Friday, June 5, 2009

H1N1 swine flu in 52 states and territories, Indian Country cases emerge

by Terri Hansen
Environment and Science Reporter

Update June 5: The H1N1 flu has reached 52 states and territories, claiming 27 lives. IHS epidemiologist Dr. John Redd reported 35 confirmed and 13 probable cases across Indian Country May 25. Arizona Pima County Health Dept confirmed one death in Pinal County. Adults over age 60 may have immunity due to previous exposure or vaccination against a similar strain, and those born before 1957 may carry some pre-existing immunity.

May 6: The much talked about Influenza A/H1N1 virus, a never-before-seen, rapidly spreading swine flu strain has so far spared most of Indian Country. The Tohono O’odham Nation in the Arizona Sonora Desert reported four cases, all children, and all are recovering.

There are eight more probable cases in Pima County, Ariz., and 20 suspected cases elsewhere. A suspected case that closed a tribal campus at the Confederated Tribes of the Grand Ronde in Oregon was not the H1N1 strain.

The Havasupai Tribe, whose village in the Grand Canyon flooded last August, put off reopening to June 1, disappointing hundreds of would-be visitors. “We’re a small isolated community,” said vice-chairman Matthew Putesoy. “People come from all over the world to visit and even though we’ve lost our economy, we couldn’t take the risk.”

The U.S. has declared a state of emergency, and health officials say flu cases are likely to grow in coming days. The World Health Organization alert level remains at Phase 5, a strong indication that a pandemic is imminent and the time to implement planned mitigation measures is short. The WHO is warning against over-confidence, although most cases of the flu have been mild. A pandemic means world wide, and is not an indication of the severity of illness.

Dr. John Redd, branch chief of the IHS Division of Epidemiology, said the IHS is responding aggressively. “I’ve been on the job for 11 or 12 days,” he said. “We activated our emergency coordination center early on, and all of the tribes have put their emergency response plans into action. We feel the response has gone very well.”

Non-IHS medical providers are coordinating with state and local governments to provide services, Dr. Julia Wong, a physician with the Portland, Ore., Native American Rehabilitation Association said.

Its impact on non-federally recognized Indian nations could be harder. “We are on our own,” said Jennifer Lagergren of the Chinook Nation, a non-federally recognized tribe in Washington State. She worries if the flu virus does reach them, it will spread fast. “We live more close together with each other, with our children, our elders.”

Chief Albert Naquin of the non-recognized Isle de Jean Charles Band in Louisiana said tribal leaders attended a state funded class last year to learn what actions to take in a pandemic flu. But without grant monies the tribe cannot implement those procedures. “I pray this is just a scare to us, and that no life is lost because of this flu,” Naquin said.

Flu experts are struggling to predict how dangerous this new strain will be. During the swine flu threat of 1976, government programs rushed to vaccinate nearly 25 percent of the population. Only 200 came down with the flu but 500 people developed Guillian-Barre syndrome, a rare neurological disorder that causes temporary paralysis; 25 died. It cost the government their credibility, and millions of dollars in damages.

But memories of the 1918 Spanish flu – that affected Native Americans and Alaskan Natives especially hard – is a harrowing reminder that novel strains of human-to-human transmissible swine flu can turn into human plagues. This new swine flu strain lacks the genes that made the 1918 pandemic so deadly, the CDC has said.

Nor is this flu particularly virulent. CDC spokesperson Karen Hunter said, “It’s just that it’s a new strain and the human population hasn’t built up a resistance.” She said 36,000 deaths a year are flu-caused and the CDC is not expecting this flu to exceed that. There are concerns this strain could mutate and return in a more virulent strain the fall.

Mexican authorities noticed higher than usual number of respiratory illnesses in mid-March. In early April the CDC was investigating cases in California and Texas. They made their official announcement April 24. As of this report, the flu had spread to 38 states, and 21 countries. The U.S. has had two deaths, in Texas.

Newsweek is reporting that in 2005 a Wisconsin teenager who butchered pigs came down with an H1N1 swine flu virus, the first part of an evolutionary tree that has led to this current strain, which has evolved in a quadruple strain of human, bird and two types of swine virus. But even though this is pig virus, eating pork won’t give it to you.

Flu is caused by airborne spread of droplets, and everyday actions, such as avoiding contact with someone who is sick can keep you from getting it. The symptoms of this flu are usually fever, cough, sore throat, headaches or muscle aches, fatigue, and occasionally vomiting and diarrhea. If you or someone in your family has symptoms, call your medical provider for additional instructions. Young children may not have typical symptoms, but may show signs of low activity and have difficulty breathing.

The CDC and IHS is asking that those with any respiratory illness stay home from work or school to avoid spreading infection to others. Smart actions can protect you and your family: washing hands thoroughly and frequently with soap or using an alcohol-based hand sanitizer, practicing social distancing – keeping a distance between you and those who are sick, and using disposable tissues or sneezing into your elbow to keep from sending germs airborne.

Two anti-viral medications, Tamiflu and Relenza, are effective treatments for those with serious illness if used early. Most cases of this flu are mild, and do not need medical attention. Some clinics and emergency rooms cannot handle the number of patients seeking diagnosis and treatment, and say it’s putting heart attack and trauma patients at risk. They ask that you assess your situation, and make wise choices.

The IHS maintains their own stockpile of the anti-viral drugs, Redd said. If those supplies deplete then medical facilities will receive anti-viral drugs from the Strategic National Stockpile.

The U.S. Education Department said school closures have affected well over 500,000 children. Health officials are changing their school closure policy, keeping schools open but keeping sick kids home so schools don’t become infected. Messages have gone out to employers by different organizations, asking them to understand when parents have to stay home.