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H1N1pdm09 Confirmed Again In Montgomery Co Texas
Recombinomics Commentary 23:45
December 19, 2013

As of Thursday afternoon, one additional case of H1N1 has been confirmed in Montgomery County. This patient is currently in an area hospital receiving treatment. Labs are being repeated on all remaining cases by the CDC. There are currently two confirmed H1N1 cases in Montgomery County.

The above comments are from the latest of three press releases from the Montgomery County Public Health District in Conroe, Texas.  Yesterday’s release announced the first lab confirmation of cases in a cluster described in the first press release.  That cluster included 8 individuals (between ages of 41-68) who had been hospitalized at the Conroe Regional Medical Center (see map).  Four had died and all had textbook H1N1pdm09 symptoms, but had tested negative on a rapid test (which has a notoriously low sensitivity, especially for H1N1pdm09 cases).

The samples from the clusters were subsequently sent to the CDC, where H1N1pdm09 confirmation and sequencing is expected.  The lab confirmation yesterday was followed by media reports noting that the working definition was H1N1pdm09 infections for all eight cases in the original cluster, as well as additional cases in other area hospitals.

The latest press release confirms that an additional case is H1N1pdm09 infected, and media reports note that there are now six recent deaths that are assumed to be H1N1pdm09 cases, as well as 14 critical cases.

These recent events highlight the limitations of the rapid tests and area doctors have been instructed to treat symptomatic patients as H1N1pdm09 cases, even if the rapid test is negative.  Texas leads the nation in ILI cases with an intensity level of 10 on a scale of 10.

These deaths raise concerns that the 2013/2014 flu season in the United States will have striking similarities to the 2009 pandemic.  Although the sequence of events in 2013 is slightly later than the fall of 2009, the spiking of cases in the south in December is similar to the August southern spike in 2009.

H1N1pdm09 confirmation of the fatal cases, and associate sequence data will be useful.  To date only one Texas H1N1pdm09 sequence has been released from the 2013/14 season and H274Y has been detected in four cases in Louisiana, raising Tamuflu resistance concerns.  The death toll also raises concerns for D225G, which was disproportionately present in severe/fatal H1N1pdm09 cases in 2009.

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