No Prior Existing Conditions but Dead Anyway

Morning-glory · Jun 28, 2009

Indigo Girl, You have put a lot of work into this thread. One of the questions that I have is when was the last time a H1N1 virus was doing its rounds? I'm curious because some of the articles above mention that the older the person is the less likely to die from this flu. If this is a new mutation of the virus, why would anyone born after 1918 have any immunity to it at all?

I saw something somewhere that decendants of the plagues in Europe (1300-1800) are showing immunity to other conditions (AIDS or Flu, I can't remember). Would this be some wierd inherited immunity?

I'll try and find something. If I do I will post it.

It is sad to see young, healthy kids die so quickly. I, like everyone else dread the coming of the fall. I work in psych and one of the concerns is that these people as under a lot of stress, take meds that are hard on their bodies and when they are sick enough to be hospitalized, they generally are not very good at the whole hygene thing.

We had a terrible cold/flu like thing going around patients and staff in Feb. I was off work for a week. I don't usually take that long to get going again. I have to wonder if this was an H1N1 infection.

Enough for tonight. I will do some homework and see what I can come up with.

indigo girl · Jun 29, 2009

Kenosha County, Wisconsin

http://www.wisn.com/health/19888291/detail.html

Health investigators are looking into the death of Bradford High School baseball star Sam Schissel to determine whether or not it is related to H1N1. Wisconsin officially has four H1N1 flu deaths, three in Milwaukee and one in Wausau. Tests will determine whether the death of the healthy Kenosha County teenager is the state's fifth.
"We were lucky to have him for 18 years, and he impacted so many lives," Sam's father, Jim Schissel said.
Jim Schissel said Sam had been sick for about 10 days and appeared to be recovering when Saturday morning he stopped breathing. He died the day before his 19th birthday.
Jim Schissel said his son was the picture of health before developing flu like symptoms that developed into pneumonia.
An autopsy will determine what happened but Jim Schissel said he's wondered if it was the H1N1 flu.
Three of the people who've died from H1N1 in Wisconsin had pneumonia and the fourth had pneumonia-like symptoms.
The Kenosha hospital said they have forwarded the case along to the Kenosha County Medical Examiner's office and they will perform and autopsy.

http://scienceblogs.com/effectmeasure/2009/06/swine_flu_warning_signs_that_s.php

In children, signs that need urgent medical attention include fast breathing or trouble breathing; blueish or gray skin color; not drinking enough fluids; severe, persistent vomiting; not waking up or not interacting.; being so irritable that the child doesn't want to be held; and flu-like symptoms improve, but then return later with a fever and a worse cough. Those are warning signs we physicians think about all the time, with respiratory infections. And they're good to have in mind with this new influenza-like illness caused by the novel H1N1 strain. Just good things for parents to have in the back of their mind.
In adults, we look at another set of warning signs that suggest the need for urgent medical attention: difficulty breathing or shortness of breath; pain or pressure in the chest or abdomen; sudden dizziness, confusion, persistent or severe vomiting that doesn't go away; and flu-like symptoms that improve, but then come back again with a fever or worsening of cough.
(Statement by Dr. Anne Schuchat, CDC Press Briefing, May 28, 2009)

indigo girl · Jun 30, 2009

One of the questions that I have is when was the last time a H1N1 virus was doing its rounds? I'm curious because some of the articles above mention that the older the person is the less likely to die from this flu. If this is a new mutation of the virus, why would anyone born after 1918 have any immunity to it at all?

No one has a good answer just some general observations such as in the link below:

http://www.wired.com/wiredscience/2009/06/swinefluhistory/

(hat tip flutrackers/chuck)

Morning-glory · Jun 30, 2009

Thanks.

Makes sense that because it was around as late as 1977, that us older folks would have had some exposure to it, therefore some immunity.

lamazeteacher · Jun 30, 2009

"Jim Schissel said Sam had been sick for about 10 days and appeared to be recovering when Saturday morning he stopped breathing." quote from first link given on this page, by indigo girl

Denial and lack of regard/caution following government recommendations given to schools, printed in newspapers, and on TV news programs (predisposing community conditions), regarding s/s of flu seem to have been the cause of this tragic death!

It's possible too, that secondary infection could have stemmed from bacteria in Sam's mouth, via plaque. It's been proven that dental contamination can lead to infections in the heart, it might have been present in many colonies, orally, and carried into the blood stream following vigorous toothbrushing that caused bleeding.......

Every community's health department should target employers of young people and summer school and recreation programs, and convey urgency about going to the doctor within a day or two of having any of these s/s: sore throat, cough, muscular aches and pains, nausea, fever that appears to recede, then comes back again. Tamiflu needs to be given within 48 hours of the first s/s, to be of maximum effect to battle H1N1.

Here's an article proving the dental connection, coming from the American Heart Association in Dallas:

DALLAS, June 10 - Good dental hygiene and health may be crucial in preventing heart valve infection, according to research reported in Circulation: Journal of the American Heart Association.

In a study of 290 dental patients, researchers investigated several measures of bacteremia (bacteria released into the bloodstream) during three different dental activities - tooth brushing, a single tooth extraction with a preventive antibiotic and a single tooth extraction with a placebo.

As expected, researchers found bacteria in the blood more often with the two extraction groups than with the brushing group. However, the incidence of bacteremia from brushing was closer to an extraction than expected. "This suggests that bacteria get into the bloodstream hundreds of times a year, not only from tooth brushing, but also from other routine daily activities like chewing food," said the study's lead author Peter Lockhart, D.D.S.

In 2007, the American Heart Association modified its recommendation that preventive antibiotics be used prior to most dental procedures for the great majority of those at risk for infective endocarditis (IE) - a rare but life-threatening infection of the lining of the heart or heart valve that can occur when bacteria enter the bloodstream. The association now recommends preventive antibiotics only for patients at the highest risk for a bad outcome from IE.

In this double-blind, placebo-controlled study, researchers sought to determine if daily dental activities like tooth brushing posed as much risk for IE as major dental procedures (e.g., tooth extractions) for which preventive antibiotics might be prescribed. Researchers drew blood from each patient a total of six times - before, during and after these interventions - and analyzed the samples for bacterial species that are associated with IE.

They found that bacteria enter the bloodstream in most patients early on during a dental

extraction or tooth brushing, and that bacteria can still be found in the blood as long as an hour after these procedures in a small number of cases.

"While the likelihood of bacteremia is lower with brushing, these routine daily activities likely pose a greater risk for IE simply due to frequency: that is, bacteremia from brushing twice a day for 365 days a year versus once or twice a year for dental office visits involving teeth cleaning, or fillings and other procedures," said Lockhart, chair of the Department of Oral Medicine at the Carolinas Medical Center, Charlotte, N.C.

"For people who are not at risk for infections such as IE, the short-term bacteremia is nothing to worry about," he said.

"If you stop oral hygiene measures, the amount of disease in your mouth goes up considerably and progressively and you'll have far worse oral disease," Lockhart said. "It's the gingival (gum) disease and dental caries (decay), that lead to chronic and acute infections such as abscesses. It's that sort of thing that puts you at risk for frequent bacteremia and presumably endocarditis if you have a heart or other medical condition that puts you at risk."

"The incidence of IE-related bacteremia from all blood draws was 23 percent in the tooth-brushing group, 33 percent in the extraction plus antibiotic group, and 60 percent for the extraction-placebo group," Lockhart said. The researchers therefore found that amoxicillin significantly decreased the incidence of bacteremia from an extraction but did not eliminate it altogether.

The highest incidence of positive IE-related bacterial cultures occurred within five minutes of all three procedures, with the majority (93 percent) of patients with bacteria in the blood experiencing the condition for less than 20 minutes after the procedures. Only 5 percent of the extraction-placebo group and 2 percent of the brushing group still had bacteria in the blood at one hour.

"The human mouth is colonized by a larger variety of bacteria than any other body area, and many of the bacterial species in the mouth that cause disease are found in the periodontal pocket (below the gum line) adjacent to the teeth," said Lockhart, adding that some of those species have been associated with IE. "Bacteria commonly gain entrance to the circulation through ulcerated gingival (gum) tissue surrounding the teeth, but oral hygiene reduces gingival disease and reduces that risk."

Patients in this study came to an urgent care clinic in need of tooth extractions. So it's likely they had a higher level of dental disease and poorer oral hygiene than the general population.

The researchers are analyzing additional data from this study to determine if there is a direct correlation between the level of dental disease and the likelihood of IE bacteria getting into the bloodstream.

According to the American Heart Association, those at highest risk for adverse outcomes from IE are 1) patients with a prosthetic cardiac valve or prosthetic material used for cardiac valve

repair; 2) previous endocarditis; 3) cardiac transplantation recipients who develop cardiac valve abnormalities; and 4) congenital heart disease for unrepaired cyanotic congenital heart disease, including palliative shunts and conduits; completely repaired congenital heart defect with prosthetic material or device, during the first six months after the procedure; or repaired congenital heart disease with persisting leaks or abnormal flow at the site or adjacent to the site of a prosthetic patch or prosthetic device.

Coauthors are: Michael T. Brennan, D.D.S., M.H.S.; Howell C. Sasser, Ph.D.; Philip C. Fox, D.D.S; Bruce J. Paster, Ph.D.; and Farah K. Bahrani-Mougeot, Ph.D.

The study was funded by the National Institute of Dental and Craniofacial Research, National Institutes of Health.

Statements and conclusions of study authors that are published in the American Heart Association scientific journals are solely those of the study authors and do not necessarily reflect association policy or position. The American Heart Association makes no representation or warranty as to their accuracy or reliability.

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indigo girl · Jun 30, 2009

Buffalo, New York

http://www.buffalonews.com/cityregion/niagaracounty/story/719178.html

It does not sound like either of these kids had a prior health condition according to their families. One seen three times at the ER, and the other twice. Both developed MRSA as a complication.

I think that we can in fact infer that both had no prior health issues as the hospital spokesperson sputters about how impossible it is to predict bad outcomes in these cases.

Two of the local cases have turned deadly.
On Saturday, Maya Harden, 9, of Buffalo, died in Women & Children's Hospital, where she had been in critical condition for about 11 days.
One week earlier, on June 20, Matthew Davis, 15, died in the same hospital from swine flu complications.
Citing confidentiality constraints, they wouldn't say whether any of those seven has a life-threatening illness.
Both Maya and Matthew had gone to the hospital at least once previously before being admitted.
Maya, a fourth-grader at Charles R. Drew Science Magnet School 59, was taken to the Women & Children's emergency room on June 12 with flu-like symptoms. She went home and seemed to be getting better but took a turn for the worse, so her mother took her back June 14. She was sent home the next morning before being taken back to the hospital June 16.
Similarly, Matthew, who attended Harvey Austin School 97, had gone to the emergency room June 15, before being admitted to Women & Children's June 17.
Health officials say it's not fair to criticize emergency rooms for such deaths, because there is no way to predict the illness getting so much worse after the initially mild symptoms.
Women & Children's officials declined to comment on that point, referring the question to Billittier, who talked generally about the situation, without commenting on the two cases.
"Is there any way to predict that people will have bad outcomes if they have mild symptoms and no [pre-existing] risk factors?" Billittier asked. "There is no way to predict that outcome, and that is not unique to swine flu."
While health officials won't discuss specifics of the two cases, comments from family members of both youths did not suggest any such underlying health problem.
"He was a very healthy boy," Matthew's mother, Lucretia Belton, said. Maya's mother, Akea Hollingsworth, said, "She was healthy, with no severe health issues."
Matthew and Maya did share one condition. At the time they were admitted to the hospital, each had developed a complicating condition, being co-infected with a type of bacteria called MRSA-methicillin- resistant staphylococcus au-reus.
"Both children were unusually ill with severe lung disease . . . and that was unusual," Dr. Howard S. Faden, chairman of infection control and director of virology at Women & Children's, said last week, before Maya's death.

(hat tip PFI/howmanydays)

indigo girl · Jun 30, 2009

Clark County, Nevada

http://www.kvbc.com/Global/story.asp?S=10612337

Southern Nevada health officials say a 33-year-old Clark County man infected with the swine flu virus has died.
The Southern Nevada Health District said Monday that the man had no underlying heath conditions and had been hospitalized since June 15. He died Sunday.

(hat tip PFI/howmanydays)

indigo girl · Jul 1, 2009

http://www.midhudsonnews.com/News/2009/July09/01/Swine_flu_OC_Death-01Jul09.htm

I am including this case as someone who was previously healthy because information comes from a flu forum where the family is personally known to someone posting on that forum. Obviously, we would never have known that she had no prior existing conditions from the media report. There are probably many, many others that we will never learn of either, unless the families talk to the press.

This woman leaves behind two small children.

Orange County Health Commissioner Dr. Jean Hudson said a 32-year-old Newburgh woman died on June 23. She had been admitted to St. Luke’s Cornwall Hospital since June 13, she said.
Specimens were sent from the Medical Examiner’s Office and results were received in the past 24 hours.

(hat tip PFI/bbkaren)

indigo girl · Jul 10, 2009

Alexandria, Virginia

http://trancy.net/2009/07/04/july-4-david-twomey-washington-d-c-us/

Lived in Alexandria, and worked in D.C. No prior health problems in any of the many articles on his death, but he did have strep and staph which would have complicated his case. He died June 30th.

He was only 27 years old, and a very handsome young man, this is a shame. I feel for his family.

indigo girl · Jul 10, 2009

Calgary, Canada

http://www.cbc.ca/canada/calgary/story/2009/07/09/calgary-swine-flu-death-h1n1.html

A young woman with no pre-existing health issues has been confirmed as Calgary's first death linked to the H1N1 flu.
The victim, who was not named, had been sick for about two weeks before she was admitted to a Calgary hospital on June 29, said Dr. Richard Musto, medical officer of health for Calgary and area, on Thursday.
Tests confirmed she had swine flu on June 30, and she died Wednesday night, he said.
"That's our assumption, that swine flu was a major contribution to her death," Musto told reporters.

indigo girl · Jul 12, 2009

The UK

http://www.dailymail.co.uk/news/article-1199107/Week-long-battle-UKs-fit-swine-flu-victim.html

The only Briton to die of swine flu and not to have underlying health problems fought for life for nine days.
He was admitted to Basildon Hospital in Essex on July 1 and was placed in isolation in the intensive care unit.
The man, who came from the local area, was understood to have been in full health before contracting the virus. Despite this, he lost his battle against the flu strain on Friday morning.
A hospital spokeswoman could not confirm whether he had been given Tamiflu.
Doctors concluded that he died of the H1N1 flu strain but the case has been referred to the coroner's office for a post-mortem examination to determine the exact cause of death.
There have been 15 swine flu-related deaths so far in the UK but this latest case has raised fears that the strain is becoming more virulent.
Professor Steve Field, chairman of the Royal College of General Practitioners, said the latest death should not lead to panic. 'I'd have expected a death with no underlying causes to have happened earlier,' he said. 'It doesn't change anything we're doing.'

(hat tip/flutrackers)