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Paradigm Shift Intervention Monitoring
Cluster Coughing Blood At Admission
The above comments confirm that the death cluster in Calvert County, Maryland were due to influenza A and the siblings arrived at the hospital coughing blood, as indicated in the earlier anecdotal report, which also claimed that the funeral director was hospitalized.
The initial Clavert County announcement described five cases, including four from one family. The reasons for the downgrade to four remain unclear. However, the attack rate for the affected family is 100% and the case fatality rate is at least 75%.
These high rates and the coughing of blood raise concerns that the infection is due to H5N1 or a virulent H3N2v, both of which have D225G (as does H1N1pdm09 in severe and fatal cases), which is associated with lung infections followed by organ failure (which was also described in the anecdotal report)
Detail on the serotype of the cluster followed by sequence data would be useful.