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H1N1 Death Cluster in San Pedro Sula Honduras

Recombinomics Commentary 16:50
April 9, 2011

Seven SARI deaths were reported this week in San Pedro Sula.

Influenza A H1N1 has reappeared in Honduras, according to the chief warden of Health, Dr. Thomas Guevara.

"Through him we have the virological surveillance of respiratory diseases, reported a case last week of H1N1 detected in San Pedro Sula", he said. 

The above comments on seven fatal SARI (Severe Acute Respiratory Illness) cases described in the week 12 Pan America Health Organization report, coupled with the media report on confirmed H1N1 in the San Pedro Sula, strongly suggests that the H1N1 sub-clade circulating in Mexico in association with a high frequency of severe and fatal cases is also causing a high rate of deaths in Honduras.

Three sets of sequences were recently released from samples from patients in Chihuahua, including two fatal cases.  One of the sequences had D225N, and it is likely that D225N would also be found in the lungs of the other fatality, since both sequences were identical for the rest of the gene and it is likely that both fatalities with traffic officers in the same unit.

Anecdotal reports indicate this sub-clade is rapidly spreading in Central and South America, and D225N is frequently detected. Moreover, the Chihuahua data suggests that the D225N would be detected at a higher frequency in samples collected from the lower respiratory tract.

Recently released sequences from the United States, from vaccinated patients, support vaccine breakthrough driven the receptor binding domain change A189T, as well as the new glycosylation site at S165N, which may mask antigenic sites.  The four non-synonymous HA changes in the isolate from New Jersey,
A/New Jersey/AF21791/2011, are present on all novel H1N1 sequences, suggesting that the vaccination campaigns in Mexico and Venezuela, as well as neighboring countries, will have limited impact on the spread of this deadly sub-clade.

More information on the seven fatal cases in Honduras, including epidemiological and demographic data, as well as sequences from severe and fatal cases throughout the region, would be useful.

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