H1N1's Links to Pneumonia Appear Clearer

As Flu's Characteristics Become More Evident, Virus Seen to Pose Greater Threat to Young, Otherwise Vibrant People

(Washington Post)  By Washington Post Staff Writer Rob Stein

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As swine flu continues to spread around the globe, a clearer and in some ways more unnerving picture of the most serious cases has started to emerge, indicating that the virus could pose a greater threat to some young, otherwise vibrant people.

The virus can cause life-threatening viral pneumonia much more commonly than the typical flu, prompting the World Health Organization on Friday to warn hospitals to prepare for a possible wave of very sick patients and to urge doctors to treat suspected cases quickly with antiviral drugs.

Experts stress that most people who get the H1N1 virus either never get sick or recover easily. But some young adults, possibly especially women, are falling seriously ill at an unexpectedly rapid pace and are showing up in intensive care units and dying in unusually high numbers, they say.

Although why a minority of patients become so sick remains a mystery, new research indicates that H1N1 is different from typical seasonal flu viruses in crucial ways -- most notably in its ability to penetrate deep into the lungs and cause viral pneumonia.

"It's not like seasonal influenza," Nikki Shindo of the World Health Organization said at the conclusion of a three-day meeting of more than 100 experts the WHO convened in Washington to review swine flu. "It can cause very severe disease in previously healthy young adults."

Meanwhile, the Centers for Disease Control and Prevention reported Friday that vaccine production was proceeding more slowly than hoped. Officials had predicted that about 40 million doses would be available by the end of October, but that projection will probably fall short by about 10 million to 12 million doses, said Anne Schuchat, director of the CDC's National Center for Immunization and Respiratory Diseases.

"Eventually, anyone who wants to be vaccinated will be able to be, but the next couple of weeks will continue to be a slow start," she said. So far, 11.4 million doses have become available and states have ordered about 8 million doses, but the vaccine will not become available in large amounts until November, she said.

The WHO's warning came as U.S. health officials reported that the number of states reporting widespread flu activity was up to 41, including Maryland and Virginia, and that the death toll among children had climbed to 86. Maryland has reported 10 deaths and Virginia health officials say eight people, including one child, have died. There have been no reports of deaths among District residents.

So far, the virus does not seem to sicken or kill people more often than the typical flu. But the pattern of people getting seriously ill is far different than in typical flu seasons. The elderly, who are usually most vulnerable, are generally spared; children, teenagers, pregnant women and young adults are the most common victims.

Officials have been closely monitoring the virus for signs it has mutated into a more dangerous form, and they have also been testing animals for the virus because of fears that infected livestock could cause more-lethal mutations.

Federal agriculture officials said Friday that pigs from the Minnesota State Fair had tested positive for H1N1, which would make them the first documented pig infections in the United States, if follow-up tests confirm the results. But there are no signs that the pigs were sick or that the animals had infected any humans. Children staying near the fair had gotten the virus, but there was no sign they were infected by the pigs.

Seasonal flu viruses tend to infect primarily the upper respiratory system. But recent animal studies and autopsies on about 100 swine flu victims show that H1N1 infects both the upper respiratory tract, which makes it relatively easy to transmit, and also the lungs, which is more similar to the avian flu virus that has been circulating in Asia.

"It's like the avian flu on steroids," said Sherif Zaki, chief of Infectious Disease Pathology at the CDC. He noted that unusually large concentrations of the swine flu virus have been found in the lungs of victims: "It really is a new beast, so to speak."

About a third of patients who required intensive care had bacterial pneumonia, but H1N1's proclivity to infect lung cells makes it more likely than seasonal flu to cause viral pneumonia, which can lead to life-threatening lung damage.

"Remarkably different is this small subset of patients that presents very severe viral pneumonia," Shindo said.

One of those patients was Karen Ann Hays of Sacramento, Calif., an otherwise healthy nurse whose hobby was tackling grueling triathlons. Despite desperate measures to keep her alive, Hays, 51, died in July within days of coming down with swine flu.

"I have seen more cases like this in the last three months than I have in the last 30 years," said Peter Murphy, director of intensive care at the Mercy San Juan Medical Center in Carmichael, Calif., who tried to save Hays.

Although it remains unclear how frequently the virus makes people seriously ill, recent reports from Mexico, Canada, the United States, Australia and New Zealand indicate that perhaps 1 percent of patients who get infected require hospitalization. Between 12 to 30 percent of those hospitalized need intensive care, and 15 to 40 percent of those in intensive care die.

While about two-thirds of U.S. patients who were hospitalized in the spring had other medical conditions, the CDC reported this week that an analysis of more than 1,400 hospitalized victims found perhaps half had no serious health problems.

About one-third of those around the world who have died or became seriously ill from swine flu appear to have been vulnerable because they had heart or lung disease, chronic kidney problems, or other ailments that usually put people at risk. But others had conditions that many may not immediately associate with frailness, such as mild asthma, high blood pressure, high cholesterol and obesity.

"Many of these people look just like you or me," said Anand Kumar, an associate professor of critical care and infectious disease at the University of Manitoba in Winnipeg, Canada, which was hit hard by the pandemic's first wave last spring.

There appears to be no way to predict with certainty who may suffer serious, life-threatening complications, since some victims have had no other health problems.

For instance, Stacey Hernandez Speegle, 30, of Madison, Calif., who died in July, "was in great shape. She was on the softball team. She had two young children. She was renovating her house," said her mother, Tamara Brooks. "It's just so hard to believe."

Although it has been well publicized that pregnant women appear to be at increased risk, some evidence has started to suggest that being female may itself be a risk factor, for reasons that remain unclear.

"There's no question that women, and particularly young women, are getting hit disproportionately," said Kumar. He noted that women tend to have more fat tissue, which can help stimulate a dangerous inflammatory response to infections.

And some of those who develop serious illness deteriorate soon after starting to feel ill. They require oxygen masks, ventilator machines to pump oxygen into their lungs to keep them alive, and drastic, often rarely used measures to try to save them within days of the first fever, ache or cough.

"The rapidity of it is striking," said Andrew R. Davies, deputy director of intensive care at Alfred Hospital in Melbourne, Australia.

Some of the cases in Australia and New Zealand were so severe that doctors resorted to a much more aggressive, less commonly used treatment known as extracorporeal membrane oxygenation (ECMO). It involves siphoning patients' blood into a machine to remove carbon dioxide and then infuse it with oxygen before returning it to their bodies.

"It's quite an extreme form of treatment," said Steve Webb, a clinical associate professor at the Royal Perth Hospital in Australia.

Other doctors have tried administering nitric oxide and putting patients in a bed that turns them upside down to help their lungs work better. "Our back was against the wall," Murphy said, adding that after the deaths of patients such as Hays his hospital is working to make ECMO available.

"It's very difficult to get this double-barreled message out that: 'Yes, most cases are mild, but in a small percentage of cases these cases are disastrous,'" Vanderbilt University's William Schaffner said. "But the message is: Don't underestimate H1N1."

Of the at least 86 Americans younger than 18 who have died from H1N1, 11 deaths were reported in the past week. About half of the deaths in the past month were among teenagers, Schuchat said. Since Aug. 30, 43 pediatric deaths have been reported, including three in those younger than age 2, five among those ages 2 to 4, 16 in those ages 5 to 11, and 19 among those ages 12 to 17, she said.

"These are very sobering statistics," Schuchat said, noting that only about 40 or 50 children usually die during an entire flu season.

Virginia Health Commissioner Karen Remley said Friday that although the majority of H1N1 cases in the state are "mild and moderate," significant numbers have become seriously ill.

In Maryland, at least 257 people have been hospitalized with confirmed cases of H1N1 since June, health officials said.

At least 2,914 Americans have died from flu-related illnesses since the H1N1 began, the CDC said.

Staff researcher Madonna Lebling and staff writer Michael Laris contributed to this report.

[ln1glass]

I was not feeling well on Friday by Saturday I was on the floor coughing, thinking my lungs were going to fall out. Sunday went to ER they told me I had H1N1 symptoms so they gave me Tamaflu no cough medice. Monday I called my doctor they gave me Thesslons which are little pellets of cough medicine. Didn't work. Tuesday went to back to the ER got a chest x-ray and a breathing treatment to calm my cough. They gave me an inhaler when I left. They call me to tell me the people looking at my x-ray found some signs of Pnemonia. It's been a long week. Hoping this all will help me. I hope this help somebody else. If you can't stop coughing and you go to the ER make sure they take x rays on you or your kids.

[mnfelkel]

2 weeks ago I went to my doctor with fever, chills, body aches, headache and a cough. I asked her to test me for swine flu and asked for the Tamiflu. I had received the seasonal flu shot a month before but not the H1N1 vaccine. I am a teacher and the day my symptoms started, we sent home about 10 8th graders and 3 who were absent were confirmed cases of the H1N1. My doctor refused to treat me for the flu and sent me home with K-flex and a diagnoses of a sinus/bronchitus infection. Needless to say a week later I was still running a high fever with spikes from 101 to almost 103 that weekend. When I went back to my doctor the following Monday, a few blood tests and chest x-rays showed that it had developed into pneumonia. My mother died from pneumonia in April, so I was horrified and scared to death. I have 2 small children that I am not ready to leave yet! All my doctor said was that it did look like I had the flu. Well, duh! I knew it the first day I went!! I am very upset and will now be changing my family doctor! I am currently taking avelox which seems to help. Luckily, the pneumonia was not as serious as it could have been, but it developed very fast! H1N1 is nothing to play with, but my doctor certainly did not take it seriously!

[ln1glass]

I just don't think that enough people are even taking this Seriously. Hope you feel some relief too.

[cooookie94]

Take this flu seriously folks. Enough of the wacky conspiracies...

Another example, 12 year old boy, first few days high fever ~103, followed by dry cough and low grade fever coming and going ~100 - 101. After 7 days went to doctor, they checked oxygen absorption and lungs were clear. low grade fever and dry cough continued, today is day 10, went to doctor and now he has bacterial pneumonia. Not in hospital yet but give an oxygen machine and meds to attack the bacterial infection.

As others have noted, family members not affected, sister 9 and parents (mid 40s) were not infected with this. Earlier this year in Spring all 4 of us got sick and that was probably where we first experienced this flu/h1n1. That started with high fever, dry cough but lasting only 4-5 days then we all recovered.

None of us have had the h1n1 flu shots yet this year, 6+ hour wait two weekends ago when it first became available in our area, same weekend my son got it. It probably would not have helped my son in this case. Highly recommend getting the shot if you have the opportunity so your immune system can prepare itself.

Take away, watch for a dry cough, and fever that comes and goes, even low grade fever. Don't hesitate to go to doctor for the lung checkouts and to catch complications as early as possible.

[ksnyder1661]

My wife got the seasonal flu shot; a few days later she developed a cough. She got checked out and the doctor said it was nothing to worry about, just a case of bronchitis. She got some cough medicine and mild antibiotics.

About a week later she checked into the emergency room with pneumonia. Two days later she went on a respirator and a week later she was dead. The doctors tried everything to save her - they had her on all of the antibiotics and antifungals they had. They didn't try antivirals because they weren't able to diagnose her conclusively with H1N1; all of the tests they ran came back negative (the tests aren't completely reliable).

I encourage everyone to take coughs very seriously this winter.

[ln1glass]

So for your loss. I have it now. I'm a mother of four. I have Pnemonia nobody could detect for 5 days. My heart breaks for you. I will keep spreading the word on this matter. God keep your heart at peace

[truedeity]

truedeity wordpress com has some really interesting stuff on this topic.

[missmom1]

my oldest son 17 had swine flu and then pneumonia... had fever for 13 days... was hospitalized for 3 days. is going back to school tomarrow. =) still has some fluid in lungs but is much better and very bored!! was very scary for awhile. we do not get any vaccinations!! my 6 yr old had fever for 2 days and was done, I did not catch it at all this yr. nor did anyone coming and going to see him when he was sick. wierd virus because he was scary sick and he is the one who never gets sick...

[DrRiskie]

This is a great article but to keep up with the latest H1N1 developments I always look at <a href="http://www.infectiousdiseasenews.com> Infectious Disease News</a> for late breaking updates.

[Ms_enza]

If you get an email from the Dept. Of Health saying not to eat canned pork because of the N1H1... Ignore it. It's just spam.

[tmittelstaed]

5jbutler - , "all said the same thing, that only flu around is the H1N1. So why did I not get it?"

Because you already had it. You got it months ago, probably in the spring, and were one of the ones who showed no symptoms, your body produced antibodies, and that was that. You probably didn't even realize you were sick at all.

The CDC estimated there were about a million cases of H1N1 netween April 2009 and June 2009. That's what they publish right now. But what matters is the distribution, published here:

http://www.cdc.gov/flu/weekly/

According to this, swine flu reports came from all states. Meaning that by April 2009, Swine Flu was completely spread throughout the US. In short, the vaccine is too little, too late.

[5jbutler]

I have 3 children 15, 10, 8 all tested positive with type a flu in the same week. My husband was sick the same time as well. My teens turned into pneumonia. We caught it very early and he is doing fine. The others are doing well, too. Here is what gets me, I was the only one in the house that recieved the seasonal flu shot. I slept with my sick kids, kissed them, ate after them but guess what, I didn't not get it. I live in Maryland, I talked to nurses at the local hospital, health department, peditrians office and propmpt care locations, all said the same thing, that only flu around is the H1N1. So why did I not get it? Either there is a different flu going around or the regular flu shot is protecting you. I would like to know how many people that get the seasonal flu shot actually are getting H1N1.

[jwells17]

I too had the reg flu shot about a month ago and this past week my two sons and wife have had the H1N1 flu virus (13,4,29). I have No signs or symptoms but my wife is now in the hospital w/pneumonia and she is 34wks pregnant. They are telling us to deliver baby now.

[saladbar09]

My 11-yr-old son had H1N1 last week and ended up with pneumonia. We also caught it early and he's fine. He did NOT receive any flu shots. His entire school was closed b/c 40% of the kids were out sick. My 12-yr-old daughter goes to a different middle school, and as of last week they at 15% of the population out. Over the weekend, 2 very close friends of hers came down with it, and another 6 girls that she knows and sees in school just became ill over the weekend. My daughter has (so far!) no signs of the flu. SHE DID receive the seasonal flu shot (nasal spray) about a month ago. I was wondering the same thing - if that shot is offering her some kind of protection. I believe I had the H1N1 at the same time as my son (I was helping out at a school dance 3 days befor the school closed down.) I had a low-grade fever for about 4-5 days and a very deep cough. I don't feel congested at all, but I feel like I'm very slightly short of breath sometimes. Is it possible for me to have a viral pneumonia without being congested or having a fever? I did not get any flu shots this year.

[deanie1970]

I have 2 children, 3 and 5, both with H1N1. My husband also has it and has developed pneumonia. I slept with my husband while he was sick and slept with my children through this ordeal. I too did not get sick and I never ever had any type of a flu vaccine, not even seasonal. So the regular flu shot is not protecting me.

[tiger4856]

For all you people who think that H1N1 isn't as big of a deal as they make it to be, know from someone who has had it and ended up getting the pneumonia that is talked about in this article. It was the sickest I have every been and I am in the under 20 age group. You are much better off getting the shot than to take your chances with it.

[saladbar09]

You are so right. For most people, the flu comes and goes. But for a some, it develops very quickly into a very dangerous illness. My son started with symptoms on Tuesday morning, and by Friday morning he had pneumonia. Be careful...watch the fever, especially if it goes away and then comes back -that means there's an infection and get to a doctor!

[bayside2]

Doctors big pharma and some govt employees are set to become billionaires from this vaccine. Dont believe everything you hear from media or govt...In britian they gave this vaccine to homeless and 21 died (BBC),..Take charge of your own life....Investigate...

[ocreader]

The following is a response for texas-aggie, who is obviously more concerned with wing-nuts...rather than the possible "reality" and ramifications of the CDC claiming that "all" must receive this vaccine...especially those, whose young immune systems haven't been allowed to function, as designed!
Suppose I'm a "wing-nut" and proud of it!...will glad donate my dosage to texas-aggie, seems like they need another!

Thursday, July 30, 2009

The Washington Post confirmed today that the swine flu vaccine, which is set to be rolled out nationwide this fall in what some fear could ultimately become a mandatory vaccination program, will contain mercury, a toxin linked with autism and neurological disorders.

Claims by the CDC and the Institute of Medicine, following a whitewash study that ignored previously verified evidence, that thimerosal, a mercury based preservative, has no causal relationship to skyrocketing cases of autism have been soundly rejected by top doctors and scientists ever since.

Epidemiologist Tom Verstraeten and Dr. Richard Johnston, an immunologist and pediatrician from the University of Colorado, both concluded that thimerosal was responsible for the dramatic rise in cases of autism but their findings were dismissed by the CDC.

Cases of autism in the U.S. have increased by 1,500 per cent since 1991, which is when vaccines for children doubled, and the number of immunizations is only increasing. Just one in 2,500 children were diagnosed with autism before 1991, whereas one in 166 children now have the disease.

In 1977, a Russian study found that adults exposed to ethylmercury, the form of mercury in thimerosal, suffered brain damage years later. Studies on thimerosal poisoning also describe tubular necrosis and nervous system injury, including obtundation, coma and death. As a result of these findings, Russia banned thimerosal from children?s vaccines in 1980. Denmark, Austria, Japan, Great Britain and all the Scandinavian countries have also banned the preservative,? writes Dawn Prate.

Mercury is classified by The Department of Defense as a hazardous material that could cause death if swallowed, inhaled or absorbed through the skin, and the EPA is now limiting mercury emissions from factories because the toxin ?can damage the brain and nervous system and is especially dangerous to fetuses and small children,? but according to the CDC it?s perfectly safe to inject into your child?s bloodstream.

Despite concerns about thimerosal and mercury, which have led to the preservative being reduced or removed from a large portion of vaccines over the last five years, thimerosal will be an ingredient of the swine flu vaccine which is set to arrive in the U.S. this September.

?Some of the vaccine will be stored in multi-dose vials containing thimerosal, an antibacterial additive that contains mercury,? reports the Washington Post today in an article about which groups will receive the swine flu vaccine first.

?There will also be single-dose syringes without thimerosal, a substance that some assert is harmful to children,? adds the article, without mentioning whether or not people who take the vaccine will get a choice or even be informed if it contains mercury.

Around 12,000 U.S. children will be used as guinea pigs for the experimental swine flu vaccine also known to contain the dangerous ingredient squalene, which has been directly linked with cases of Gulf War Syndrome and a host of other debilitating diseases.

Squalene ?contributed to the cascade of reactions called ?Gulf War syndrome. (GIs developed) arthritis, fibromyalgia, lymphadenopathy, rashes, photosensitive rashes, malar rashes, chronic fatigue, chronic headaches, abnormal body hair loss, non-healing skin lesions, aphthous ulcers, dizziness, weakness, memory loss, seizures, mood changes, neuropsychiatric problems, anti-thyroid effects, anaemia, elevated ESR (erythrocyte sedimentation rate), systemic lupus erythematosus, multiple sclerosis, ALS, Raynaud?s phenomenon, Sjorgren?s syndrome, chronic diarrhea, night sweats and low-grade fever,? according to Micropaleontologist Dr. Viera Scheibner.

Pharmaceutical companies can be assured that they won?t face reprisals for the many thousands of injuries and deaths that will inevitably occur as a result of exposing millions to mercury and squalene during a mass vaccination program, because the government has already acted to provide them with blanket immunity from lawsuits.

?Vaccine makers and federal officials will be immune from lawsuits that result from any new swine flu vaccine, under a document signed by Secretary of Health and Human Services Kathleen Sebelius,? reported the Associated Press earlier this month.

[P0STING_AWAY]

I am suspecting that your tinfoil hat is screwed on .... JUST A LITTLE TOO TIGHT

[missmom1]

Thank you for this very insightful... and true statement. I matches what I have found to be true with vaccines and autism as well!! and more folks should investigate facts instead of wondering if our foil hats are screwed on too tight!!! I have an autistic son... and he used to be normal! I am well aware that the vaccines contributed to his abnormal behavior..... lucky for him that I read and believe in educating myself. I stopped all further vaccinations after age 3 and he is high functioning! which is way better than some autistic children I have had the pleasure to learn meet and learn about in my fundraisers over the past 3 yrs. stick to your guns on this ocreader and keep trying to educate others. some one will listen and the idiots, well lets hope they aren't reproducing anyway!

[Texas_Aggie]

For the wing nuts who think this is all a hoax, please read this article. If you try to convince yourself that these data are all fabricated, then there is no hope for you.

[simplecat123]

"Officials had predicted that about 40 million doses would be available by the end of October, but that projection will probably fall short by about 10 million to 12 million doses, said Anne Schuchat, director of the CDC's National Center for Immunization and Respiratory Diseases."

40-10=12 thanks for filling me in!!

[caragat]

NO... what they meant was that the original estimate was going to fall short approximately 10-12 million doses....not that it was going to equal 12 million doses!! I can see where that might be confusing though.

[slick1ru2009]

Canada has stopped giving the regular flu shot because unpublished study shows it makes people more susceptible to swine flu. How come the US doesn't follow suit? http://www.npr.org/templates/story/story.php?storyId=113316256

[rwsmith29456]

There is evidence that this is what made the early 1900s flu so deadly.