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more on Pennsylvania fatality

http://www.wfmz.com/lehighvalleynews/25 ... etail.html

Local Man Pa.'s First Flu-Related Death

The Pennsylvania Department of Health Monday reported the state's first death related to the flu.

Officials said the patient was a 45-year-old man from Lehigh County, one of two infected people being treated at Lehigh Valley Hospital within the last week.

"Young, otherwise healthy individuals, coming into he hospital with H1N1 pandemic strain and both ended up on a ventilator," said Dr. Luther Rhodes, III, Chief of Infections Diseases for LVHN. "Certainly, it could be a chance occurrence, but it's very unusual early in the season to see not one, but two cases of young, otherwise healthy, individuals get so ill from influenza."

It is NOt a chance occurence.

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PA Influenza Weekly Report -- Week ending November 20, 2010 (Week 46)

ACTIVITY: LOCAL

There was a small increase in flu cases and influenza-like illness (ILI) in Pennsylvania, the increase was more pronounced in the western part of the state.
(ILI is defined as patients presenting with fever over 100*F, cough and/or sore throat in the absence of a known cause other than influenza.)


Summary

Eventhough influenza activity was minimal in Pennsylvania during week 46, 3 flu hospitalizations were reported, two of which resulted in death.
· Flu-related Emergency Department (ED) visits were low throughout the state. Several ED's in the SW region of the state had elevated visits for influenza-related illnesses. Multi-state comparisons of influenza ED visits can be found at, http://www.isdsdistribute.org/.

· 18 lab positive influenza cases were reported in Pennsylvania, down from 22 reported the previous week. Most of them reported from the NE region of the state and were influenza type A.

· 104 (1%) of 10, 256 outpatient Doctor Visits were attributed to Influenza-like Illness (ILI), same as the previous week.

· Seasonal A/H3N2 influenza continues to be the dominant flu strain this flu season, about 70% (7 of every 10) flu viruses currently circulating in Pennsylvania are the seasonal A/H3N2. However, the 2009 Pandemic H1N1 virus may be on the increase.

· Three influenza-asociated hospitalizations were reported.
· Two influenza-asociated deaths were reported, the first influenza deaths this season.

· The proportion of deaths attributed to pneumonia and influenza (P&I) was below average.

(...)

Source: http://www.portal.state.pa.us/portal/se ... 490&mode=2

Commentary

http://www.recombinomics.com/News/11241 ... _PA_2.html

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I agree.

This signals a cluster with a high fatality rate in a very short period of time which raises serious concerns. Serotype is not given by PA Health dept. but initial reports suggest pH1N1 is responsible for at least one out of two deaths and just 3 hospitalizations.

What are your thoughts on why they didn't give further details on these deaths?

Sub-type and location must be released. Sequences would be very useful, too.

This underplaying of deaths is common worldwide, as is the withholding of critical information. It is likely that the two deaths were the patients at Lehigh Valley who were on ventilators. Both were initially cited as young and previously healthy.

The PA report does say that H1N1 may be on the rise, but again gives no detail (in part becaiuse most cases are not serotyped). The profile of "young and previously healthy on ventilators" would signal H1N1, but the report really has no detail and I was unable to find media reports on the second death. Last year PA would break down H1N1 cases and deaths by county.

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PA put out a "Health Advisory" on Monday

http://www.portal.state.pa.us/portal/se ... 22-adv_pdf

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The Pennsylvania Department of Health (PADOH) has noted increasing influenza activity in several parts of the commonwealth, including influenza A (H3N2) in the Southwest region and 2009 influenza A (H1N1) virus in the Lehigh Valley area. As a result, severe illness and one death have occurred in the Lehigh Valley. Two nursing home outbreaks of influenza A/H3N2 have been reported, one in Southeast Pennsylvania in late summer and a more recent outbreak in the Southwest region.

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Patients with severe illness in hospitalized patients or fatalities where influenza is suspected should have respiratory specimens submitted to the state Bureau of Laboratories for testing. For information or for assistance to facilitate specimen submission to the Bureau of Laboratories, clinicians should call 1-877-PA HEALTH.
Laboratory confirmed influenza is a reportable condition in Pennsylvania. All cases of influenza with laboratory evidence of infection (rapid tests, other antigen tests, PCRs, or cultures) are reportable. Cases should be entered into PA-NEDSS, the PADOH electronic surveillance system. Unusual cases of influenza and clusters should also be reported by telephone to the appropriate local health department office. If you do not know the proper jurisdiction to contact, please call 1-877-PA-HEALTH.

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..."The Pennsylvania Department of Health (PADOH) has noted increasing influenza activity in several parts of the commonwealth, including influenza A (H3N2) in the Southwest region and 2009 influenza A (H1N1) virus in the Lehigh Valley area. As a result, severe illness and one death have occurred in the Lehigh Valley..."


..."Clinicians should consider the diagnosis of influenza in persons with influenza-like-illness (ILI) and collect specimens for diagnostic testing. Patients with severe illness in hospitalized patients or fatalities where influenza is suspected should have respiratory specimens submitted to the state Bureau of Laboratories for testing."...

Comment:

This clearly suggest pH1N1 is the cause of the deaths and hospitalizations in the Lehigh Valley. So, this time a more lethal strain is starting to pop up and yet we don't have any report even pointing out sub-type or location. Also, mention to a more aggressive surveillance in severe cases with ILI shows that PA Health dept. is looking for a deadlier pH1N1 or trH3N2 which raises concerns of a new potential epidemic has begun in Pennsylvania .

Data must be released without delay.