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Fatal H1N1 In Young UK Adults Raise Pandemic Concerns
Recombinomics Commentary 21:45
December 10, 2010

The 10 people who have died were all adults under 65 and most, but not all, had some underlying health conditions, the Health Protection Agency said.

Experts today expressed surprise at the number of deaths caused by the H1N1 virus this winter.

But crucially the bug has not mutated into a more severe form or targeted the elderly who are most at risk from the virus.

However there have been a significant number of calls to NHS Direct - indicating there is quite a lot of swine flu around.

Pressure has been building on intensive care in recent days with the worst affected patients treated on Extra-Corporeal Membrane Oxygenation (ECMO) machines which bypass the lungs to artificially oxygenate the blood. "A good many intensive care units are seeing severely ill cases including some using ECMO beds," Dr Watson said.

The above comments note the recent increase in H1N1 deaths in previously healthy young adults in the United Kingdom.  This resurgence of severe disease in young adults was not predicted when the WHO declared an end to the pandemic phase of the 2009 outbreak.  There had been a lull in cases over the summer, and predictions were made that the virus would become more like seasonal flu and target the elderly.  However, this prediction was based more on wishful thinking than real science, and this season the main target of H1N1 is again younger adult patients.

A recent report on fatal cases from last season noted that previously healthy young adults were dying because of a robust immune system.  Poorly matched H3N2 antibodies were failing to clear the H1N1, leading to a more vigorous immune response which led to the destruction of lung tissues and death.

Last season Mill Hill declared an D225G positive isolate from Ukraine, A/Lviv/N6/2009,  a “low reactor” raising concerns that the frequency of H1N1 with D225G would increase this season, leading to more deaths in young patients, since many would have antibodies to the wild type H1N1, eliminating competition which would lead to a higher frequency of H1N1.

A small change in the percentage of patients with D225G could have a dramatic effect on health care delivery, because as noted above the severe cases require ECMO machines, which could quickly be in short supply if a new wave of severe cases appears.

The levels of H1N1 are just beginning to increase in many countries, although the UK may be leading the wave in western Europe.  There are reports of increases in eastern Europe, including Ukraine, raising additional concerns of a more severe pandemic, WHO proclamations notwithstanding.

Release of sequences from these more severe cases in the UK as well as Ukraine and Russia, were D225G was widespread last season, would be useful.

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