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H1N1 Cluster in Romania Raises Concerns
The above translation describes two fatal H1N1 infections in Caracal, Romania which were said to have come from a common source. Although fatalities in eastern Europe have been rising, the case fatality rate has been well below 0.1%. Therefore the deaths of two patients from a common source would be cause for concern.
Recently released sequences from the region have had receptor binding domain change at position 225. Two such changes, D225G and D225N have been linked to a case fatality rate of 100% in many of the countries in the region.
Since detection of these two polymorphisms is low, the overall H1N1 is also low, but there are concerns that an increase in frequency in such sequences would lead to clear transmission and a dramatic jump in CFR. The first indication of such changes would be clusters of cases such was the two described above.
More information on these two cases and the common source would be useful.