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Paradigm Shift Intervention Monitoring
The week 23 Pneumonia and
Influenza (P&I) deaths for El
Paso, Texas set another
weekly record. The 11 deaths raised the total for the past 10
weeks to 127. In the past 10 weeks, record levels were reported
for weeks 14, 15, 18, 19, 20, 21, 22 and 23. Thus, even though
23 is three weeks
after the official end of the 2010/2011 flu season for the northern
hemisphere, deaths in El Paso remain at record double digit levels. The
P&I death rate for these ten weeks continues at a rate that is
above 12%, which is more than 1.5 times the national epidemic threshold
for the period.
The spike in deaths began in week 14, when the 19 reported deaths were 1 death shy of the weekly record reported for El Paso in the past 15 years at the CDC website, which maintains the weekly data fro the top 122 cities in the US over the past 15 years. The record of 20 was broken in week 15, when 24 deaths were reported. The numbers declined in weeks 16 and 17, but a new weekly record has been set for each of the past 5 weeks, even though lab confirmed cases have steadily declined to baseline levels as the flu season ended.
The record number of P&I deaths in El Paso has not been addressed by local or national agencies and these high levels are not reflected in lab confirmed cases raising concerns that the sampling and associated testing grossly under estimates the number of influenza deaths, particularly for H1N1. In the past 10 weeks the number of deaths in the 25-64 age group has been over represented, providing additional data linking the spike in deaths to unreported / undetected H1N1 infections, consistent with the linkage between the start of the increases and the outbreak of Chihuahua H1N1 across the border in Juarez, Mexico.
This outbreak lead to a pandemic alert, and the above data suggests that the cases are grossly under represented by the lab confirmed numbers. The pandemic alert was linked to the detection of the D225N receptor binding domain (RBD) change in the upper respiratory tract of severe and fatal cases, but sequences demonstrating a high frequency of D225N in Chihuahua have been withheld.
The withholding of these sequences, and the lack of comment on the record number of deaths in El Paso, continue to raise pandemic concerns.
Recently Swaziland has issued an H1N1 alert associated with 22 sympyomatic contacts of a fatal South African case. There have been two recent reports of H1N1 deaths in the Johannesburg Arrea (58M and 27M). One of these patients had arrived from Turkey. it is unclear if the H1N1 in Swaziland and South Africa is linked to the Chihuahua sub-clade in Mixico and South America, or is related to the sub-clade circulating in Singapore and Australia (which had also been circulating in Europe and the Middle East).
The record high number of P&I deaths in El Paso, as well as the increase in the US P&I rate to 7.20% in week 23, which is above the epidemic threshold, raises concerns that the dramatic spread of more virulent H1N1 will continue.