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H1N1 Cluster in Buffalo
New York Raises
June 22, 2009
Davis was an eighth grader at Harvey
Austin School 97 on Sycamore Street.
News 4 talked to the
15-year-old's mother Lucretia Belton. Matthew attended Harvey Austin
His mother said
complications from swine flu included pneumonia and MRSA.
She said his kidneys were
failing, and he was being kept alive by machines.
A nine-year-old girl is also
at Women and Children's Hospital with the H1N1 virus.
She's a fourth grader at
Charles Drew Science Magnet School 59's museum campus.
The above comments describe two students of magnet schools in Buffalo,
NY that are a mile apart (see updated
map). Both students were on life support yesterday, and the
middle school student (15) died after life support was withdrawn.
The elementary school student (9F) remains on life support. The
clustering of two critically ill students raises concerns about the
emergence of a more lethal strain of Pandemic H1N1.
The two serious cases may simply reflect the high level of H1N1
infections in the area. 37 Buffalo area zip codes have registered
at least one confirmed H1N1 case (see
map and list below). Moreover adjacent Niagara County
announced clusters of cases in two elementary schools, and clusters
were also described for Hamilton Ontario, just across the border from
Buffalo and Niagara county (see map).
Moreover, H1N1 has been widespread in
the Halton area, where infections have been confirmed in more than 30
schools in Oakville.
However, the state agency and media reports do not describe any
pre-existing conditions for either student and these two cases follow
two announcements by the city of New York of 14 deaths in May.
Seven were announced on Tuesday, and seven more were announce on
Friday, but these announcements lacked detail. All had died in
May and all were between the ages of 25-64. However, there was no
additional information and no mention of pre-existing conditions.
The significance of the failure to mention pre-existing remains
unclear. Many of the prior death were said to have pre-existing
conditions, but there was little evidence pointing to a strong role of
these conditions in the deaths. In Mexico, most of the fatalities
were in young adults who did not have pre-existing conditions.
Although reports of US cases have stated that 70% of fatalities had
pre-existing conditions, it remains unclear if such figures include the
14 cases announced by NYC or other cases that have been confirmed but
Recent comments in press conferences by WHO and the CDC have added to
the uncertainty. At the WHO press release introductory remarks
by Kieji Fukuda
cited 249 deaths worldwide, which raised questions, since the official
tally at the time was only 140 deaths. Last week at the CDC press
conference, opening remarks
by Dan Jerrnigan indicated that 40% of the fatal cases had
pre-existing conditions, which was much lower than the 70% cited for
the released cases. In both instances the press conference
transcript was edited to reflect the numbers for the released
cases. However, the delay in the acknowledgement of the cases in
New York raises concerns that the higher number of fatal cases and the
lower percentage of cases with pre-existing condition reflects the
current number of confirmed cases, which includes a high percentage of
fatal cases without pre-existing conditions.
The clustering of the critical cases in Buffalo raises concerns of a
Pandemic strain that is evolving and becoming more lethal. The
2009 Pandemic is tracking with the 1918 Pandemic, which produce mild
disease in the spring, and was more lethal in the fall when previously
healthy young adults.
One such change that could increase lethality is PB2 E627K. This
polymorphism is present in seasonal influenza A, including the 1918
pandemic strain. It allows for optimal replication at lower
temperatures, which may lead to a more transmissible and lethal
Pandemic strain. This change has been reported
for an isolate
from Shanghai from a patient (22F) who recovered. The collection
date, location, age and gender, suggests that the isolate came from a
Chinese national who was a student in the US and flew to Shanghai on a
flight that originated in New York with a lay-over in Hong Kong.
Thus, the virus could have originated in New York, Hong Kong, or
Shanghai, since the student developed symptoms shortly after arriving
in Shanghai. The sequencers in China promptly released full
sequences on all eight gene segments, and sequenced a clone to confirm
that the E627K was not a sequencing error. The sequence of the clone
exactly matched the original sequence.
However, this change may not offer much advantage at this time of the
year in the northern hemisphere, but the change could appear in the
southern hemisphere or could signal a change that is more widespread
and circulating in the Hong Kong area. In any event, the presence
of E627K in pandemic H1N1 strongly suggests that it will emerge in the
fall, which is cause for concern.
The Buffalo cluster however raises concerns of additional changes, so
sequencing of the isolate from the fatally infected middle school
student would be useful.
Buffalo Area Zip
Codes with at least 1 confirmed H1N1 case
at Nature Precedings