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Dramatic H1N1 CFR Spike In Mexico Raises Concerns
Recombinomics Commentary 15:59
February 12, 2010

The Feb 10 report from Mexico has confirmed H1N1 fatalities increasing to 1035, which is an increase of 9 over the Feb 8 report.  Although some of these fatalities are from earlier weeks, the steady increase in fatalities, while confirmed cases are low, raises concerns of a more virulent H1N1 and a higher case fatality rate (CFR).  Confirmed cases in Mexico peaked in October, when weekly totals exceeded 3000.  In December, weekly totals declined to about 200, where they have remained. 

However, weekly fatalities have been running at about 20, which is approximately 10% of confirmed cases.  In contrast, overall figures in Mexico were at 1% of confirmed cases on Dec 7 (713/66,323), but have risen to 1.5% (1035/70,453) in this latest update.  This change is either due to a radical change in how cases are selected for confirmation, or a significant increase in H1N1 virulence.

Sequences released in December had D225G, D225N or both in 5 of 10 HA sequences from fatal cases in Mexico, raising concerns that these changes are now more frequent, leading to a dramatic rise in CFR in confirmed cases.

Sequences from recent cases, as well as information on cases selected for lab confirmation, would be useful.

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