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Belarus H1N1 Deaths Raise Concerns
Recombinomics Commentary 16:43
November 3, 2009

The first Belarusian death from swine flu was registered by health officials on Tuesday. The victim, a 37-year-old female resident of the town of Drogichin, died on Friday, but results of blood tests confirming the presence of the H1N1 virus only became available Tuesday, said Oleg Arnautov, chief doctor of the western Brest province.

The woman reportedly had visited Ukraine's western Kovel region, currently near the centre of Ukraine's flu outbreak, in early October.

In recent weeks, the Belarusian capital Minsk has seen an estimated 10 deaths of persons suffering from pneumonia preceded by flu-like symptoms. Public health workers were working to identify the virus causing the illnesses.

The above translation describes the first confirmed H1N1 fatality in Belarus, as well as ten more likely swine flu deaths in Minsk.  These deaths are not surprising. Although Belarus has acknowledged 59 confirmed pandemic H1N1 cases, the flu activity is characterized as widespread, and over 99% of influenza A in Europe is swine flu.

The outbreak in western Ukraine (see map) has raised concerns that transmission and virulence has increased.  The number of cases may be related to seasonal weather changes.  Flu Trends shows that the Ukraine has historically had a jump in cases at this time of year, presumably linked to colder weather and availability or lack thereof of heat for homes.  Since virtually all flu in Europe at this time is swine flu, this jump in flu cases would create a jump in swine flu cases.  Moreover, the spike this year is markedly higher than prior years, which could explain the increases in hospitalizations and deaths. 

However, the hospitalization of more than 15,000 raises concerns that the death toll could increase dramatically.  Today's government update has been delayed, but a local media report on Lviv described a sharp increase in cases to 104,019 and an increase in fatalities from 30 to 37.

The above reports of fatalities in neighboring Belarus raises concerns that there are also significant numbers of hospitalized and fatal cases there.  There have been some efforts of limiting border crossings out of Ukraine, but it seems likely that the H1N1 associated with these fatal cases has already spread throughout the region.

Sequence data on isolates from fatal cases in the Ukraine and Belarus would be useful.

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