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H1N1 Death Cluster(s) In Pennsylvania Raise Concerns
Recombinomics Commentary 12:30
January 5, 2011

This season's flu has hit the Philadelphia region, killing two adults and a child in Montgomery County, officials reported Tuesday.

A 32-year-old Upper Merion woman died on Christmas, a 24-year-old Norristown man died Jan. 3, and a 2-year-old Lower Merion child died Dec. 21, said Harriet Morton, spokeswoman for the county Health Department.

She said that because of the fatalities, the department was advising all members of the public older than 6 months to go for a flu shot.

"If you have not gotten the flu vaccine, it is important, and this is why," Morton said.

In Pennsylvania thus far, there have been eight deaths, including the three in Montgomery County. Two occurred in Lehigh County, and one each in Westmoreland, Erie, and Lancaster Counties, said Holli Senior, press secretary for the state's Health Department and health communications.

The ages of the victims ranged from 2 to 65, Senior said. Three of the fatalities were due to the type A/H3N2 strain, two were due to A/H1N1, and three others have not been typed, Senior said

The above comments provide additional information on the recent cluster of deaths in Montgomery County, as well as the earlier five deaths in Pennsylvania.  The two deaths in Lehigh county were the two cases with confirmed H1N1.  It is likely that the three recent deaths in Montgomery County are the three that have not been sub-typed, but the age of the victims (2M, 32F, 24M), coupled with the clustering, strongly suggests that they are also H1N1.  Earlier the Pennsylvania Department of Health issued an advisory on an H1N1 outbreak in Lehigh County that was associated with deaths and severe illness.  Montgomery county is just south of Lehigh county and virtually all confirmed H1N1 cases in  Pennsylvania are in the counties with the five deaths described above, as well as the adjacent counties.  The region with the highest number of confirmed H1N1 cases in Pennsylvania is Philadelphia, with five, and as noted, the confirmed cases represent a small fraction of the total number of influenza cases.

The linkage to H1N1 is also suggested by the concentration of fatalities in Pennsylvania in general (with 8) and eastern Pennsylvania in particular (with 5) since the entire United States only has 19 confirmed influenza deaths, as reported by the CDC.

The two clusters in eastern Pennsylvania (Lehigh and Montgomery counties) raise concerns that the H1N1 that has been circulating in the UK and is associated with a significant spike in severe and fatal cases, is now also transmitting in Pennsylvania and could become more dominant.  Currently in Pennsylvania and the United States in general, H3N2 is the dominant strain, but H3N2 levels worldwide are declining, raising concerns that H1N1 could be dominant, as seen in the UK and Europe, leading to a third pandemic wave involving a more virulent sub-clade.

Details on the sub-type of the three fatal cases, the large number of unsubtypable cases, as well as sequence data on the five fatalities in eastern Pennsylvania and the severe H1N1 cases in Lehigh County would be useful.

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