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H1N1 Dutch Death Cluster Raises Wave 3 Concerns
Recombinomics Commentary 20:35
January 4, 2011

Two children have died of swine flu in Nijmegen, the local health board said on Tuesday. The children were aged four and 11, and the fact they both lived in the same city is a coincidence, the health board said.

National infectious disease council RIVM said there is no reason for panic, despite the resurgence of the disease, which killed 63 people last winter.

The chance of being killed by flu is 'incredibly small', RIVM spokesman Roel Coutinho said.

The above comments describe and H1N1 death cluster in Nijmegen in The Netherlands.  The flu season is just beginning to take off in The Netherland, and the report of two pediatric deaths in the same city signal clustering, as has been seen in the UK in Manchester and Liverpool.  This type of clustering signals a more virulent H1N1 and in the UK the severe and fatal cases seen in Manchester and Liverpool is now heading into southern England.  The same type of cluster in The Netherlands, which is adjacent to England is not surprising.

Vaccine breakthrough in England, Sweden, and Spain signal a new H1N1 sub-clade that is evading the current vaccine.  Similar vaccine breakthroughs were seen over the summer in Australia and initial sequences from the UK demonstrate the migration of H1N1 in Australia into the UK.

This spread is beginning to appear in other countries, including Spain, Egypt, and Israel.  The dramatic uptick in the UK signals the start of a new pandemic wave, adding further evidence of the error in the WHO proclamation that the initial pandemic phase had ended.

The current sub-clade not only is spreading rapidly, leading to the worst flu season in 20 years, but it continues to target young adults with a higher frequency of severe and fatal cases in patients without underlying conditions.

Although this change in at risk population is clear from initial data in the UK and Spain, agency announcements continue to target at risk populations identified in the waves in 2009.  Moreover, these agencies continue to claim that the immunity generated against the H1N1 in waves one and two will offer protection in wave three, but accumulating data indicate those vaccinated against California/7, as well as those infected in 2009 are still vulnerable to H1N1 infection in 2011.

Sequence data from recent severe and fatal cases in the UK, Spain, Sweden, Israel, Egypt, and The Netherlands would be useful.

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