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It was, as Laurence Manning Academy headmaster Spencer Jordan said, "the worst phone call that anyone can ever receive."

After closing his Clarendon County school for the week Wednesday because so many children were absent with flu symptoms, Jordan learned one of his students - fifth-grader Ashlie Pipkin - had died en route to a Columbia hospital. She had been diagnosed Tuesday with pneumonia at Sumter's Tuomey Regional Medical Center, and a rapid test had indicated she had the flu.

"It was the most sickening and heartfelt sorrow I've ever felt in my life. My heart goes out to her family," Jordan said Thursday, after visiting with Ashlie's family in Sumter County.

Parents and coaches expressed shock and sadness Thursday at the death of the vibrant 11-year-old, a standout on the softball field. But medical professionals are urging parents to remain calm, stressing the H1N1 flu is not a great threat to otherwise healthy children.

"That case (Wednesday) was very unusual. ... She did have some underlying asthma issues, and that put her at higher risk for complications," said Dr. Anna-Kathryn Rye, a pediatric infectious disease physician at Palmetto Health Richland.

An autopsy was conducted, and results may be available as soon as today, said Sumter County Coroner Harvin Bullock.

"It scares people. That's normal," Rye said. "Of course, people get anxious when you hear about an 11-year-old who dies from the flu.

"I'd like to send out a message for everybody to stay calm. We are expecting deaths in children and adults who are in higher risk categories, but normal children and normal adults seem to be handling the flu very well."

'MOST YOUNG PEOPLE ... GET BETTER'

State epidemiologist Dr. Jerry Gibson agreed.

The recent case is "very sad, but it's not at all characteristic of what's going to happen for most cases," Gibson said. "For most young people, it's just the flu. They get better.

"How a child, or an adult, does with this is a lot like how they would do with seasonal flu."

In other words, people with underlying health problems - asthma, diabetes, cystic fibrosis or HIV - are at greater risk and need to take special precautions and react immediately to any symptoms. But health experts still suggest otherwise healthy people should treat swine flu as they would seasonal flu. For most, that means treating symptoms with over-the-counter drugs and getting lots of fluids and rest.

"Unless there are signs of severe illness, you don't need to take children to emergency rooms," Gibson said. "You're not going to enjoy going there."

Patients with flu symptoms have been flooding emergency rooms and doctors' offices.

The pediatric emergency room at Palmetto Health Richland in Columbia is seeing an average of 40 children a day with influenza-like illness, spokeswoman Tammie Epps said.

The emergency room at Tuomey in Sumter, which treats children and adults, has been seeing about 200 people a day for the past several weeks with flu symptoms, "a huge number for us," said spokeswoman Brenda Chase.

Doctors' offices are as well-equipped as emergency rooms to deal with most flu cases. But Gibson also doesn't suggest rushing to doctors' offices at the first sign of flu symptoms. Call first, and you might be able to get enough advice over the phone to avoid a trip.

If a child has underlying health problems or shows one of the danger signs - trouble breathing, is unresponsive or inattentive, difficult to wake or refusing to eat - doctors can prescribe an anti-viral drug that lessens the time and symptoms of the flu. Tamiflu is the most common pill form, while Relenza is a nasal form.

Since Sept. 1, there have been 76 hospitalizations in South Carolina with lab-confirmed cases of flu and three deaths - not counting Ashlie Pipkin, according to DHEC. While the agency didn't break down whether those cases were all H1N1 flu, the Centers for Disease Control and Prevention have said the vast majority of the flu active now is the H1N1 strain.

'I JUST STARTED CRYING'

In Sumter and Manning Thursday, parents were grappling with the death of a child who seemed so healthy - even playing in a softball tournament this past Saturday and Sunday.

"She was a great athlete, a great person - always cheerful," said Dupree Cantley, who coached Ashlie on a Sumter all-star softball team this summer. "She was always willing to listen to the coaches. ... Before I coached her in all-stars, she beat my team in the championships with a home run. Just a great athlete and a great kid."

Headmaster Jordan had a similar reaction.

"As I walk around on my daily tours, I would go to the playground. ... Ashlie would be leading the charge on a football team with 95 percent boys, and she'd be holding her own if not beating them," Jordan said.

"This is such a shock to Laurence Manning Academy," he said. "We pride ourselves on being a close-knit family."

Of Laurence Manning Academy's 1,010 students, 287 were absent Monday, prompting the decision to close for the rest of the week.

Jordan said parents supported the decision to close the school. On Thursday, a professional cleaning crew came in to disinfect all of the school's surfaces with a bleach solution.

School will reopen Monday. Jordan said he has heard from several parents who want to be sure it's safe. "We've done everything we can do," he said.

Amy Marshall, who has a daughter in kindergarten at the school, said she agreed with the decision to close this week.

"When we found out Tuesday they were going to close I was kind of relieved," said Marshall, a graduate of Laurence Manning Academy.

"People are freaking out so bad about it. You hear about people dying. But I think 99 percent of cases had something other than flu-like symptoms," she said.

Wednesday night, after she heard about Ashlie's death, Marshall said her own daughter was misbehaving.

"I started to get mad, and then I said, 'You know what. The Pipkins don't have their daughter to hug.'

"I just started crying, and I held her."

http://www.thestate.com/breaking/story/957538.html

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www.twitter.com/hniman

Cytokine storm, viral pneumonia, inflamitory response. Are all the same type of event. Inflammation can occur in any cell type that it replicates in. Yes there can be coinfections. But the latest report i saw said that over 60 % of the worst cases had viral pneumonia, while only 30 some % had coinfections. Reasons for heart attacks. Could be neurological, could be lack of O2 from pneumonia, could be damage to the heart its self , could be inflamed blood vessels, could be red blood cells are to colagulated to pick up O2 or blood clots making it to the heart. OR ANY COMBINATION How bad it is just depends on the person & enviromental factors & meds that they take & how soon they take them. As we have seen with Tamiflu resistance. There is no set formula that covers all cases. But as far as CDC's report over 60% of the worst cases are having cytokine storms. They call it viral pneumonia.

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"The single biggest threat to man's continued dominace on the planet is the virus." Joshua Lederburg. PhD

You have to be very careful about this and read between the lines on some of these reports
ONLY "30 some % had coinfections"

For example in the spring out of Mex they reported little to no Co-infection on many reports out of there. But if you DIG and DIG you will find many of those people were tested about 4 days AFTER they had been put on antibiotics. So of course you wouldn't FIND a co-infection in many of those cases even though there may have been one there or would have been one if not treated.

1918 H1N1 was MARKED by co-infection in the majority of cases, specifically Haemophilius Inf. Until the 30's or so they thought this was the cause of 1918 pandemic.
http://en.wikipedia.org/wiki/Haemophilus_influenzae
I would also expect to see Streptococcus pneumoniae interaction
as you will also note on that page.
Here is info on Pneumovax 23
http://www.merck.com/product/usa/pi_cir ... vax_pi.pdf


I would personally make sure everyone is up on Hib, and ped-vax or pneumovax 23. But talk to your doctor ( I am not an MD) and make sure this could be something ideal for your personal situation or not.

Also keeping an eye on this one after reading reports out of the southern Hemisphere:
http://www.nlm.nih.gov/medlineplus/ency ... 000612.htm
and
http://www.nlm.nih.gov/medlineplus/ency ... 000608.htm

It would stand to reason that areas that do not vaccinate their children for Hib, or ped-vax type immunizations will have a higher incidence of reported co-infection. But then there is is also the antibiotic issue. Did they really NOT have a co-infection or did they before they were treated with antibiotics? And also note it is common to find this type of flora in many healthy people in small amounts ANYWAYS.
It is when it gets out of control it becomes and issue, and that is very common occurrence with a viral co-infection. I have my own theories on why that is.

A little prevention can go a long way in this. I have personally been aphaulled at the schools not sending out Immunization updates for all their students to be up to date on hib & Ped-vax.

That little 6 year old girl the other day in Rapid Death had a co-strep infection.
We have seen a few of those showing up. How many deaths may be prevented by just being up to date on immunizations?

Stay Safe
The Happy Scientist

Here try this link instead
http://www.meningitis.org/disease-info/ ... eumococcal
Pneumococcal Meningitis
That link states:
"Pneumococcal bacteria (Streptococcus pneumoniae) are the second biggest cause of bacterial meningitis in the UK and Ireland."

So when you start reading these "meningitis" reports in association with PH1N1 keep that in mind.
Also note it says its already in about 60% of their children.

This is why I keep suggesting the immunizations for the possible secondary infections right now.

What is the % of people that immunize their children in the US?
I expect it to be far higher than in other countries, and I bet at some point you will be able to do a direct comparison in mortality numbers between those countries which do have strong immunization campaigns to those that do not im sad to say I wish all children were immunized. It breaks my heart to see children die to something easily prevented due to their parents "un-awareness" on the matter.

Although the good news is most countries DO have antibiotics so those may help in many of the cases. But we could still reduce mortality by a bit more prevention.

I found this disturbing
http://www.bmj.com/cgi/content/extract/ ... 25_1/b3423
PLEASE tell me they ARE testing for more than
Neisseria meningitidis?


NOTE From the CDC
"Viral meningitis is generally less severe and clears up without specific treatment. "
and the also agree what I have posted previously about

"For bacterial meningitis, it is also important to know which type of bacteria is causing the meningitis because antibiotics can prevent some types from spreading and infecting other people. Before the 1990s, Haemophilus influenzae type b (Hib) was the leading cause of bacterial meningitis. Hib vaccine is now given to all children as part of their routine immunizations. This vaccine has reduced the number of cases of Hib infection and the number of related meningitis cases. Today, Streptococcus pneumoniae and Neisseria meningitidis are the leading causes of bacterial meningitis."
http://www.cdc.gov/meningitis/about/faq.html

Agree! There is, of course, a new range of severe cases that are entirely different from a standard seasonal flu, as discussed a number of times!
However, it is worth to remind that H1N1 can ALSO behave like a normal flu!

The cumulative seasonal influenza database covers a very broad spectrum of pathologies, which deserve attention as well. Influenza related literature consolidates “the sum of all seasonal”, including a vast number of possible complications. This can range from a standard bacterial pneumonia to a (rare) vision loss by retinitis as a sequel from influenza meningitis.

Therefore, the S-OIV H1N1 “normal flu” side cannot be overlooked!

Both in prevention and therapy fronts, bacterial pneumonia remain a source of concern. This includes proper vitamin balance, exercise, and, in appropriate cases, pneumonia vaccines. Better check also the “normal flu” preparedness!!

"H1N1 can ALSO behave like a normal flu! "

USUALLY behaves like normal flu.
So question, why the out liars?

I mean even in 1918 they had what 2-3 % CFR, out of all those that caught it.
Was it normal flu like for the rest of them or?

Hmmm

from Happy's posting:


This is more info about coinfection - H1N1 virus + bacterial infection:


http://www.globalpost.com/webblog/health/more-evidence-mrsa-involvement-h1n1-flu

When the H1N1 pandemic started at the end of last April, few of the case-patients seemed to have any secondary bacterial infections. This was unusual: In the 3 20th-c pandemics, the only ones for which there are good records, bacterial pneumonias seem to have accounted for a high percentage of illness and death. But H1N1 was unusual in a number of ways, and so health authorities wrote down the lack of bacterial infections as one more quirk of this novel strain.

Comes now the CDC to say that while that may have been the case in the spring, it is not now. In a conference call conducted Monday for doctors, which I covered for CIDRAP, the agency said that out of 77 deaths for which it had excellent autopsy data (a small subset of the deaths so far), 22, or 29%, had some bacterial co-involvement. Among the 22, the leading bacterium was S. pneumoniae (or Pneumococcus), but S. aureus was the second leading cause, with 7 cases, and 5 of those cases were MRSA.

(There is not yet anything online from that call to link to. A transcript is promised, and the CDC reps conducting the call said the data will be out soon in the MMWR. I'll update when possible.)

In fact, there is an emerging literature on the role of bacterial infections in illness and deaths in this flu, and an emerging consensus that bacterial infections are playing a bigger and more serious role than was thought at first. At the ICAAC meeting two weeks ago (more on that soon), KK Johnson et al of the Women's and Children's Hospital of Buffalo, N.Y., along with researchers from two other institutions, described two severe and ultimately fatal infections with H1N1 complicated by community-strain MRSA. The victims were children, a 9-year-old girl and a 15-year-old boy, who arrived at the emergency room several days after being seen for mild flu symptoms. Both children died of necrotizing pneumonia, one 11 days after being hospitalized and one 3 days. Cite (no link available): K.K. Johnson, H. Faden, P. Joshi, J. F. Fasanello, L. J. Hernan, B.P.Fuhrman, R.C.Welliver, J.K. Sharp and J. J. Schentag, "Two Fatal Pediatric Cases of Pandemic H1N1/09 Influenza Complicated by Community-Acquired Methicillin-Resistant Staphylococcus aureus (CA-MRSA)," poster G1-1558a.

Finally, there is one recent paper that is online, and it describes MRSA necrotizing pneumonia plus flu in an adult, not a child. It comes from Hong Kong, from a group that were the first to describe SARS pneumonia and thus have a lot of experience in surfing the early waves of a pandemic. In this new paper in the Journal of Infection, they describe the death from necrotizing pneumonia of a healthy 42-year-old man who was in the hospital only 48 hours. They believe this is the first H1N1+MRSA death to be recorded in the medical literature, and so they use the opportunity to issue a warning to doctors: If a flu patient arrives with what appears to be secondary pneumonia, drugs that can treat MRSA must be prescribed, or the infection will flourish unchecked and death will result. The cite is: Cheng VCC, et al., Fatal co-infection with swine origin influenza virus A/H1N1 and community-acquired methicillin-resistant Staphylococcus aureus, J Infect (2009), doi:10.1016/j.jinf.2009.08.021.

We've been talking since the beginning of this pandemic, and before that, about the unique hazards of MRSA + flu coinfection. (Archive of posts here.) It's important to understand that the bacterial pneumonias now being recorded are not only due to MRSA; Pneumococcus is playing a role as well. That is important because, unlike MRSA, we have vaccines against Pneumococcus; in the United States, one vaccine is approved for children and a second related one for adults. With no MRSA vaccine anywhere, and no H1N1 vaccine yet, it is worth considering whether to take a pneumococcal vaccine for additional protection as this pandemic unfolds.

I have been seeing 1/4th to 1/3rd with bacterial co-infections for awhile now. Problem is, I think the expectation from history, including 1918 would be to have the numbers reversed. That is, 70% with bacterial coinfection.

If 70% have no bacterial coinfection, then what is killing those? I, personally, can't come up with a different way to read this other than the virus directly causing death, either through viral pneumonia/cytokine storm or other. far less common mechanisms such as encephalitis.

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I am not a doctor, virologist, or any of type of medical/life sciences professional.

I am a layman with a background in the physical sciences.

Rapid death, and if we see it pass over the majority children in the fall and have a higher peak in 20-40 when all is said and counted I will be thinking cytokine storm.

Lets work on preventing the secondary infections before they even start. Hib and Pneumovax.


I have been fighting the bug today, or shall I say "A bug"
My co-worker decided to keep the lab AC so it was 4C in my office. At least it felt like it, I have had chills all day no fever. But feels like someone is hitting me with a damn bat. Going to bed early.
Took my D and CO3 hope it works. Really not feeling so hot.