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Health officials focused on prevention not treatment in flu case

Posted May 19, 2009

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— When a Rockingham County child died of the flu in February, state health officials decided to focus on creating more public awareness of the importance of getting a flu vaccination, rather than publicizing the limitations of a well-known flu treatment drug.

The decision stemmed from the Feb. 9 death of Haylee Renee Land, who had been diagnosed with Influenza A.

Tamiflu Health officials focus on flu prevention, not treatment

Two of the three current strains of Influenza A, including the H1N1 strain, or swine flu, can be treated with oseltamivir, marketed as Tamiflu, but the third strain is resistant to the drug.

With limited test information available in most doctor's offices, state and national health officials recommend both Tamiflu and rimantadine, commonly marketed as Flumadine, together to treat cases of Influenza A.

State health reports indicate Haylee was only prescribed Tamiflu when she was treated in Eden at Morehead Memorial Hospital on Feb. 7.

She was not treated with rimantadine until Feb. 8 when she was transferred to Wake Forest University Baptist Medical Center. She died the next day.

There are many unknown factors in Haylee's case. Tests could neither determine if she had the resistant influenza strain or if she arrived at the hospital in time for the drug to save her.

But state health officials knew they had a potential problem with some doctors possibly not knowing the best way to treat Influenza A cases.

Ultimately, they reminded doctors of the treatments, but they did not send the same warning to the public.

"Our message with this tragic case is, 'The flu is here. Flu is dangerous and can kill. Here's what you can do to prevent it,'" state Public Health Director Dr. Jeffrey Engel said. "And that is to get the shot, if you haven't had it yet."

Haylee did not get the flu shot, according to records made available to WRAL News. Engel said that was the message to the public.

"When you're doing public health messaging, you have to be on point," Engel said.

Health advocate John Tote, executive director of the Mental Health Association in North Carolina, believes the Department of Health and Human Services should have done more for the public.

"We've got to be more open with folks as we face a variety of health issues," he said. "I do believe when you begin to withhold information in a general way that it puts the department and the administration on the defensive."

Public release aside, e-mails show health officials also struggled with what to tell doctors. They did not want to imply that the death could have been prevented.

State epidemiologist Zack Moore initially suggested a warning to doctors but later wrote about leaving the child's treatment out of the alert.

Eventually, health expert Evelyn Foust wrote: "If North Carolina cases are also resistant to Tamiflu, don't we want this message to be more urgent?"

They chose not to mention the child's treatment or the resistance to Tamiflu. They chose, instead, to focus on the need to get vaccinated.

Haylee's parents have declined to comment on their daughter's death, but her grandmother told WRAL News they are speaking with an attorney.

Kerry Faunce, a spokeswoman for Morehead Memorial Hospital, declined to comment on Haylee's case but said physicians formulate treatment plans on a patient-by-patient basis.

"They do so after careful consideration of the individual patient’s unique history, clinical presentation, and such additional diagnostic findings as are deemed necessary and appropriate," Faunce said.

"While (U.S. Centers for Disease Control and Prevention) recommendations are certainly reviewed and given due consideration, each patient is treated according to what the treating physician, based on knowledge, training, experience and judgment, views as most appropriate for the patient’s needs."

Dr. David Ingram, a physician at WakeMed, said that is also typical of most physicians and that they usually only use both drugs in severe cases of influenza.

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