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Alarming H1N1 Case Fatality Rates In India
Recombinomics Commentary 20:40
July 30, 2010

Recently released fatality rates for 2010 lab confirmed pandemic H1N1 cases in India include many states with double digits fatality rates (CFRs) among lab confirmed cases.  The largest number of deaths (261) was in Maharashtra, which had a rate of 11.3%, but Gujarat had a rate of 21.4% (194/905) while Madhya Pradesh was at 40.1%.  The highest rate was 60% (9/15) in Chhattisgarh.  The 2010 rate for the entire country was 8.4%.  In 2009 the rate was 3.7% for the entire country.

Media reports have indicated that many cases were in rural areas with delayed treatment.  However rates of 20-60% are alarming and raise concerns of genetic changes.  Initial reports mention a mutation in fatal cases, which almost certainly refers to D225G.  However, more recent media reports have mentioned mutations (plural), raising concerns that other changes, such as PB1 E627K may also be more widespread than initial reports last season.  A recent report described a H1N1 fatal/severe cluster.

More detail on these fatal cases and associated sequence data would be useful.

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