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US P&I Death Rate Jumps To 8.8%
Recombinomics Commentary 15:30
January 31, 2014

Today’s CDC week 4 FluView will show a jump in the P&I Death rate to 8.8% (from 8.1% in week 3). This rise ensures a second severe flu season in a row in the United States.  Last season (2012/2013) generated a P&I peak of 9.8%, which was largely due to the dominance of H3N2, which historically takes a toll on the elderly, who usually account for 95% of the flu deaths.

However, this season pH1N1 dominates, and since its emergence in 2009, the number of deaths has been blunted by cross protection of seasonal H1N1 in older patients.  Consequently, the P&I death arte was unexpectedly low in the 2009/2010 season when pH1N1 crowded out competing serotypes, leading to a low death rate in the elderly.

In contrast to to 2009 however, this season the number of deaths has been unexpectedly high since most elderly still have cross protection and younger targets would have immunity due to natural infections by pH1N1 as well as vaccination formulas which have had a pH1N1 target for the past five years.

The domination of pH1N1 this season suggests it has evolved away from the natural immunity or immunity due to vaccinations, which may have been impacted by use of the same pH1N1 target (A/California/07/2009).
The high P&I rate this season raises serious questions about the methods and assumption used in the selection of vaccine targets.

Earlier indicators, such as the severe and fatal H1N1 cases reported in Dallas County or California will be reflected throughout the country because of the increase in polymorphisms that target human lungs.  L194I, D225G, and Q226R were noted in initial sequences released by the CDC (largely in egg isolates), and the evidence for a higher level of these changes was supported by the recently released sequences from China, where most of the sequences were from egg isolates and the vast majority of these isolates had at least one of the changes that target human lung.

Below are US cities with a P&I rate of more than 10% and at least 5 P&I deaths in week 4.

Gary IN                    35.7%
Pasadena CA        25.0%
Corpus Christi TX  21.7%
Long Beach CA     20.4%
Lowell MA               20.0%
Spokane WA          20.0%
Indianapolis IN        19.1%
Lansing MI               17.3%
Canton OH              16.7%
Fresno CA               16.6%
Worcester MA         15.6%
St Petersburg FL    15.3%
Glendale CA            15.0%
Montgomery AL       14.9%
Memphis TN             14.0%
Honolulu HI                14.0%
Minneapolis MN       13.9%
South Bend IN          13.6%
Los Angeles CA       13.1%
San Diego CA         13.1%
Albany NY                 12.8%
Albuquerque NM      12.8%
San Antonio TX        12.7%
Omaha NE                12.5%
San Francisco CA    12.2%
St Louis MO              12.1%
Dallas TX                  11.6%
Boston MA                11.5%
Springfield MA          11.4%
Tacoma WA              11.3%
Peoria IL                    11.1%
St Paul MN                10.9%
Lincoln NE                 10.9%
Mobile AL                  10.8%
Charlotte NC             10.5%
Fort Wayne IN           10.5%
Dayton OH                 10.3%
Nashville TN               10.3%
Rochester NY            10.3%
Sacramento CA        10.1%

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