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Paradigm Shift Intervention Monitoring
The HPA week 3 report on influenza in the UK shows a dramatic jump in fatal cases (to 254 from 112), which has more credibility than earlier reports, which were trailing the numbers reported by the media (and the media reports represent a small fraction of the total number of deaths). Agencies are now withholding the number of fatal cases, so the actual number of deaths remains murky. Media reports describe young patients who have flu-like symptoms, which then develops into pneumonia and death, but cases are said to have died from “natural causes”, suggesting the number of flu deaths is markedly higher than the deaths withheld by hospital administrators.
Moreover, the latest HPA report has a dramatic jump in the deaths of the elderly (>64) to 55 from 16 reported through week 2. The number of elderly deaths is now markedly higher than the number of influenza B deaths (16), indicating most of the elderly deaths are now due to H1N1.
In the past, the elderly were generally spared from H1N1 because of seasonal H1N1 infections when they were much younger. Consequently, more than 90% of H1N1 fatalities have been under 65 and initial UK reports indicated that all H1N1 deaths this season were under 65. This recently reported increase in deaths in the elderly population could signal a dramatic change in H1N1 deaths.
Usually deaths in the elderly are not lab confirmed. The patients are frequently in long term care facilities and die at the facility. No samples are collected and the number of deaths is extrapolated from death certificates and descriptions of flu-like conditions or pneumonia. Thus, the current number of elderly deaths may also be markedly higher than then 55 lab confirmed cases in the week 3 HPA report. The report includes a graph of deaths in the UK, which is well above expected levels.
The latest sequence data on recent H1N1 isolates in the UK as well as other countries in the northern hemisphere (Mongolia, Iran, Japan, Russia, United States) documents the emergence of a new sub-clade with S188T. The dominance of this sub-clade indicates it is escaping immunological defenses, and this escape may now include responses to earlier seasonal H1N1 infections by the elderly population.
More information on the H1N1 isolated from elderly patients would be useful.