BALTIMORE (March 9, 2012) -The Maryland Department of Health and Mental Hygiene (DHMH) and the Calvert County Health Department continue to investigate a cluster of cases of severe respiratory illnesses in four members of the same immediate family, of whom three have died. To date, no additional related severe respiratory illnesses have been confirmed and no other similar clusters have been identified.
Testing by the DHMH Laboratories Administration has confirmed that all four cases had the H3N2 strain of influenza A, which is known to be one of the influenza strains currently circulating in Maryland and nationwide. At least two of these cases were complicated by bacterial co-infections with methicillin-resistant Staphylococcus aureus. Staphylococcus aureus co-infection is a known complication of influenza infection.
The flu season typically can last as late as May. Vaccination is the best way to prevent influenza and its related complications that can lead to hospitalization and even death. This season’s influenza vaccine offers protection against influenza A H3N2 as well as influenza H1N1 and influenza B. DHMH recommends all individuals over the age of six months get vaccinated. In addition, DHMH reminds Marylanders to take other precautionary measures, such as hand washing and staying home if sick. Individuals with influenza-like illness (fever and sore throat or cough) should consult their healthcare providers for evaluation.
CDC Confirms Typical Human Influenza A H3N2 Virus in Maryland Cluster
March 16, 2012 – CDC has confirmed that the influenza viruses isolated from the cluster of severe respiratory illness in one family in Maryland are seasonal influenza A H3N2 viruses. Genetic sequencing has confirmed that this is a typical human seasonal H3N2 virus that is more than 99% similar to other H3N2 influenza viruses submitted by the state of Maryland this season. While full antigenic testing is pending, based on genetic sequencing of some of the samples, these viruses are close to the H3N2 component of the 2011-2012 seasonal vaccine such that vaccination should offer protection against these viruses. Testing on the Methicillin-resistant staphylococcus aureus, (MRSA) isolates is ongoing, but preliminary results indicate that some of the MRSA isolates from Maryland are pulsed-field types USA300. Strains from the USA300 MRSA pulsed-field type can cause community MRSA infections including outbreaks of skin infections.
In early March 2012, Maryland reported a cluster of severe respiratory illness in four adults in the same immediate family. Three of the four family members died. The state of Maryland reported that all four people were confirmed to be positive for seasonal influenza A (H3N2) infection by the state Laboratories Administration. MRSA bacterial co-infections are reported to have occurred in at least two of the four patients. More information about the cases in Maryland is available at http://www.dhmh.maryland.gov/publicrelations/pr.
Bacterial infections can occur as co-infections with influenza or occur after influenza infection. Staphylococcus aureus (staph) is one such bacterial co-infection. Concurrent infection (co-infection) with staph – which is what seems to have occurred in the cluster in Maryland – is a potentially catastrophic complication of influenza that can progress rapidly to serious illness and death.
No formal surveillance is conducted for influenza with bacterial co-infections, however, these are well documented in the literature going back to the 1918 influenza pandemic. While not common, these co-infections have been reported in both children and adults.
The best way to prevent influenza and its complications is an annual influenza vaccine. The United States is experiencing a late influenza season. Activity has only recently begun to increase and may continue for some time. This week’s FluView is reporting 15 states with widespread influenza activity and 5 states with high influenza-like-illness activity. Nationally, the percent of respiratory specimens testing positive for flu is 23 percent. People who have not gotten vaccinated yet this season should get vaccinated now.
Antivirals for Treatment of Influenza: A Systematic Review and
Meta-analysis of Observational Studies
Jonathan Hsu, Nancy Santesso, Reem Mustafa, Jan Brozek, Yao Long Chen,
Jessica P. Hopkins, Adrienne Cheung, Gayane Hovhannisyan, Liudmila Ivanova,
Signe A. Flottorp, Ingvil Saeterdal, Arthur D. Wong, Jinhui Tian, Timothy
M. Uyeki, Elie A. Akl, Pablo Alonso-Coello, Fiona Smaill, and Holger J.
Ann Intern Med published 27 February 2012,
Conclusion: Therapy with oral oseltamivir and inhaled zanamivir may provide a net benefit over no treatment of influenza. However, as with the randomized trials, the confidence in the estimates of the effects for decision making is low to very low.
Body Piercing: Complications and Prevention of Health Risks
Holbrook, Jaimee; Minocha, Julia; Laumann, Anne
“Body and earlobe piercing are common practices in the USA today. Minor complications including infection and bleeding occur frequently and, although rare, major complications have been reported. Healthcare professionals should be cognizant of the medical consequences of body piercing.
Complications vary depending on the body-piercing site, materials used, experience of the practitioner, hygiene regimens, and aftercare by the recipient. …….As body piercing continues to be popular, understanding the risks of the procedures as well as the medical and psychosocial implications of wearing piercing jewelry is important for the medical practitioner.”
“….Using the WEI JET with SJV provides adequate oxygenation during tracheal intubation in apneic patients for a prolonged period of time, with no difference in complications compared to the standard intubation technique. PetCO2 monitoring facilitated intubation in patients with a Grade III glottis view…..”