Although there have been recent posts on ProMED-mail about a "new erythromycin sensitive respiratory illness" plaguing Los Angeles, we have been isolating many strains of influenza A from these patients. Part of my work is to run a walk-in clinic on Mondays for our HIV/AIDS patients and it's been my experience that they are the sentinels for community-acquired respiratory diseases. Two [years] ago I saw a lot of pertussis but this year it looks like typical influenza.
The isolates have not been subtyped yet, but I would not be surprised to learn that we have A/Sydney, as many people have had two discrete bouts of influenza-like illness, one in October/November and now again in December/January. Among eleven patients I saw last Monday with recent and fairly classic symptoms, none required admission to the hospital. So, even among the immunocompromised, it appears to have the usual virulence.
I've been a little surprised by the lack of preparation for an influenza epidemic/pandemic. Although the H5N1 strain does not appear to be spreading very efficiently [or at all - Mod.CHC] person-to-person, it seems reasonable to me that "passage" through humans could be just as effective in increasing virulence as recombination in pigs.
As I wrote to Jim Chin [CDPC-mail] and told Nancy Cox [CDC], the public's interest in this story could be used to increase acceptance of influenza and pneumococcal vaccines, particularly by health care workers (HCWs), who are notoriously under-immunized and likely to transmit influenza to their patients.
Secondly, we need a policy on distribution and use of amantadine/rimantadine. Vaccines take some time to produce. Amantadine/rimantadine have a three-year shelf-life and of course have other uses. We need to assure that there will be antivirals available, particularly for HCWs in emergency room and outpatient clinic. From past experience, if there is an outbreak that carries a significant risk of death, HCWs won't come to work. They will be panicked by the press reports like everyone else. The following was our lesson from AIDS: Only if [health care workers] believe they have a reasonable method to prevent infection will they continue to work during an outbreak that carries significant risk of mortality to them. Perhaps, more likely and so more important, real measures to prevent influenza in HCWs during an outbreak might reduce transmission to patients, where mortality is much more likely.
Peter N.R. Heseltine, MD, FACP, Professor of Medicine, University of Southern California, LAC+USC Medical Center 1200 N State St. Box 596, Los Angeles, CA 90033, Tel: 213 226-6705, Fax: 213 226-2479, e-mail: heseltin@hsc.usc.edu
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