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Public Health Update

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

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  1. Public Health Update David Kirschke, MD Medical Director / Health Officer Northeast Tennessee Regional Health Office

  2. 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

  3. 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)

  4. 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

  5. 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

  6. 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

  7. 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

  8. 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

  9. 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

  10. 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

  11. 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

  12. Flu Season Fever Cough Think Influenza! Sore Throat Rapid Flu Test?

  13. 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.”

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