Health Alerts > 7/27/09 H1N1 and vaccine and West Nile virus
Nationally, confirmed cases are 43,771 with 302 deaths.
Neurologic complications, including seizures, encephalitis, encephalopathy, Reye syndrome, and other neurologic disorders, have been described previously in association with respiratory tract infection with seasonal influenza A or B viruses, but not with novel influenza A (H1N1) virus. The current MMWR includes a report that summarizes the clinical characteristics of those four cases. Patients were aged 7--17 years and were admitted with signs of influenza-like illness (ILI) and seizures or altered mental status. Three of the four patients had abnormal EEGs. In all four patients, H1N1 viral RNA was detected in nasopharyngeal specimens but not in CSF. Antiviral therapy included oseltamivir (four patients) and rimantadine (three patients). All four patients recovered fully and had no neurologic sequelae at discharge. These findings indicate that, as with seasonal influenza, neurologic complications can occur after respiratory tract infection with novel influenza A (H1N1) virus. For children who have ILI accompanied by unexplained seizures or mental status changes, clinicians should consider acute seasonal influenza H1N1 virus infection in the differential diagnosis, send respiratory specimens for appropriate diagnostic testing, and promptly initiate empirical antiviral treatment, especially in hospitalized patients. Full article at http://www.cdc.gov/mmwR/preview/mmwrhtml/mm5828a2.htm
Vaccine update: no firm number or date of arrival for an H1N1 vaccine as of yet. Currently, the priority groups to receive the vaccine would be:
o Healthcare workers and public safety workers
o Children ages 6 months to 18 years
o Pregnant women
o People with chronic diseases
Post exposure antiviral chemoprophylaxis with either oseltamivir or zanamivir can be considered for the following persons (full reports at http://www.cdc.gov/h1n1flu/recommendations.htm):
1. Close contacts of cases (confirmed, probable, or suspected) who are at high-risk for complications of influenza
2. Health care personnel, public health workers, or first responders who have had a recognized, unprotected close contact exposure to a person with novel (H1N1) influenza virus infection (confirmed, probable, or suspected) during that person’s infectious period.
H1N1 State/Local
As of July 23rd, we have 291 confirmed cases of the pandemic H1N1 and two deaths in the state. Specific county data will no longer be reported.
Just a reminder that virtually all Influenza A activity in the US is now H1N1.
Vaccine Update
As of August 2010, all children grades 6 though 12 will be required to have a Tdap booster and Menactra for school. If you are seeing children this summer for well child visits or school physicals, please consider providing these vaccinations or referring them to Super Shot or Dept of Health to get a head start on immunizing this large number of children.
West Nile Virus: we had another positive mosquito sample this week, so the virus is out there.
Please feel free to call with any questions. Deb McMahan, MD
