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zoom RSS ニューヨークで5人目の死者は1才の子ども/豚インフルエンザ 米国医療事情

<<   作成日時 : 2009/06/02 20:20   >>

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ニューヨークで5人目の死者は1才の子ども/豚インフルエンザ
 ABCがフライイングで(05/19)発表し、NYTも記事内に載った症例と思われる。劇症型の1才例。
 市保健当局広報のErin Bradyが月曜日に2才以下の死亡例を市として5例目と発表した。個人情報保護を理由に詳細発表は拒否した。今までの4人は34〜55才だった。死因の確定にはさらに時間がかかるという。
 最初の犠牲者Wiener氏は肥満と高血圧、動脈硬化性心疾患があったことも発表した。また、Rikers島の市刑務所で47人の感染が確認されたと言う。(NYT)
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 ニューヨーク市で16ヶ月幼児が豚インフルエンザにより死亡した可能性があり保健当局は調査中である。
画像 火曜日のブルームバーグ市長の発表によれば、クイーンズのJonathan Zamoraが月曜夜9:30に重症インフルエンザ様症状でElmhurst Hospital Centerに入院し、1時間後に死亡した。新型H1N1インフルエンザウイルスによるものかどうか調査中であるという。
 市長はRikers Island prison complex刑務所でもインフルエンザが蔓延していると言うが、閉鎖は不可能である。
 月曜日に4つの学校で103人がここ1週間でインフルエンザ様症状となり、16の学校を閉鎖した。日曜日夜に55歳の副校長ミッチェル・ウィーナーが死亡し、米国で6番目の死者となった。
 CDCのDr. Anne Schuchatによれば、新型インフルエンザの重症度は季節性のものと同程度か少し高い程度であろうがはっきりとした結論は言えず、今流行のインフルエンザ様疾患の半数を占めているとも言う。(ABC 05/19)
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ニューヨーク市でさらに二人死亡/豚インフルエンザ
http://kurie.at.webry.info/200905/article_47.html
ニューヨークで2人目の死者/豚インフルエンザ
http://kurie.at.webry.info/200905/article_45.html
検査の重要性と小児科医が直面する難題/米国医療事情 新型インフルエンザ
http://kurie.at.webry.info/200905/article_41.html
ニューヨーク市公立中学の副校長が豚インフルエンザで死亡/米国 新型インフルエンザ
http://kurie.at.webry.info/200905/article_33.html
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5th in City, a Small Child, Dies With Swine Flu
http://www.nytimes.com/2009/06/02/nyregion/02flu.html
By JAMES BARRON
Published: June 1, 2009

A fifth person in New York City ―a child less than 2 years old ― has died with swine flu, a spokeswoman for the city’s health department said on Monday.

The spokeswoman, Erin Brady, cited patient confidentiality laws in refusing to release the victim’s name or say in what borough he or she lived.

The baby was by far the youngest victim of the H1N1 virus in New York City. The first four who died ranged in age from 34 to 55.

Ms. Brady said that tests had confirmed that the child had swine flu, but that it was not yet known whether that was the cause of death. She said the medical examiner would have to do more tests to try to establish what role the virus had played in the baby’s death.

At the same time, a spokeswoman for the medical examiner’s office said that tests on the first victim, an assistant principal at an intermediate school in Queens, had confirmed that the cause of death was swine flu. But the spokeswoman, Ellen Borakove, said that tests on that patient, Mitchell Wiener, 55, had listed “significant and contributing” factors: obesity and hypertensive and arteriosclerotic heart disease.

Mr. Wiener died on May 17, five days after he was hospitalized and three days after city officials closed his school, Intermediate School 238 in Hollis.

Swine flu, first identified in April, is known to spread rapidly ― more rapidly than seasonal flu, from what health department officials can tell. In a regular flu season, people under 2 and over 65 are particularly vulnerable, as are people with underlying health problems. What had been unusual about H1N1 was the initial spread among teenagers.

Ms. Brady said on Monday that there were 47 confirmed cases of swine flu in the city jails on Rikers Island. But what appears to be a high number may be a function of testing.

Officials have been testing inmates aggressively because the outbreak at Rikers, reported on May 15, involved an isolated cluster. Officials wanted to monitor it closely, much as they did at St. Francis Preparatory School, where they confirmed 69 cases and believe that hundreds of students and teachers may have had lower-grade cases of swine flu.
Sign in to Recommend More Articles in New York Region ? A version of this article appeared in print on June 2, 2009, on page A21 of the New York edition.
Times Reader 2.0: Daily delivery of The Times - straight to your computer. Subscriber for just $3.45 a week.

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Health Officials Probe Possible Second NYC Flu Death
Experts Debate Next Moves as New Cases Reveal Nature of Swine Flu's Threathttp://abcnews.go.com/Health/SwineFluNews/story?id=7618896
By LAUREN COX and DAN CHILDS
ABC News Medical Unit
May 19, 2008

New York City health officials are looking into the death of a 16-month-old toddler as a possible swine flu case as tensions around the city rise in response to the new virus.
Photo: Younger Swine Flu Hospitalizations, Deaths Raise Questions: Experts Debate What to Do as New Cases Reveal Nature of swine flu's threat.
Late Sunday night Mitchell Weiner, a 55-year-old assistant school principal in New York City, died... Expand
Late Sunday night Mitchell Weiner, a 55-year-old assistant school principal in New York City, died of the swine flu he likely contracted in an outbreak at his school. The beginning of this week ushered in a new level of concern about the new, largely mysterious virus. Collapse
(ABC News Photo Illustration)

Jonathan Zamora, of Corona, Queens, was admitted to Elmhurst Hospital Center Monday night around 9:30 with a high fever and "severe flulike symptoms," according to a Tuesday morning announcement by New York City Mayor Michael Bloomberg. Officials at Elmhurst Hospital Center told the Associated Press that the boy died an hour after being admitted. Thus far, health officials have not confirmed whether the child did indeed have the novel strain of the H1N1 influenza virus that leads to swine flu. The U.S. Centers for Disease Control and Prevention is looking into the case.

Bloomberg also said the flu is spreading at the Rikers Island prison complex, including four confirmed and four more probable cases. The jail can't be closed, but authorities are taking steps to contain the outbreak, he said.

The latest possible fatality comes just two days after the city's first confirmed death of a patient with swine flu. Meanwhile, amid a new cluster of school closings and revived discussions about whether the World Health Organization should raise the pandemic alert to the highest level, there is a new level of concern about the still mysterious swine flu virus.

On Monday, New York City officials closed 16 schools after 103 students in four schools came down with influenza-like symptoms in the past week. Late Sunday, 55-year-old assistant principal Mitchell Wiener died from complications of the swine flu he likely contracted in an outbreak at his school.

Wiener's untimely death was the sixth in the United States that has been linked to swine flu.

But while the American deaths and the outbreak's rapid spread across the country has raised fears, health officials said it's still not clear how bad swine flu really is.

"The illness severity that we're seeing is still similar to what we've seen with seasonal influenza," Dr. Anne Schuchat, director of the CDC's National Center for Immunization and Respiratory Diseases, said Monday at a press conference. "I think our best estimate right now is that fatality is likely a little bit higher than seasonal influenza, but not much higher."

Despite that, the new virus may be contributing to higher than normal levels of flu infections in general for this time of year -- as well as more school-based outbreaks, which Schuchat said are unusual for spring time.

"About half of what we're seeing lately is the novel H1N1 strain," she said.

Mysteries surrounding the illness remain. Schuchat said that even with the climbing reports of cases, the overall numbers are not yet high enough to make solid conclusions about how severe this illness will be in terms of sickness and death.

"Things could change quickly, and we do continue our efforts to prepare for fall, where history tells us we could have another outbreak," she said. "I think it's important to dispel the idea that we're out of the woods or that this was a problem that really didn't merit response," she said.

Worldwide, health officials are identifying more cases. According to WHO statistics released Tuesday morning, 9,830 cases of swine flu have now been identified in 40 countries, and 79 of those infected have died.

Yet prominent infectious disease experts say that even if the WHO does raise the pandemic alert to 6 -- the highest level -- the formal classification is not likely to sway future public health response.

Experts Debate What a Swine Flu Pandemic Threat Level Means

"Pandemic level is another disservice; it reflects only the degree of spread of a bug and nothing else," Dr. Frank James of the School of Public Health and Community Medicine at the University of Washington, Seattle told ABC News. "If a team of experts went out looking for the bug widely they could find it now in enough areas to qualify this as a Level 6."

Dr. William Schaffner, chairman of the Department of Preventive Medicine at Vanderbilt Medical School, also wondered what a "Level 6" definition would mean for people affected.

"I continue to wonder whether this is useful, given the general level of severity of the illness," he said. "Recall that these levels relate only to geographic distribution of the illness, not severity."

To further complicate the matter, severity of the flu is not the only important signal to those fighting infectious disease. If it is too lethal, the flu might defeat itself by killing its victims before there's time for the virus to spread.

"One of the better determinants is the incubation period," said Robert I. Fields, chair of the department of health policy and public health at the University of the Sciences in Philadelphia.

Fields said a long incubation period with mild to no symptoms would allow the virus to spread quickly and widely before people quarantine themselves. Couple a long incubation period with a particularly deadly strain, and doctors have their "worst nightmare" of a flu virus, Fields said.

When to See the Doctor for the Flu

While experts search for signs of how deadly the swine flu may become on a global scale, family physicians and emergency medical doctors say patients at home are in the same quandary: how to tell if this flu will pass as usual or turn serious and deadly.

"People who are walking around with a normal-grade fever shouldn't be going to the emergency room for treatment, even though they are," said Dr. Andrew Sama, a member of the American College of Emergency Physician's Board of Directors.

Sama said the majority of flu cases can be treated at home or with a phone consultation, or a visit to the family doctor.

In the most severe cases, Sama said patients will be shuttled off to the intensive care unit to protect from respiratory failure. He said most people survive, "But generally speaking not everyone who is on a respiratory ICU treatment can be saved."

"Generally speaking only people who are really ill from the flu -- non-stop vomiting, extremely high fever, inability to eat and drink, excessive weakness, chest pain, severe cough, lethargy, trouble breathing -- should come in," he said.

However Sama and Dr. Lori Heim, the president-elect of the American Academy of Family Physicians, said three specific groups of people should go to the doctor with much less severe symptoms: children under age 4 with a high fever, people with compromised immune systems and the elderly.

"If you're one of the lucky people in the country who has a regular physician, calling them would be my first choice," Heim said. "But if you can't breathe, don't wait for a phone call back."

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