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They were on a flight from Istanbul to
Joburg on May 18 when his condition worsened: “By the time we landed in
Joburg, he was so ill that he couldn’t even stand up. His chest was so
tight that he struggled to breathe,” his wife said.
She said that while her husband was being treated at the second hospital, a 27-year-old man had also died of swine flu-related complications.
The above comments describe two fatal H1N1 infections in a hospital in Pretoria/Johannesburg early in the flu season in the southern hemisphere. Since the first patient recovered prior to relapse and death it is unclead if the death was linked to the H1N1 in Turkey or a local H1N1 that was acquired at the hospital.
Similarly the relationship of the H1N1 in South Africa to the Chihuahua sub-clade in South America, or the Tamiflu/Relenza resistant H1N1 in Australia is unclear. Both sub-clades are rapidly spreading in the southern hemisphere and the Chihuahua sub-clade is associated with more severe outcomes inked to D225N. The sub-clade in Australia also has changes near the receptor binding domain (R208K, I219V), which may contribute to immunological escape and/or virulence.
One or both of the fatal cases appear to be linked to the 22 symptomatic contacts that precipitated the H1N1 alert issued by Swaziland.
Release of sequences and epidemiology associated with the fatal cases in South Africa would be useful.