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Paradigm Shift Intervention Monitoring
The Pneumonia and Influenza
(P&I) death rate in week 16 in the United States has increased to
7.98% (which will be reported in tomorrow’s FluView) marking the 13th
consecutive week when the rate is at or above the epidemic
threshold. This increase is at a time of the year when lab
confirmed influenza cases in the US have been in sharp decline (see
graph below), raising concerns that an H1N1 variant has emerged,
leading to more severe and fatal cases.
The Pan American Health Organization (WHO’s agency for North and South America) has issued a 2011 H1N1 pandemic alert and requested member countries to activate their "National Preparedness Plans for the pandemic" due to H1N1 generated "significant demands on health services" in multiple countries. The cited outbreaks in Ecuador, Mexico, and Venezuela match public and anecdotal reports of a novel Chihuahua sub-clade with receptor binding domain change D225N, which was associated with severe and fatal H1N1 cases.
The outbreak in Chihuahua, Mexico was cited in the April 6 report, began with the deaths of two Juarez traffic patrol officers (26M and 36M) who were partners. To date 2 of the 11 public sequences from this sub-clade in Chihuahua have D225N, but anecdotal reports cite five additional sequences which have been withheld.
This sub-clade has also appeared in the United States, including Texas (A/Texas/07/2011). In El Paso, which is across the border from Juarez, 8 more P&I deaths were reported for week 16, bringing the three week total to 51 deaths, the highest three week total reported at the CDC website for the 15 year data for the 122 reporting cities in the US, which includes El Paso.
In El Paso, as well as the entire country, lab confirmed cases of influenza have been in sharp decline since peaking in February as seen in the national graph below, through week 15.
The increasing and persistent high levels of P&I deaths, especially in the past several weeks when lab confirmed influenza cases approached baseline, continues to raise concerns regarding an emerging H1N1 variant and an associated high frequency of severe and fatal cases such as those associated with the Chihuahua sub-clade with D225N.
Release of D225N positive sequences from Chihuahua, Mexico is overdue, as are H1N1 sequences from severe and fatal cases in the United States, Ecuador, and Venezuela.