Influenza that fickle fellow

While influenza epidemics occur annually the variation in the timing, peak and magnitude remain a mystery. So far influenza in NYC has been mild. Several surveillance systems are used to gauge the severity of flu season and by any of them either flu hasn’t arrived yet or the strain has not varied much from last season. Outpatient visits for influenza-like illness in NYC are still below the 2.5% threshold and of nearly 1800 lab tests done for flu in the first week of 2012 less than 20 were positive (during peak flu season this can range as high as 15%). Elsewhere in the country the story is much the same with only a few states showing activity, but no hot regions.  Most of the circulating strains are the H3-type with smaller proportions of H1 and B; all components of this year’s vaccine. Looking at the world picture there is activity in Northern Africa and Japan, however, in general activity remains low.

It is still a good idea to get a flu shot, especially if you have a chronic illness. 

http://gis.cdc.gov/grasp/fluview/main.html

To smokers and their loved ones everywhere

Quit. Muster all your intestinal fortitude and just do it.  While not all smokers will end up ravaged by lung, throat or bladder cancer no one escapes unscathed. Heart disease, stroke, peripheral vascular disease, emphysema, hypertension, chronic bronchitis, prematurely aged skin, loss of fertility … the list is long and only grows  the more we learn. If everyone in the US quit smoking health care costs would plummet and we might just be able to pay off our national debt in a few years.

Last week I passed five male teens on the corner smoking. A few minutes later I passed five girls of the same age. So, I stopped and asked them, “Do any of you smoke?” They all made faces and a few started to edge away but three yelled back, “No way!” I then asked, “Would you date a boy that smokes?” In unison they all sang, “No.” There are good reasons why people can’t smoke in offices, bars or in city parks. The smoke is toxic and the rest of us don’t want to share your poison. When I see parents puffing around their young kids I want to whack them across the back of their heads, but social decorum requires I keep my opinions to pages like these.

Consider that a person can survive a few weeks without food, a few days with out water and barely a few minutes without oxygen.  When you smoke you are inhaling hot, toxic gases into the most miraculous and delicate of all the human organs. Deep in the lungs the exchange of oxygen for carbon dioxide happens at a thinner than tissue paper layer of cells. Those hot, toxic gases are destroying this life-sustaining interface with every puff. Sure, you’ve got millions of alveoli, but do you really want to burn them like kindling?

For the young, here’s a news flash: smoking isn’t cool. If you think it is you’ve been duped by advertising and peer pressure, the same stuff that said it was cool to wear crocs and designer jeans. You don’t see people doing that anymore, do you? If you’re old, there are still health benefits to gain from quitting a long-term addiction. Don’t be that person wheeling a tank of oxygen behind you. The one who can’t walk two blocks to the market or climb a half flight of stairs. Who at forty is mistaken for an AARP member. Who on their deathbed look back at their life and say, “Why didn’t I just quit?” Save yourself a bundle of woe. Quit smoking.

Unusual infection strikes four infants

Four infants have been sickened by an uncommon environmental bacterium called Cronobacter sakazakii in November and December. A single case has occurred in four states: Missouri, Illinois, Oklahoma and Florida. CDC is working with state and local health departments to investigate, but at this time there does not appear to be a connection. Two of the infants died of the infection and a DNA fingerprint analysis for the cases did not suggest a common link. Investigators in Missouri were able to identify Cronobacter in opened containers of powdered infant formula, premixed formula and a bottle of water. How the contamination occurred is as yet unknown but unopened samples of formula and water with the same lot numbers have reassuringly tested negative.

Cronobacter is not a reportable disease in New York unless several cases are recognized as being linked. The State and City Health Departments sent notices last week to hospital physicians, nurses and laboratories asking them to report any positive cultures in infants. No suspect cases have been reported in NYC.

Cronobacter mostly affects people with weakened, or in the case of neonates, undeveloped immune systems. Because it exists in the environment there are multiple opportunities for the bacteria to contaminate food, however, heat does destroy the bacteria.  Ordinarily CDC learns of 4-6 cases per year but in 2011 there were 12 in infants. Whether this represents a contamination of a commercial product or just better recognition is not known, but under investigation. There have been outbreaks in the past connected to powdered formula. Affected infants are generally less than a month old and have fever, irritability or listlessness and poor feeding. Medical consultation for infants with these symptoms should be sought without delay.

The World Health Organization recommends that whenever feasible infants be exclusively breastfed until the age of six months.

Radio interview with Bobby DeMuro of Radio Exiles on the novel Mailaise

Swine Flu update

The CDC has learned of two cases of swine origin influenza A of the H3N2 strain in Minnesota and West Virginia. The WV case appears to have occurred in a young child and local health officials, in conjunction with the CDC, are investigating and testing other ill children. Those kids could have routine seasonal viruses, like RSV, another flu strain or the newest swine-origin flu to cross over to humans. Disease with this strain continues to be mild.

In NYC there isn't much flu around to speak of and all surveillance systems are at or below baseline. Stay tuned.

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

http://www.cdc.gov/media/haveyouheard/stories/novel_influenza.html

http://www.dhhr.wv.gov/oeps/disease/flu/Pages/fluSurveillance.aspx

Another Swine Flu variant crosses over

It was reported last week that three children in Iowa contracted a swine-origin triple reassortment influenza A (H3N2). You may recall the H1N1 pandemic in 2009 started in the US in a similar fashion with cases in children in California and Texas before the HS outbreak in New York City. None of children were hospitalized and all recovered. Person-to-person transmission is suspected and these cases bring the total of swine-origin H3N2 infections in humans to 18. Because very few people with influenza actually get tested and diagnosed there likely have been more of these cases. What does it mean? Will there be another pandemic? As far as public health officials in Iowa can tell sustained transmission is not happening, so a pandemic seems unlikely. At least for now. Meanwhile, in NYC, the flu season hasn't yet arrived.

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6047a3.htm?s_cid=mm6047a3_w

Two with Haff Disease equals a hole in our understanding

Last week a woman bought fish from a Brooklyn market and prepared it for herself and her mother.  The next day the younger woman, who ate more of the fish, vomited and experienced muscle pain severe enough that she made a visit to a nearby hospital. Laboratory tests showed muscle enzyme levels 300 times normal, evidence of rhabdomyolysis, the release of the muscle protein myoglobin into the bloodstream. She had none of the usual risk factors for rhabdomyolysis such as extreme muscle overuse, trauma, muscle compression or drugs. Within a few hours her mother presented to the same hospital with similar, but less severe symptoms. Both women were treated and are expected to make full recoveries. No additional cases have occurred.

First reported in 1924, Haff disease gets its name from the Koenigsberg Haff, a brackish inlet of the Baltic Sea where the syndrome was first described. The syndrome is characterized by the sudden onset of severe rhabdomyolysis with nausea, vomiting, chest pain, shortness of breath, and pain with light touch. In Europe Haff disease has been associated with consumption of burbot, eel, and pike. In the United States 23 cases have been reported since 1984 and have followed the consumption of Buffalo fish, crayfish, and salmon. Like paralytic shellfish and ciguatera poisoning, a heat-stabile toxin is suspected but has yet to be identified.

The Buffalo Fish (Ictiobus cyprinellus) is a fresh-water fish and was reported to have been eaten by the two NYC Haff disease cases. Samples of fish from the market have been sent for testing and a temporary embargo has been placed while a trace-back to the source is underway.