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Paradigm Shift Intervention Monitoring
Tomorrow’s MMWR shows a
pneumonia and influenza death rate of 8.89% for week
6, which is well above the epidemic threshold. This level is
markedly higher than the week
4 spike of 8.45%
or the week
5 rate of 8.03%. The week 6 rate is approaching the five year
high of 9.1% set in week 11 in 2008. The rate is expected to rise
because pandemic H1N1 became the dominant serotype in the US last week,
and influenza deaths are a trailing indicator.
Earlier this season H3N2 was dominant, but levels of H3N2 have been declining, while H1N1 has been increasing. A recent report out of the UK indicated the failure rate for the H1N1 vaccine was approximately 50%, which was not a surprise because of the dominance of the sub-clade with S188T in the UK, including sequences which were identical to H1N1 isolates in the United States. This sub-clade has become dominant across the northern hemisphere, including the United States.
Many states are reporting widespread influenza activity, providing additional data supporting immunological escape from the H1N1 circulating last season, as well as the vaccine target for 2009 and the 2010/2011 season. Remarkably, this same outdated target, A/California/07/2009, was recommended by WHO today as the target for the northern hemisphere in 2011/2012.
As seen in the spike in the P&I data and the dominance of the S188T sub-clade, the WHO selection procedure for influenza vaccine targets continues to be hazardous to the world’s health.