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Commentary


High H1N1 Case Fatality Rate in Lehigh County Pennsylvania
Recombinomics Commentary 14:30
December 1, 2010

"Young, otherwise healthy individuals, coming into he hospital with H1N1 pandemic strain and both ended up on a ventilator," said Dr. Luther Rhodes, III, Chief of Infectious Diseases for LVHN.

The flu has already claimed the lives of a 28-year-old man and a 45-year-old man, both from Lehigh County. Both of the men died within the past two weeks and both had underlying health conditions, Senior said.

The above comments on the Pennsylvania H1N1 death cluster at Lehigh Valley hospital are curious.  The first comments are by the head of infectious diseases at the hospital, while the latter comments are from a spokeswoman for the Pennsylvania Department of Health. 

Both deaths were noted in the week 46 PA report, which listed three reported flu cases from Lehigh country for the entire flu season.  This high case fatality rate is somewhat dependent on reporting and testing.  The PA Department of Health had issue a November 22 health advisory noting an H1N1 outbreak  and associated severe disease in Lehigh county, but testing was minimal and only led to the reporting of one case that was not fatal.
 
The two fatalities (45M and 28M) have not been identified, and their “underlying conditions” have not been delineated.  Agencies frequently cite “underlying conditions”, which are broadly applied to fatal H1N1 cases with little or no evidence that the underlying condition played any role in the patient’s death.

Death clusters are associated with a more virulent H1N1 rather than an unusual risk, which was seen in the death ckuster at Duke Medical Center where D225G and D225N were found in two of the three fatal cases.  The “underlying condition” mantra is widely cited by reporting agency, creating a false sense of security.  Although morbid obesity (BMI greater than 40) has been linked to to a small increased risk, more general obesity (BMI greater than 30) is cited as an "underlying condition".  Pregnancy is also considered an underlying condition, although most risk is linked to pregnant women in the third trimester.  The same broad applications of underlying conditions are applied to patients with well controled diabetes and asthma.

Thus, the high case fatality rate in Lehigh County, Pennsylvania is cause for concern, agency head pats notwithstanding.

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