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Paradigm Shift Intervention Monitoring
"Currently there is no case of H1N1
locally," Dlamini said. He said the 22 suspected cases are all people
who visited or met a man from Pretoria with the virus. "The man was
infected and eventually died in South Africa."
The above comments are associated with a H1N1 alert issued by Swaziland, which is just east of Pretoria in South Africa. The linkage of 22 symptomatic patients to one case signals efficient transmission, raising concerns that this sub-clade is highly infectious and virulent.
Recent media reports have described two fatal cases in the Pretoria/Johannesburg area. One case (58M), who resides in Cape Town, developed symptoms when flying from Turkey to Johannesburg. Another patient (27M) was reported to have died in the same South African hospital from H1N1.
Sequences from Iraq and Iran identified a rapidly spreading sub-clade in circulation in the Middle East in early 2011. This sub-clade was also circulating in Singapore and Australia after it acquired S246N, an NA polymorphism which conferred resistance to Tamiflu (oseltamivir), and Relenza (zinamivir) and synergized with H274Y.
Sequence data on H1N1 linked to the two recent fatal cases in South Africa would be useful.