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Vulnerable patients at special risk for latest strain of flu

Tribune photo by SCOTT ISKOWITZ

Dr. Juan Dumois checks Victoria Rori Lynch, 4, for symptoms of swine flu at All Childrens Hospital in St. Petersburg.

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By MARY SHEDDEN | The Tampa Tribune

Published: August 28, 2009

TAMPA - Jill Hechtman is getting used to the swine flu.

The obstetrician expects her pregnant patients to call when they have flu-like symptoms: fever, sore throat, a bad cough. But this new strain of flu is hitting an already vulnerable population far more often and more seriously than bugs of years past.

"The patients are getting sicker," said Hechtman, who diagnosed two new swine flu cases this week.

Influenza, a respiratory infection, usually runs its course in a few days for most healthy people. But complications from the swine, or H1N1, strain appear to be particularly dangerous for pregnant women, young children and people suffering from respiratory conditions such as asthma, chronic bronchitis and emphysema.

Norman Edelman, chief medical officer for the American Lung Association, said seasonal flu always has been a serious concern for these particular groups. The difference is that swine flu is a new strain and scientists are still trying to get a handle on it.

"We don't know what kind of flu season we will have yet," he said.

The Centers for Disease Control announced on Friday that swine flu was responsible for another 34 deaths last week, bringing the national total to 556. Those most recent deaths include five children, the CDC said, and at least one pregnant woman, a 22-year-old in Hillsborough County.

Five other Hillsborough adults who have died this year had underlying respiratory disease or conditions that affected their pulmonary system, Health Department spokesman Steve Huard said.

While pregnant women account for just 1 percent of the U.S. population, the group is responsible for 6 percent of related swine flu hospitalizations and 6 percent of the deaths, the CDC has reported.

Hechtman, medical director of Tampa Obstetrics, said that's because pregnancy weakens the regular immune system, and a growing belly means there is less room for the lungs to take deep breaths. Reduced pulmonary function means you're working harder to breathe and increasingly exhausted, adding to the risk, she said.

The key to staying well is avoiding crowds, where the flu spreads quickly; keeping your distance from sick co-workers and friends; and frequent hand-washing or sanitizing, Hectman said.

"Everyone shouldn't have to put a mask on; but when you're walking around, make sure you are using Purell," she said.

High-risk persons also should get treatment as soon as symptoms appear. Most cases are being treated with anti-viral drugs such as Tamiflu and Relenza.

"Call or get to your doctor as soon as possible," Hectman said. "It's important to get the Tamiflu right away. It will reduce the symptoms and severity."

Children are especially vulnerable because they're often carriers of a virus, said Juan Dumois, director of pediatric infectious diseases at All Children's Hospital in St. Petersburg. Children prone to respiratory infections need to be particularly cautious, as the swine flu hasn't seemed to wane the way the seasonal flu does in the summer.

Dumois said all but one of the patients he tested for influenza in the last four months had swine flu. That includes a 10-year-old boy who had two younger siblings at home, one with asthma. Dumois opted to also treat those children with anti-viral medicine, as they were at high risk of getting swine flu.

"At the time a decision is made to treat someone, the doctor should also be addressing other high-risk persons in the home," he said.

Chicago resident Pam Senger was on vacation in St. Petersburg when her 4-year-old daughter couldn't stop coughing or shake a fever. She suspected the girl, Rori Lynch, had swine flu, because she suffered from a round of respiratory infections last winter. She was diagnosed with pneumonia, but the experience of spending three days in the hospital has convinced the mom to get her daughter all possible flu vaccinations when they are available. She doesn't want to chance Rori getting sick again.

"Now I'm more worried she's even more at risk for it," she said.

Those at high risk and people who come into contact with them are among the priority groups for the first round of swine flu vaccinations, expected to be available by about mid-October.

That includes parents and caretakers of children younger than 6 months, health care workers and adults ages 25 to 64 with underlying medical conditions. Anne Schuchat, director of the CDC's National Center for Immunization and Respiratory Diseases, said that should address nearly half the national population.

She said the high risk-groups as well as the elderly should get vaccinated as soon as possible for seasonal flu. Seasonal flu shots will be widely available within the next few weeks.

The Lung Association's Edelman said that while more people are aware of the swine flu and its risks, he's worried the public will not heed warnings that people need vaccinations for both it and the seasonal flu. Seasonal flu is responsible for an estimated 36,000 deaths nationwide every year.

"I would be double cautious," he said.

Reporter Mary Shedden can be reached at (813) 259-7365.

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