Montgomery County, Tx Influenza-Like Illness Investigation Update – Dec 18th

 

 

# 8088

 

Over the past 36 hours we’ve been following a report out of Montgomery County, Texas where an unidentified flu-like illness had hospitalized 8 local residents in recent weeks, killing 4 of them. This afternoon the Montgomery County Public Health Department announced on their Facebook page they would hold a press conference before 5pm local time to update the public on what their investigations have shown.

 

At 6pm EST the following update was posted on the MCPH’s Facebook page, indicating that one case has been identified as being H1N1 influenza, while the cause (or causes) of the other illnesses have yet to be determined.  The investigation is ongoing.

 

12/18/2013
UPDATE: INFLUENZA LIKE ILLNESS ARISES IN MONTGOMERY COUNTY

As of Wednesday afternoon, there has been one confirmed case of H1N1 virus. Of the eight reported cases, four patients have deceased. Of the remaining four cases in an area hospital, one case has tested positive for the H1N1 virus. Two of the patients tested negative for all flu viruses. Montgomery County Public Health District is awaiting test results for the remaining patient. The 2013 Influenza vaccine does protect against the H1N1 virus. At this time no known deaths received the vaccine.

Based on CDC data, the H1N1 virus is nationally on the rise. It can reasonably be expected that the occurrence of more H1N1 cases will be reported. Public Health Officials will continue to monitor the situation diligently and will provide more information as it is received.

The Montgomery County Public Health District is grateful for Conroe Regional Hospital’s astute physicians who recognized the unusual nature of the illness and began the appropriate testing to reach a diagnosis.

Montgomery County Public Health District has been in discussion with the Texas Department of State Health Services along with the CDC to coordinate investigation efforts. Despite ongoing investigations, it cannot be emphasized enough that common infection control practices should be followed to prevent the spread of infection. As with common flu strains, some people are more likely to develop flu complications than others. Please reference the CDC’s website, http://www.cdc.gov/flu/about/disease/high_risk.htm, which further explains the high risk population, including children under the age of 5, adults over the age of 65, and people with certain medical conditions.

 

It is also recommended that you receive your flu shot. Montgomery County Public Health Clinic is offering the vaccination by appointment, while supplies last. Call (936) 523-5020 to set up an appointment. For any other questions or concerns, please contact the Public Health hotline at (936) 523-5050. The line will be staffed Monday thru Friday from 8AM-5PM, it is for non-media inquiries only.

 

As I wrote this morning, now is the time of the year when we should all be cognizant of, and diligent in, practicing good flu hygiene.  The CDC recommends:

• Wash your hands often with soap and water or an alcohol-based hand rub.
• Avoid touching your eyes, nose, or mouth. Germs spread this way.
• Try to avoid close contact with sick people.
• Practice good health habits. Get plenty of sleep and exercise, manage your stress, drink plenty of fluids, and eat healthy food.
• Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
• If you are sick with flu-like illness, stay home for at least 24 hours after your fever is gone without the use of fever-reducing medicine.

And, with holiday travel and gatherings, and the bulk of the flu season still ahead  . . it isn’t too late to get that flu shot.

 

I’ll update this story again, once more news becomes available.

 

++

HK CHP: Epidemiological Investigation & Response To H7N9 Case

 

# 8037

 

This morning  Hong Kong’s CHP has published a detailed accounting of their epidemiological tracing, and follow up, of contacts of their H7N9 patient this morning, with additional details on their quarantine plans that I blogged about earlier today (see HK: H7N9 Contact Tracing, Testing, Isolation & Quarantine). Among the revelations:

 

The patient’s traveling companion has now been located (see Video: HK Officials Seeking Traveling Companion Of H7N9 Patient), has tested negative, and remains asymptomatic.

At this point more than 200 people with potential exposure have been offered Tamiflu ® prophylaxis, most of whom are medical staff or hospital employees (see H7N9: CDC Guidance On Antiviral Chemoprophylaxis  for additional background).

The CHP is undertaking a massive public awareness campaign on H7N9 prevention.

 

All of which illustrates the seriousness with which Hong Kong’s public health authority is treating this single case.

3 December 2013

Epidemiological investigation and follow-up actions by CHP on confirmed human case of avian influenza A(H7N9) 

A spokesman for the Centre for Health Protection (CHP) of the Department of Health (DH) today (December 3) provided an update on the first confirmed human case of avian influenza A(H7N9) in Hong Kong affecting a woman aged 36.

 

"The Serious Response Level under the Government's Preparedness Plan for Influenza Pandemic has been activated while the CHP's epidemiological investigation and follow-up actions are currently in full swing," the spokesman remarked.

 

As of 2pm today, contact tracing conducted by the CHP has located 17 close contacts and over 200 other contacts. Details are as follows:

 

(A) 17 close contacts of the patient have been quarantined and prescribed with Tamiflu prophylaxis, including:

1. All ten home contacts, including four with non-specific symptoms, have been quarantined in Princess Margaret Hospital (PMH). Their specimens all tested negative for the avian influenza A(H7) virus upon preliminary laboratory testing by the Public Health Laboratory Services Branch (PHLSB) of the CHP;

2. The female travel collateral aged 33 who visited Shenzhen with the patient has been located and has remained asymptomatic. Her specimen tested negative for the avian influenza A(H7) virus upon preliminary laboratory testing by the PHLSB and she was transferred to PMH for quarantine; and

3. Six patients who stayed in the same cubicle with the confirmed patient in Tuen Mun Hospital (TMH) are currently under quarantine in hospital pending laboratory testing.

    The Lady MacLehose Holiday Village in Sai Kung under the Leisure and Cultural Services Department has been converted as quarantine centre and asymptomatic close contacts will be transferred there.

(B) Over 200 other contacts of the patient have been put under medical surveillance and offered with Tamiflu prophylaxis, including:

1. The two private doctors, Dr Simon Wong Siu-shan (Shop 17, G/F, Kai Hei Land Building, 385 Castle Peak Road) and Dr Wong Chun-yan (Shop 102A-103, G/F, Kam Wah Shopping Arcade, Tuen Lung Street), practising in Tuen Mun whom the patient respectively consulted at about 11am on November 25 and around 8.30pm on November 26 have been located. Both doctors, their staff, patients and accompanying relatives (over 30 persons) have all remained asymptomatic; and

2. Over 170 healthcare workers (HCWs) in TMH and QMH and the ambulance officers involved in patient transfer between the two hospitals have been identified. Seven of the HCWs who presented with non-specific symptoms have been tested negative for the avian influenza A(H7) virus.

    Contact tracing by the CHP is ongoing.

    "The CHP has also enhanced surveillance over suspected cases in public and private hospitals starting from today," the spokesman added.

    The CHP has issued letters to doctors and hospitals, kindergartens, child care centres, primary and secondary schools, as well as residential care homes for the elderly and disabled to keep them abreast of the latest situation.

    "The confirmed case has been notified to the World Health Organization, the National Health and Family Planning Commission, the General Administration of Quality Supervision, Inspection and Quarantine of the Mainland as well as health and quarantine authorities of Guangdong, Zhuhai and Macau," the spokesman said.

    "All border control points (BCPs) have implemented disease prevention and control measures. Body temperature checks and health surveillance have been enhanced. The Port Health Office of the DH has maintained liaison with the Shenzhen Entry-Exit Inspection and Quarantine Bureau in paying attention to travellers, and also cross-boundary students, who present with fever or are symptomatic. Suspected cases will be immediately referred to public hospitals for follow-up investigation," the spokesman remarked.

    Regarding health education to travellers at BCPs, distribution of health education pamphlets, the display of posters on avian influenza A(H7N9) in departure and arrival halls, in-flight public announcements, environmental health inspection, and the provision of regular updates to the travel industry via meetings and correspondence have all been escalated.

    The DH will keep a close eye on the latest development and adopt corresponding port health measures.

    The CHP's hotline (2125 1111) has been set up for public enquiries which will operate from 9am to 6pm. As of 4pm today, 13 enquiries were received.

    "Travellers, especially those returning from avian influenza A(H7N9)-affected areas, with fever or respiratory symptoms are reminded to immediately wear facial masks, seek medical attention, and reveal their travel history to doctors. Healthcare professionals should also pay special attention to patients who might have had contact with birds, poultry or their droppings in affected areas," the spokesman advised.

    The spokesman also urged travellers not to visit wet markets with live poultry in the affected areas and to avoid direct contact with poultry, birds and their droppings. If contact has been made, they should thoroughly wash their hands with soap and water.

    Members of the public should remain vigilant and are reminded to take heed of the following preventive advice against avian influenza:

• Poultry and eggs should be thoroughly cooked before eating;
• Wash hands frequently with soap, especially before touching the mouth, nose or eyes, handling food or eating; after going to the toilet or touching public installations or equipment such as escalator handrails, elevator control panels or door knobs; or when hands are dirtied by respiratory secretions after coughing or sneezing;
• Cover the nose and mouth while sneezing or coughing, and hold the spit with a tissue and put it into a covered dustbin;
• Avoid crowded places and contact with fever patients; and
• Wear a mask when respiratory symptoms develop or when taking care of fever patients.

    The public may visit the CHP's avian influenza page (www.chp.gov.hk/en/view_content/24244.html) and its website (www.chp.gov.hk/files/pdf/global_statistics_avian_influenza_e.pdf) for more information on avian influenza-affected are

China Seeks To Reassure On Bird Flu

 

Guilty as charged?     Photo Credit – FAO

 

# 6047

 

The news wires this morning are filled with reports on the investigation into the death of a Shenzhen bus driver late last week from the H5N1 virus (see Shenzhen Bird Flu Suspect Dies).

 

The substance of most of these reports appear to be based on the details released in a Xinhua News Service report overnight.

Xinhua is the official news service (some would say press agency) of the Chinese government.

 

The gist of the report (linked below) is that health officials have reportedly identified the H5N1 strain, and have determined through genetic analysis that while pathogenic in humans, it is `not transmissible’.

 

First the Xinhua report (emphasis mine), then I’ll return with a little more.

 

Authorities identify virus leading to Guangdong bird flu death

Source: Xinhua  |   2012-1-2  HEALTH authorities in south Guangdong province have identified the type of the virus that led to the death of a bus driver, but the cause of the bird flu remains unclear, a local disease control center confirmed today.

 

The receptor of the virus, a highly pathogenic H5N1, is poultry, according to a statement released by the Shenzhen Disease Control Center.

 

Though it is highly pathogenic to human beings, the virus can not spread among people, the center said in the statement, adding that there is no need for Shenzhen citizens to panic.

 

Genetic analysis also indicated that the virus was spread directly from poultry to human, according to the statement.

 

A 39-year-old man surnamed Chen in Bao'an district of Shenzhen was hospitalized for fever on December. 21 and tested positive for the H5N1 avian influenza virus. Chen died of multiple organ failure Saturday afternoon.

 

Health authorities are trying to figure out where Chen acquired the virus.

 

The Guangdong Department of Agriculture announced Saturday that no epidemic of bird flu among poultry had been reported in the province.

 

This reassuring missive – complete with the standard admonishment `not to panic’ – is unfortunately both contradictory, and lacking in detail. 

 

We are told in two places that the route of infection is unclear, and in another that genetic analysis shows it was from direct contact with infected poultry.

 

But at the same time we are assured by the Agriculture Department that no outbreaks of H5N1 have been reported in poultry anywhere in the Province.

 

The `receptor’ of the virus – by that I assume they mean the RBD (Receptor Binding Domain) – is stated as being `poultry’. 

 

I’m assuming they mean avian in nature (an affinity for alpha 2,3 receptor cells).

 

A virus’s ability to bind to specific cells is controlled by its RBD or Receptor Binding Domain; an area of its genetic code that allows it to attach to, and infect, specific types of host cells.

 

(A Very Simplified Illustration of RBDs)

Like a key into a padlock, the RBD must `fit’ in order to open the cell to infection.

 

Humans, unlike birds, have mostly alpha 2,6 receptor cells in their upper respiratory tract, making it difficult for avian viruses to attach. Humans do have some a2,3 receptor cells deep in the lungs and in their gastrointestinal tract.

 

The declaration that the `virus can not spread among people’ would therefore seem a bit strong, as we’ve seen limited transmission of avian-adapted viruses among humans in the past.

 

That this virus is not yet well adapted to human physiology - and therefore unlikely to be spread from one human to another - is probably a more reasonable assessment.

 

The lack of additional cases thus far in the province is obviously a good sign, and if that trend continues, would lend credence to the government’s claim that this is not an easily transmissible strain.  

 

But a lack of scientific detail - along with an overly reassuring tone and China’s chequered history on the reporting of previous disease outbreaks - makes it difficult to come away from this report completely assuaged.

Australia: No Clear Answers On Child’s Death

 

 

# 4889

 

 

 

Last April we began hearing reports of an unexpected number of adverse side effects among young children in Australia who had received CSL Ltd.’s  Fluvax seasonal flu vaccine.

 

The total number of reports were small (several hundred) out of tens of thousands of shots given, but significantly higher than normal.

 

Most of the side effects were related to fever, with some children experiencing febrile convulsions. Others experienced nausea and vomiting, or injection site inflammation (see Australia Investigating Adverse Vaccine Reactions).

 

Of most concern was the death of a 2 year old girl named Ashley, who died the day after receiving the shot (see Australian Vaccine Investigation Widens).

 

Obviously a suspicious timeline, but as we’ve seen many times in the past, correlation doesn’t always imply causation.

 

In June the Coroner investigating the case announced that autopsy results had failed to establish a cause of death (see Australian Coroner: No Link To Vaccine In Childs Death).

 

To be absolutely fair, saying `they’ve found no evidence to link the death to the vaccine’ isn’t quite the same as saying they have `proof that the vaccine didn’t cause the death’.

 

But that sort of definitive proof is often impossible to come by, particularly when no cause of death can be established.

 

Fast forward to today, and the Coroner has closed the investigation, with essentially no new developments. 

 

The coroner stated that while a link between her death and the vaccine cannot `absolutely be excluded’ that he found nothing to causally connect Ashley’s death to the flu vaccine.

 

Which, judging from the Australian newspaper headlines this morning, isn’t being taken as particularly reassuring.

 

Flu shot not ruled out in toddler's death

 

While technically accurate, this isn’t the headline I would have chosen. But then, it isn’t my job to sell newspapers.

 

With the investigation at a close, we will probably never know the true cause of Ashley’s tragic death. 

 

While it can’t be stated with 100% certainty that the vaccine didn’t in some way contribute to Ashley’s death, absolutely no link to the vaccine has been established.

 

 

Which would seem to me to be pretty good news and the real story here.

 

Unfortunately, inconclusive answers and headlines like the one above help to foster the public’s anxieties over the safety of vaccines.   

 

And it doesn’t seem to matter how many positive reports we get about the overall safety and overwhelming benefits of vaccination.

 

All it takes is one sensational story like this to undermine them.