Respiratory illness - adenovirus 14 -hits remote Alaska island - FluTrackers

[HenryN]

Re: Respiratory illness hits remote Alaska island

We do not know if the patients are diagnosed at this time or not.

The original media report is dated Oct 1 and as of yesterday there was "no diagnosis". If there were 26 "confirmed" or "suspect" cases by Oct 1 and the CDC had already been contacted, then the comments on Oct 3 that there was "no diagnosis" remains suspect and will remain so until a full diagnosis is given (no speculation required).

[kiwibird]

Re: Respiratory illness hits remote Alaska island

Local speculation is obviously rife; Quote from www.city-data.com 11:27 pm local time

"I heard on the radio that it's not bird flu and there will be no quarantine. It's cold and flu season everyone gets sick every year, but now people have a reason to be extra scared."

[HenryN]

Re: Respiratory illness hits remote Alaska island

Local speculation is obviously rife; Quote from www.city-data.com 11:27 pm local time

"I heard on the radio that it's not bird flu and there will be no quarantine. It's cold and flu season everyone gets sick every year, but now people have a reason to be extra scared."

Thanks for the update, but the local speculation above does not explain the involvement of the CDC. Alaskan state health can diagnose colds and flu, which do not require the involvement of the CDC or the medivacing of patients off the island.
I had a talk with one of my island contacts. She said that the story was being carried on Anchorage TV (which is NOT close to the island), which she heard from friends. They only get one TV station on the island (accessed via "rabbit ears" antenna).

[HenryN]

Re: Respiratory illness hits remote Alaska island

I went thru many papers and made plenty of calls. So I found out this.
. From another call I found a nice lady to tell me this ..it is a regular flu and that people were gettin pnumonia. There is no quarintine on the island and she knew of both towns, but would not VERIFY it was 26 ill. She said the very ill, some which had prior respiratory problems, and any other serious cases, were moved to the Katchikan Hospital. .

I had a long conversation with a contact on the island. She said that serious cases are frequently flown to Katchikan (or Juneau).

Her husband had heard that 25 cases were medivaced off the island and 25 more were waiting to medivaced. She also indicated that there were only 5000 people on the island, so if the medivacing of 50 is accuarte, that would be a VERY big number (1% of population).

[HenryN]

Re: Respiratory illness hits remote Alaska island

USA: Respiratory illness hits remote Alaska island
News about: UNITED STATES
Date: Thu 2 Oct 2008
Source: KTUU.com, Alaska [edited]
<HTTP: www.ktuu.com Global story.asp?S="9116462">
---------------------------------------------
The Alaska State Health Department and US Centers for Disease Control (CDC) are investigating an outbreak of a respiratory illness on Prince of Wales Island. Health department officials are reporting 26 suspected or confirmed cases of the unknown illness in communities like Craig and Klawock. Officials say 7 people have been hospitalized. Symptoms of the illness include a severe dry cough and a fever above 101 [deg F / 38.3 deg C].

The health department says so far the state is not prohibiting travel to and from the island or quarantining anyone, but is advising people to practice good respiratory hygiene. "Basically you can go a long way [towards preventing spread] with just washing your hands meticulously and covering your cough, and using tissues and throwing them away," medical epidemiologist Dr Beth Funk said. "Don't leave them [used tissues] lying around, just sort of simple things like that." The health department is collecting samples and sending them to the CDC, as well as testing samples in an Anchorage lab. [Byline: Angela Blanchard]
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[It is extremely unusual for no provisional diagnosis to be given for an outbreak in the USA, let alone for fever and cough at this time of year in Alaska. I wonder why they don't suspect influenza A or some such seasonal pathogen. How can there be confirmed cases when they don't know what the cause is? Any further information will be welcome.

PRINCE OF WALES ISLAND, USA: 2231 sq mi (5,778 sq km), off SE Alaska; largest island of the Alexander Archipelago. The island is heavily forested, but has little arable land, no source of freshwater, and no available areas for ship docking. Many of the islanders left when the pearl-shell industry, once profitable, declined after the 1950s -- see <HTTP: www.questia.com library encyclopedia prince-of-wales-island-united-states.jsp>. Craig's population has varied following trends in the commercial fishing industry. As of the census of 2000, the population was 1397. The population of Klawock was 854 at the 2000 census (Source: Wikipedia.com). - ProMed Mod.JW] [The US state of Alaska can be located on HealthMap/ProMED-mail interactive map at <HTTP: healthmap.org promed?g="5879092&v=64,-150,3">. Prince of Wales Island is one of the islands of the Alexander Archipelago, just west of the northern half of the Canadian province of British Columbia. It can be seen at <HTTP: healthmap.org promed?g="5844324&v=55.666,-132.083,8">. - ProMed CopyEd.MJ]
<SMALL>Source: ProMed Newsgroup Date: 4/10/2008</SMALL>
<SMALL></SMALL>
<SMALL>http://www.tmb.ie/exodus/news.asp?id=85550</SMALL>

[HenryN]

Re: Respiratory illness hits remote Alaska island

Small Mystery Disease in Alaska

<!-- google_ad_section_end --><TABLE class=attributes><TBODY><TR><TD>zogger
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There's a short report about an undiagnosed mystery respiratory disease hitting a remote place in Alaska, which is also part of a big migratory bird flyway, with some concerns over H5N1.

<!-- google_ad_section_end --><!-- google_ad_section_start -->ed.z.: Haven't covered any bird flu news for a long time, thought I'd rectify that. Hopefully this case in Alaska is a minor nothing, but it's still "out there", cases keep showing up. The linked website is the best for that subject.

http://technocrat.net/d/2008/10/4/50939

[Farmer]

Re: Respiratory illness hits remote Alaska island

I am just reading this thread for the first time today. Certainly the media reports tell us little:

"USA: Respiratory illness hits remote Alaska island
News about: UNITED STATES
Date: Thu 2 Oct 2008
Source: KTUU.com, Alaska [edited]
www.ktuu.com Global story.asp?S="9116462">
---------------------------------------------
The Alaska State Health Department and US Centers for Disease Control (CDC) are investigating an outbreak of a respiratory illness on Prince of Wales Island. Health department officials are reporting 26 suspected or confirmed cases of the unknown illness in communities like Craig and Klawock. Officials say 7 people have been hospitalized. Symptoms of the illness include a severe dry cough and a fever above 101 [deg F / 38.3 deg C]. ..."


I agree with Kent, that one potential interpretation is that the "suspected and confirmed cases" may be classified according to their consistency with a working case definition. Using a multilevel case definition to classify ill persons and to discern cases from noncases is a standard method during the early phases of an epidemiologic investigation.

We are only given maybe part of a definition by this report: "severe dry cough" and "fever above 101[deg F / 38.3 deg C]."

Because we have not yet learned of the diagnosis, I see three possible explanations.

1- It is a truly undiagnosed respiratory disease, and they are in the process of investigation with no answers yet.

2- They know what it is, but are slow to report.

3- It is H5N1 or another respiratory disease of epidemic/pandemic potential and they are figuring out their communication strategy. I believe that this scenario may be less likely because they have not seemed to ring quarantine the area, are actively transporting sick people off island and the locals are not reporting distribution of Tamiflu or other preventive measures.

[HenryN]

Re: Respiratory illness hits remote Alaska island

I am just reading this thread for the first time today. Certainly the media reports tell us little:

"USA: Respiratory illness hits remote Alaska island
News about: UNITED STATES
Date: Thu 2 Oct 2008
Source: KTUU.com, Alaska [edited]
www.ktuu.com Global story.asp?S="9116462">
---------------------------------------------
The Alaska State Health Department and US Centers for Disease Control (CDC) are investigating an outbreak of a respiratory illness on Prince of Wales Island. Health department officials are reporting 26 suspected or confirmed cases of the unknown illness in communities like Craig and Klawock. Officials say 7 people have been hospitalized. Symptoms of the illness include a severe dry cough and a fever above 101 [deg F / 38.3 deg C]. ..."


I agree with Kent, that one potential interpretation is that the "suspected and confirmed cases" may be classified according to their consistency with a working case definition. Using a multilevel case definition to classify ill persons and to discern cases from noncases is a standard method during the early phases of an epidemiologic investigation.

We are only given maybe part of a definition by this report: "severe dry cough" and "fever above 101[deg F / 38.3 deg C]."

Because we have not yet learned of the diagnosis, I see three possible explanations.

1- It is a truly undiagnosed respiratory disease, and they are in the process of investigation with no answers yet.

2- They know what it is, but are slow to report.

3- It is H5N1 or another respiratory disease of epidemic/pandemic potential and they are figuring out their communication strategy. I believe that this scenario may be less likely because they have not seemed to ring quarantine the area, are actively transporting sick people off island and the locals are not reporting distribution of Tamiflu or other preventive measures.

There are several additional pieces of information, which are still in the unconfirmed category, but would significantly impact the above, if confirmed.
It seems that a dry cough and temp of 101 are a bit shy of a case definition that would generate "confirmed" cases. One obvious possibility is pneumonia, which can be confirmed by x-ray, and pneumonia was mentioned by one of the residents called on the island, so it may be part of the case definition, but not mentioned in the media report.

Two other residents have brought up the medevacing of patients, and they had heard that 25 were medivaced out Friday, and 25 more were waiting to be medevaced out. If true, this would be VERY important, since there are only about 3500 on the island. They had also heard that there was a quarantine, but this has not been confirmed (and they live on the opposite side of the island and have no direct knowledge of the quarantine, which may be similar to the self imposed quarantine for contacts of SARS patients in 2002).

[Metlakatla]

Re: Respiratory illness hits remote Alaska island

Hi. I am from Klawock, though I am not there right now. My mother is, and she just told me that the illness seems to be affecting people who are heavy drinkers.

[Metlakatla]

Re: Respiratory illness hits remote Alaska island

ProMed may say there's no areas for ship docking, but there is in nearby Ketchikan - a major stop for the many cruise ships going through SE Alaska. The last ships leave Whittier/Seward about September 20th - then proceed south. Those cruise ship passengers and crew (from many foreign countries) typically bring out-of-season flu here in summer. People from Craig & Klawock could easily have been employees of the tourism industry - although I"d expect any of their illnesses to also infect Ketchikan.

No, not really. The ships don't come to POW. Ketchikan is not close enough for people on the island to commute there for tourism jobs; the ferry price alone in order to do so would be more than someone would make, and it's a 3 hour ride one way.

If it were cruise ship related, it would have hit Ketchikan and the other port cities hard.

[sharon sanders]

Re: Respiratory illness hits remote Alaska island

Welcome Metlakatla!

Do you know what the symptoms are and how many are ill?

[HenryN]

Re: Respiratory illness hits remote Alaska island

Hi. I am from Klawock, though I am not there right now. My mother is, and she just told me that the illness seems to be affecting people who are heavy drinkers.

Are any hunters, and have any developed pneumonia? How many have been medevaced out?

[Metlakatla]

Re: Respiratory illness hits remote Alaska island

All I've heard is that a lot of people are getting sick and that Klawock is the community most affected. That would indicate that whatever it is, it's contagious. According to my mom, quite a few people have gotten sick, just figured it was the usual flu, and didn't seek treatment.

[sharon sanders]

Re: Respiratory illness hits remote Alaska island

Thanks for everything Metlakatla.

[Metlakatla]

Re: Respiratory illness hits remote Alaska island

Are any hunters, and have any developed pneumonia? How many have been medevaced out?

No...no hunters that I know of. It's primarily affecting the Native people in Klawock. I don't know for sure how many have been medivaced--eight or ten perhaps.

It is not all that unusual to medivac people on the island -- weather conditions being what they are, they often err on the side of caution. They almost always medivac the elders--simply because if their condition does become serious and the weather turns, they have access to better medical care than what can be provided on the island.

Still, the care that can be provided on the island is pretty good.