Pediatric deaths under investigation

Posted March 04, 2008

IDPH is investigating a cluster of approximately 20 deaths in children less than four years of age across Iowa since last December. This is a higher than the expected number of deaths for this time of year.

Most children had mild to severe respiratory symptoms prior to death. Multiple viruses have been isolated in laboratory tests including influenza A and B, respiratory syncytial viruses (RSV), and adenoviruses. At this time it is unknown whether these viral infections were the principal cause of death.

The Iowa Department of Public Health (IDPH), including the Center for Acute Disease Epidemiology (CADE) and the State Medical Examiner’s Office, is collaborating with other states and the Centers for Disease Control and Prevention, and University Hygienic Laboratory in this investigation. Health care providers are encouraged to contact CADE at 1-800-362-2736 with information about:

• cases similar to those in the cluster
• cases of severe pediatric illness with respiratory symptoms of unknown etiology
• cases of viral infection, including influenza, with rare or unusual complications, such as acute necrotizing encephalitis and hepatitis

We are asking the parents of young children to:

1. Keep children away from people with respiratory diseases/symptoms
2. Keep children home from child care or school when ill
3. Vaccinate all children with flu vaccine
4. Wash hands before carrying or playing with young children
5. Avoid situations where large numbers of people gather, because some may be ill

Influenza update

Iowa is seeing slightly higher numbers of lab-confirmed influenza cases in 25 to 64 year olds. Both young children and those over 64 account for the highest numbers of hospitalizations attributed to influenza for this reporting week. The percentage of physician visits due to influenza-like illness remains high. Nationally, widespread activity was reported by 49 states.

The Centers for Disease Control and Prevention is emphasizing a three-point approach to combat flu. The following should be practiced by health care providers and communicated to patients:

Get an influenza vaccine. While the vaccine is not a perfect match for two of the flu strains circulating in the U.S and Iowa, the vaccine will still provide some protection (about 50%) against these, and good protection (70-90%) against the other strains. Protect yourself -- wash hands frequently and cover coughs and sneezes. Take antiviral medication if recommended by a health care provider. Patients with influenza who go to the doctor within 48 hours after the onset of symptoms may benefit from antiviral medication. For more information on influenza activity in Iowa, view this week's Iowa Influenza Surveillance Network report at http://www.idph.state.ia.us/adper/common/pdf/flu/flu_report_8.pdf or visit http://www.idph.state.ia.us/adper/iisn.asp.

Now that Iowa is seeing a widespread level of activity for Influenza virus, the influenza rapid tests are performing very well (i.e. the positive predictive value is high). Labs no longer need to send specimens to UHL for confirmation. The University Hygienic Laboratory (UHL) requests that laboratories continue to report positives and negatives through the survey monkey that is sent to them weekly by Erin Graf. Your activities in reporting your testing is very beneficial to IDPH for their surveillance activities.

If you have any questionable influenza test results, positives or negatives, UHL will accept any specimens you wish to send. Also, if there are influenza related mortalitie, those specimens should be sent to UHL