Local Reports of Swine Flu Increasing

One Ashe County Child Confirmed, At Least 30 Probable Student Cases at ASU

Story by Corinne Saunders

In mid-July of this year, seven campers attending Camp Broadstone, an outdoor education center run by ASU, were confirmed as having the virus H1N1—commonly referred to as “swine flu”—according to university officials. None of the campers who tested positive for the virus were from Watauga County.

Novel H1N1 was declared a pandemic by the World Health Organization in June, meaning that the virus has been detected everywhere in the world, and every state in the United States has confirmed cases of H1N1 since its discovery.

The new flu strain has, however, recently been making an increasing number of appearances in the High Country.

“We have had confirmed cases of H1N1 since Camp Broadstone,” said Robert Ellison, a staff physician with ASU Student Health.

ASU has not seen “huge numbers” of students with H1N1, but the illness is “beginning to be a dominant pattern,” he said. “Last week, approximately 30 students with influenza-like illness [had a] pattern [of symptoms] indicative of H1N1,” he said.

According to a press release sent out by the Appalachian District Health Department, the most common symptoms of H1N1 flu include a fever of 100 degrees Fahrenheit or more, sore throat, chills, runny or stuffy nose, cough, body aches, fatigue and/or headache, though some cases have included diarrhea and/or vomiting. These symptoms closely resemble the symptoms of the seasonal flu.

More students displayed the cluster of symptoms indicative of H1N1 last week than the previous week, and Ellison said he expects a continuing upward trend this week and in subsequent weeks.

Those displaying the cluster of symptoms are encouraged to self-isolate until they are fever-free for 24 hours without the use of fever-reducing medications such as Tylenol or Motrin.

Self-isolating is taking oneself out of a social context, such as work, classes, church and other places, Ellison said. The illness pattern has overall been mild, with a fever and feeling badly diminishing after three to four days in most cases, he added.

“We have more concern with people with underlying health issues, such as asthma, diabetes or heart problems,” he said. “Most of our students are not requiring anti-flu medicines such as Tami flu.”

In regards to confirming H1N1 cases, Ellison said the logic follows, “If it has four legs, a tail and barks, it’s probably a dog.”

The highly suggestive symptom patterns may not necessarily mean a person has H1N1, but it is extremely likely, he said.

“We are limited by the state laboratory,” he said. “We can only submit up to three specimens per week to be confirmed.”

ASU has a special relationship with the state health department, Ellison added—most health departments are not allowed to send specimens unless a person has been hospitalized.

The Appalachian District Health Department confirmed one case of H1N1 flu on Thursday, August 27, in a school-aged child who was hospitalized in Ashe County. Health department officials are currently waiting on confirmation of H1N1 for another child.

“There has been an increase in flu-like illness in Ashe County,” said Jennifer Greene, Appalachian District Health Department’s health promotion supervisor and public information officer.

“Currently we are following guidelines established by the CDC [Centers for Disease Control and Prevention],” she said. “We are testing for H1N1 only if people are hospitalized or have severe illness.”

Medical Professionals Focus on Prevention
“What we’re telling people to focus on is prevention,” Greene said. “[H1N1 is] still relatively new, so people need to educate themselves about what it is and how to prevent it. We are treating this just as we’re treating seasonal flu.”

Tips for preventing the spread of all flu viruses, as listed by the Appalachian District Health Department, include: frequent hand-washing with soap and warm water, especially after coughing or sneezing; using alcohol-based hand cleaners when you cannot wash your hands; covering your nose and mouth with a tissue when you cough or sneeze and throwing away tissues immediately after use; coughing or sneezing in the crook of your upper arm, not your hands, when you do not have a tissue; avoiding touching your eyes, nose or mouth; and trying to avoid close contact with sick people.

The health department recommends singing “Happy Birthday” two times while washing your hands to be sure you’ve washed long enough to be most effective.

Flu viruses spread mainly person-to-person through coughing or sneezing, and sometimes, people may catch flu by touching something infected and then touching their mouth or nose.

“We’re seeing a higher incidence of seasonal flu for this time of year statewide,” said Kristin Millsaps, WHS school nurse and lead nurse for Watauga County Schools (WCS).

To her knowledge, she said no child in WCS has been hospitalized for a flu-like illness, so no cases of H1N1 have been confirmed.

The confirmations of influenza that Millsaps has received are from rapid tests, given at local physicians’ offices, for type A or type B of the seasonal flu, she said.

In preparation for any potential outbreaks of H1N1, seasonal flu, strep throat or other contagious illnesses, WCS began a uniform use of disinfectant this year, said Clarissa Schmal, student services director.

For the first time, the school system is providing a uniform product, directed to be used in the same way after each school day to disinfect classrooms, buses, gymnasiums, cafeterias, offices and other areas, Schmal said. In the past, teachers often brought their own products, and a variety of disinfectants had been used prior to this school year.

Another new practice is closely monitoring an Excel spreadsheet that tracks attendance at each of the schools, Schmal said.

“Attendance would be one of the factors to determine if schools would be dismissed, and if all schools would be dismissed, or just the school with the highest percentage of absenteeism or just certain populations, [such as] those with compromised immune systems,” Schmal said.

The monitoring of attendance is one aspect of surveillance, which is part of the school system’s Pandemic Flu Plan, Millsaps said.

Schmal, along with all four WCS nurses and Safe Schools Coordinator Dennis Ray, attended a Multi-Discipline H1N1 Operational Briefing on Tuesday, September 1.

WCS Superintendent Dr. Marty Hemric sent out a letter to parents that listed flu symptoms and precautions, as well as a reminder to keep students home if they are sick. He also sent letters to all school principals, which they should share with their staff, so that everyone is on the same page, Schmal said.

“We’re trying to calm fears by education right now,” Millsaps said. “[That] is our goal. Panic is never going to solve anything.”

Millsaps posted H1N1 facts on the WCS page. To view her page, click to www.watauga.k12.nc.us, then to Watauga High School and then to student health services.

The nationwide pandemic is considered mild at this time, but if it were to move up to severe, and great numbers of students were absent, a meeting would be held to determine necessary actions, such as school closures.

The focus is on education and preventative measures, she said, because “our absentee rate is still very low, so that’s a good sign.”

“Now is the time to remember to make prevention a part of your family’s daily habits,” said Danny Staley, director of the Appalachian District Health Department, in a recent press release. “We are continuing to stay abreast of current information about local, state and national flu trends. We want the public to know that now is not the time to panic, but to take time to discuss prevention and alternative family routines if someone in the family does get sick.”

A vaccine for H1N1 flu is expected to be available in late fall. Currently, the CDC recommends the following priority groups be vaccinated first: pregnant women, people who live with or care for children younger than six months, healthcare and emergency medical services personnel, people between six months and 24 years old and adults ages 25 to 64 with chronic health disorders or compromised immune systems.

“We are prepared to vaccinate people and for people to have convenient times to be vaccinated,” Greene said.

As of press time, the number of immunizations to be sent to the High Country once the vaccine is available has not been determined. The H1N1 vaccine will consist of a two-shot series, with the second shot to be given three to four weeks after the first for the series to be effective.

“We don’t expect any major shortage in the vaccine,” Greene said.

Pharmacist John Stacy at Boone Drug at Deerfield said people in the community have been calling Boone Drug about the H1N1 vaccine.

“In mid-October, it’s only going to be released to health departments, although we are hoping we can help [staff there] give out the shots,” he said. “We have the regular flu vaccine and we have plenty of Tami flu oral medication [for flu prevention and treatment].”

While the H1N1 flu vaccine is important for those who meet the recommended groups, it is still important to receive a seasonal flu vaccine when it becomes available this fall, Greene said.

An Appalachian District Health Department press release stated that people should seek medical care from their healthcare provider if they think they are sick.

Seek emergency medical care if you have a medical emergency, such as difficulty breathing or shortness or breath, pain in your chest or abdomen, sudden dizziness, confusion, severe or persistent vomiting, flu-like symptoms that improve but then return with fever and worse cough, and for babies if they have bluish or gray skin color, lack of responsiveness or are extremely irritable.

For more information, click to www.flu.nc.gov or www.cdc.gov/h1n1flu or call the N.C. CARE-LINE at 1-800-662-7030 (TTY 1-877-452-2514).

To learn more about the virus, click to www.flu.gov or talk to your doctor. 

For more information on local updates, click to www.emergency.appstate.edu, www.apprhs.org or www.apphealth.com or call the health department at 828-264-6635.

Wait…What Exactly is H1N1?

As High Country Press reported earlier this year, according to Robert Boyd of the McClatchy Newspapers Washington Bureau and countless AP reports, H1N1 is the initials of two sugar proteins—their scientific names are hemagglutinin and neuraminidase—that sit on the surface of the virus.

There are 16 types of the H protein, numbered H1 through H16, and nine types of the N protein, numbered N1 through N9. That makes 144 possible combinations of the virus.

The H2N2 combination caused a brief swine flu epidemic in 1957. An H3N2 strain was the source of another epidemic in 1968. The bird flu virus that began in Southeast Asia a decade ago was an H5N1 combination.

According to Boyd, H1N1’s particular combination of bird, pig and human viral genes had never before been found in the U.S. or elsewhere, so people have no immunity to it. The virus is a descendant of the H1N1 virus that killed tens of millions of people worldwide in the pandemic of 1918 to 1919, mixed in with recent strains of swine and bird flu viruses. The 1918 virus originated in birds and then jumped to humans. This year's virus apparently jumped from a pig to a 5-year-old boy in Veracruz, Mexico, who passed it on to other humans, Boyd said.

White House: 2009-H1N1 National Preparedness and Response Overview

A press release was sent out on Tuesday, September 1, from the Office of the Press Secretary of the White House. It reads as follows:

The health and safety of the American people is the first priority of President Barack Obama. Since the novel 2009-H1N1 flu virus emerged in the United States during the third week of April, the President has received regular briefings and asked his Cabinet to spare no effort in addressing this national security challenge. The Secretary of Health and Human Services is leading the way on public health preparedness and response efforts, the Principal Federal Official for domestic incidents, the Secretary of Homeland Security is coordinating the supporting activities of Federal departments and agencies and facilitating response actions with state, local and territorial governments and tribal and private sector partners, while other Cabinet officials are leading complementary initiatives in their area of responsibility. It is a well-coordinated, all hands on deck approach. All federal efforts are aimed at reducing the impact of 2009-H1N1 on the health and wellbeing of Americans and on the economy and functioning of society. 

Key elements of our preparedness and response efforts include:

Preparing for a fall wave of H1N1 flu with great team work across the Nation
-Implementing a National Framework for 2009-H1N1 preparedness and response, including the four pillars of surveillance, mitigation, vaccine and communications.

-Partnering with Congress, governors, mayors, territorial and tribal officials, state and local health departments and emergency managers, the medical community, private-sector entities and community-based groups for an effective response.

-Issuing medical, science-derived public guidance for K-12 schools, institutions of higher education, businesses and employers and families across the country available 24/7 on www.flu.gov.

Making steady progress on developing a safe, effective and voluntary H1N1 flu vaccine
-Preparing for a voluntary, but strongly recommended, H1N1 flu shot program to be available to all Americans that wish to participate over a period of time.

Encouraging Americans to act on a shared responsibility to reduce the impact of H1N1 flu
-Calling on individuals and families to plan for the fall flu season and to take steps to prevent the spread of the H1N1 flu.

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