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Paradigm Shift Intervention Monitoring
This day two more people joined the
H1N1 influenza deaths in the state of Chihuahua. A man died in the
state capital after being hospitalized since March 15. Also this day a
young woman, died in an IMSS clinic in Juarez, she had symptoms since
22 March. According to the state Health Department confirmed the 12
deaths are six in Juarez, Chihuahua and five more in the town of
The above translation describes the mounting H1N1 death toll in Chihuahua, Mexico, as well as the clustered nature of the deaths. One cluster is in the north, in Juarez and undoubtedly linked to the initial fatalities in the traffic department, where two officers who were partners died and a third member of the department was in critical condition.
The first three HA sequences released represented a novel sub-clade and one of the three had D225N. Thus far 11 HA sequences have been released and 8 represent this Chihuahua sub-clade, including a sequence with D225N and D225G. thus, two of the eight HA sequences from the Chihuahua sub-clade have D225N in pharyngeal swabs collected from the upper respiratory tract.
Anecdotal data indicates that at least five additional HA sequences from Mexico have D225N in samples from severe and fatal cases signaling clustering of this polymorphisms, which is almost certainly present in the death cluster in Guadalupe y Calvo, located in southern Chihuahua.
CORRECTION: The second cluster is in the capital Chihuahua, and the title has bee changed to reflect this translation error.
This clustering in time and space of a novel sub-clade with D225N contradicts the CDC and WHO working hypothesis that D225G and D225N are “spontaneous mutations” that do not transmit. The WHO made this claim for D225G and the CDC noted a change in PB2, K340N, which was present in the sub-clade circulating in Ukraine and Russia in 2009. However, the Chihuahua sub-clade is distinct and the PB2 from from two of the five closely related Chihuahua sub-clade in the United States did not have K340N, casting further doubt on the WHO and CDC analysis and conclusions.
Release of the additional sequences with D225N would be useful.