By Paul Kleyman and Viji Sundaram
New America Media

Evidently, the swine flu upholds an old American tradition, after all: It doesn't discriminate by age — especially when it comes to death.

Previous reports suggesting that older H1N1 flu victims are less prone to severe outcomes than children and young adults have been called into question by a new report published Nov. 3 in the Journal of the American Medical Association (JAMA).

The article states, "In contrast with the common perception that pandemic 2009 influenza A (H1N1) infection causes only mild disease, hospitalization and death occurred at all ages, and up to 30 percent of hospitalized cases were severely ill."

Although one-third of those hospitalized were ages 18 or younger, the authors write that people age 50 or older have the highest rate of death once hospitalized.

“What our study shows was that once you were hospitalized, if you were elderly, you have a higher risk of dying,” said Janice K. Louie, of the California Department of Public Health, Richmond, Calif. Louie study appears in JAMA.

Louie, and her fellow researchers examined the records of the first 1,088 hospitalized and fatal cases due to the pandemic in California. Although 7 percent of this 18 or younger died after hospital admission, the death rate was 18-20 percent — about one in five — for hospitalized adults 50-plus. Overall the death rate was 11 percent, or one in nine.

Dr. Thomas Frieden, director of the federal Centers for Disease Control and Prevention, noted that the results of Louie’s study matches with one done by his agency. H1N1 affects all age groups, including those over 65.

“If they get it, it can be every bit as severe as seasonal flu, consistent with other data,” Frieden is quoted as saying at a news conference.

To avoid having apparently mild cases escalate into serious illness, Louie and her colleagues advise clinicians to closely monitor those 50 or older, who turn up with an flu-like symptoms regardless of initial results.

Once hospitalized, adults, especially those with potentially aggravated underlying conditions, "should be carefully monitored and treated promptly with antiviral agents."

Interestingly, the authors noted that besides the usual risk factors, such as asthma, a new one appears evident among those hospitalized — obesity. They call for more study of this finding.

Findings of the new study do not change the CDC’s recommendation for vaccination, which focuses on younger people, those with such chronic conditions as asthma, and pregnant women.

What they do suggest is that doctors should not dismiss the risks to older patients, said Frieden.

Copyright New America Media 2009

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