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Paradigm Shift Intervention Monitoring
In Low California, José
Bustamante Moreno, secretary of Health, said that two sick patients
have presented himself; one of them died
The above translation describes an H1N1 death in Baja, California. Like Chihuahua, the dead and severe cases represent a large percentage of detected cases. Media reports in Mexico are now starting to mention multiple “mutations” which again suggests that the H1N1 has evolved considerably.
The sequences from swine in Costa Rica as well as a large array of reassortants (primarily H1N2) which have swapped genes with pandemic H1N1 raise concerns of additional jumps back to human. This likelihood is increased because the genes circulating in swine have circulated previously in humans.
The Costa Rica swine sequences had pandemic H1 and N1, but there were many changes that would create serotyping issues and would have limited cross reactivity with protective antibodies.
This recent history, coupled with the large number of severe and fatal cases in Mexico, relative to the total number of cases identified raises, concerns that an evolved sub-clade has jumped back to humans from swine.
The appearance of this sub-clade would be likely to happen at this time of year for the same reasons the 2009 pandemic began in late season. Competing flu genomes are declining now in the northern hemisphere, creating an environment favorable for the emergence of a new sub-clade.
This level of concern has led to travel checks on those arriving in Mexico City from Chihuahua and Texas. However, the H1N1 has already spread throughout Mexico, so such checks are unlikely to succeed.
Release of sequences from the outbreaks in Mexico and Venezuela is now overdue.