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Paradigm Shift Intervention Monitoring
After confirming 12 cases of H1N1
influenza, the Epidemiologist of the Ministry of Health Alfredo
Rodríguez Trujillo warned that the holiday season puts them at
risk of infection in the state.
He said that so far there have been 500 suspected cases, and are the border towns of the south: Tampico, Madero and Altamira most at risk of infection.
The above translation confirms H1N1 in Tamualipas, where a red alert had been declared because of 120 suspect cases. Since the April 9 alert the suspect cases have been confirmed and the number has jumped from 120 to 500 cases primarily localized to three towns along the southern border of the state. This dramatic jump to 500 cases in a small region of one state in Mexico highlights the rapid spread of the H1N1 virus in mid-April when flu cases traditionally decline. Moreover, the spike in cases is for a novel sub-clade of H1N1 in a season that was dominated by H3N2 in Mexico. H3N2 levels have dramatically declined, allowing for the emergence of a novel sub-clade of H1N1. Spread is following the timeline of the emergence of pandemic H1N1 in 2009.
However, D225N is frequently found in this novel sub-clade, which may be associated with anecdotal reports of patients in northern Mexico presently at Emergency Departments with nose bleeds and breathing difficulties. These patients are filling up ICU beds and Mexico has launched training programs for care of H1N1 patients in ICU’s.
Additional anecdotal reports indicate this sub-clade with D225N is rapidly spreading throughout South America, well in advance of the flu season in the southern hemisphere. Moreover, data from surveillance of the US military and dependents identifies this novel sub-clade in patients who were previously vaccinated, casting serious doubts on the success of efforts to contain the H1N1 spread with vaccination fences.
The rapid increasing in confirmed and suspect H1N1 cases raises additional concerns that the presence of D225N will lead to more severe and fatal cases.
Release of sequences from the United States as well as severe and fatal cases in countries south of Mexico is now overdue.