CDC To Monitor Children's Flu Complications: Drug-Resistant Staph A New Wrinkle

SFgate ^ | 12-8-2003 | Daniel Yee

[blam]

The nation's health agency plans to closely watch flu complications among children, who have swamped hospitals in some states and surprised doctors with the severity of their illnesses.

A new concern is the rise of a common drug-resistant staph infection that is complicating efforts to treat children with the flu, an official with the Centers for Disease Control and Prevention said Monday.

[blam]

Thanks for the link riri ,deserves its own thread

[Coroner]

Vancomycin is effective against MRSA, unfortunately Vanco resistant strains are starting to pop up.

[torstars]

Here is another article on a toddler's death after getting immunized

"Neither the Council Bluffs Health Department or the Iowa Department of Health have confirmed that 20-month-old Caitlin Mouw died last Tuesday from the flu.

But her parents said doctors told them that all signs point to it. Caitlin had received the flu vaccine at her 18-month checkup."

http://www.theomahachannel.com/iowabureau/2690746/detail.html

[torstars]

I was also struck by reports of sudden deaths in previously health children. These deaths happened within a couple of days of onset of symptoms and did not appear to involve secondary infections.

[blam]

They don't know if the baby died from the flu virus yet. It seems like two moths would have been enough time to acclimate to the shot, huh?

[blam]

Ping.

[Judith Anne]

I wonder if the child had the Fujian strain...immunization doesn't work against it, right?

Anyway, this is shaping up to be a hard season.

[torstars]

Yes, it seems unlikely that the shot had anything to do with the baby's death. There have been a couple of reports of deaths in young, previously healthy children or toddlers. The virus is consistently changing, so I was curious to see if the vaccine was reducing the severity of the disease, especially in younger, immunologically naive patients, but there have been a few reports describing fatal cases in children already immunized.

[Think free or die]

This is pretty scary stuff. Our school-age sons had flu shots the day after Thanksgiving, so hopefully they'll have some protection against these ugly diseases and complications. Flu is hitting their school already. I've heard quite a few reports of flu in our area of SE Pennsylvania now.

[torstars]

I think that 70-80% of cases in the US are Fujian. I suspect that virtually all of the deaths in previously healthy children are Fujian - that is how things were shaping up in Europe. The Fujian stain has changed quite a bit from A/Panama/2007/99

[torstars]

Several reports have indicated the flu is moving east in the US. The initial cases were in Texas, Colorado, and Wyoming, but eastern states are showing more activity. I expect the % of cases that type as Fujian to also increase. The other H3N2 isolates are typing out as Panama-like.

[torstars]

This is pretty scary stuff.

Julie Gerberding and Antony Fauci appearing on network and cable TV on the same day to talk about flu is a clear signal that there is considerable concern.

[torstars]

This is what A/fujian/411/2002 looks like.

[torstars]

Here's A/panama/2007/99

[Judith Anne]

Thanks for your interest and participation on this thread. I haven't heard any statistics on the distribution of the two different strains, do you know a source for that?

[blam]

BTW, welcome to Free Republic.

[Think free or die]

I expect the spread of flu was nicely assisted by all the Thanksgiving holiday travel. Our older son's fifth grade class of 24 was missing 4-5 kids today, of whom at least one has flu. I don't think the rest of them are on cruises. We keep telling our sons to wash their hands and keep their hands off their faces.

[torstars]

The antigen characterization is listed in CDC Weekly reports.

In the latest report:

"Antigenic Characterization: CDC has antigenically characterized 157 influenza A (H3N2) viruses collected by U.S. laboratories since October 1 and found that 45 (29%) were similar antigenically to the vaccine strain A/Panama/2007/99 (H3N2), and 112 (71%) were similar to the drift variant, A/Fujian/411/2002 (H3N2). The A/Fujian strain predominated in Australia and New Zealand during the recent Southern Hemisphere influenza season and is a drift variant related to the vaccine strain, A/Panama/2007/99. Antibodies produced against the vaccine virus cross-react with A/Fujian/411/2002-like viruses, but at a lower level than against A/Panama/2007/99 (H3N2). Vaccine effectiveness depends, in part, on the match between vaccine strains and circulating viruses and cannot be determined by laboratory testing. Although vaccine effectiveness against A/Fujian/411/2002-like viruses may be less than that against A/Panama/2007/99-like viruses, it is expected that the current U.S. vaccine will offer some cross-protective immunity against the A/Fujian/411/2002-like viruses and reduce the severity of disease. One influenza A(H1N1) virus was antigenically characterized and was similar to the vaccine strain A/New Caledonia/20/99. "

[torstars]

I think that on of the reasons that flu seems to peak in January is linked to holiday travel and gatherings.

[Judith Anne]

I apologize for seeming lazy, I'm doing two things at once tonight, and one of them is FReeping...did the statistic you gave earlier, about the 80% Fujian strain, come from the CDC?

[suzyq5558]

Our whole family has been zapped .my son and eldery FIL havn't came down with it yet but i suspect they will.it went through the rest of us boom boom.we have asked our MIL if she isnt better by tommorrow that she needs to see her dr. she has congestive heart failure and she is always coughing and coughing but she really sounds bad.
I have asthma and when i came down with this i thought i was going to have to go to ER it really kicked the asthma into high gear but i take strong meds for it and that has really helped.
at first i thought we were just getting colds but we all started running fevers and having the headaches and chills,yuckkky,my daughter missed a week of school and my hubby was home from work for a week also. and were still all coughing and hacking.this stuff is awful.
im concerned more for my inlaws who are not in the greatest of health and they got the flu shot ,the rest of us did not and yet they still got this flu and pretty bad.
hope everyone stays well.

[joesnuffy]

unfortunately Vanco resistant strains are starting to pop up.

And I bet the most likely place to catch it...is in hosptial...nosocomial infection..

[torstars]

Yes, the 80% was my recollection of the CDC, Canada, and European data. Here are the fujian/panama numbers for Canada

[Judith Anne]

Thanks again.

[torstars]

they got the flu shot ,the rest of us did not and yet they still got this flu and pretty bad.

The cross reactivity data is mostly from animals and the current version of fujian-like flu has already drifted from last years A/fujian/411/2002 which I believe is what was used in the animal tests.

The next flu batch (for southern hemisphere) will probably use A/Wyoming/3/2003, which is from a Feb 2003 isolate, and the current version has already drifted from Wyoming also.

WHO is clearly playing "catch up", but may be accelerating mutations by using a vaccine that is only partially effective against Fujian (although 20-30% of H3N2 in the US is much closer to the Panama strain in the current vaccine).

[suzyq5558]

So in other words the vaccine may not be as affective?

[uncbob]

If the FLU is this bad it should be treated like they are treating SARS

Maybe close the schools where it is present

[Coroner]

bingo!!

[torstars]

The current vaccine uses A/Panama/2007/99 which was the prevalent strain in 1999, but Fujian is creating most of the current problems and the current vaccine is only partially effective against Fujian.

[suzyq5558]

AHA gotcha, so my MIL would have been a lot sicker then. well the rest of us have been feeling pretty darn crummy.

[blam]

"hope everyone stays well."

Sorry to hear about all the sickness, I hope everyone gets better soon. I would insist that your in-laws go to the doctor.

[suzyq5558]

Well thats kind of a stickler for us in dealing with my MIL.
dr's and nurses do not like her,she is the worst ,i kid you not. when she had her stroke she accused everyone from the poor nurses to the doc that they were all trying to kill her.
she complains non stop. the nurses cannot make her happy or comfortable,she had the congestive heart failure episode and accused the medic's at the house of trying to suffocate her and screamed all the way to the ER geesh it was terrible she yells at the nurses and everyone else .then she had to have a stent put in and lord what a nightmare for everyone ,my whole family boycotted her with that trip to the hospital.
when she had to go ER in california she accused the staff of treating her so badly they made her walk from three flights up all way down to the lobby cause they all hated her.which we all knew was not true for lords sake.
she is a most difficult person to deal with and really hates dr's even though they have saved her life several times,i do not understand. and yes she is a delusonal communist. i kid you not, she has told us plenty of times she is a socialist. and now she lives under our roof and has to keep a lot of things to herself and it just kills her that we do not see the world the way she does.
love her dearly but.........
so in conclusion it's very difficult to get her to the dr. office,but we will force her if she keeps coughing the way she has been.
im now done ranting. can you tell we have already tried earlier to get her to the dr.?

[blam]

"can you tell we have already tried earlier to get her to the dr.?"

Boy howdy. Do you know/like Jack Parr? (He always said, "I kid you not.")

[suzyq5558]

My dad is alway's saying "i kid you not" i guess i picked it from him. i feel silly but is Jack Parr an old movie star? im not up on movies really, although i do like old movies i dont pay a lot of attention to all the actors.
i now feel quite inadaquate lol

[suzyq5558]

testing</>

[blam]

Jack Parr was the first of the late night TV hosts. I believe it was johnny Carson that took over from him.

Jack Parr

"Television and radio pioneer Jack Paar has been called the most imitated personality in broadcasting. He virtually created the late-night talk show format as the host of THE TONIGHT SHOW, one of televisions longest running programs. Of him, the WASHINGTON POST said, "Jack Paar was genuine, and the footprints he left on the loony moonscape of television are enormous; they will be there forever."

[torstars]

Here is another report from the MA DOH website (which relies on CDC info):

"Influenza has been reported in all regions of the United States and has been widespread in 10 states (Arkansas, Colorado, Idaho, Nevada, New Mexico, Pennsylvania, Tennessee, Texas, Utah and Washington) and regional in 9 states. Also, this year is earliest since the 1976-77 influenza season that the percentage of specimens testing positive has exceeded 10%. Of the isolates typed by CDC, 99% of isolates were identified as type A and 1 % identified as type B. Over 80% of the A (H3N2) viruses have been identified as the A/Fujian (H3N2) strain. This strain has been associated with the more severe cases and deaths in children reported in the western states. Because of the changes in the influenza virus, the current vaccine may be slightly less effective in preventing influenza caused by the A/Fujian (H3N2) strain. However, the influenza vaccine is the best tool we have and it is expected to be effective in preventing severe disease and complications from influenza. Every year, people at high risk for complications from influenza are strongly recommended to get their flu shot as soon as possible."

[torstars]

The sub-type may be dependent on when and where you catch the flu. It seems that the more severe cases in the West are Fujian, and the cases that are just beginning to show up in the east are Panama. However, it looks like the Fujian strain is spreading to the east.

This type of spread is not unexpected. The Fujian strain started in China last year and was widespread in New Zealand and Australia this summer (southern hemisphere's winter).

Now Fijian is starting in the western United States and working its way east. Here is a media report from the Cincinnati area (southern Indiana/Ohio and northern Kentucky). Flu in general is still relative weak, although still earlier than seen in recent years. Only a few isolates have been subtyped, and they are all Panama (which is covered in the current vaccine):

"In Colorado, more than 6,300 people have been infected and at least six have died. A few other deaths have been reported in Texas, Oklahoma and New Mexico, according to the federal Centers for Disease Control and Prevention. The big concern: a flu strain called type A/Fujian for which this year's vaccine offers only partial protection.

So far in the Tristate, the few cases that have gone all the way through testing have been type A/Panama, a strain that is covered by this year's vaccine. No cases of A/Fujian influenza have been reported to local public health officials.

Season starting early

Cincinnati Children's Hospital Medical Center has reported 70 cases of influenza. Mercy Anderson treated 26 adults and six children with flu symptoms over the weekend. Smaller numbers of cases have been seen at other Mercy hospitals, according to Mercy Health Partners spokeswoman Karen Kuhn. Several cases also have been reported at Bethesda North, said TriHealth spokesman Joe Kelley.

Ohio and Kentucky remain listed among 13 states with "sporadic" flu activity. Indiana is among 16 states with "regional" flu activity, according to the CDC. That means flu season is starting somewhat early this year. In Greater Cincinnati, cases usually peak in January and February and can continue into April. "

[torstars]

From today's Chicago Tribune:

"Some doctors in California, Texas and Colorado say they have been overwhelmed by the severity of flu in children this year. On one day last week, Children's Medical Center in Dallas reported two dozen children with flu symptoms, most severe enough to need ventilators."

http://www.chicagotribune.com/news/local/chicago/chi-0312090138dec09,1,4626524.story?coll=chi-newslocalchicago-hed

[torstars]

There havebeen some school closings:


Schools in Trousdale County, 35 miles northeast of Nashville, are closed until Monday because so many of their 1,300 students have the flu, said Kim Karesh, spokeswoman for the Tennessee Department of Education.

Trousdale is the only school system in Tennessee to have closed because of the flu, Karesh said.

Memphis and Shelby County has had 653 flu-like illnesses reported, which is high for this time of year, said Brenda Ward, spokeswoman for the local health department.

http://www.theleafchronicle.com/news/stories/20031209/localnews/2284.html

[torstars]

Here's a report suggesting the outbreak is now beginning to take off in Northern California. Kaiser is well established there, and uses its network of hospitals to monitor the outbreak. Some there are using "epidemic" to describe the recent rise. I would assume that most of these are Fujian:

"Health giant Kaiser Permanente, which conducts influenza surveillance for the state health department, reported Monday that 390 patients in its Northern California region tested positive for the flu virus in the week ending Dec. 6.

``I have never seen anything like this,'' said Dr. Roger Baxter, a consultant who for the last eight years has overseen Kaiser's flu vaccine program in Northern California, where the health company serves 3.2 million patients. ``We're in an epidemic situation.''

The 390 cases last week represented a dramatic bump from the same week last year when Kaiser doctors reported only one case of the flu. Baxter said there has been an upswing in the number of flu cases at doctors' offices and Kaiser hospitals in San Jose, Santa Clara, San Francisco, Alameda and other areas. The week ending Nov. 29 there were 229 flu cases reported.

And it's still early in the flu season, which typically tapers off in March.

Baxter added that an abnormally high 30 percent of those people with flu-like symptoms who were tested for influenza last week received positive results for the virus. Typically, a 10 percent result indicates an outbreak."


http://www.bayarea.com/mld/mercurynews/living/health/7448956.htm

[Judith Anne]

Thanks for all your work, bringing this information to the thread.

[riri]

Do you know, off hand, what the prevalent strain was last year?

[mewzilla]

So when do the kids pick up the staph, before or after they enter the hospital? If it's after, then some hospitals need to do a better job of infection control.

[riri]

The Fujian strain started in China last year and was widespread in New Zealand and Australia this summer (southern hemisphere's winter)

Am I to assume it wasn't as brutal in the SH because they have had more exposure the strain?

[Judith Anne]

Staph is ubiquitous. I kid you not. And children aren't sterilized on admission to the hospital. I am positive that you have staph organisms on your body right now.

Seriously, staph and other infections attack when the resistance is low, due to other illness.

[torstars]

In the US the prevalent H3N2 strain was Panama-like last year. Fujian began last year in China. There was some Fujian in the US last season, but most was Panama.

[torstars]

Am I to assume it wasn't as brutal in the SH because they have had more exposure the strain?

No, it was quite severe in Australia and New Zealand (although I'm not sure about children's deaths). I think that Fujian just emerged in China at the end of 2002.

[torstars]

Today's CDC press conference pretty much verified what I suspected happened in the selection of this year's vaccine strains. I think the sequence goes something like this.

Last year Fujian emerged from Fujian Province in China. The virus was detected in several locations in mainland China and also made an appearance in the US in early 2003.

In the spring the components of the current vaccine were chosen. Fujian was on the radar screen, but the initial isolate, A/Fujian/411/2002, did not grow well in eggs, which is how flu virus in killed vaccines is produced. A/Wyoming/3/2003 had just been isolated and there was little data on its stability in eggs. Therefore, the current vaccine used the tried and true A/Panama/2007/99 to represent H3N2 strains.

This summer Fujian was the dominant strain in Australia and New Zealand. It was one of their worst flu seasons and a Fujian-like virus was selected to replace Panama-like for the upcoming flu season in the southern hemisphere.

Thus, the vaccine under development will be ready for the flu season in the southern hemisphere, but it will be too late for the current season on the northern hemisphere.