Possible "Hemorrhagic Pneumonia" Cases?

[Reasonable Rascal]

Physicians Asked to be on the Lookout for Possible “Hemorrhagic Pneumonia Cases” Among Influenza Patients

(First notice of this bulletin was Sept. 25, 2009. Sorry for the delay in finding this. RR)

http://www.ncmedsoc.org/blog/wp-content/uploads/2009/09/HemorrhagicPneumonia.pdf

The CDC says that there have been some anecdotal reports of possible "hemorrhagic pneumonia" cases among influenza patients who have died or been hospitalized for severe illness. The phrase "hemorrhagic pneumonia" is somewhat outdated, and most clinicians will not use the term to describe this condition, which can be a very rare complication of viral respiratory infection. Some other terms that can be used to describe this include diffuse alveolar hemorrhage (DAH), which can be caused by infections but doesn't have to be, and hemorrhagic pneumonitis. In any event, it's a serious complication that will sometimes lead to acute respiratory distress syndrome (ARDS). It occurs very rarely as a complication of seasonal influenza, and there is some concern that it might be more common in H1N1 infections.

The CDC is asking state health officials to look out for possible cases that may involve clusters of patients who might have these symptoms, or a large proportion of cases with these symptoms (e.g., 4 of 5 deaths). They will invariably be among the most severely ill influenza patients (i.e., deaths, ICU patients).

This is a hard diagnosis to make, and the most telling symptom may be hemoptysis (bloody sputum, frothy bloody cough), although not all cases will have it.

• Acute onset of rather more severe respiratory infection (dyspnea‐‐ difficulty
breathing‐‐ is common)

• Hemoptysis is often seen on initial presentation (~70% of cases)

• CXR and physical exam will suggest alveolar infiltrates (radiographic opacities)

• Diagnosis is usually made by BAL (brochoalveolar lavage) and pathology testing (increasingly more hemorrhagic fluid/secretions from sequential BAL

Email sent by the Regional Liaison Officer, Region IV, H1N1 Response Surveillance and Epidemiology Team, Centers for Disease Control and Prevention

Questions concerning possible cases or this email may be directed to Medical Epidemiologist Zach Moore, MD, at the North Carolina Division of Public Health

[Reasonable Rascal]

http://www.timebomb2000.com/vb/showthread.php?p=3553017&highlight=hemorrhagic#post3553017

September 25, 2009

Dear Colleague:

Influenza-related activities continue to be on the upswing with both increased reports of influenza-like illness and the anticipated arrival of the novel H1N1 vaccine within the next few weeks. Please continue to reach out to the Virginia Department of Health (VDH) for information about novel H1N1 influenza.

This week Surveillance reports maintain influenza activity at the "Widespread" level which means that influenza is present in three or more of Virginia's five regions. Several outbreaks of respiratory illness are being investigated with novel H1N1 confirmed in at least one of them. Please continue to report suspected influenza outbreaks to your local health department. VDH is also interested in hearing about any cases of diffuse alveolar hemorrhage (DAH) and hemorrhagic pneumonitis that might be associated with novel H1N1.

Accurate Communication and information about both seasonal influenza and novel H1N1 influenza is very important to the public, especially as they are faced with two flu vaccines and a new flu strain. The VDH Inquiry Center (1-877-ASK-VDH3) and PHIC@vdh.virginia.gov is a reliable resource for them as well as our website at www.vdh.virginia.gov.

Direct Clinical Care updates this week include a very helpful September 22 release from the Centers for Disease Control and Prevention (CDC) "Updated Interim Recommendations for the Use of Antiviral Medications in the Treatment and Prevention of Influenza for the 2009-2010 Season." Of particular note is that the focus for pediatric treatment is on children younger than 2 years of age with notation that children 2 to 4 years of age with mild illness do not necessarily require antiviral treatment. This guidance article also gives a clear description of the populations currently believed to be at higher risk for complications from novel H1N1. You can find this article on the CDC website at www.cdc.gov. Your local health director is also a good resource for questions about recommendations for prophylaxis and treatment.

Community Mitigation efforts are ongoing. Given the prevalence of influenza-like symptoms and documented novel H1N1 in the under-24 years of age population, VDH is working closely with our schools and institutes of higher learning to support their efforts to maintain student health. We are working at the state and local level to promote keeping ill students home, decreasing the need for "return to school" notes from doctors, and providing resources to students, their families, and the schools. Please continue to let us know if you detect any potential outbreaks involving schools, colleges and universities.

Vaccination If you have pre-registered, you will receive an informational email Monday, September 28th, to complete the registration process. If you have not pre-registered, you can do so at the following link: http://www.vdh.virginia.gov/epidemiology/immunization/. You will be able to register using this same link even if you haven't already pre-registered.
Vaccine delivery is still anticipated to begin in mid-October, but final details as to how much and the proportion of the various types of vaccine is pending.

I realize this is a very busy time for all of the medical community and the challenges of this disease, with much unknown and much yet to come are significant. Thank you for all you do and please feel free to reach out to your local health departments.

Sincerely,

Karen Remley, MD, MBA, FAAP
State Health Commissioner