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Emergence of Novel H1N1 In the United States in 2011

Recombinomics Commentary 15:35
April 7, 2011

Savannah McCann came home from Desert Hills Elementary the morning of Jan. 18 after vomiting, and had spent the rest of the week resting, with an occasional cough and fever, under her family's and doctor's care.

It was about 10 minutes after her father got home from work Saturday that the third-grader suddenly said she was having trouble breathing. "We called 911," her father, Brent McCann said Tuesday. "Her breathing got more and more shallow."

Just 15 minutes after her first complaint, she had died.

"She took her last breath as the EMTs walked in," said her mother, Melanie McCann.

The little girl was taken to MountainView Regional Medical Center and given heavy doses of epinephrine, but the efforts failed to revive her. Doctors said the influenza mutation appeared to have suddenly attacked Savannah's liver, kidneys and brain, her mother said.

"She had no other health issues, none, that's how absolutely awful that virus is," Melanie McCann said.

The above comments describe the fatal H1N1 infection of an 8 year old girl in Las Cruces, New Mexico in January, 2011, raising concerns that the novel sub-clade circulating in Juarez, Mexico was previously circulating in the United States.  The Chihuahua outbreak has been epidemiologically linked to travelers from Las Cruces, New Mexico and Odessa, Texas indicating the sub-clade was present in the southern United States prior to the March outbreak in Chihuahua.  Additional sequence data from military personnel and dependents also identified the sub-clade in multiple states in early 2011 including New Jersey, North Carolina, South Carolina, Florida, and Arizona.  Moreover, the most recent 2010 United States isolate was from Pennsylvania, which had D225G.

Pennsylvania has reported the highest number of influenza deaths in the country.  However, many were reported as unsubtypable.  However, the week 13 report has a dramatic jump in H1N1 cases in the Pittsburgh (Allegheny County) and Philadelphia metropolitan areas, with 1603 and 934 respectively, in contrast to week 10 numbers, which showed 93 and 24.  This dramatic change may be more related to testing than to new cases and may be linked to data from Chihuahua, where initially testing failed to identify H1N1 (cases were initially described as atypical pneumonia and index case was not H1N1 confirmed, although the case’s partner was also fatally infected and confirmed).

Thus, the emerging sub-clade may have been more widespread than reported due to testing problems and lack of 2011 sequences from the United States.

Moreover, the timing of the outbreak in Chihuahua and Venezuela may reflect an evolutionary advantage for the emergence of this sub-clade, as H3N2 levels decline and the advantage for H1N1 at this time of year, as was seen in the 2009 outbreak in Mexico.

Release of 2011 sequences from the United States is long overdue.

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