Pandemic Alert Levels were also is a confusing phenomenon. The Pandemic Alert Levels based on the World Health Organization are based on the spread of the virus itself, not the virulence of the virus, not the mortality rate of the virus, but merely the spread, how efficient and how sustain human to human transmission occurs.
So we are now at level 6 Pandemic. It is world wide, it is easy transmissible and the degree of virulence is still to be identified. It's a concern as to how virulent it will be, but we just don't know yet.
To give you some numbers though, in United States they just released the September statistics, over 16000 hospitalizations directly related to H1N1 in the United States, over 1300 deaths related to H1N1, 11 of them in children. So it is out there, it is across Southern states significantly, some Western states, we haven't seen it quite as much up here yet perhaps even if we got hit hard earlier in the Spring so there is some kind of immunity that evolve as well as we probably hope vaccination will do in order to decrease the numbers. But those are the September numbers just released yesterday by CDC.
And this really is the proof of the pudding in terms of the danger of that shift. You could see that every time there is a major shift, this is the H1N1 shift, here is what H2 develops, here is where H3 develops and H1N1 comes back. Every time there is a shift you see a spike in the mortality rate of the new strength and it is been consistent for the last 80 plus years. But I think it gives us an understanding of what we are dealing with now that we another and some global shift, but now that we have an increase in the virulence and the transmissibility.
1918, I think this description really is very apt, As their lungs filled up, the patients became short of breath, increasingly cyanotic, gasping for several hours, they became delirious, incontinent, and many died struggling to clear their airways of a blood-tinged froth that some times gushed from nose and mouth. It is a dreadful business.
Pretty good description of Pneumonia and Influenza that is as true today as then and really Pneumonia and lung disease is the primary complication and the most significant cause of ongoing morality and morbidity in Influenza.
The things to remember is that you start with a primary like viral pneumonia, but secondary bacterial pneumonia is a leading cause of mortality when you take a look at postmortem specimens. And what we have seen for many years is that Pneumococcal infection is the most common cause of secondary mortality, but what we are now seeing is that MRSA is moving into the population and in the spring it was identified as a cause of mortality in the population as a whole.
So certainly we want to make sure patients are vaccinated for their Pneumococcus, but only think about treating with anti-microbial considered both Pneumococcus and MRSA as the bacteria you need to cover for patients who are sick with Influenza Pneumonia where you are worried about that secondary infection.
The other thing to remember is there are non-pulmonary complications and that's supposed to that excess mortality that we saw up in the graph and so Myositis, Encephalopathy, Myocarditis and other cardiac complications have clearly been identified and clearly are cause of more morbidities and causes of mortality with Influenza infection.
Numbers we have seen before, 25 billion in 1918 died or infected in United States, and half the million died, worldwide they estimated 500 million people were sick and 20 or 100 million people died from Influenza during the pandemic.
And ultimately more people died from Influenza pandemic than HIV as well as both World War I and World War II. And here is a wonderful book that was written, 'The Story of the Great Influenza Pandemic In 1918' and it's really very likely that the reason why World War I actually ended it was much more because of Influenza than any side actually winning the war. They were just running out of soldiers and the peak in the soldier-age population, when you look at mortality rate it was tremendous. And so they just hit that population very badly terrible living conditions, food, sleeping and exhaustion as well as people living closely together with bad hygiene. So really there was a lot of reason for the pandemic during those years.
In general complications tend to occur in the very young and the very old, children. Children under the age of 2 more common and elderly over the age of let's say 65 -- we won't include the 46-64 it's out of like being identified in that population anymore. And we really do see that.
What's interesting is that H1N1 we are seeing complications across the board and you are not seeing it's specifically only in those populations, it's much more evenly dispersed and in fact, the elderly maybe at a lower risk of severe morbidity and mortality with H1N1 and some of that maybe related to immunologic response. Because it seems that part of the reason for mortality with H1N1 relates to cytokine storm and the release of inflammatory mediators give a very robust immunologic response and since elderly have a more blunted immunologic response due to loss of that ability as we get older our immune system gets insufficient, they get infected but their mortality rate may in fact be six days or can be lower than what we would have expected otherwise. It is an interesting phenomenon of this virus.
Ultimately children and healthy adults bear the burden of this infection, often the ability to transmit the infection to others, the demands on the healthcare system as well as the economy as a whole, as well as social situations. And we all know the peak year or the peak time of the year when we are seeing the flu, but we are seeing it much earlier this year than we generally see it. We saw it in the spring, we are seeing it now in September, it's almost unheard of these kind of numbers during this times of year.
Infection is clearly highest in children, there is no question about it. More than 40% of children in the population are going to be infected in any given year and that really goes right across the school age, much more common. And children although frequently have milder disease can have serious complications and this is a partial list of those serious complications that we can get in a pediatric population and ultimately death is the obviously the most serious complication and fortunately death uncommon in children, roughly about 50 deaths a year nation wide. But in any given year we may have a form of Influenza with a more significant virulence leading to greater pediatric death.
The 2003-2004 season where the average death rate tripled, about a 150 deaths that year, if you remember that's when we had very early case of Influenza out in Colorado and Denver and in the West and it hit us in an earlier time. But the mortality rate was higher that year. So the virulence spread from year to year.
A thing to remember the pediatric population especially is that there is no -- Influenza doesn't play favorites, of the children in that 2003-2004 season who died with Influenza almost half of them previously healthy with no underlying co-morbidity. So there would have been no expectations, these children would have been sicker, they just were and the spread of mortality was fairly even across the board.
So wasn't that the baby 6 months and younger died more commonly, pretty much across the board even 5-10 years old and healthy teenagers succumb to Influenza.
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