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Closings Raise Pandemic Concerns Recombinomics
September 2, 2009
Mounting illnesses have forced the Alcoa
City Schools to close through Labor Day.
The 1,800-student system decided Tuesday to extend the holiday for its
elementary school, middle school and high school after the absentee
rate hit 30 percent. Normally it's around 5 percent.
According to Director of Schools Tom Shamblin, some of the illnesses
are confirmed flu cases. Other illnesses included stomach viruses,
fevers and upper respiratory infections. Shamblin said middle schoolers
were impacted the most, with a nearly 30% absentee rate.
The above comments describe a
large pandemic H1N1 outbreak in schools in Alcoa, TN, which is just
south of Knoxville (see zoomed
map). Although other schools in the area also have high
absenteeism rates (see broader
view), they have followed the CDC recommendations on keeping
schools open. These other schools also cite a wide range of
symptoms, as noted above. All of these symptoms have been
previously reported for swine flu, and it is likely that the vast
majority of these students are H1N1 infected. The number of
infected students is much high than confirmed cases, due to limited
testing of patients who meet the CDC case definition, as well as the
high frequency of infections which do not develop a fever (and
therefore do not meet the H1N1 case definition).
of fever has been reported
previously in Mexico and Chile, but a fever is included in the CDC case
definition, so the symptoms listed for hospitalized H1N1 confirmed
cases is 93%, leading many to assume the lack of a fever signals the
lack of infection. Consequently, a runny nose is frequently
diagnosed as allergies, and gastro-intestinal problems are called
"stomach flu", and other flu-like symptoms are called "upper
respiratory infections" and in some cases an influenza A positive
result is interpreted as seasonal or "normal" flu, even though 99% of
influenza A positive patients at this time are swine flu because the
traditional flu season has not begun.
Thus, the swine flu cases are
easily noticed, even though the diagnoses, as seen above, are
incorrect. These misdiagnoses, especially those which attribute
symptoms to allergies, lead to more H1N1 infections because these
students come to school, and remain in school because they have no
fever. Moreover, the lack of testing leads to misconceptions
about the H1N1 frequency in the area.
This lack of testing has been
prevalent for months, so confirmed cases suggest that H1N1 levels in
the region are low, and the explosion of cases creates "sticker
shock" for returning students and parents. The high level of
infections cited above is not limited to Tennessee. H1N1 is
the south because the school year began in early August.
However, high levels are being reported elsewhere. Almost 30% of
students are also absent in Iowa, where there were large outbreaks last
spring and around Marshalltown (see map).
However, the limited number of swine flu testing kits shipped by the
CDC precluded testing of the hundreds of symptomatic patients at the
local clinic. Therefore these patients were not confirmed, even
though attending physicians were certain that the patients were H1N1
Thus, the limited testing of
H1N1 coupled with a case definition that includes fever has led to a
significant under-reporting of cases, even in schools were absenteeism
is approaching 30%. Moreover, sick students without fever
continue to attend school, leading to massive outbreaks as described
above. Therefore the explosion of cases in the south is likely to
spread throughout the northern hemisphere as a new flu season begins in
the absence of an effective vaccine and amid growing concerns of
at Nature Precedings