H1N1 not yet at peak, only high-risk patients tested

If you thought one H1N1 influenza virus was more than enough, try two.

Two strains of H1N1, seasonal and novel, also known as “swine” influenza, are currently in human circulation.

However, all patients who come to UK Health Services with “influenza-like illnesses” are being treated for only Seasonal Influenza A, unless they are considered a high-risk patient.

The Novel H1N1 virus is a direct descendant of a virus that caused a pandemic  from 1918 to the ’50s, said Dr. Chris Nelson, associate professor of pediatrics who specializes in infectious diseases.  When it disappeared from human circulation, it transferred into the animal reservoir and has been hiding there for 50 years.

In March 2009, it reemerged in Mexico City. People more than 60 years old were exposed to the H1N1 influenza as children, and their immune systems are capable of resisting the virus, Nelson said

“That’s how the (H1N1) viruses are different,” Nelson said.  “This Novel H1N1 strain … has not been seen by most of us and that’s why it’s causing a major worldwide pandemic.”

Therese Smith, UK Emergency Management specialist, said the exact number of students who experienced the Novel H1N1 Influenza was unknown since the public is asked to self-report.

Students who go to University Health Services comprise the current numbers Emergency Management has, Smith said. Since May, Smith said health services have only had 50 self-reports, most of which were students.

Smith said from Sept. 14 to Sept. 19, University Health Services reported 74 out of 1,003  patients had influenza-like illnesses.

UHS reported out of the 898 patients that were treated at university facilities, 101 had influenza-like illnesses last week.

Reports are made from students who seek medical attention from any UK medical facility, as well as from reports received by Residence Life.  Those who live in the residence halls and report an illness are given a mask to wear outside of their dorm room, Smith said.  Patients treated at UK also receive a mask if they show influenza-like symptoms.

Smith said the university does not monitor student or faculty attendance, but faculty can use the Academic Alert Referral System to report an unusually high number of absences in their classes. The alert system is a way for the UK Emergency Management to monitor flu activity on campus, but only a few notices have been received through the system, she said.

Nelson said the emergency room at UK Hospital sees eight to 10 patients with influenza-like symptoms per day.

“Everything that’s flu right now is certainly H1N1,” Nelson said. “However, everything that looks like flu may not be flu. There are other illnesses going around right now that may look like an influenza illness.”

Nelson said the Centers for Disease Control and Prevention recommends only high-risk or hospitalized patients be tested and treated for Novel H1N1. High-risk patients include pregnant women, people who care for children younger than 6 months, healthcare workers and young children.

Lexington is expected to receive its first allotment of the Novel H1N1 vaccine in two weeks, but the number of available vaccines will be small and will be given to high-risk patients first, Smith said.

“The best public health defense we have for any illness is a vaccine,” Smith said.  “We are encouraging (students) to go ahead and get the seasonal flu vaccine … because once we start seeing seasonal flu and Novel H1N1 together, that’s when your numbers really increase and things could be bad.”

Nelson said the UK Pandemic Planning Workgroup has been working on  an H1N1 vaccine prioritization plan, which will determine who exactly will receive the vaccine. Decisions on who — healthcare workers or patients — will receive the vaccine first in a limited availability setting will be made using the CDC recommended prioritization list.

“If there is still vaccine after (the initial distribution), then anyone who wishes to receive the vaccine will be offered the vaccine, and it will be first-come, first-served,” Nelson said.  “We have no waiting list.”

The Novel H1N1 is a pandemic because it meets three criteria: it is a new virus, it causes human infection and it causes sustained infection across the globe, Nelson said.

Nelson said the peak of the Novel H1N1 in the U.S. is unknown for sure, but is most likely to occur in late 2009 or early 2010.  Nelson said the Novel H1N1 strain will replace a seasonal influenza by next year.

Nelson said there are currently three Influenza A viruses and one Influenza B virus in the same season.  He said one or more will eventually be forced out, and reemerge years from now, like Novel H1N1.

“Mother Nature can only handle so many viruses in the population,” Nelson said.  “Now, we have four viruses.  We’re writing human history, this is unprecedented that we’ve had four.”