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Flu Epidemic in Pacific Atolls Raises Concerns
Recombinomics Commentary 13:04
April 1, 2009

A small group of New Zealand health officials are on their way to Tokelau to help the tiny island nation cope with its worst health crisis in 30 years.

About 10 per cent of the 1,500 people living there are reporting flu-like symptoms.

All public gatherings have been cancelled and schools closed.

"Given that there are a couple of nurses on each of the atolls and that's the main health work force, supported by some hospital aid and - on two of the atolls, a doctor - they're quite stretched," she said.

The above comments describe a flu outbreak in Tokelau (see map).  The small island community has no airfield, roads, or automobiles, so treatment and updates are delayed.  The influenza strain has not been determined, but vaccines and anti-virals are in route and expected to arrive on Sunday.

The flu season is beginning in the southern hemisphere, and this outbreak may signal the severity of the upcoming season, although this population is somewhat immunologically naïve and the spread may not signal a trend for a more diverse population.

However, there were widespread outbreaks which led to school closings in Japan and South Korea, which were linked to Tamiflu resistant H1N1.  Moreover, reports from Japan and Taiwan suggested that the H1N1 was vaccine resistant.  The dominant H1N1 in these countries had acquired A193T as one of the changes at positions 187, 189, and 196 (G189A).  The H1N1 target for the southern hemisphere is unchanged, so vaccine resistant H1N1 strains would be resistant to the vaccine in route to Tokelau.  The current target, A/Brisbane/59/2007, was isolated prior to acquisitions on HA and NA that are associated with the fixing of H274Y, so the ability to halt the worldwide dominance of Tamiflu resistant H1N1 will be limited this season in southern hemisphere as well as next season in the northern hemisphere, since the H1N1 target for then 2009/2010 season is also unchanged.

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