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Spike In US Pneumonia and Influenza Deaths
Recombinomics Commentary 20:09
January 29, 2010

The CDC Week 3 influenza report has been released and once again there were no reported cases of seasonal influenza A.  2 cases of influenza B were reported and the vast majority of cases (98%) were pandemic H1N1, indicating seasonal influenza A has been crowded out in the US.  The frequency of influenza detection has risen slightly and is at the highest level since week 50, signaling the end of the fall wave and the beginning of a winter wave.  However, although the detection rate rose slightly, the P&I deaths spiked higher and are now well above the epidemic threshold and as high as it has been since the peak of the 2008/2009 season.

This dramatic jump in deaths raises concerns that the current H1N1 is more virulent and lethal than the H1N1 circulating in the fall. The early appearance of that virus dramatically increased the P&I, which then declined as the H1N1 levels declined.  However, the current jump is well ahead of such a corresponding jump in H1N1, which would support a more lethal H1N1.

Recent reports from Tennessee have described a higher frequency of children with H1N1 entering the ICU as well as a higher percentage dying.  These results are early, but mimic the increase in case fatality rate in eastern Ukraine in association with the release of sequences from Oct/Nov which had a strong association of D225G/N with fatal cases, who had significant lung damage.

The low number of positives in the US may reflect a sampling problem.  Most tested samples have been from hospitalized patients, but the fatal and severe cases frequently are associated with a rapid movement of virus to the lungs and a high false negative rate.  A high false negative rate would keep lab confirmed cases artificially low and preclude aggressive antiviral treatment.  Similarly the increase in H274Y may also impact treatments involving Tamiflu.

Since most H1N1 fatalities have been young adults, an age distribution on fatal cases would be useful.

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