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Paradigm Shift Intervention Monitoring
Additionally, we are learning that some
cases in this group were previously vaccinated.
The above comments regarding the Chihuahua sub-clade are from the Air Force week 16 infuenza report, and further supports comments made at the 2011/2012 vaccine advisory committee meeting, as well as sequences previously released b the Air Force from vaccinated hosts.
These comments increase concerns that the failure of the CDC to identify low reactors in this sub-clade is tied into their heavily biased antigen characterization assay, which has only identified 7 H1N1 low reactors in the past two seasons.
The Chihuahua sub-clade has a newly acquired gylcosylation site due to S165N, as well as a receptor binding domain change, A189T, which is at a position implicated in immunological escape of seasonal H1N1 in the 2009/2010 season.
The vaccine breakthrough raises serious concerns regarding the emerging sub-clade, which contributed to the pandemic alert. Moreover, the high frequency detection of D225N in severe and fatal cases increases those concerns.
The number of fatalities is rising in Chihuahua, Mexico and recent media reports describe the death of a social activist who was not included in the confirmed H1N1 fatalities in Chihuahua. This death increases concerns that the number of H1N1 fatalities in Mexico is markedly higher than the 5 cases in Chihuahua or 8 cases in Juarez.
Similarly, the close similarity between sequences in the United States and Mexico suggests that severe and fatal cases in the United States also have D225N.
Release of the sequences in Mexico with D225N, as well as additional examples in North and South America, would be useful.