Alabama Mystery Illness: It Wasn't the Bird Flu, So What Was It?

When seven people in southeastern Alabama went to the hospital last week with the same symptoms of unknown origin, doctors feared this marked the genesis of the next flu pandemic. Fortunately, the Alabama Department of Public Health (ADPH) has identified the “mystery illness” as a mixture of influenza A and H1N1, rhinovirus (cause of the common cold), and bacterial pneumonia.

The seven symptomatic patients ranged from age 24 to 87 and lived in the mid-sized cities of Dothan and Luverne. They presented with symptoms of fever, cough, and shortness of breath. Two of the patients died shortly thereafter; the other five are currently in recovery.

Physicians were concerned that because the patients were not closely connected to one another, the outbreak may be widespread. On May 21, ADPH issued a public health alert calling for increased safety measures in hospitals for patients with respiratory symptoms. Health care officials interviewed the patients and their families about recent travel and exposure to risk factors. Specimens were tested to rule out bird flu and coronavirus at the ADPH Bureau of Clinical Laboratories in Montgomery. 

This mystery illness engendered heightened anxiety, precaution, and inquiry as it coincided with recent outbreaks of bird flu (aka avian flu or H7N9) in China and a “SARS-like” coronavirus in the Middle East. The spread of the illnesses to this part of Alabama is not improbable, as the aircrafts at the military base nearby frequently fly overseas. No cases of either virus have been reported in the U.S.

"This is a great example of science sorting through the mystery of a 'pseudo-outbreak,'" says Dr. Richard Besser, chief health and medical editor for ABC News. “These were a variety of infections that just happened to occur close in time."

Despite the fortunately anti-climactic diagnoses of the Alabama cluster, health care officials ask physicians to continue diligent year-round surveillance and to submit flu specimens for testing. They also remind us that the most effective methods to stop a pandemic before it starts are the ones we all know already: cover your cough, use soap and water, don't put your fingers in your mouth, and keep your hands to yourself.

The bird flu is still very rare in humans, but a mutation of the virus could lead to a worldwide pandemic. Dr. Besser predicts, "The first cases of the next SARS or the next flu pandemic could look very much like this. You treat every one of these clusters the same: You attack it with rapid public health science."