Enterovirus D-68 (HEV-D68) Update

States reporting suspected or confirmed HEV-D68

 

 

# 9045

 

Although lab confirmation is still awaited in some areas, the outbreak of severe respiratory illness in kids that we saw pop up N.W. Missouri a little over a week ago (see Kansas City Outbreak Identified As HEV 68), and then a few days later in St. Louis (see Missouri Health Alert On Enterovirus 68), has now been reported in at least four more states.

This week we’ve seen media reports of hospitals being slammed with (mostly young) patients with respiratory infections in Ohio, Illinois, Kansas, Missouri, and most recently Colorado.  While test results haven’t come back for all of these locations, local doctors are pointing their fingers at the emerging EV 68 virus.

 

A sampling of some of the media coverage overnight includes:

 

Severe respiratory virus impacting hundreds of kids reaches Colorado

kdvr.com - ‎15 hours ago‎

DENVER — A potentially severe virus that has plagued hundreds of children across a 900-mile stretch in the Midwest in recent weeks has made its way to Colorado.

Colorado children's hospitals see spike in severe respiratory illness

The Denver Post - ‎12 hours ago‎

Children's hospitals in Denver are experiencing an alarming spike in a severe respiratory illness — especially among very young children and those with asthma — that may be caused by an uncommon viral pathogen.

Hospitals across Denver are on alert for a respiratory illness that can leave ...

The Denver Channel - ‎4 hours ago‎

At Rocky Mountain Hospital for Children, physicians report about 10 of the 20 beds in their pediatric intensive care unit are young people battling the virus. "Our pediatric floor is full of patients with pretty severe respiratory distress," said Dr.Raju Meyappan

Denver hospitals see virus spike in kids

9NEWS.com - ‎10 hours ago‎

DENVER - Denver hospitals and pediatricians offices are seeing a spike in a respiratory virus that is hitting kids hard who have histories of asthma and wheezing. ... "It seems to be what's happening with this virus which is more severe than other viruses.".

 

Often called EV 68, this virus is primarily known for producing respiratory symptoms - similar to that seen with rhinoviruses - although in some cases it can be severe enough to require hospitalization. There are reports of a number of children ending up in intensive care, some requiring ventilatory assistance, over the past week.

 

While children are usually the hardest hit, adults are not immune. Co-morbidities – such as asthma – can exacerbate the symptoms.

 

The virus (genus Enterovirus - family Picornaviridae – species HEV-D) –  is just one of a large family of small RNA viruses that include the three Polioviruses, along with myriad non-polio serotypes of Human Rhinovirus, Coxsackievirus, echovirus, and human, porcine, and simian enteroviruses.

 

HEV-D68  was first indentified in 1962, but until about 5 years ago, had not been often reported. The CDC called attention to its emergence several years ago - (see MMWR: Clusters Of HEV68 Respiratory Infections 2008-2010) – which looked at a half dozen  HEV 68 associated clusters that occurred in Asia, Europe, and the United States during 2008--2010.

 

EV 68’s rarity up until now in North America likely equates to very low levels of community immunity, which probably explains its rapid dissemination over the past couple of weeks, spurred on by the start of the school year.

 

For most kids (and adults) this will likely prove little more than a nasty `cold’ or virus.  But in a small percentage of cases, it can turn severe, and so parents need to pay particular attention this fall.  This virus appears to have `legs’, and so we could see a busy start to the winter respiratory illness season. 

 

While rarely seen in the United States, over the past 10 years we’ve seen this virus on the ascendant in China, The Netherlands, Japan, and the Philippines, sometimes producing significant outbreaks. 

 

A few recent studies include:

 

J Med Microbiol. 2014 Mar;63(Pt 3):408-14. doi: 10.1099/jmm.0.068247-0. Epub 2013 Dec 9.

Detection of enterovirus 68 as one of the commonest types of enterovirus found in patients with acute respiratory tract infection in China.

Lu QB¹, Wo Y, Wang HY, Wei MT, Zhang L, Yang H, Liu EM, Li TY, Zhao ZT, Liu W, Cao WC.

Author information

Abstract

Human enterovirus 68 (HEV-68) is an enterovirus associated with respiratory illness. In China, no information about HEV-68 is available for children yet. This study aimed to investigate the presence of HEV-68 in mainland China between 2009 and 2012 and to explore the migration events of HEV-68 across the world.

Among 1565 samples tested from children, 41 (2.6%) were positive for HEV and 223 (14.3%) for human rhinovirus (HRV). Seven (17.1%) of 41 HEVs were HEV-68. Two HEV-68- and five HRV-positive samples were detected in 585 adult samples. HEV-68 is the predominant type of enterovirus in children with acute respiratory tract infection (ARTI), followed by HEV-71 and coxsackievirus A6. Three HEV-68-infected children presented with severe pneumonia and one presented with a severe asthma attack.

The viruses were attributed to two novel distinct sublineages of HEV-68 based on phylogenetic analysis of partial VP1 gene sequences. Migration events analysis showed that the USA and the Netherlands were possible geographical sources of HEV-68, from where three strains migrated to China.

In conclusion, HEV-68 may play a predominant role among the enteroviruses associated with ARTI in children. Additional surveillance is needed to clarify the reason why HEV-68 causes such a wide spectrum of disease, from asymptomatic to severe respiratory disease and even death.

Virology. 2012 Feb 5;423(1):49-57. doi: 10.1016/j.virol.2011.11.021. Epub 2011 Dec 15.

Emergence and epidemic occurrence of enterovirus 68 respiratory infections in The Netherlands in 2010

Meijer A¹, van der Sanden S, Snijders BE, Jaramillo-Gutierrez G, Bont L, van der Ent CK, Overduin P, Jenny SL, Jusic E, van der Avoort HG, Smith GJ, Donker GA, Koopmans MP.

Author information

Abstract

Following an increase in detection of enterovirus 68 (EV68) in community surveillance of respiratory infections in The Netherlands in 2010, epidemiological and virological analyses were performed to investigate the possible public health impact of EV68 infections.

We retrospectively tested specimens collected from acute respiratory infections surveillance and through three children cohort studies conducted in The Netherlands from 1994 through 2010. A total of 71 of 13,310 (0.5%) specimens were positive for EV68, of which 67 (94%) were from symptomatic persons. Twenty-four (34%) of the EV68 positive specimens were collected during 2010. EV68-positive patients with respiratory symptoms showed significantly more dyspnea, cough and bronchitis than EV68-negative patients with respiratory symptoms. Phylogenetic analysis showed an increased VP1 gene diversity in 2010, suggesting that the increased number of EV68 detections in 2010 reflects a real epidemic.

Clinical laboratories should consider enterovirus diagnostics in the differential diagnosis of patients presenting with respiratory symptoms.

J Clin Virol. 2011 Oct;52(2):103-6. doi: 10.1016/j.jcv.2011.06.019. Epub 2011 Jul 29.

Upsurge of human enterovirus 68 infections in patients with severe respiratory tract infections

Rahamat-Langendoen J¹, Riezebos-Brilman A, Borger R, van der Heide R, Brandenburg A, Schölvinck E, Niesters HG.

 

Abstract

BACKGROUND:

Enterovirus 68 (EV68) belongs to species Human enterovirus D. It is unique among enteroviruses because it shares properties with human rhinoviruses. After the first isolation in 1962 from four children with respiratory illness, reports of (clusters of) EV68 infections have been rare. During the autumn of 2010, we noticed an upsurge of EV68 infections in the Northern part of the Netherlands in patients with severe respiratory illness.

OBJECTIVES:

To give a detailed description of the clinical and virological data of patients with EV68 infection identified in 2010, and compare these with data collected in 2009.

STUDY DESIGN:

We systematically collected clinical data from patients with an EV68 infection detected in 2010. We added four patients with an EV68 infection from 2009. Further characterization of EV68 was performed by partial sequence analysis of the VP1 genomic region.

RESULTS:

In 2010, EV68 was identified as the only cause of respiratory illness in 24 patients, of which 5 had to be admitted to the intensive care unit. Sequence analysis revealed different lineages in the majority of EV68 detected in 2010 as compared to the 2009 isolates.

CONCLUSIONS:

We noticed an increase of EV68 infections and present clinical as well as sequence data, in which two distinct phylogenetic clusters could be identified.

The advice being given this year is pretty standard, but worth repeating:

• Get your flu shot (no, it won’t prevent EV 68, but it could help prevent a dual flu - Enterovirus infection)
• stay home if you are sick & obtain consultation from your health care provider 
• avoid contact with those who are sick
• practice good `flu hygiene’  (cover coughs & sneezes)
• Avoid touching your face, mouth, and eyes with unwashed hands
• and wash your hands often

 

 

EID Journal: Respiratory Viruses & Bacteria Among Pilgrims During The 2013 Hajj

Credit Wikipedia

 

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While MERS cases have thankfully  declined over the summer months, there remain concerns that it may return this fall during the time of the Hajj (early October), when roughly 2 million devout from around the world will make the pilgrimage to the Saudi Holy sites.

 

Mass gatherings such as the Hajj, Chunyun (Chinese New Years-Spring Festival), Carnival in Rio, Mardi Gras, and the Super Bowl all bring together huge groups of people, and all have the potential to amplify the transmission of diseases.

 

The good news is, that while mass gatherings may provide greater opportunities for disease outbreaks, history has shown that major epidemic outbreaks have been rare. One notable exception was the 1918 Liberty Loan Parade in Philadelphia, which was attended by as many as 200,000 people.

 

During the 1918 Pandemic, most cities instituted strict public health ordinances; they closed schools, movie houses, pool rooms, restaurants . . even churches. But Philadelphia went ahead with a massive parade on September 28th of that year, apparently heartened by the low number of flu cases reported in Pennsylvania to that point.

 

Over the next three weeks, at least 6,081 deaths from influenza and 2,651 deaths from pneumonia were registered in Pennsylvania, most occurring in Philadelphia (CDC source).

 

While a particularly dramatic example, concerns over seeing a repeat of this sort of thing run high enough that mass gathering medicine has now become a specialty (see Lancet: Mass Gathering and Health), and public health agencies around the world gear up for every large gathering event (see How The ECDC Will Spend Your Summer Vacation & The ECDC Risk Assessment On Brazil’s FIFA World Cup)

 

Although they carry the highest potential impact, public health concerns for these mass gathering events go far beyond exotic diseases like MERS and pandemic influenza.  

 

Tuberculosis, pneumococcal disease, meningococcal disease, chickenpox, pertussis, polio, cholera, mumps and a plethora of other respiratory viral and bacterial diseases all rank high on the list of potential infectious disease threats, along with concerns over food-borne and vector borne illnesses.

 

To try to quantify the risks of acquiring, and spreading, some of the more commonly seen respiratory pathogens during the Hajj, a group of researchers have – for the second year in a row – tested a group of Hajjis both before and after the Hajj for carriage of a variety of bacterial and viral pathogens.

While carriage these  pathogens among test subjects was high prior to attending the Hajj, they increased markedly immediately post-Hajj, indicating efficient transmission of several respiratory pathogens.

 

 

Respiratory Viruses and Bacteria among Pilgrims during the 2013 Hajj

Samir Benkouiten, Rémi Charrel, Khadidja Belhouchat, Tassadit Drali, Antoine Nougairede, Nicolas Salez, Ziad A. Memish, Malak al Masri, Pierre-Edouard Fournier, Didier Raoult, Philippe Brouqui, Philippe Parola, and Philippe Gautret

Abstract

Pilgrims returning from the Hajj might contribute to international spreading of respiratory pathogens. Nasal and throat swab specimens were obtained from 129 pilgrims in 2013 before they departed from France and before they left Saudi Arabia, and tested by PCR for respiratory viruses and bacteria. Overall, 21.5% and 38.8% of pre-Hajj and post-Hajj specimens, respectively, were positive for ≥1 virus (p = 0.003). One third (29.8%) of the participants acquired ≥1 virus, particularly rhinovirus (14.0%), coronavirus E229 (12.4%), and influenza A(H3N2) virus (6.2%) while in Saudi Arabia. None of the participants were positive for the Middle East respiratory syndrome coronavirus. In addition, 50.0% and 62.0% of pre-Hajj and post-Hajj specimens, respectively, were positive for Streptococcus pneumoniae (p = 0.053). One third (36.3%) of the participants had acquired S. pneumoniae during their stay. Our results confirm high acquisition rates of rhinovirus and S. pneumoniae in pilgrims and highlight the acquisition of coronavirus E229.

 

More than 2 million Muslims gather annually in Saudi Arabia for a pilgrimage to the holy places of Islam known as the Hajj. The Hajj presents major public health and infection control challenges. Inevitable overcrowding within a confined area with persons from >180 countries in close contact with others, particularly during the circumambulation of the Kaaba (Tawaf) inside the Grand Mosque in Mecca, leads to a high risk pilgrims to acquire and spread infectious diseases during their time in Saudi Arabia (1), particularly respiratory diseases (2). Respiratory diseases are a major cause of consultation in primary health care facilities in Mina, Saudi Arabia, during the Hajj (3). Pneumonia is a leading cause of hospitalization in intensive care units (4).

<SNIP>

In this study, we confirmed that performing the Hajj pilgrimage is associated with an increased occurrence of respiratory symptoms in most pilgrims; 8 of 10 pilgrims showed nasal or throat acquisition of respiratory pathogens. This acquisition may have resulted from human-to-human transmission through close contact within the group of French pilgrims because many of them were already infected with HRV or S. pneumoniae before departing from France. Alternatively, the French pilgrims may have acquired these respiratory pathogens from other pilgrims, given the extremely high crowding density to which persons from many parts of the world are exposed when performing Hajj rituals. Finally, contamination originating from an environmental source might have played a role.

(Continue . . . )

 

If all of this sounds vaguely familiar, you may recall the following Clinical Infectious Diseases study (also co-authored by Ziad Memish) - Unmasking Masks in Makkah: Preventing Influenza at Hajj – from 2012

.

Each year more than 2 million people from all over the world attend the Hajj pilgrimage to Saudi Arabia. At least 60% of them develop respiratory symptoms there or during outward or homebound transit [1, 2] During recent interpandemic years, approximately 1 in 10 pilgrims with respiratory symptoms in Makkah have had influenza detected by polymerase chain reaction tests of respiratory samples [3, 4]. Pneumonia is the leading cause of hospitalization at Hajj, accounting for approximately 20% of diagnoses on admission [5].

 

All of this has the potential to help seed emerging strains of viral and bacterial diseases around the world, and while perhaps not nearly as dramatic as a pandemic outbreak, still carries with it considerable public health implications.

 

But this year – with fears that MERS might spread internationally  – public health officials must also be concerned with those 60%-80% of Hajjis who will return home this fall with respiratory symptoms.

 

We’ve discussed the The Limitations Of Airport Screening in the past, so in a different approach, the following sign appears in airports in the United Kingdom urging self-reporting of illness and travel history to one’s doctor. Similar signs have been erected at airports around the globe (see MERS Advisories Go Up In Some US Airports).

.

 

While we don’t know if MERS will make a return during the Hajj, given the high incidence of respiratory illnesses reported in returning Hajjis, I expect that we’ll be hearing a lot about testing for suspected MERS-CoV this fall. 

 

Undoubtedly the vast majority of these travelers will have influenza, Rhinoviruses, RSV, HCoV E229, or simple bacterial pneumonia, but ruling out the MERS coronavirus is going to represent a major public health logistical challenge, even in places like the UK and the United States.

 

How well this can be accomplished in low-resource regions of the world, to where many of the pilgrims will be returning, remains to be seen. The hope is that the level of MERS cases will remain low in the Middle East during the time of the Hajj,  as it has for the past two years. 

 

Stay tuned.

Mackay: Putting Respiratory Viruses In Perspective

 

Credit VDU Blog – Dr Ian Mackay

 

#8618

 

While wait for the test results from the MERS exposed HCWs in Orlando (and announcement later this morning from the World Health Organization’s IHR Emergency Committee Meeting on MERS), Dr. Ian Mackay has a wonderful `explainer’ on the wide world of respiratory viruses, which include far more `players’  than most people imagine.

 

Follow the link to read:

 

Keep calm and call the lab...without it, you know less than you think you do

This morning there are 2 symptomatic healthcare workers (HCWs) in the United States (of America; I'm just going to use the "US" from from here on) who came into contact with the recently diagnosed MERS-CoV positive 44M (age and sex confirmed yet?) imported case.

The news has driven something of a twitter storm in the #MERS channel. Not unexpected I guess. The implication is that these 2 have acquired MERS-CoV from contact with the imported MERS-CoV-positive person. 

But that link is still far from proven yet.

(Continue . . . )

 

Watching Egypt Again . . .

 

# 8186

 

Since the Arab Spring revolution of 2011 and the subsequent political turmoil, reporting on H5N1 out of Egypt has nearly vanished.  The number of human cases reported in 2011 was 39, while in 2012 it numbered 11, and last year was just 4.

 

Whether this signifies an actual drop in the number of infections, or a change in surveillance and reporting is unknown, but it does appear that the media has been less inclined to report on outbreaks than they were a few years ago.

 

Nevertheless, with rumbling from other Arab nations regarding their MERS-CoV outbreaks, we’ve begun to see a bit more in the Egyptian media about possible respiratory outbreaks, including media speculation that either H5N1 or MERS is to blame.  

 

So far, the government has denied both scenarios.

 

Yesterday, Sharon Sanders on FluTrackers posted a series of reports emanating from Mansoura Hospital, suggesting that a 65 y.o. there had been diagnosed with `bird flu’. 

 

The discovery of the injury as "bird flu" b "Internists Mansoura" and refused to move Fever
Saturday, January 18th, 2014 - 11:54

Dakahlia - Osama Mr. Sharif Deeb

Witness Hospital Internal Medicine at the University of Mansoura case of extreme emergency, after the discovery of a medical condition, Department of the liver called "a. A." 65 years, are infected with bird flu, and rejected the hospital's management transferred to the Fever Hospital, causing resentment among the hospital staff and the fear of contagion workers or patients who are.

 

Meanwhile, these reports were being denied by the Ministry of Health and the governor of Dakahlia.

 

Health" denies the emergence of "bird flu" in Dakahlia ..

And stresses: follow the latest diagnostic tools for HIV prevention

Started - Hiba Abdullah and Mahmoud Nofal

Denied the Ministry of Health and Population, the rumors about the emergence of bird flu cases in the province of Dakahlia, noting that the disease did not show any case infected since April 2013 . . .

 

While this may have been nothing more than an erroneous report, lending credence to it are other media sources that have been reporting on a pair of suspected H5N1 cases in Port Said.  Again, a hat tip to Sharon Sanders who started this FT thread.

 

Emergency hospitals in Port Said after the discovery of cases of bird flu in the governorate

Wrote: Regional Office for the Suez Canal and the Sinai - Mohammed Eweda January 18, 2014 16:00

Port Said Governorate lifted the state of emergency, in all hospitals in the province, following the discovery of cases of bird flu in the governorate.

When he said "my dream Aallna" Director General of Health in Port Said, on Saturday afternoon it was the discovery of two infected with bird flu, the first case was transferred to a hospital in Mansoura university (Mansoura is in Dakahlia province s. ) , after it was ascertained virus positive ones.

As has been the reservation to the second case, a hospital dietary district climate, and is now in stable condition after taking the drug "Tamiflu".

 

Between government denials, and dodgy machine translations from the Arabic, it isn’t at all certain what is going on there. Adding to the confusion, there are separate reports of 4 doctors hospitalized with `pneumonia’ or `respiratory illness’ over the past few weeks, three of whom have supposedly died.   Again from Flutrackers.

 

1)Dr. Ahmed Abdullatif – deceased

Egypt - Ministry of Health closes private hospital after death of a doctor from pneumonia - negligence alleged - Banha, Qalyubia governorate - December 28

2)Dr. Osama (last name assumed to be Rashid) - hospitalized on respirator

Egypt - Doctor, 37, hospitalized suspected novel coronavirus - tests pending - Mansoura, Dakahlia govenorate - January 8

3)Dr. Doaa Ahmed Ismail – deceased

Egypt - Unknown respiratory virus killed pregnant doctor - alleged to be coronavirus - another hospitalized - in Dakahia govenorate January 17

4)Dr. Yasser Barbary – deceased

Egypt - Health denies infectious diseases in hospitals in Qaliubiya govenorate after the death of a doctor - investigation demanded by coalition of doctors - January 18

 

Media and official explanations for these deaths range anywhere from `MRSA’ pneumonia, to `unknown virus’, to speculation that it is due to MERS or Avian Flu. It could even be the pH1N1 virus, given its impact this year.

 

Frankly, your guess is as good as mine, and we could easily be seeing a mixture of causes, rather than a single etiology.

 

While the official position seems to be there  is nothing untoward is going on there, for a variety of reasons, the newshounds of Flublogia will be keeping their eyes on Egypt over the next few weeks to see what develops.

Referral: Mackay On Respiratory Viruses In Health Care Workers

Photo Credit PHIL (Public Health Image Library)

# 7607

 

A topic we’ve touched on a number of times before (see EID Journal: Nosocomial Transmission Of 2009 H1N1 & A Hospital Is No Place For A Sick Person) is the carriage and transmission of respiratory viruses by healthcare workers to patients.

 

Today, Dr. Ian Mackay takes a look at a study on more than 300 ill and asymptomatic HCWs that screened them for a variety of respiratory viruses.  Follow the link below to read the intriguing findings:

 

Healthcare workers may stay on the job when ill and can be shedding viral RNA...

Tuesday, 27 August 2013

 

 

The asymptomatic carriage and shedding of viruses comes as less than a complete surprise, as we’ve seen evidence of this in the past (see The Very Common Cold, PLoS One: Influenza Viral Shedding & Asymptomatic Infections).

 

But as Ian points out, the more they test the more we learn.

 

One of the revelations that came out of CIDRAP’s 2009 H1N1 conference in Minneapolis (see CIDRAP On Business’s Biggest Concern) was group polling that showed that Hospitals were among the least likely to make it easy for employees to stay home if they were sick.

 

As a paramedic, I know that my colleagues and I worked `sick’ often, as I wrote back in 2009:

 

EMT’s and paramedics were a scarce resource, and since everyone was working at least a 56-hour-week . . .  trying to find someone to fill a shift was a major hassle.

 

So we worked with colds, with the flu, with aching backs, and Lord knows what else  . . . because the system required it.  And there were real (unwritten) punitive downsides to calling in sick. 

 

Thirty years later, it appears that many HCWs are still penalized if they are unwilling to work `sick’.  Sick leave for HCWs often comes out of an accrued PTO (Paid Time Off) account which combines vacation, holiday, and sick time off. 

 

Workers accrue hours based on shifts worked, and their seniority.

 

Employees who haven’t sufficient hours `banked’ (or part-time workers who aren’t usually enrolled in PTO plans), must take unpaid leave if they fall ill.

 

Live polling of the attendees at the 2009 CIDRAP conference indicated that industries other than Health Care, such as manufacturing, were more likely to give employees paid time off for the flu and for taking care of sick family members.

 

Obviously, working `sick’ is a risk to both patients and colleagues alike.

 

It is a sad commentary that those who are most likely to get sick `in the line of duty’ are among the least likely to enjoy a liberal paid sick leave policy.

Dothan Respiratory Illness – No Unusual Pathogens

 

Dothan, Ala Perry-Castañeda Library Map Collection

# 7313

 

A story we’ve been following for a couple of days now (see here, here, and here) is an outbreak of an unknown respiratory illness in the Dothan, Alabama area that has resulted in at least two deaths.

 

Today, during a webcast press conference held by the Alabama Department of Public Health, public health officials announced that test results are back on 7 of the cases, and no unusual pathogens were detected.

 

These cases were reportedly infected with a mixture of influenza A, Rhinovirus, and `normal’ bacterial pneumonia (see ADHP Press release)

 

While `flu season’ may be over, influenza is known to circulate at low levels year-round.  And – as I can sadly attest right now – rhinovirus infections circulate during the summer as well. 

 

Normally thought of as `mild’, or the `common cold’, rhinoviruses we now know can - on rare occasions - cause serious illness. 

 

During the fall of 2009, we saw an outbreak among children of an unusually virulent rhinovirus strain (see When The `Flu’ Isn’t The Flu) diagnosed by the Children’s Hospital of Philadelphia.

 

In 2010, in Study: HRV In Long-Term Care Facilities, we examined a research piece which looked at the incidence of Rhinovirus among patients in long-term care facilities in Canada during the last half of 2009.

 

Rhinovirus Outbreaks in Long-term Care Facilities, Ontario, Canada

DOI: 10.3201/eid1609.100476

Longtin J, Marchand-Austin A, Winter A-L, Patel S, Eshaghi A, Jamieson F, et al. Rhinovirus outbreaks in long-term care facilities, Ontario, Canada. Emerg

Infect Dis. 2010 Sep; [Epub ahead of print]

 

Essentially what they found was a high prevalence of HRV (Human Rhinovirus) infection (60%), and that these viruses were implicated in a number of serious illnesses and deaths.

 

Pretty much proving that it doesn’t necessarily require some exotic virus to put you in a bad way.

 

Returning to the Press conference, Sharon Sanders of FluTrackers tweeted the highlights below.

Alabama Health Alert Message On Respiratory Cluster

Dothan, Ala Perry-Castañeda Library Map Collection

 

UPDATED 14:45 hrs:  Lisa Schnirring at CIDRAP NEWS has just posted a report that summarizes what we know till now about this cluster.

 

Alabama officials probe respiratory illness cluster

 

 

# 7309

 

My thanks to the reader who sent me the link to the following Alert Message from the Alabama Department of Health on the unidentified respiratory cluster in and around Dothan, Alabama (see Updating The Dothan, Alabama Respiratory Cluster Story).

 

 

 

Alabama Department of Public Health ALERT Message 5/21/13

On 5/16/13, a pulmonologist in Southeast Alabama reported to the Alabama Department of Public Health (ADPH) that three patients had been hospitalized with cough, shortness of breath, and pneumonia, were on ventilators, and had no known cause for their illness.

 

The ADPH and the Houston County Health Department began an epidemiology investigation to interview the families about travel and exposure. 
Specimens were requested  and submitted to the ADPH Bureau of Clinical Laboratories (BCL) in
Montgomery.  

On 5/17/13, BCL reported one of the three patients tested positive for 2009 H1N1.  On 5/18/13, this
patient died.  On 5/19/13, the same hospital reported that a transferred patient on a ventilator with respiratory symptoms had died.  On 5/19/13, this hospital had nine additional patients present to the emergency department with influenza-like illness and three of those patients were admitted.  Specimens have been collected on all patients.  The BCL has tested all specimens on a PCR flu panel and one tested positive for AH3.  The specimens were also forwarded to CDC for additional testing.  

At this time, there is no epidemiological link between these patients.  While two patients have tested positive for influenza, the exact role of influenza in this cluster is unknown.  On 5/21/13, ADPH sent a News Release regarding the situation.

ADPH has reiterated that healthcare providers should use standard precautions when dealing with
patients with respiratory illness.  Physicians should use clinical judgment in determining the best
treatment for their patients since the etiology of the outbreak is unknown at this time.  

REPORTING 

Please report all patients currently hospitalized with pneumonia, with unknown cause (regardless of quick
flu test results), to www.adph.org/epi, Respiratory Illness REPORT Card.

SPECIMEN COLLECTION

For patients who present  with fever (>100.4F) and cough or shortness of breath with unknown cause
(regardless of quick flu test results), please submit an upper tract specimen, ie, oropharyngeal (OP) swab or nasopharyngeal (NP) swab, to the Bureau of Clinical Laboratories as part of ADPH's year-round
influenza surveillance program. 

For more information about collecting, packing, and submitting lab specimens, please go to http://adph.org/bcl/assets/Guide_Lab_Test_Inf_Virus_092210.pdf or call BCL 334-260-3429, Microbiology Division.

For patients who present with pneumonia with unknown cause (regardless of quick flu test results),
please collect and submit  a lower tract specimen, ie, bronchoalveolar lavage, tracheal aspirate, or
sputum, to the BCL.

For patients admitted to the hospital with cough or shortness of breath, and pneumonia (regardless of
quick flu test results), with unknown cause, please send both upper and lower tract specimens.  Multiple respiratory specimen types with ample volume are preferred. 

If you have any questions, please contact the Epidemiology Division at 1-800-338-8374 and ask to
speak with staff involved in the Respiratory Illness Outbreak.

Updating The Dothan, Alabama Respiratory Cluster Story

 

Dothan, Ala Perry-Castañeda Library Map Collection

 

UPDATED -  See  Alabama Health Alert Message On Respiratory Cluster

 

# 7308

 

While we don’t have an answer yet of the cause of a small geographically linked cluster of unidentified respiratory illnesses in southeast Alabama (see Press Conference On Dothan, Alabama Respiratory Cluster), we do have another video news report from a local TV station that provides us with a few more details.

 

 

(Click Image to watch 2 minute Newscast)

 

WFSA-TV reports that the cases all involve adults (age range from early 20’s to late 80s), and they were all admitted to the Southeast Alabama Medical Center starting last Thursday.

 

Two patients have died (reported by other media as over the weekend), and samples are being tested by the CDC.

 

I’ve not been able to locate the `letter’ to doctors the newscast describes, any announcement on the the SAMC webpage, or any HAN (Health Alert Network) message from the state or CDC regarding this case (updated Aabama Health Alert Message On Respiratory Cluster).

 

Hopefully we’ll get some clarity over the cause from the lab tests sometime today.

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.

CDC: Calvert County Flu Typical Seasonal H3N2 Strain

 

 

# 6228

 

 

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

# 6211

 

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

# 6210

 

 

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

 

 

 

# 6206

 

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

 

# 6204

 

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

 

 

 

# 6201

 

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.

Calvert County Update

 UPDATED: 1710hrs EST Mar 6th.

According to WTOP news, in Washington D.C., the son  and daughter died from an influenza A infection (strain not disclosed).  A h/t to Crof for the link.

 

UPDATE: Cluster of respiratory-related deaths under investigation in Md.

Medstar Washington Hospital Center reports the son and daughter who died in the hospital had Influenza A. They also had other medical conditions, officials say.

The 81-year-old mother's cause of death is still under investigation.

The health of the other daughter (and fourth victim) is improving, hospital officials say.

 

# 6200

 

 

Earlier today we learned of a cluster of unusual deaths in a family in Calvert County, Maryland, from some type of unidentified `respiratory infection’ (see Maryland: Conflicting Reports On Cluster of Respiratory Deaths).

The Calvert County Health Department has updated their press release to state that there are no new cases as of 3:15 pm EST today.

 

The Washington Post has an article by Lena H. Sun that adds a little to the story, including that samples will be sent to the CDC for testing.  It now appears that there are 3 known deaths, and a fourth person appears to be recovering in the hospital.

 

Three dead from cluster of respiratory illnesses in Calvert County, Md.

 By Lena H. Sun, Tuesday, March 6, 3:32 PM

 

As far as what the cause of this illness might be, there are a lot of possibilities, and it will probably take several days to sort them out.

 

Stories like these often take on a life of their own, sometimes with a good deal of embellishment.

 

In that regard, I’m seeing a number of dubious looking comments left on local news sites, by readers purporting to have some kind of `insider knowledge’ of the situation. 

 

The old adage that A rumor can make it half way around the world before truth has got its boots on has never been truer since the advent of the internet.

 

With anonymous comments left on websites,  Caveat Lector should definitely be your guide.

Maryland: Conflicting Reports On Cluster of Respiratory Deaths

Note: There are now several updates to this story (here & here), and future updates can be found by searching HERE.

 

 

# 6199

 

Occasionally we see strange reports of illness that sound ominous or unusual crossing the news wires, but most of the time the causative agent turns out to be something fairly mundane.

 

`Mystery Fevers’ in Asia usually end up due to some kind of arbovirus, and mass illnesses in schools or cruise ships usually turn out to be norovirus.

 

But of course, every once in awhile, something unique will turn up, as did the novel H1N1 virus in Mexico three years ago

 

Today, we’ve multiple (and conflicting) reports coming out of Calvert County Maryland on a family where either 4 or 5 members contracted some sort of respiratory illness, and (depending on the source) subsequently 2, 3, or 4 of them have died.

 

We’ve a couple of news reports, a brief press release from the Calvert County Health Department, and a brief phone call by Sharon Sanders of FluTrackers to the CCHD trying to get details.

 

First, the press release, which suggests four illnesses and 2 deaths.

 

PRESS RELEASE FOR IMMEDIATE RELEASE CALVERT COUNTY HEALTH DEPARTMENT

DAVID L. ROGERS, MD MPH HEALTH OFFICER

CONTACT INFORMATION: 410-535-5400

March 6, 2012

This is a case of an elderly woman living in a rural setting in the Lusby area. She became sick on or about February 23, 2012, with upper respiratory symptoms, at her home. She was cared for at home by three of her children, a son and two daughters. They developed similar upper respiratory symptoms on or about February 28, 2012.

 

They were all hospitalized and became critically ill and two have subsequently died. One caregiver is currently at the Washington Hospital Center. This appears to be confined to a single family and there is no reason to believe, at this time, that others have been infected with this illness.

 

 

Sharon Sanders of FluTrackers placed a call to the CCHD (who are being swamped by inquiries), and talked to someone who stated the index case (the mother) also died, making 3 deaths. You can follow their tracking of this story on this thread.

 

Two news reports say there were five people stricken by this illness, and four died.  You can view those reports at the following links.

 

Health Alert: Four Deaths Reported in Calvert County

March 6, 2012

Calvert County Health Department (CCHD) is aware of a cluster of severe respiratory illnesses in five (Lusby area), including four members of a Calvert County family, residing approximately a mile south of the power plant. All five were hospitalized over the last two weeks. Four of the five have died of their illnesses.

(Continue . . .)

 

 

The first story we saw (h/t Carol@SC on the Flu Wiki) came from the local NBC TV affiliate. It too cites 5 illnesses and 4 fatalities.

 

 

Cluster of Deaths Following Flu-Like Symptoms in Calvert County

Cause of illness not immediately determined

Tuesday, Mar 6, 2012  |  Updated 11:29 AM EST

 

 

Multiple deaths in a single household from a respiratory illness are unusual enough to make health officials take notice. These are, however,`early days’, and testing and epidemiological investigations take time. 

If we get some more definitive information on this cluster, I’ll pass it along.

 

In the meantime, regardless of what this turns out to be, getting a seasonal flu shot and practicing good `flu hygiene’ (covering coughs, washing hands, staying home when sick), are your best protections against winter respiratory illnesses.

Study: Respiratory Viruses & Air Re-Circulation In Cars

 

 

 

# 5460

 

 

Two weeks ago a neighbor with a raging upper respiratory infection called me from the hospital Emergency Room and asked if I’d pick him up and take him home. 

 

A reasonable enough request, so I agreed.  But I did take a couple of precautions.

 

I brought a surgical mask for my coughing passenger to wear, and I drove him the five miles home with the windows rolled down.

 

Turns out, not only did I not catch whatever bug my neighbor had, according from a new study out of Australia, my instincts were right as well.

 

We don’t have a published study (one may show up eventually), but we do have a news report from 9NEWS on a presentation made to the Thoracic Society of Australia and New Zealand Annual Scientific Meeting in Perth this week.

 

The study compared the air flow and recirculation of viruses between a late model automobile and an `old clunker’ from 1989, and concluded that the `air-tightness’ of new cars could increase the risks of contracting a respiratory virus from a fellow occupant.

Dr. Scott Bell, Director of Thoracic Medicine at the Prince Charles Hospital in Brisbane is quoted as saying:

 

"Put simply, if you are travelling for around 90 minutes in a relatively modern car with air circulation on low, you are almost certain to catch influenza from another infected passenger.

 

The key message is that high risk people should be cautious of who they travel with in passenger cars during outbreaks of influenza."

 

 

Running a newer automobile’s air conditioner with it’s ventilation set to high (not re-circulating) was the functional equivalent of driving with a window partly down, which sucked a large number of viral particle out of the vehicle.

 

While lacking somewhat in scientific detail, you can read the entire article at:

 

Old cars safer than new to avoid the flu

17:47 AEST Mon Apr 4 2011

Travelling in old "clunkers" rather than late-model cars could protect people from catching the flu, new medical research shows.

 

But of course, you don’t have to buy an old clunker for car pooling during flu season.  You can reduce your risks by simply remembering to roll down a window, or run the a/c or heat on high ventilation.

Turns out, your Mother was right, after all.

 

A little bit of fresh air is good for you.