Austin H1N1 ECMO Machines Maxed Out
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trapper/kcmo
11 y
1,504
http://www.recombinomics.com/News/12261301/H1N1_Austin_ECMO_Max.html
Commentary
Austin H1N1 ECMO Machines Maxed Out
Seton officials say in the last two weeks the number of flu patients doubled from about 200 to 400 confirmed cases. And five patients with the H1N1 virus were put on a special heart-lung machine to help them breathe.
Recombinomics Commentary 12:00
December 26, 2013
Weingarten says the procedure is complex and often requires a team of over 35 physicians, nurses, perfusionists, and respiratory therapists for each individual ECMO case, which does not include the team of lab technicians that provide critical life-saving patient information. Patients require 24-hour care while they are connected to the device, which may last a few days or several weeks.
The above comments are from media reports of a press conference at Seton Medical Center on December 24 updating the H1N 1 situation in Austin, Texas (see map), which serves central Texas, with a modern center that includes 5 EMCO machines, which require significant resources as noted above.
EMCO machines are used for H1N1 patients who can no long breathe on their own or oxygenate their blood. These functions are assumed by the ECMO machine in a last ditch effort to allow the patient to repair the extensive lung damage and associated complications.
The presentations cited an case in 2012 who was 8 months pregnant when infected with H1N1. After delivery of a healthy baby by C-section the patient recovered after 4 weeks on an ECMO machine. As noted above in the current outbreak, 5 patients were hooked up to the five machines at Seton (and a sixth machine was kept in reserve to substitute for a machine that loses functionality during treatment. One of those five cases had been recently taken off the machine, but as noted above, the number of flu patients has doubled in the past week, raising concerns that the ECMO resource will be taxed significantly.
The five patients were between ages in the 20’s to 50’s (1 twenties, 3 forties, 1 fifties) and did not have pre-existing conditions other than obesity. In addition to the five adult patients on ECMO machines, one child (10M) had just come off an ECMO machine at the affiliated Dell Children’s Hospital. In addition to the six cases cited above, two pregnant women had died and many additional middle age and young adults were in ICUs at Austin area hospitals.
This concentration of severe H1N1 cases in the Austin area has raised concerns that the current outbreak will be more severe than 2009. Although adult deaths are not reportable, a Texas summary of H1N1 in 2009-2010 cited 240 deaths in Texas, which was concentrated in cases <65. The current outbreak is clearly targeting this population, raising concerns that the virus has drifted away from the 2009 version, leading to its dominance in Texas and across North America.
The early numbers in Austin raise concerns that these cases will tax health care delivery. There have already been shortages on vaccine and Tamiflu reported in the area. Both items are not in short supply nationwide, and the current demand in Austin has led to delays in distribution, but there a no nationwide or statewide shortages at this time.
However, the 2013 outbreak is about 3 months behind 2009, raising concerns that the current outbreak will peak in February, when conditions favor the spread of influenza.
Release of sequences from severe and fatal cases in eastern Texas would be useful.
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- CDC Issues H1N1 Advisory trapper/kcmo
11 y
1,446
This is a reply to # 2,136,375
http://www.recombinomics.com/News/12251301/H1N1_CDC_Alert.html
Commentary
CDC Issues H1N1 Advisory
While CDC has not detected any significant changes in pH1N1 viruses that would suggest increased virulence or transmissibility, the agency is continuing to monitor for antigenic and genetic changes in circulating viruses, as well as watching morbidity and mortality surveillance systems that might indicate increased severity from pH1N1 virus infection.
Recombinomics Commentary 20:30
December 25, 2013
The above comments from the December 24 CDC H1N1 Health Advisory suggests the sequences from the recent cluster in Conroe or the confirmed cases in the greater Houston area are similar to the H1N1 sequences which have been recently released by the CDC.
The advisory follows the December 20 alert by the Texas Department of Health, as suggested. The Texas alert was largely in response to media reports of a mystery illness in Conroe Texas involving 8 cases with textbook swine flu symptoms who tested negative on a rapid test, which may have delayed treatment. Four of the cases died, so the Texas and CDC releases instruct physicians to treat patients based on the symptoms and condition rather than rapid test results and they should not delay treatment due to pending re-test results.
To date, the CDC has released one set of sequences, A/Texas/36/2013, from a Texas case infected this season. The severity of a subset of cases in eastern Texas has raised concerns that the sequences have receptor binding domain changes, such as D225G or D225N, which was predicted for severe and fatal cases in Ukraine in November, 2009. These changes were subsequently identified in severe and fatal cases in other countries, although the CDC noted the early appearance of these changes in milder cases in the spring of 2009.
D225G has not been seen in any US cases this season, but was present in an August collection in Utah (A/Utah/08/2013) as well as two Florida cases with June collection dates (A/Florida/13/2013 and A/Florida/16/2013). Therefore, release of sequences from severe of fatal H1N1 cases in Texas, as well as Florida, or other areas would be useful.
Similarly, oseltamivir resistance (H274Y) has been seen in four cases in Louisiana (A/Louisiana/07/2013, A/Louisiana/08/2013, A/Louisiana/10/2013, A/Louisiana/13/2013) as well as a case in Mississippi, A/Mississippi/11/2013, and Utah, A/Utah/10/2013, which is a concern given the proximity to eastern Texas as well as anecdotal reports of resistance in Texas. H274Y would seriously impact the utility of Tamiflu treatment.
Therefore, the immediate release of sequences from late November and early December would be useful.
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- H1N1 Q226R In Mississippi
trapper/kcmo
11 y
1,499
This is a reply to # 2,136,377
http://www.recombinomics.com/News/12261302/H1N1_Q226R_MS.html
Commentary
H1N1 Q226R In Mississippi
The recent high frequency of severe and fatal H1N1 cases in Texas has raised considerable concern. H1N1 frequencies are approaching 100% in Texas and throughout the United States. The highest levels of influenza like illness (ILI) has been reported in the south (TX, LA, MS, AL) and the number of patients on ECMO machines in Austin has raised concerns that these serious cases could severely tax health care delivery. ECMO machines are resource dense and in limited supply. 5 adults (aged from 20’s to 50’s) on ECMO machines at one institution maxed out the resources (although one is kept in reserve to address potential mechanical problems).
Recombinomics Commentary 21:45
December 26, 2013
The CDC has been releasing a small set of H1N1 sequences every 2-3 weeks. Included were oseltamivir resistant (H274Y) sequences from Louisiana, Mississippi, and Utah, which could seriously limit Tamiflu treatment, even if present as a minority species.
Receptor binding domain changes which target the lung via gal 2,3 receptors could lead to the lung damage being reported for young and middle aged adults, including pregnant women with severe or fatal pneumonia. D225G was present in summer sequences from Florida (A/Florida/13/2013 and A/Florida/16/2013) and Utah, A/Utah/08/2013.
However, more recent sequences from October collections from patients (10M and 29M) in Mississippi (A/Mississippi/09/2013 and A/Mississippi/10/2013) have raised similar concerns for Q226R, which also targets gal 2.3 receptors. Virus isolated on eggs (which selects for D225G and/or Q226R) had Q226R, while virus isolated on mammalian cells had Q226 (all other positions on H1, N1, and MP were identical for each set).
These mixtures raise concerns that H1N1 can form pseudotypes with Q226 on the H1 for transmission, and Q226R on H1 for expansion in the lower respiratory tract. Most of the public H1N1 sequences are from mammalian isolates, raising concerns that D225G and Q226R are more common than indicated by sequences in public database.
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- check out this pattern
uchihaMadara
11 y
1,507
This is a reply to # 2,136,396Using the CDC's own data, it looks like influenza like illness is happening mostly around Texas, Mississippi, Louisiana, and Alabama.
Try this link: http://www.cdc.gov/flu/weekly/index.htm#ISTE
The weird part is that it's the states nearest the Gulf of Mexico.
Can anyone dig up the pattern for Mexico's Influenza Like Illness' reported?? Does Mexico have that data?
The WHO is terrible to navigate and only gives data without exactly where the numbers come from given a geographical region.
Many people are sick around Fort Worth/Dallas too, coughing galore.- Re: check out this pattern
trapper/kcmo
11 y
1,468
This is a reply to # 2,136,399the time is near that i have kept warning about - be able to make colloidal silver, own a nebulizer and know how to use both. at the very least!
- Re: check out this pattern
trapper/kcmo
11 y
1,468
- check out this pattern
uchihaMadara
11 y
1,507
- Re: CDC Issues H1N1 Advisory glaxony
11 y
2,126
RR 100% Cured
This is a reply to # 2,136,377Got Bad sore throat, nausea, felt horrible. H202 didn't do much for it. Slight improvement. Put Iodine on my tongue and brushed it in. Slight improvement. Comes back fast. Was definitely flu because oscillococcinum helped, but I ran out. Was getting worried that I might have to spend a few days in bed when the h202 and Iodine wore off so quickly. Took some home made colloidal silver. Bingo. In two hours I was feeling great. This was a mean one. It got in my lungs and was stinging me. Big green snot was coming out from behind my nose. CS kicked it's butt. I am nearly done with it in a few hours of taking CS, just three doses. Headache completely gone. I will stay on the CS for a few more days to keep it from coming back. Don't need no breathing machine and 20 nurses.Advertisement
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- H1N1 Q226R In Mississippi
trapper/kcmo
11 y
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- CDC Issues H1N1 Advisory trapper/kcmo
11 y
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