Swine flu now primary isle flu


POSTED: Monday, July 27, 2009

The so-called “;novel”; H1N1 Influenza A (swine flu) “;is not novel anymore,”; says Dr. Chris Whelen, State Laboratories Division administrator.

“;It's fairly predictable, based on the numbers we're seeing, that if somebody's got flu, it almost certainly is the swine flu strain,”; Whelen said.

Hawaii's first three H1N1 cases were confirmed May 5. The state Health Department laboratory has concentrated for 2 1/2 months on subtyping specimens from clinical and private laboratories to determine whether people are getting sick from swine flu or seasonal flu.

Four Hawaii deaths have been reported associated with swine flu — all with underlying medical problems. Most people with the virus have recovered at home without requiring medical treatment.

The state lab in Pearl City receives 120 to 150 specimens a day for testing, but since swine flu is the predominant circulating strain, it is no longer necessary to subtype all of them, Whelen said.

To try to contain his laboratory's high volume of work, he said he has directed the virology section to test no more than 42 specimens a day with the excess spilling over to the Biological Response Laboratory for testing.

“;I don't want folks to get the impression that we're just a swine flu lab,”; Whelen said. “;We're much more than that. ... We need to back up from that immediate infectious disease problem ... and start looking for the next big thing that may show up.

“;There is a lot of concern about the next influenza season,”; he said. “;It takes resources to be prepared.”;

The U.S. Centers for Disease Control and Prevention said Friday the H1N1 virus, combined with regular seasonal influenza viruses, poses a potential threat of significant illness with hospitalizations and deaths during flu season.

Dr. Sarah Park, state epidemiologist and chief of the Disease Outbreak Control Division, expressed concern “;about ensuring capacity for our state laboratory at an adequate level. The capacity has never been great, and this (swine flu) has really stretched them to their limits. Now they have to deal with the economic crisis on top of that,”; she said.

“;We're going through the same thing the rest of the state is,”; Whelen said. “;It's a real challenge.”; He said the lab has 81 civil service positions and 16 exempt federally funded positions. He lost five positions — four from Oahu and one from the Big Island district lab — in the budget process. About five vacant positions for chemists and microbiologists have been frozen.

Whelen said his laboratory is trying to be sensitive to needs of the Disease Investigation Branch and community physicians “;but judiciously use resources and my precious personnel resources.”;

Many people in his laboratory have been pulled into the influenza testing project, he said, and he would like to get them back to their regular jobs and “;normalize the virology lab's operation to look for respiratory viral disease other than influenza that may be impacting our community.”;

The laboratory is moving toward “;a surveillance mode,”; with enough subtyping for investigations of severe cases, he said. “;We're looking for at-risk folks, those with more severe disease and indications that the virus may be behaving badly, causing more severe disease.”; Continuous surveillance is needed because influenza changes with time, he said.

The laboratory also is shifting more to viral culture and cultivations “;in concert with CDC to make sure vaccine development progresses and look for antiviral resistance that may emerge over time,”; Whelen said.

He commended Park's staff and the “;community laboratory effort.”;

“;By far the laboratory science community in Hawaii really stepped up and exceeded what I thought was even possible in these circumstances.”;

In his laboratory, he said, the staff is “;so passionate about what they do, I've really had to pull back pretty hard on the reins sometimes because this (swine flu) is not going to go away.”; Despite no money for overtime, he said, “;folks stay here late every night. I'm telling them to get out of here at a decent time. It's the kind of problem a lab director likes to have.”;