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Paradigm Shift Intervention Monitoring
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US Wave 3 Start
Confirmed By H1N1 Increases in Region 4
The latest CDC report shows an overall rise (from 8.9% to 13%) in samples positive for H1N1 in Region 4 in the week 4 report, providing additional evidence for the start of wave 3 in the United States. Earlier media reports had described increases in various states in region 4. Le Boehner children’s hospital in Memphis had seen an increase in hospitalized patients and a high frequency were being admitted to the ICU, where at least 2 of the 7 died. One was from MS while then other was from TN. University of North Carolina hospital also reported an increase in confirmed H1N1 in college students, and the North Carolina website showed an increase in samples testing positive for H1N1 to 25%, the highest level since mid-November when wave 2 was declining.
These sharp increases in region 4 raise concerns that these cases will spread. Region 4 led the nation at the beginning of the fall wave, which largely followed school openings. Many of the schools in region 4 opened in August. The rise in positive patients in region 4 raises concerns that wave 3 will be more severe, with an associated increase in deaths.
Tamiflu resistant H1N1 with D225G/N was found in the Duke fatal cluster in October/November increased concerns for more fatalities. The three fatalities at Duke were in the same ward and infected with the same H1N1, which had H274Y in NA and Y223H in HA.
Release of sequences from the severe cases in TN and NC would be useful.