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Paradigm Shift Intervention Monitoring
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In Severe H1N1 in Memphis Tennessee Children
"Over the past 3 weeks or so, we've had about 17 or 18 admissions to Le Bonheur with confirmed influenza. I should say that we believe all or almost all of these will prove to be the novel H1N1 influenza virus."
Infectious disease doctors believe its the only virus circulating in significant amounts in the community right now.
"I think 7 of the 17 or 18 have been admitted to the ICU. So that's a bit of a shift of what we saw before."
The above comments describe an increase in sever H1N1 cases in children in Tennessee. The Children’s Medical Center (see map) had seen high numbers of patients in the fall, which led to the use of tents to cover the overload. The current spike is well below earlier levels, but the frequency of cases admitted to the ICU is higher.
The increase in severe cases represents the concerns linked to the H1N1 evolution and increased reports of D225G/N, which have been tightly associated with severe and fatal cases. In the fall, the number of exposed to H1N1 was high, leading to protective immunity and a sharp decline in cases. However, there current is virtually no seasonal influenza A in circulation in the United States, but the traditional flu season is beginning, whicj will likely lead to emergence of a new swine H1N1 strain. Mill Hill has reported a Ukraine isolate with D225G as a low reactor, raising concerns that immunity generated bu infection with wild type H1N1 or protection from the H1N1 killed vaccine will select for D225G/N variants, leading to a higher frequency of severe or fatal cases.
Consequently, the increase of ICU cases in Tennessee children is cause for concern.