PITTSBURGH — The recent death of an otherwise healthy Butler County woman from the H1N1 flu was made an object lesson on how taking early precautions might be the best defense against the swine flu.

The message came from forensic pathologist Dr. Cyril Wecht, who was hired by the family of Deborah Spangler of Renfrew to conduct an autopsy in the wake of her untimely death.

"This was a 45-year-old woman in perfect health, and that's what makes this case significant," Wecht said. "The autopsy revealed evidence of the viral infection as well as a secondary, bacterial infection."

Wecht and Dr. Bruce Dixon, director of the Allegheny County Health Department, confirmed H1N1 with complications as the cause of death.

Spangler visited Butler Memorial Hospital on Sept. 7 with flu-like symptoms and was sent home, Wecht said.

By the time she returned the morning of Sept. 10, her symptoms had considerably worsened, and a chest X-ray revealed "lung complications," but it was already too late. She died at about 6 p.m. that day.

"Mrs. Spangler's case was not unique, but highly atypical," Wecht said.

Butler Memorial legally cannot discuss whether Spangler was treated on Sept. 7 before being sent home, or, in retrospect, whether the hospital staff performed adequately in her overall treatment, said John Righetti, a spokesman for Butler Health System.

Wecht and Dixon also spoke of treatments for those who contract the swine flu.

TAMIFLU and similar medications use oseltamivir phosphate, an orally taken, antiviral drug that slows the spread of influenza virus between cells in the body by stopping the new virus from chemically cutting ties with its host cell, Wecht said.

On whether the drug could have saved Deborah Spangler's life, Dixon said "it certainly wouldn't have hurt her and, even toward the end, it may have had some positive effect."

The Centers for Disease Control and Prevention states that, of 77 fatal H1N1 cases studied nationally, 22 have involved pneumonia, a staphylococcus infection or another bacterial complication, such as Spangler's.

The CDC monitors only hospitalized cases of H1N1, not asymptomatic cases, by tracking emergency room visits and school absences due to flu-like symptoms.

Spangler's death was the second H1N1-linked fatality in Western Pennsylvania. The other was a 27-year-old Allegheny County man whose name was not released.

More than 20 deaths have been attributed to H1N1 in Eastern Pennsylvania.

"We have had this disease in Western Pennsylvania now for five months, and we have two confirmed deaths. It's important not to create a panic," Dixon said. "We need to remind people that simple public health reduces the spread of any infection."

His message mirrored a public service announcement created by Gov. Ed Rendell, which asks people to wash their hands often, cover their mouth and nose with a tissue when they sneeze and avoid touching their eyes, nose or mouth.

"For most people, this has been a fairly indolent disease. You are sick for three or four days and then you recover," Dixon said "This is influenza. This is not some arcane disease that no one has ever heard of."

He said H1N1 recovery is affected not only by quality of care, but by the amount of the virus a person has been exposed to, genetic factors, immune system response and pre-existing lung conditions such as asthma or emphysema.

Both Dixon and Wecht said the real danger lies in peoples' tendency to "tough it out" when they are sick, going to work or school instead of resting or seeking medical attention.

"If you start having a shortness of breath, you should seek medical attention immediately," Dixon said.

Wecht added that common congestion is marked by coughing up white mucus, while a yellow hue is indicative of an infection, which makes any virus more dangerous.

"Each year, about 200,000 people in the U.S. are hospitalized with the common flu, and about 36,000 of them die. It is unfortunate, but all of these things need to be considered," Wecht said.

Doctors in Australia already are administering an H1N1 vaccine, funded by the government. The U.S. government also will provide free vaccinations to the public.

Pennsylvania placed an order Wednesday for the first, live attenuated versions of the vaccine, which should arrive within a week to 10 days, Dixon said.

Children younger than 5 years old and pregnant women will have to wait until a dead vaccine is introduced, but there is no time frame on when that will happen.

Dixon said the first wave of vaccinations will be distributed to pediatricians for children between 5 and 9 years old.

"As more vaccine becomes available, we will expand its use to other groups," he said

The second wave of vaccinations likely will focus on the 10 to 24-year-old age group as well as health care workers dealing directly with patient care.

Unlike the common flu, H1N1, or swine flu, has affected primarily children and young adults, Dixon said, and older adults will be the last group vaccinated.

"We're assuming people born prior to 1957 have more of an innate resistance to the H1 strain," he said.

The military will receive the vaccine before the public, Dixon said, and even though the vaccine is free, doctors may still charge for an office visit or an inoculation fee.

Dixon said the H1N1 vaccine, though new, is no more dangerous than any other vaccine.

"Complications with vaccinations have been with us ever since vaccines were invented. But as with the vaccines for polio or the measles, this one is necessary," Dixon said.

As with the common flu, it will be each individual's decision whether to be vaccinated.

Dixon said vaccine producers are concentrating on H1N1 vaccines and many have reduced or stopped production of the common flu vaccine.