In the latest H1N1 weekly report by the California Department of Public Health, Director Dr. Mark Horton reported the third weekly decline in the hospitalization rate, but also higher deaths in the current week. Although the rate of weekly hospitalizations has been falling, Dr. Horton continues to expect a third wave of the disease. Further, the situation for pregnant women is critical and the tests are not reliable.

For Orange County, only one person succumbed to the illness last week. That’s the lowest death rate in OC for several weeks. Statewide, 32 people died from H1N1 and there were 209 new hospitalizations across California for the week. This brings the statewide pandemic total hospitalizations to 8,003 and the deaths to 449.

In addition to declines in hospitalization rates, according to Dr. Horton, the percentage of patients presenting in doctors’ offices with influenza like illnesses also has fallen. “All of these are indicating that certainly here in California, as has been reflected nationally, there certainly are some indications that there’s been a trend in decreasing intensity of the infection and the pandemic”.

Even though some of the indicators are positive, California still has “widespread disease”. Horton said “We are now only 1 of 7 states across the country that are reporting themselves {as having widespread H1N1 disease}, but it indicates that, particularly here in California compared with the rest of the country, we are continuing to see this as a significant threat here in California.”

In response to a question from OC180NEWS.com, Dr. Horton said “A third wave would not be a surprise to us. If I had to guess or predict, I would say that there is going to be a third wave. I think that we can fully expect that is going to happen.”

With regard to pregnant women, Dr. Horton said “528 pregnant women have been hospitalized with this condition and 17 have died. This represents a higher death rate than we would have expected and a higher death rate than most other target groups and age groups that are experiencing this. So, there’s no question that the pregnant women are disproportionally affected.”

Dr. Janice Louie, CDPH section chief, Influenza and Respiratory Diseases Section, went further. “Pregnancy itself appears to be an important risk factor.” Dr. Louie indicated women who have given birth within the last two weeks are included in this at risk population.

Not only are pregnant women at a greater risk from H1N1, but they are more susceptible to negative outcomes from delays in getting treatment. Dr. Louie said “We noted that women who receive late anti-viral treatments—more than two days after their symptom onset--were four times more likely to be in an intensive care unit or to die than those who received prompt treatment, which again emphasizes the importance of treating this population early on.

So, if you are pregnant, or have given birth within two weeks, and you start to have flu like symptoms, don’t waste time about getting to your doctor. Quick treatment with antiviral drugs could mean the difference between life and death. However, getting to the doctor quickly is only the first part of the problem. The real problem comes when your doctor administers a test for H1N1 in the office—the so called “quick test”.

Dr. Louie, in a study just published in the New England Journal of Medicine, found that these tests are not very accurate when they indicate the patient does not have H1N1. She said “Rapid flu test were falsely negative in 42% of the cases, and so we noted that physicians should not be relying on this test to make a diagnoses of H1N1.”

So, step one is, if you feel the symptoms, go to the doctor. Dr. Horton said “What we have stressed is the most common symptoms include fever, sore throat, and other respiratory symptoms--cough, congestion, trouble breathing.”

The trouble is pregnant women might feel some of these symptoms just because of the pregnancy. According to Dr. Louie, “It is very difficult because pregnant women often are achy and they might feel short of breath as pregnancy progresses.” Dr. Louie went so far as to indicate that the quick test in doctors’ office is not useful.

Her bottom line answer: “Do not rely on these tests and start treatment and while you are evaluating the patient, send a specimen off for a very good test, called PTR, and that will give you the definitive answer. If it’s negative, treatment can stop.

The Orange County Health Care Agency, HCA, continues to offer an appointment only clinic at its 17th Street facility in Santa Ana. As of this week, the restriction of only people in the five target groups has been lifted.
To schedule an appointment at the county’s free clinic, call the Health Referral line at 1-800-564-8448, Monday to Friday between 8:00 a.m. and 5:00 p.m. H1N1 Vaccination Clinic hours:
Monday to Saturday, 8:00 a.m. - 4:30 p.m. Closed for lunch 11:45 a.m. - 12:45 p.m. daily

Click here to go to the HCA web site.

Another way to find the H1N1 vaccine is through Google. They have a zip code based locator; click here to go to the page.