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Doctors See Increase in Dangerous Flu Cases at UIHC

IOWA CITY, Iowa - Doctors at UIHC are dealing with more dangerous flu cases in recent weeks than normal.

“(Flu season) is during the winter months in this part of the world,” said Doctor William Lynch. “It goes right up to February, March, and April sometimes.”

The Centers for Disease Control in Iowa reported widespread flu activity in the state. Data shows the surge in cases started in mid-February. Doctors believe more young people are getting the flu this year because they are less likely to get the flu shot.

“I’ve never had a flu shot, and I never thought that I would get that sick,” said Jennifer Kent, 29, of Burlington. Kent left the hospital Tuesday afternoon, after a one week stay in Iowa City.

“I had influenza B with pneumonia,” Kent said. “I almost died.”

Kent credits Extracorporeal Membrane Oxygenation, or ECMO, for saving her life. It’s a treatment that is normally used to help infants breathe, but in recent years doctors have found a way to treat adults with the technology, Lynch said.

“We are getting busier and busier, so we are doing 20 adults or so a year, when five years ago, we weren’t doing any,” said Lynch.

UIHC is the only hospital in the state that offers such treatment for adults. Lynch said he’s a little surprised by the sudden increase in demand for ECMO, and said it is only used for those patients who are near death.

“Doctors basically told me that she is very sick and she’s got a very very low chance of surviving through the night,” said Shannon Kent, Jennifer’s husband. “I broke down and said lets do it, at least with ECMO she’ll have a 50 percent chance of surviving.”

The idea behind the machine is simple: It breathes so the patient doesn’t have to, therefore letting the lungs recover faster.

“It’s the same idea of breaking your leg and putting it in a cast,” said Lynch. “You don’t use your leg while it heels.”

But Lynch says the best way to avoid getting the flu, and potentially avoid ECMO, is through prevention. The Iowa Department of Public Health said this years flu vaccine fights all three strands of active influenza.

Indiana covering IA outbreak in its week 46 report

Routine influenza surveillance in Iowa indicated a novel influenza virus in three children in North Central Iowa. This influenza A (H3N2) recombinant virus has also been detected in other states in recent months. The virus contains components of human, avian, and swine influenza viruses, as well as components of influenza A (H1N1) virus. All transmission has been human-to-human, and transmission appears to be limited. No additional cases have been identified in the last week. None of the ill persons has had any known exposure to animals. No serious illnesses or deaths associated with this novel influenza A (H3N2) virus have been reported, and all ill persons have recovered. Surveillance for this virus has been enhanced at clinics and emergency rooms in the area.
 Two human infections with novel influenza A viruses were detected in individuals from Indiana. Both patients were infected with swine-origin influenza A (H3N2) viruses. Both were hospitalized but have been discharged and both have recovered from their illnesses. One case was hospitalized in July, 2011 and one in October, 2011. There has been no evidence of an epidemiological link between these two patients and no sustained human-to-human transmission of these viruses has been found.

http://www.in.gov/isdh/files/Week46-2011.pdf

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Influenza activity is increasing in Iowa. There have been six laboratory confirmed cases of influenza identified since October.
This includes three cases of a novel influenza strain in children in Webster and Hamilton counties. This virus, an influenza A/H3N2 recombinant virus, has also been detected in Pennsylvania, Maine, and Indiana in recent months and contains components of human, avian, H1N1, and swine influenza. All spread in Iowa has been human to human, and spread appears to be limited; no further cases have been identified in the last week. Symptoms are similar to regular seasonal flu. Because the virus is unique, surveillance has been increased at clinics and emergency rooms in the area.
The proportion of outpatient visits due to influenza‐like illness (ILI) was 0.7 percent, which is below the regional baseline of 2.3 percent. The percent of influenza rapid tests that tested positive increased while the percent of respiratory syncytial virus (RSV) rapid tests that tested positive decreased. There was one influenza‐associated hospitalization that occurred in a child and which was reported from sentinel hospitals for this reporting period. The percent of school absence due to illness increased slightly and 3 schools in region 4 reported 10 percent and greater absenteeism (all which appear to be related to gastrointestinal viruses, such as Norovirus). No new cases of other respiratory viruses were detected in this reporting week. For the season, other respiratory viruses identified include rhinovirus, adenovirus, parainfluenza 1‐2, RSV, and human metapneumovirus (hMPV).

http://www.idph.state.ia.us/IDPHChannel ... 448D1F1A0D

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Note that Iowa is reporting the hospitalization (in week 46) of a child under the age of 5 who appears to be H3

http://www.idph.state.ia.us/IDPHChannel ... 448D1F1A0D

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I have a call into IDPH.

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All characterized samples in Iowa this season have been influenza A, and all sub-typed influenza A has been H3.

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Testing algorithm

http://www.shl.uiowa.edu/kitsquotesform ... orithm.pdf

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Detail

http://www.shl.uiowa.edu/kitsquotesform ... season.pdf

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Uses
CDC Human Influenza Virus Real–Time RT–PCR Diagnostic Panel

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Eight days after patient A's illness onset, real-time reverse transcription--polymerase chain reaction (rRT-PCR) testing of respiratory specimens from patients A, B, and C at SHL indicated possible S-OtrH3N2 influenza virus. At CDC, preliminary rRT-PCR diagnostic results were inconclusive but indicated probable infection with a swine-origin influenza A (H3N2) virus. Subsequent complete genome sequencing at CDC confirmed all three specimens as S-OtrH3N2 with the M gene from the pH1N1 virus.
http://www.cdc.gov/mmwr/preview/mmwrhtm ... 0d1123a1_x

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