May 22, 2013 (CIDRAP News) – Alabama health officials are investigating a cluster of severe respiratory infections from an unknown origin centered around the Dothan area and have asked the state's health providers to be alert for and report similar cases.

In a press release yesterday the Alabama Department of Public Health (ADPH) said seven people have been hospitalized with similar symptoms: fever, cough, and shortness of breath. Two of the patients have died. The ADPH said it and the Houston County Health Department are conducting the investigation and have consulted with the US Centers for Disease Control and Prevention.

Dothan, in Houston County, is in the southeastern corner of Alabama near both Georgia and Florida. A report from local TV news station WSFA said hospitalizations in the cluster began on May 16 at the city's Southeast Alabama Medical Center.

An ADPH alert to health providers said the first three cases were flagged on May 16 by a pulmonologist who reported that three patients with similar symptoms were on ventilators and had no known cause for their illness.

Tests on samples sent that day to the ADPH clinical lab revealed on May 17 the 2009 H1N1 influenza virus in one of the patients, who died the following day. Another patient who was transferred to the same facility and placed on a ventilator died on May 19.

Polymerase chain reaction flu panel testing on three other patients who were admitted yielded one H3 influenza positive. The ADPH said though two patients have tested positive for influenza, it's unclear what role the viruses played in the cluster illnesses.

So far no epidemiologic links have been found among the patients, the ADPH said.

State health officials said patient ages range from the early 20s to the late 80s, according to the WSFA report. Peggy Blakeney, area administrator from the ADPH, said the patients are from an eight-county service area that includes Barbour, Coffee, Crenshaw, Dale, Geneva, Henry, Houston, and Pike counties, according to a report yesterday in the Dothan Eagle.

Blakeney told the Eagle that it's early in the investigation and it's not clear if the illness is contagious, though so far no illnesses in family members have been detected.

Alabama health officials said there's no evidence that any of the patients had traveled outside the country where they could have been exposed to the new H7N9 influenza virus or the Middle East respiratory syndrome coronavirus (MERS-CoV), NBC News reported yesterday.

The ADPH asked clinicians to report all patients hospitalized with cough, shortness of breath, and pneumonia from an unknown cause, regardless of rapid flu test results, and to submit both upper and lower respiratory tract samples. It asked them to collect upper respiratory samples from patients who have flulike illness as part of year-round surveillance and a lower respiratory tract sample from patients who have pneumonia.

See also:

May 21 ADPH health alert message

May 21 ADPH press release

May 21 WSFA news report

May 21 Dothan Eagle story

May 21 NBC News report