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Pneumonia and Influenza Deaths Exceed Epidemic Threshold

Recombinomics Commentary 23:39
April 1, 2010

Tomorrow’s week 12 MMWR indicates the P&I death rate has increased to 7.8% (878 P&I deaths/11189 total deaths), which is above last week’s 7.7% and above the epidemic threshold, although tomorrow’s CDC week 12 FluView uses last week’s 7.7% and says the P&I level is below the threshold.  However, the graph in tomorrow’s report does show a rise for week 12 and does show the level crossing the epidemic threshold.

The rise above the threshold is a concern, since many states are reporting low levels of H1N1 and a very low number of samples are being tested.  The state reports are more dependent on lab testing than the P&I frequency, which is more related to clinical presentation.  The epidemic threshold has begun to decline because week 12 is past the traditional flu season and is also past the peak for other respiratory infections, so a higher percentage of the P&I rate will be due to pH1N1, since seasonal flu has all but disappeared.  This was also true when the P&I rate spike higher in January, which was dismissed as a statistical blip.

The high P&I is inconsistent with the state reports, which show no states reporting widespread influenza and only three states reporting regional levels.  This disconnect suggests that the current surveillance system is failing.  This failure is due in part to limited testing.  Physicians have been told not to test milder cases, and the testing in general is abysmal.  Many sites use the rapid test, which has a sensitivity as low as 10%.  Thus, 9 of 10 H1N1 infected patients test negative.  However, pH1N1 can rapidly move into the lower respiratory tract, so journal reports are now describing false negatives in nasopharyngeal swabs used in PCR testing..

Moreover a media blitz declaring an end to the pandemic has taken H1N1 off the radar of many patients and physicians. 

pH1N1 targets a younger population.  90% of fatalities are younger than 65, while for seasonal flu, 90% of fatalities are over 65.  Thus, many in the prime target group do not seek prompt medical attention because they read the media misinformation.  Moreover, since pH1N1 has crowded out seasonal flu, surveillance sites that serve an older population simply reduce the percent positive because these older patients have little flu.  Most have circulating neutralizing antibodies from exposures decades ago, either from 1918, earlier seasonal H1N1, or the 1976 swine flu vaccine.  Consequently, the samples from these surveillance sites have no influenza and largely represent other respiratory diseases.

Thus, the current surveillance program is heavily dependent on tests that fail and a surveillance mix designed to detect seasonal flu.

Consequently, the number of cases and deaths are a grossly underestimated, even when the CDC adjust the 2,000 lab confirmed deaths to 11,000 deaths.  The P&I data indicates the adjusted numbers are a 4-5 fold under-estimate, and these misleading numbers in the weekly CDC reports are hazardous to the world’s health.

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