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Public Health Update. David K irschke , MD Medical Director / Health Officer Northeast Tennessee Regional Health Office. Notice to Clinicians: Early Reports of pH1N1-Associated Illnesses for 2013-14 Influenza Season. CDC Health Advisory: December 24, 2013

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public health update

Public Health Update

David Kirschke, MD

Medical Director / Health Officer

Northeast Tennessee Regional Health Office

notice to clinicians early reports of ph1n1 associated illnesses for 2013 14 influenza season
Notice to Clinicians: Early Reports of pH1N1-Associated Illnesses for 2013-14 Influenza Season
  • CDC Health Advisory: December 24, 2013
  • CDC has received a number of reports of severe respiratory illness among young and middle-aged adults, many of whom were infected with influenza A (H1N1) pdm09 (pH1N1) virus
  • Multiple pH1N1-associated hospitalizations, including many requiring intensive care unit (ICU) admission, and some fatalities have been reported
  • If pH1N1 virus continues to circulate widely, illness that disproportionately affects young and middle-aged adults may occur
influenza associated pediatric death
Influenza-associated Pediatric Death
  • 12 year old female
  • No significant past medical history
  • Developed influenza-like illness 2 Jan 2014
  • Seen at urgent care 3 Jan 2014
    • Rapid influenza test negative
    • Provider (NP) prescribed oseltamivir (Tamiflu)
progression of illness
Progression of Illness
  • 5 Jan 2014 found collapsed on floor by mother
  • Pronounced dead at hospital about 40 minutes later
  • Viral panel positive for pH1N1
  • Autopsy revealed Staph aureuspneumonia
vaccination history
Vaccination History
  • Patient had received influenza vaccination in past (2005, 2007, 2010, 2011)
  • Did not receive influenza vaccination during 2013-2014 season
    • Pediatrician
    • School-located vaccination
    • Pharmacies
2012 13 vs 2013 14 influenza seasons
2012-13 vs 2013-14 Influenza Seasons
  • Last season Influenza A H3N2 predominant
    • Greater overall hospitalizations and influenza-related deaths
    • Primarily among persons aged 65+ years
  • This season Influenza A H1N1 predominant
    • Increased hospitalizations and deaths among persons aged 18-64 years
    • Moderate number of pediatrics deaths reported
influenza surveillance eip
Influenza Surveillance - EIP
  • 2013-2014 Influenza Season
  • Among all hospitalizations, 7,941 (92.6%) were associated with influenza A
    • 97% were 2009 H1N1
  • People 18-64 years accounted for approximately 60% of reported hospitalizations
  • Most commonly reported underlying medical conditions among adults were obesity, metabolic disorders, cardiovascular disease, and chronic lung disease (excluding asthma)
    • ~12% of hospitalized adults had no identified underlying medical conditions.
    • ~43% of hospitalized children had no identified underlying medical conditions
adult influenza a h1n1 death
Adult Influenza A H1N1 Death
  • 41 year old male
  • Only past medical history GERD
  • Has never received influenza vaccine
  • 19 March 2014 developed fever, cough, sore throat (influenza-like illness or ILI)
  • Wife and 2 children also ill with same symptoms
adult influenza a h1n1 death1
Adult Influenza A H1N1 Death
  • Urgent care initiated levofloxacin and ceftriaxone
    • Influenza test?
    • No antivirals
  • Admitted to hospital 23 March with respiratory distress
    • Rapid flu test negative
    • Changed antibiotics
    • No antivirals
adult influenza a h1n1 death2
Adult Influenza A H1N1 Death
  • Department of Health consulted by IP
  • Concerned about severe respiratory illness of unknown origin
    • Healthcare contact developed respiratory illness
  • TDH advised that influenza likely
    • Antiviral therapy
    • Appropriate testing
adult influenza a h1n1 death3
Adult Influenza A H1N1 Death
  • Influenza A H1N1 eventually verified at state lab
  • However, treatment was delayed
  • Patient died after prolonged hospital course
  • Wife was also hospitalized but recovered
think influenza

Flu Season

Fever

Cough

Think Influenza!

Sore Throat

Rapid Flu Test?

the princess bride
The Princess Bride
  • Six-fingered man: “Do you think it might be [flu]?”
  • Prince Humperdinck: “I always think everything might be [flu], which is why I'm still alive.”