs an appropriate disaster plan, just as everyone should have a good first aid kit, a `bug-out bag’, and sufficient emergency supplies to last a bare minimum of 72 hours.

 

Most preparedness experts would recommend that people should consider maintaining a 2-week supply of supplies in their home.  A topic I address in When 72 Hours Isn’t Enough.

And businesses, if they hope to survive a pandemic (or any other disaster), need a comprehensive business continuity plan. Although there are many good resources on the web to get you started, a couple of places to begin are The Business Continuity Daily and Cambridge Risk Perspectives, both of which provide daily reviews of current threats and advice on preparedness.

 

One of the nation’s leaders in pandemic and disaster planning is Public Health - Seattle & King County.  In 2008 they produced a 20 minute film called Business Not As Usual, designed to help introduce businesses to the core concepts of pandemic planning.

Frankly, this video should be required viewing for every businesses owner, manager, and employee.

 

 

Flu.gov maintains a pandemic planning and preparedness page, where the following appears.

 

Their advice (and this is for before a pandemic threat becomes imminent).

 

Given the speed at which a well-adapted virus could spread globally (days or weeks), the time to practice and prepare for the next pandemic is now, not after an outbreak has begun. Given the seriousness with which U.S. and International  agencies and organizations obviously give the pandemic threat, it only makes sense to take it seriously yourself.

 

For more on pandemic preparedness, you may wish to revisit:

NPM13: Pandemic Planning Assumptions

The Pandemic Preparedness Messaging Dilemma

Pandemic Planning For Business

CDC: Pandemic Planning Tips For Public Health Officials

H7N9 Preparedness: What The CDC Is Doing

WHO International Travel & Health Update On Avian Influenza

 

Credit WHO

 

# 8210

 

With the recent importation of a human case of H5N1 to Canada (see CDC HAN Advisory On Canadian H5N1 Case), recent H5N1 activity in Vietnam and Cambodia, and the second wave of avian H7N9 infections on the rise in Eastern China, the potential – while slight – nonetheless exists for travelers to be exposed to, and infected by, one of these avian flu viruses.

Today the World Health Organization posted the following advice to travelers on their International Travel & Health webpage.

 

World - Avian influenza in humans

23 January 2014 - Some avian influenza (“Bird Flu”) viruses can infect humans and cause disease. These include H5N1, H7N3, H7N7, H7N9 and H9N2. Some of these infections have been very severe and some have resulted in deaths, but many infections have been mild or even subclinical in humans.

 

Symptoms of avian influenza in humans have ranged from typical human influenza-like symptoms (fever, cough, sore throat, and muscle aches) to eye infections, pneumonia, severe respiratory diseases (such as acute respiratory distress syndrome), and other severe and life-threatening complications.

 

Avian influenza infections in birds or humans are observed in parts of Asia, Europe, the Middle East, and Africa. During an outbreak of avian influenza among poultry, there is a possible risk of infection to people who have contact with infected birds or surfaces that have been contaminated with secretions or excretions from infected birds. With certain types of avian influenza, human infection may occur even though there is no apparent outbreak among poultry. However, the risk from avian influenza is generally low to most people. Infection cannot result from properly handled and cooked poultry and eggs.

 

WHO does not recommend any travel restrictions to affected countries. However, WHO advises that travellers to countries with known outbreaks of avian influenza avoid poultry farms, contact with animals in live bird markets, being close to areas where poultry may be slaughtered, and any surfaces that appear to be contaminated with faeces from poultry or other animals. Travellers should also wash their hands often with soap and water and avoid eating undercooked eggs.

 

A diagnosis of infection with an avian influenza virus should be suspected in individuals who develop influenza-like symptoms while travelling or soon after return from an area where avian influenza is a concern. Travellers should be advised that if exposure to individuals with suspected avian influenza illness or severe, unexplained respiratory illness occurs, and they in turn develop symptoms, they should urgently consult health professionals.

FDA & CDC Warn On Weight Loss Supplement

 

# 7846

 

 

There is an erroneous belief that whatever over-the-counter (OTC) medicines and supplements may lack in effectiveness, they make up for in safety.  The truth is that most OTC meds, and even a lot of `natural’ supplements, are quite capable of causing illness or even death under the `right’ (read: `wrong’)  dosage and/or circumstances.

Last week, in The Perils Of Not Knowing Your Dose, we looked at the impact of acetaminophen (Tylenol ®) overdoses in this country each year. 

 

Last night the CDC issued a HAN Health Advisory, along with and advisory from the FDA, on an OTC weight loss product called OxyElite Pro that has been tentatively linked to a number of cases of acute hepatitis and/or liver failure. 

The FDA recommendation is to:

`. . . stop using any dietary supplement product labeled as OxyElite Pro while the investigation continues. Consumers who believe they have been harmed by using a dietary supplement should contact their health care practitioner’

 

Here are some excerpts from the CDC’s HAN Alert.

 

Distributed via the CDC Health Alert Network
October 8, 2013, 2:30 ET (14:30 PM ET)
HANINFO-00356

Acute Hepatitis and Liver Failure Following the Use of a Dietary Supplement Intended for Weight Loss or Muscle Building

Summary

Recently, a number of previously healthy individuals developed acute hepatitis and sudden liver failure of unknown cause after using a dietary supplement for weight loss or muscle building. CDC recommends increased vigilance by public health agencies, emergency departments, and healthcare providers for patients who develop acute hepatitis or liver failure following use of a weight loss or muscle building nutritional supplement. CDC requests that state health departments report such occurrences to the CDC. CDC also recommends that, as part of a comprehensive evaluation, clinicians evaluating patients with acute hepatitis should ask about consumption of dietary supplements.

Background

On September 9, 2013, the Hawaii Department of Health (DOH) was notified of seven patients with severe acute hepatitis and sudden liver failure of unknown cause. The patients were previously healthy and sought medical care from May through September 2013. Clinicians reported that the seven patients had all used OxyELITE Pro, a dietary supplement marketed for weight loss and muscle gain, prior to illness onset.

The investigation is ongoing and the data presented are preliminary. Thus far, clinicians have reported 45 patients to the Hawaii DOH in response to a public health alert. Of those, 29 patients, including the original seven, were confirmed to have acute hepatitis after using a nutritional supplement for weight loss or muscle building. The median age of the 29 patients is 33 years; 14 (48%) are male. The date of the first reported laboratory test was used as a proxy for illness onset and ranged from May 10 through October 3, 2013. The most commonly reported symptoms included loss of appetite, light-colored stools, dark urine, and jaundice. Median laboratory values reported at the peak of illness were the following:

• aspartate aminotransferase (AST) 1,128 IU/L;
• alanine transaminase (ALT) 1,793 IU/L;
• alkaline phosphatase 150 IU/L; and
• total bilirubin 12.6 mg/dL.

Ten patients had liver biopsy data available at the time of this report. Seven had histology consistent with hepatitis from drug/toxic injury, with findings including hepatocellular necrosis and cholestasis. Three patients had liver biopsy findings of acute hepatitis associated with other etiologies such as autoimmune hepatitis. Eleven (38%) patients were hospitalized, with a median duration of seven days. One patient died, and two patients received liver transplants. Two remain hospitalized, and all other hospitalized patients have been discharged.

Of the 29 identified patients, 24 (83%) reported using OxyELITE Pro during the 60 days prior to illness onset. There was no other dietary supplement or medication use reported in common by more than two patients.

National case finding efforts have identified several individuals from states outside Hawaii with reported OxyELITE Pro or other weight loss or muscle building dietary supplement use prior to the development of acute hepatitis of unknown cause. CDC, in collaboration with state health departments, is collecting additional clinical and epidemiologic information from these individuals to determine if this outbreak is national in scope.

<SNIP>

Recommendations

• Clinicians evaluating patients with acute hepatitis should ask about consumption of dietary supplements as part of a comprehensive evaluation.
• Clinicians should report patients meeting the case definition to the local or state health department, as well as the US Food and Drug Administration’s MedWatch program online at https://www.accessdata.fda.gov/scripts/medwatch/ or by phone at 1-888-INFO-FDA.
• People who use dietary supplements for weight loss or muscle gain should do so with caution and under a medical provider’s close supervision.

And here is the Health Advisory from the FDA.

 

OxyElite Pro: Health Advisory - Acute Hepatitis Illness Cases Linked To Product Use

[Posted 10/08/2013]

AUDIENCE: Health Professional, Consumer

ISSUE: The FDA, along with the Centers for Disease Control and Prevention (CDC) and the Hawaii Department of Health (DOH), are investigating a growing number of reports of acute non-viral hepatitis in Hawaii. The Hawaii DOH has reported that 24 of these cases share a common link to a dietary supplement product labeled as OxyElite Pro.

BACKGROUND: OxyElite Pro is distributed by USPlabs LLC of Dallas, Texas, and is sold nation-wide through a wide range of distribution channels, including the internet and retail stores that sell dietary supplements. There have been 29 cases of acute non-viral hepatitis with an unknown cause identified in the state of Hawaii.  Eleven of the 29 cases have been hospitalized with acute hepatitis, two cases have received liver transplants and one person has died. CDC is also looking at other cases of liver injury nationwide that may be related. Symptoms of all types of hepatitis are similar and can include fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine, clay or gray-colored bowel movements, joint pain, yellow eyes, and jaundice.

The epidemiological investigation is being conducted by the Hawaii DOH and the CDC. As part of FDA’s associated investigation, the agency is reviewing the medical records and histories of patients identified by the Hawaii DOH. The FDA is also analyzing the composition of product samples that have been collected from some of these patients. Additionally, the FDA is inspecting the facilities involved in manufacturing the product and reviewing production and product distribution records. Because USPlabs LLC has informed FDA that it believes counterfeit versions of OxyElite Pro are being marketed in the US and have been on the US market for some time, FDA is also investigating whether counterfeit product is related to any of the cases of acute  hepatitis.

RECOMMENDATION: The FDA advises consumers to stop using any dietary supplement product labeled as OxyElite Pro while the investigation continues. Consumers who believe they have been harmed by using a dietary supplement should contact their health care practitioner.

Healthcare professionals and patients are encouraged to report adverse events or side effects related to the use of these products to the FDA's MedWatch Safety Information and Adverse Event Reporting Program:

• Complete and submit the report Online: www.fda.gov/MedWatch/report.htm
• Download form or call 1-800-332-1088 to request a reporting form, then complete and return to the address on the pre-addressed form, or submit by fax to 1-800-FDA-0178

[10/08/2013 - Recalls, Outbreaks & Emergencies - FDA]

[10/08/2013 - Health Alert Network Advisory  - CDC]

Indiana Reports Rare Typhoid Infection

 

Photo Credit NHS 

 

# 6910

 

 

Somewhat synchronistically, It was just a week ago that I briefly mentioned the infamous and sad story of `Typhoid’ Mary Mallon (see Influenza Transmission, PPEs & `Super Emitters’).

 

Mallon was a cook and housekeeper in the early part of the last century, who also happened to be an asymptomatic carrier of Typhoid bacteria. Over the years she infected scores of others, never really accepting that she was responsible. 

 

In 1910, after several years in quarantine she was released with her promise never to work again as a cook. In 1915 an investigation into another typhoid outbreak led to her once again, where they found her working under an assumed name, as a cook.

 

She spent  nearly 3 decades of her life in involuntary quarantine in a cottage on the grounds of Riverside Hospital on North Brother Island in the East River, New York City.

 

While still common in some developing countries, Typhoid fever is rarely seen today in the United States. The CDC’s Typhoid Fever FAQ states the U.S. sees only about 400 cases of Typhoid each year, of which 3/4ths are brought into this country via international travel. 

 

Fortunately - unlike in Typhoid Mary’s day - we have antibiotics to treat this often persistent Salmonella bacterial infection.

 

Deaths from Typhoid Fever (not to be confused with Typhus, which is a Rickettsia bacterial infection carried by lice, fleas or ticks), have declined greatly since the chlorination of water supplies in industrialized nations began early in the last century, along with the development of antibiotic treatments. 

 

 

Yesterday it was announced that a case of Typhoid has been detected in a food service worker at a restaurant at Purdue University. 

 

First the press release from the Indiana Health Department, then I’ll come back with more.

 

State Health Officials Investigating Typhoid Fever Case at Purdue University

Start Date: 2/5/2013 12:00 AM

INDIANAPOLIS—State health officials announced today a positive case of typhoid fever in a food handler at Purdue University. Local health officials and Purdue University are working with the Indiana State Department of Health to investigate the case and assess the risk to the public.

 

Anyone who ate at the Boiler Bistro, John Purdue Room, or the coffee shop, Lavazza, at Marriott Hall on the Purdue campus from Jan. 23 to Jan. 25, 2013, may be at risk. Health officials advise these individuals to see a healthcare provider right away if they start to experience symptoms such as a high fever (103° to 104° F), weakness, stomach pains, headache, nausea, vomiting, diarrhea, or loss of appetite. In some cases, a rash of flat, rose-colored spots may appear. Symptoms usually begin within 8-14 days after exposure, but could potentially appear for up to 30 days.

 

“Unfortunately, symptoms of typhoid fever can resemble other illnesses, so for those individuals who may have been exposed, it’s critical to see healthcare provider right away if you begin to experience symptoms,” said State Health Commissioner William VanNess II, M.D. “Be sure to tell your physician that you may have been exposed to typhoid fever.”

 

People are at risk of typhoid fever if they eat food or drink beverages that have been handled by someone who has Salmonella Typhi or if sewage contaminated with the bacteria gets into the water used for drinking or washing food. Typhoid fever is more common in areas where hand washing is less frequent and water can be contaminated with sewage.

 

The only way to know if an illness is typhoid fever is to have samples of stool or blood tested for the presence of Salmonella Typhi bacteria. If you suspect you have typhoid fever, do not prepare any food or drink for anyone or care for young children or hospitalized patients.

 

Typhoid fever is a life-threatening illness caused by the bacterium Salmonella Typhi. In the United States, approximately 400 cases of Typhoid fever occur each year with 75 percent of these acquired while traveling internationally. Typhoid fever is still common in the developing world, where it affects about 21.5 million persons each year. The case being investigated recently traveled internationally and this is where the infection was acquired.

 

Even if symptoms disappear, people can still carry Salmonella Typhi, and the illness could return or could be passed on to other people. Typhoid fever can be successfully treated with appropriate antibiotics and persons given antibiotics usually begin to feel better within two to three days. Deaths rarely occur; however, persons who do not get treatment may continue to have fever for weeks or months. If left untreated, typhoid fever may be fatal.

 

For more information about typhoid fever, visit www.in.gov/isdh/25418.htm. To visit the Indiana State Department of Health, go to www.StateHealth.in.gov.

 

 

Salmonella Typhi, the causative agent of Typhoid Fever, is a bacterium that has no known natural reservoir outside of humans. It is usually acquired via the fecal-oral route, often by consuming food or drink that has been handled by someone who is shedding the Salmonella Typhi bacteria.

 

The NCEZID (National Center For Emerging and Zoonotic Infectious Diseases lists the clinical features of infection:

 

Typhoid fever has an insidious onset characterized by fever, headache, constipation, malaise, chills, and myalgia with few clinical features that reliably distinguish it from a variety of other infectious diseases.

Diarrhea is uncommon, and vomiting is not usually severe. Confusion, delirium, intestinal perforation, and death may occur in severe cases. The etiologic agent may be recovered from the bloodstream or bone marrow, and occasionally from the stool or urine.

 

Of course, not everyone gets sick who contracts this bacteria, and some people can shed the pathogen for months or years asymptomatically.

 

The CDC’s MMWR Summary of Notifiable Diseases — United States, 2010 provides this overview.

 

Typhoid Fever

Typhoid fever is rare in the United States, and approximately 75% of cases are associated with international travel (1). The risk of infection is highest for international travelers visiting friends and relatives in countries where typhoid fever is endemic, perhaps because they are less likely than other travelers to seek pre-travel vaccination and to observe strict safe water and food practices.The risk also is higher for travelers who visit the most highly endemic areas, such as the Indian subcontinent, even for a short time (2).

From 1960 through 1999, a total of 60 outbreaks of typhoid fever were reported in the United States (3). The first domestically acquired outbreak of typhoid fever in over a decade occurred in 2010. Twelve cases were identified, and illness was linked to consumption of imported frozen mamey fruit. Mamey from the same producer in Guatemala also was implicated in the previous domestic typhoid fever outbreak, which occurred in 1999 (4).

 

 

And finally, some advice for those planning a trip to areas where Typhoid Fever remains endemic, again from the CDC Typhoid FAQ.

 

How can you avoid typhoid fever?

Two basic actions can protect you from typhoid fever:

1. Avoid risky foods and drinks.
2. Get vaccinated against typhoid fever.

It may surprise you, but watching what you eat and drink when you travel is as important as being vaccinated. This is because the vaccines are not completely effective. Avoiding risky foods will also help protect you from other illnesses, including travelers' diarrhea, cholera, dysentery, and hepatitis A.

 

"Boil it, cook it, peel it, or forget it"

• If you drink water, buy it bottled or bring it to a rolling boil for 1 minute before you drink it. Bottled carbonated water is safer than uncarbonated water.
• Ask for drinks without ice unless the ice is made from bottled or boiled water. Avoid popsicles and flavored ices that may have been made with contaminated water.
• Eat foods that have been thoroughly cooked and that are still hot and steaming.
• Avoid raw vegetables and fruits that cannot be peeled. Vegetables like lettuce are easily contaminated and are very hard to wash well.
• When you eat raw fruit or vegetables that can be peeled, peel them yourself. (Wash your hands with soap first.) Do not eat the peelings.
• Avoid foods and beverages from street vendors. It is difficult for food to be kept clean on the street, and many travelers get sick from food bought from street vendors.

Disaster’s Hidden Toll

 

  +

Credit NHK News – Fukushima evacuation zone March 2011

 

# 6846

 

With our short attention span, and the news media’s proclivity for moving on to the next big disaster or story, we often don’t closely follow the struggle to rebuild disaster stricken communities, which can take months or even years.

 

And for some caught in harm’s way, whose homes and businesses were destroyed - and loved ones lost - there is no going back to the way things used to be.

 

Not surprisingly, that can produce significant mental and physical health challenges for those affected.

 

Today we’ve a report out of Japan showing that the earthquake/tsunami of March 2011 that killed more than 20,000 people in Japan also had a long-term, largely unseen, effect on nursing home patients who were forced to evacuate to temporary facilities.

 

A study shows a 2.4 fold increase in deaths during the 8 months following the earthquake.  Deaths not caused by the quake, tsunami, or radiation release itself – but likely brought on by the stress of having to live in make-shift emergency shelters.

 

A unusually large number of these excess deaths were due to pneumonia or bronchitis, which many attribute to insufficient emergency shelters provided for the elderly and frail.

This report from the Ashasi Simbum.

 

Death rates spike among elderly evacuees from Fukushima

January 11, 2013

By YURI OIWA/ Staff Writer

Former residents of nursing homes near the Fukushima No. 1 nuclear plant died at a higher rate than usual in 2011, a study has shown, likely because of the stress of evacuation and having to live in temporary accommodations such as draughty school gyms.

 

Researchers from the Fukushima Medical University studied reports submitted to the Fukushima prefectural government by 34 institutions for the elderly and found that the death rate over eight months in 2011 was 2.4 times that of the same period in 2010.

(Continue . . . )

 

A similar result was found in this study of nursing home evacuations from the University of South Florida.

 

The Effects of Evacuation on Nursing Home Residents With Dementia

Lisa M. Brown, PhD, David M. Dosa, MD, MPH, Kali Thomas, MA, Kathryn Hyer, PhD, MPP, Zhanlian Feng, PhD, Vincent Mor, PhD

Background: In response to the hurricane-related deaths of nursing home residents, there has been a steady increase in the number of facilities that evacuate under storm threat. This study examined the effects of evacuation during Hurricane Gustav on residents who were cognitively impaired.

 

Conclusions: The findings of this research reveal the deleterious effects of evacuation on residents with severe dementia. Interventions need to be developed and tested to determine the best methods for protecting this at risk population when there are no other options than to evacuate the facility.

 

 

We’ve looked at other post-disaster health impacts in the past, such as in Post Disaster Stress & Suicide Rates. One disaster discussed was a 1999 7.3 earthquake that struck in Chi-Chi, Nantou county in central Taiwan killing more than 2,300 people.

 

A study that subsequently appeared in the Taiwan Journal of Medicine (Disease-specific Mortality Associated with Earthquake in Taiwan Hsien-Wen Kuo, Shu-Jen Wu, Ming-Chu Chiu) found `a considerable increase in the number of suicides after the earthquake’.

 

PTSD (Post Traumatic Stress Disorder) can often occur in the wake of a disaster or traumatic experience. Symptoms may include anxiety, depression, suicide and PTSD may even lead to drug and alcohol-related disorders.

 

Victims of personal violence, rescue and medical workers, victims of disasters, terrorism, physical or psychological trauma, and/or a combat zone are all at risk of suffering some level of PTSD.

 

In Psychological First Aid: The WHO Guide For Field Workers we looked at the need for, and a guide for providing psychological first aid (PFA) in a post-disaster environment.

 

The CDC also provides a website which contains a number of resources devoted to coping with disasters.

 

Coping With a Disaster or Traumatic Event

Trauma and Disaster Mental Health Resources

The effects of a disaster, terrorist attack, or other public health emergency can be long-lasting, and the resulting trauma can reverberate even with those not directly affected by the disaster. This page provides general strategies for promoting mental health and resilience. These strategies were developed by various organizations based on experiences in prior disasters.

 

As does the National Center For PTSD - including videos - on how to provide Psychological First Aid.

A reminder that a disaster’s impact can linger long after the story has fallen off the front pages, and that indirect casualties can follow months after the initial event.

PLoS One: Influenza Viral Shedding & Asymptomatic Infections

Photo Credit PHIL (Public Health Image Library)

 

# 6776

 

 

Despite major advances in the study of influenza viruses, there remain significant gaps in our understanding of just how they work once they infect a human (or any other animal) host. 

 

Basic questions, such as `How long are we infectious?’, or `How common are asymptomatic infections?’  remain only partially answered.

 

Complicating matters, variations in individual host’s immune responses, and different strains of flu may produce varying results. Meaning that most studies can only add incrementally to our knowledge, rather than completely answering these questions.

 

Previously, we’ve seen evidence of asymptomatic and `presymptomatic’ shedding of influenza viruses.

 

In 2011, in EID Journal: Pre-Symptomatic Influenza Transmission we looked at three clusters of suspected pre-symptomatic transmission of the 2009 H1N1 virus in Japan.

 

And in Pre-Symptomatic Transmission Of H1N1 Influenza In the Ferret Model, researchers inoculated ferrets with the 2009 H1N1 flu, and then placed them near uninfected ferrets (some in direct contact, others in adjacent cages) at different stages after infection.

 

They then tested the exposed ferrets to see when, and under what circumstances, they became infected. They found that ferrets became infectious just 24 hours after becoming infected, and nearly 24 hours before showing the earliest outward signs of infection (fever).

 

 

The importance of all of this is, if presymptomatic and asymptomatic carriers of a flu virus are able to efficiently transmit the illness on to others, then strategies that seek to identify and isolate flu cases would have only limited success in containing a pandemic.

 

Similarly, understanding how long a person sheds the virus after becoming infected is crucial, so we can know when it is (relatively) safe for flu victims to return to work or school without endangering others.

 

The CDC’s general take on this topic is:

 

The Flu Is Contagious

Most healthy adults may be able to infect others beginning 1 day before symptoms develop and up to 5 to 7 days after becoming sick. Children may pass the virus for longer than 7 days. Symptoms start 1 to 4 days after the virus enters the body. That means that you may be able to pass on the flu to someone else before you know you are sick, as well as while you are sick. Some persons can be infected with the flu virus but have no symptoms. During this time, those persons may still spread the virus to others.

 

 

Yesterday, a new study appeared in PloS One, conducted in Germany over 4 flu seasons (2007-2011) and involving 4 flu strains - seasonal (A(H3N2), A(H1N1), influenza B, and pandemic (A(H1N1)pdm09 - that looks at many of these transmission issues. 

 

Comparison of Shedding Characteristics of Seasonal Influenza Virus (Sub)Types and Influenza A(H1N1)pdm09; Germany, 2007–2011

Thorsten Suess, Cornelius Remschmidt, Susanne B. Schink, Brunhilde Schweiger, Alla Heider, Jeanette Milde, Andreas Nitsche, Kati Schroeder, Joerg Doellinger, Christian Braun, Walter Haas, Gérard Krause, Udo Buchholz

Background

Influenza viral shedding studies provide fundamental information for preventive strategies and modelling exercises. We conducted a prospective household study to investigate viral shedding in seasonal and pandemic influenza between 2007 and 2011 in Berlin and Munich, Germany.

Methods

Study physicians recruited index patients and their household members. Serial nasal specimens were obtained from all household members over at least eight days and tested quantitatively by qRT-PCR for the influenza virus (sub)type of the index patient. A subset of samples was also tested by viral culture. Symptoms were recorded daily.

Results

We recruited 122 index patients and 320 household contacts, of which 67 became secondary household cases. Among all 189 influenza cases, 12 were infected with seasonal/prepandemic influenza A(H1N1), 19 with A(H3N2), 60 with influenza B, and 98 with A(H1N1)pdm09. Nine (14%) of 65 non-vaccinated secondary cases were asymptomatic/subclinical (0 (0%) of 21 children, 9 (21%) of 44 adults; p = 0.03).

 

Viral load among patients with influenza-like illness (ILI) peaked on illness days 1, 2 or 3 for all (sub)types and declined steadily until days 7–9. Clinical symptom scores roughly paralleled viral shedding dynamics.

 

On the first day prior to symptom onset 30% (12/40) of specimens were positive. Viral load in 6 asymptomatic/subclinical patients was similar to that in ILI-patients. Duration of infectiousness as measured by viral culture lasted approximately until illness days 4–6. Viral load did not seem to be influenced by antiviral therapy, age or vaccination status.

Conclusion

Asymptomatic/subclinical infections occur infrequently, but may be associated with substantial amounts of viral shedding. Presymptomatic shedding may arise in one third of cases, and shedding characteristics appear to be independent of (seasonal or pandemic) (sub)type, age, antiviral therapy or vaccination; however the power to find moderate differences was limited.

 

 

While this was a relatively small study, and their findings don’t always align perfectly with others we’ve seen (for instance, children didn’t appear contagious any longer than adults), it does provide us with some interesting data.

 

• First, nearly 1/3rd of cases began shedding virus while pre-symptomatic
• Second, viral loads in (six studied) asymptomatic cases were similar to that to patients exhibiting ILI (influenza-like-illness) symptoms.
• Third, viral load among symptomatic patients peaked on illness days 1, 2 or 3 and declined steadily until days 7–9

 

Some other gems (bolding mine) excerpted from this open access article include:

 

• Overall 63% of non-vaccinated secondary household cases had an ILI-syndrome and the proportion of asymptomatic/subclinical secondary cases was 14%.
• Frequency distribution of clinical symptoms did not differ between A(H1N1)pdm09 cases and non-pandemic influenza cases.
• Interestingly, 21% of adult secondary cases were asymptomatic/subclinical, while all children that contracted influenza were symptomatic.
• Based on the population of ambulatory patients investigated we found no evidence that the amount of shedding is particularly higher in children, nor that duration of viral shedding is significantly longer in children compared to adults.

 

 

The authors conclude by saying:

 

In summary, our study addresses several important questions on clinical manifestation, duration of infectiousness, viral shedding patterns, including shedding before symptom onset and in asymptomatic/subclinical patients, as well as the effect of vaccination and antiviral therapy on viral shedding.

 

Important single results include the finding that children do not seem to be infected asymptomatically, that shedding one day before symptom onset may occur in one third of influenza patients, that asymptomatic/subclinical influenza patients occur rarely, but viral load (and probably infectiousness) may be substantial, and vaccinated influenza patients do not show different shedding patterns compared to non-vaccinated cases with ILI.

 

Overall results do not show marked differences between seasonal influenza (sub)types and influenza A(H1N1)pdm09.

Early Flu Cases Begin To Emerge

 

Photo Credit CDC Influenza Home Care Guide

# 6745

 

While it may not tell us a lot about how the rest of the 2012-2013 flu season will go, over the past couple of weeks several states have begun reporting spikes in early influenza activity.  The last FluView report from the CDC (Nov 17th) indicated flu activity was increasing in parts of the country; notably in the south central and southeastern states.

 

Likewise, the Flu Near You weekly online survey (of self reported symptoms) shows the greatest rate of ILI (Influenza-like-Illness) activity currently in the middle southern states.

 

Flu Near You map  11/29/12

 

NOTE: ILI’s can include many non-influenza viral illnesses, including adenovirus, parainfluenza, rhinovirus and others which are indistinguishable from influenza without laboratory tests (see Dozens Of Ways To Spell `I-L-I’).

 

Although `flu season’ can begin as early as October some years, it is generally December before the virus really begins to make its presence widely known. The Thanksgiving holiday, which often brings many family members together, may play a part in kick starting the epidemic each year.

 

Yesterday South Carolina’s Department of Health and Environmental Control issued the following notice, which included word of a pediatric flu fatality.

 

FOR IMMEDIATE RELEASE
Nov. 28, 2012

Flu cases spiking early, first flu death in South Carolina

COLUMBIA, S.C. – The S.C. Department of Health and Environmental Control notes the state’s first flu-associated death of the season, as well as a significant and earlier-than-normal increase in influenza activity, the agency announced today.

 

“Tragically, a child from Barnwell County has become our first confirmed influenza-associated death of the season,” said Linda Bell, M.D. and interim state epidemiologist. “The flu can be especially serious for the very young and the elderly.

 

“Our latest statewide activity report indicates that influenza has quickly reached ‘widespread’ levels in South Carolina,” Dr. Bell said. “Flu activity typically peaks in February, and it is very unusual for us to see this number of cases so early in the season. Therefore, we strongly encourage vaccination to prevent the flu and its potentially serious consequences.”

(Continue . . .)

 

Similarly, reports from Central Florida indicate an early start here as well.  This from the Orlando Sentinel.

 

Flu season hitting earlier, local clinics say

1:09 p.m. EST, November 27, 2012|By Marni Jameson, Orlando Sentinel

Flu season has arrived in Central Florida, and it's well ahead of schedule, according to Dr. Tim Hendrix, medical director for CentraCare, which operates 21 clinics throughout Central Florida.

 

The CentraCare clinics saw 250 confirmed cases of the flu last week alone. That's more than a 10-fold increase in flu cases compared to Thanksgiving week last year, when the clinics reported 21 confirmed cases, said Hendrix.

(Continue . . .)

 

Other states now confirming flu activity include Arizona, Missouri, Colorado, Maine, New York and Ohio. Most surveillance reports are trailing indicators – showing us the level of activity 1 to  2 weeks ago – so the level of activity today could be different.

 

In any event, if you haven’t gotten your flu shot, now would be an excellent time to do so, as it takes a couple of weeks to begin building antibodies once you get the shot.

 

No, it won’t protect you against non-influenza viral illnesses, and the protection it provides against the flu can vary from year-to-year and person-to-person. 

 

A meta-analysis by CIDRAP in 2011 (see A Comprehensive Flu Vaccine Effectiveness Meta-Analysis) found the trivalent inactivated vaccine (TIV) had a combined efficacy of 59% among healthy adults (aged 18–65 years).

 

Still, flu shots have an excellent safety profile and remain one of the most effective preventatives against catching influenza. Beyond that, being vigilant (read: obsessive) regarding day-to-day flu hygiene is your best safeguard.

 

The CDC recommends:

 

 

Take everyday preventive actions to stop the spread of germs.

• Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
• Wash your hands often with soap and water. If soap and water are not available, use an alcohol-based hand rub.
• Avoid touching your eyes, nose and mouth. Germs spread this way.
• Try to avoid close contact with sick people.
• If you are sick with flu-like illness, CDC recommends that you stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities. (Your fever should be gone without the use of a fever-reducing medicine.)
• While sick, limit contact with others as much as possible to keep from infecting them.
• See Everyday Preventive Actions  [257 KB, 2 pages] and Nonpharmaceutical Interventions (NPIs) for more information about actions, apart from getting vaccinated and taking medicine, that people and communities can take to help slow the spread of illnesses like influenza (flu).

 

Of course, if all of these preventatives fail, stay home so you don’t share your virus with the world. If you are at high risk of complications, contact your doctor to see about taking antiviral medications.

Otherwise, CDC’s Influenza Home Care Guide should see you through.

Hong Kong’s Coronavirus Response

Coronavirus – Credit CDC PHIL

# 6738

 

No city experienced a greater impact from the SARS epidemic a decade ago than did Hong Kong in 2003. Between March 11th and June 6th, a total of 1750 cases were identified, and of those, 286 died.

 

From the JRSM (Journal of the The Royal Society of Medicine) in August of 2003, we get this description of the spread of the disease in the city.

 

 The SARS epidemic in Hong Kong: what lessons have we learned?)

Lee Shiu Hung, MD FFCM

(Excerpt)

The SARS epidemic in Hong Kong has gone through three phases. The first was an explosive outbreak in a teaching hospital, affecting a large number of hospital staff and medical students. This phase took place in March 2003.

The second phase was an outbreak in the community as a result of the spread of infection from the hospital to the community. This reached its peak in early April 2003 when the disease affected a housing estate known as Amoy Gardens; a total of 329 residents in that estate came down with the disease and 33 died.

The third phase began in early May, with continuing occurrence of the disease in eight hospitals and more than 170 housing estates throughout the city but with the daily number of new cases declining from double to single digits in mid-June (the time of writing).

(Continue . . .)

 

Out of this trial by fire, Hong Kong’s Centre For Health Protection was born, and today it arguably runs one of the most proactive disease surveillance systems in the world.

So one should not be surprised to find a link to the new coronavirus front and center on the CHP’s home page.

 

On September 27th, just 3 days after being notified of the first coronavirus case, Hong Kong modified their Prevention and Control of Disease Ordinance (Cap. 599) to include “Severe Respiratory Disease associated with Novel Coronavirus”  as one of the statutorily notifiable diseases (see Letter To Doctors).

 

You’ll find a variety of notices, and letters to institutions regarding this emergent coronavirus on this page.

 

Today the Hong Kong government posted some remarks by their Secretary for Food and Health, Dr Ko Wing-man. As you’ll see, that while they are watching this situation carefully, at this time they have no plans to upgrade their alert level.

 

 

SFH on overseas cases of Severe Respiratory Disease associated with Novel Coronavirus

Following is the transcript of remarks made by the Secretary for Food and Health, Dr Ko Wing-man, after attending a public function this afternoon (November 25):

Secretary for Food and Health: Regarding the new novel coronavirus causing severe respiratory disease, there is a concern that over a span of two months, another batch of four new cases (three from Kingdom of Saudi Arabia and one from Qatar) was confirmed by the World Health Organization (WHO). The WHO also pointed out that we cannot assume the source of infection is only present in the countries concerned. Patients who have not got a history of travel to these two particular middle-east countries but developed symptoms of illness similar to the diseases caused by this new novel coronavirus, they might still be considered necessary to undertake the test for the new coronavirus.

Reporter: (On emergency level in Hong Kong for an outbreak of the new disease)

Secretary for Food and Health: The Centre for Health Protection of the Department of Health is consistently conducting risk assessment, following up on whether there will be any new information or new cases reported. Up to this moment, there is no need to upgrade our response level for the infectious disease outbreak. However, the new reported cases (due to infection with the novel coronavirus) highlighted the need to enhance our surveillance measures, both at the hospitals as well as at the immigration check points. 

(Please also refer to the Chinese portion of the transcript.)

Ends/Sunday, November 25, 2012
Issued at HKT 20:23

 

You can pretty much expect an enhanced level of surveillance around the world in the coming days as a result of last week’s announcement from the World Health Organization (see WHO Announces Additional Coronavirus Cases).

 

It is far too soon to know whether this virus will pose a major public health threat, but one of the lessons learned from the SARS outbreak of 2003 is that delays in reporting can have deadly consequences.

 

It is far better for public health officials to be hyper-vigilant today, than to have to play catch up tomorrow.

Studies Weigh In On The `Obesity Paradox’

 

Photo Credit CDC PHIL

 

 

# 6651

 

While just about everyone will concede that being lean and athletic is preferable to being soft and pudgy, there is a growing body of evidence that – with some medical conditions, at least - having a bit of extra poundage could be beneficial to your long-term survival. 

 

Research has shown that patients having a BMI > 30 actually are more likely to survive certain medical conditions than patients with a normal or below-normal body mass index.

 

It’s called the `Obesity Paradox’, and quite frankly, it’s been driving doctors and researchers just a little bit nuts for years.  

 

Now, before anyone cries `foul’, there are plenty of health risks that come from being obese, including diabetes, coronary artery disease, sleep apena, hypertension, and stroke. The point here isn’t that being overweight is healthier.

 

it isn’t.

 

But for people with certain medical conditions, including diabetes, congestive heart failure, kidney dialysis, heart attacks, and Asthma - carrying extra pounds appears to improve their outcomes.

 

This curious (and controversial) finding was first described in the literature in 1999, regarding survival rates of patients on kidney dialysis (see Influence of excess weight on mortality and hospital stay in 1346 hemodialysis patients). 

 

Since then, this phenomenon has inspired a good deal of research, much of it coming to similar conclusions.

 

Overnight we saw this press release come from the American College of Chest Physicians.

 

 

'Obesity paradox': Extra weight linked to better outcomes for septic shock, asthma exacerbation

Although obesity is linked to a variety of health risks, new research indicates that obese patients may have an advantage over nonobese patients in certain health situations, including septic shock and acute asthma exacerbation.

 

In two separate studies presented at CHEST 2012, the annual meeting of the American College of Chest Physicians, researchers compared outcomes in obese (BMI >30) vs nonobese patients with either septic shock or acute asthma exacerbation. Results showed that, although obese patients with asthma are more at risk for asthma exacerbations, near fatal exacerbations were more prevalent in nonobese patients.

 

Likewise, obese patients with septic shock had decreased mortality compared with nonobese patients. Researchers attribute this "obesity paradox" partly to a blunted pro-inflammatory cytokine response in obese patients.

 

 

Recently,  JAMA published a pooled analysis of 5 cohort studies that found – surprisingly – that : “Adults who were normal weight at the time of incident diabetes had higher mortality than adults who are overweight or obese.”

Original Contribution | August 8, 2012

Association of Weight Status With Mortality in Adults With Incident Diabetes

Mercedes R. Carnethon, PhD; Peter John D. De Chavez, MS; Mary L. Biggs, PhD; Cora E. Lewis, MD; James S. Pankow, PhD; Alain G. Bertoni, MD, MS; Sherita H. Golden, MD, MS; Kiang Liu, PhD; Kenneth J. Mukamal, MD, MPH; Brenda Campbell-Jenkins, PhD; Alan R. Dyer, PhD

JAMA. 2012;308(6):581-590. doi:10.1001/jama.2012.9282.

 

 

 

We’ve another large study out of Sweden that looked at patient outcomes with acute coronary syndromes (ACSs)  – and you guessed it – obese patients had better survival rates after a heart attack than patients of normal weight.

 

Evidence for obesity paradox in patients with acute coronary syndromes: a report from the Swedish Coronary Angiography and Angioplasty Registry

Oskar Angerås, Per Albertsson, Kristjan Karason, Truls Råmunddal, Göran Matejka, Stefan James, Bo Lagerqvist, Annika Rosengren and Elmir Omerovic

Conclusion In this large and unselected group of patients with ACSs, the relation between BMI and mortality was U-shaped, with the nadir among overweight or obese patients and underweight and normal-weight patients having the highest risk. These data strengthen the concept of the obesity paradox substantially.

 

 

Similarly, from the American Journal of Cardiology, we get this study from earlier this summer, on survival rates of patients with congestive heart failure.

Volume 110, Issue 1 , Pages 77-82, 1 July 2012

The Obesity Paradox in Men Versus Women With Systolic Heart Failure

Adrienne L. Clark, BA, Jennifer Chyu, Tamara B. Horwich, MD, MS

Abstract (excerpt):

In multivariate analyses, normal BMI and normal WC were associated with higher relative risk for the primary outcome in men (BMI 1.34, WC 2.02) and women (BMI 1.38, WC 2.99). In conclusion, in patients with advanced HF, high BMI and WC were associated with improved outcomes in both genders. Further investigation of the interaction between body composition and gender in HF outcomes is warranted.

 

 

Admittedly, many of these medical conditions may well have been brought on by the patient’s obesity to start with, so none of these results should be construed as a green light for binge eating brownies.

 

As to why obese individuals may fare better with certain medical conditions that those of normal, or below normal, weight?  

 

There are plenty of theories.

 

• It has been suggested that heavier patients may develop medical conditions earlier, may get more aggressive treatment, and thereby have a survival advantage.
• Some theorize that hospitalizations and chronic illnesses – which often induce weight loss - put those without fat reserves at a disadvantage.
• There is even speculation that adipose tissue may secrete protective cytokines and hormones (cite).

 

The truth is, no one really knows.

 

Finally, in 2005 epidemiologist Katherine Flegal published a study called Excess deaths associated with underweight, overweight, and obesity that looked at data from two decades of NHANES surveys, and found that mortality among those slightly overweight (BMI 25 -29) was less than those in the `normal’ weight category (BMI 20 -25).

 

This study found that it was really the extremes of being over or underweight that contributed to higher mortality.

 

Personally, I’m not sure what conclusions we can draw from all of this, but it is certainly food for thought.

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.