Entries in #H7N9; H7N9; bird flu; avian influenza; Dothan; MERS; pandemic; CDC; H5N1 (3)

Alabama DoH: "No new viruses, no new bacteria" in Dothan cluster

As I type this, the top Alabama health official is holding a press conference.  And a major tip 'o the cap to my buddy Mike Coston for giving me the link!

The health officer says there are three different agents at work in the cluster:  Rhinovirus (4), influenza (I missed the number), and (3) bacterial pneumonia infections. There were multiple and overlapping infections in several of these cases.

The hubub, this official states, is due to the heightened states of alert pertaining to H7N9 and MERS-CoV.

"A clustering of common organisms" is the reason why this group of disassociated illnesses was grouped together.

One death was aged 34; the other was age 55. 

According to this man, "WNL" means "Within Normal Limits," referring to tests.  He says it also means "We never looked," referring to the individual persons who fell ill.  It was the number of persons falling so ill, in such a short timeframe and in such a small area, and in such an environment as we are working in today with H7N9 and MERS, that prompted the closer inspection. 

I like his candor and his folksy demeanor.   Case closed.

However, the question is still out there on Houston.

Are Dothan, Houston mystery illnesses linked? 

The cases all come from nowhere.  They involve bright, energetic, athletic students.  They begin feeling feverish, exhausted, shaken. Then they experience violent seizures, are sent into a medically-induced coma.  And then, for two of the three afflicted students, they die.

The Houston Chronicle reports from early May are chilling.  Students 60 miles apart, with no apparent links, succomb to the same symptoms.

Now, in Dothan, Alabama, we are seeing a hauntingly familiar situation unfold.  With the exception of the seizures, the symptoms are strikingly similar. 

A television station much closer to the outbreak -- NBC affiliate WPMI, Mobile/Pensacola, is reporting that:

Doctors investigating the illness have not yet found a common denominator in the patients, whose ages range between the 20’s and 80’s, other than their symptoms. Doctors tested samples from the 7 patients at the state health lab to determine if there is from them to find “strain matching fingerprint” she added.

Doctors are analyzing those tests with investigators from the Centers for Disease Control & Prevention’s Atlanta office. State health officials, The Alabama Department of Public Health and the Centers for Disease Control Respiratory Laboratory are analyzing lab tests from all seven patients. Officials hope to have preliminary results on the samples back by Wednesday or Thursday morning.

Okee dokee, it is late Thursday morning.  What do we know? 

All eyes on Dothan, Alabama (!) respiratory outbreak 

OK, THIS is unsettling.  Prior to this week, I only knew Dothan as the city where my parents were married, and where my wife, stepson and I would stop on the way to Tuscaloosa during his recruitment by the Crimson Tide. Dothan is about a two-hour drive from Tallahassee, in southeastern Alabama.  It is a large town, and a crossroads for persons traveling from Interstate 10 to Interstates 65 or I-85.

But now, Dothan is known as the epicenter of an outbreak of a still-unknown respiratory outbreak.  And forgive me if it is a bit worrisome to me on several levels.

First, the situation on the ground here in Tallahassee:  I am on Month 5 of some sort of mystery ailment.  It is, apparently, some sort of allergy, brought on by (I theorize) an Alien Spore Cloud of some magnitude.  I say this because, roughly, 2000% of Tallahasseans are suffering as well.

A couple of weeks ago, I traveled with my beautiful wife to a conference she was working in Cocoa Beach.  I was able to get some quality body-surfing time, although my "rescue" at the hands of misguided marine biologists who misinterpreted my body surfing as the throes of a beached whale was not appreciated.  Just kidding on that one.  I said to myself, "Self, this salt air and seawater should wipe out whatever it is in my sinuses that is causing me Hell." 

WRONG!  later that day, I restarted my routine of sneezing and dealing with a runny nose.

It seems that every other Tallahassean, including my wife, is suffering the same fate. So you can see where a respiratory incident could easily be misinterpreted -- until people stop breathing, that is.

Back to the Dothan cluster.  From the Alabama Department of Public Health, dated 5/21/13:

 On 5/16/13, a pulmonologist in Southeast Alabama reported to the Alabama Department of Public Health (ADPH) that three patients had been hospitalized with cough, shortness of breath, and pneumonia, were on ventilators, and had no known cause for their illness. The ADPH and the Houston County Health Department began an epidemiology investigation to interview the families about travel and exposure. Specimens were requested and submitted to the ADPH Bureau of Clinical Laboratories (BCL) in Montgomery.

On 5/17/13, BCL reported one of the three patients tested positive for 2009 H1N1. On 5/18/13, this patient died. On 5/19/13, the same hospital reported that a transferred patient on a ventilator with respiratory symptoms had died. On 5/19/13, this hospital had nine additional patients present to the emergency department with influenza-like illness and three of those patients were admitted. Specimens have been collected on all patients. The BCL has tested all specimens on a PCR flu panel and one tested positive for AH3. The specimens were also forwarded to CDC for additional testing.

The story gets more interesting, as three additional residents have been diagnosed with -- whatever.  From Montgomery, Alabama television station WSFA 12:


The number of mystery illness cases affecting Alabama is growing. Wednesday, Alabama Department of Public Health spokeswoman Dr. Mary McIntyre confirmed the number rose to ten overnight from a previous report of seven. Two people have died.

"Since we sent out the alert to providers last night, we have had three additional patients/cases," Dr. McIntyre told WSFA 12 News. "These patients all have the same symptoms of cough, shortness of breath and "something" on their chest x-rays," she explained.

Of interest is the fact two of the afflicted -- including one of the deaths -- tested positive for influenza.  One of the deceased tested positive for H1N1, and another patient tested positive for A/H3. Whether this was seasonal H3N2 or swine H3N2 is not known.  My hunch is it is the more virulent form of H3N2 that we saw at the tail end of this flu season.  That caused such a spike in elderly deaths that it prompted the CDC to do a pretty exhaustive analysis -- the spike in deaths was that great.

This incident might not have generated the corresponding amount of publicity, were it not for the vigilance in the face of H7N9.  H7N9, by the way, seems to have taken a vacation. 

Of the original seven cases, three remain hospitalized.  Two were discharged, and two met their Maker.

ABC News theorizes that these cases may not be a cluster of anything except overreaction. However, we know that three people are still on ventilators and the community is on pins and needles.

NBC News reports that Alabama health officials are not taking any undue chances.  While I doubt the medical facilities have any negative air-pressure rooms (we are talking rural Alabama here), they are taking all the precautions they can:

The hospital is using respiratory precautions, which include requiring staff to wear special N95 masks that reduce the chance of infection.

With H7N9, MERS-CoV and God knows what else out there, no one is taking any chances.  The CDC is a three-and-a-half-hour road trip away; close enough to spend quality time in Dothan.