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H1N1 Spread In North
Doctors at Cape Fear Pediatrics describe the flu as a dull roar. Most of the cases they have seen have been the H1N1 flu.
They are also seeing a viral stomach virus with fever and vomiting.
The above comments on upper and lower respiratory illness in North Carolina have much in common with reports from last fall, when schools were reporting double digit absenteeism and the illnesses responsible were said to be seasonal flu, stomach flu, bronchitis, allergies, or strep. However, the symptoms matched those of swine flu and in the fall H1N1 was the major virus in circulation. Since there are more respiratory viruses circulating at this time of the year, calling the above cases H1N1 is more difficult.
Seasonal flu has essentially disappeared, so cases considered seasonal flu based on an influenza A positive test are almost certainly H1N1. The influenza rapid test has always had a low sensitivity, which is even lower for swine H1N1. The CDC has reported sensitivities as low as 10%, which would then lead to misdiagnosis based on the extremely high rate of false negatives.
Similarly, H1N1 infections are frequently fever free, which also leads to misdiagnosis and a gross undercount of cases. However, even with these limitations the detection frequency for H1N1 has steadily increased this year, signaling a new wave, which has also been reported in other states in the southeast (region 4).
Concerns remain high that this new wave will have a higher frequency of D225G and D225N leading to more severe and fatal cases. Sequences from the more severe and fatal cases would be useful.