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UK ECMO Shortfalls Raise H1N1 Concerns
Recombinomics Commentary 07:20
December 22, 2010

The latest official figures show there were 302 people being treated in intensive care with "confirmed or suspected influenza" compared with 180 at the height of the 2009-10 pandemic. Most of those in hospital were suffering from H1N1 swine flu, officials said.

The above comments begin to demonstrate the magnitude and potential impact of the spike in severe and fatal H1N1 cases in the UK.  Many, if not most, of these ICU patients will require an ECMO machine to oxygenate their blood, and such machines are in short supply.  Last season at least one patient was transported out of the country for ECMO treatment because of the shortage, and the numbers above indicate the potential for a far greater crisis this season, which is just beginning.

The spike in ICU cases has been sharp.  Last week’s HPA report cited 100 cases, which have now more than tripled in 10 days, with little indication that the rate is slowing.  Warnings of spread into the rest of Europe have been sounded, and Spain has already noted a similar trend, including a high percentage of patients without underlying conditions.

Last season the vast majority of severe and fatal cases had underlying conditions, which were broadly defined and included obesity, diabetes, asthma, and pregnancy, which covered a significant percentage of the population.  However, this season less than half of the severe and fatal cases have the broadly defined underlying conditions.

Thus, the at risk population is larger and the increase in cases has been quicker, threatening to significantly impact care for patients requiring an ECMO machine.  The lack of this treatment significantly impacts case fatally rates and leads to unnecessary deaths.

Recently released sequences do not contain D225G, which has been previously linked to severe and fatal cases especially in Ukraine and Russia.  Last season the level of D225G was low, raising concerns that an increased level could produce dramatic spikes in severe and fatal cases similar to the reports from the UK.  The sequences released thus far are from collections made prior to the December spike.

Initial media reports describe some clustering, such as severe and fatal cases in Bury in the Greater Manchester area, raising concerns that growth of such clusters would severe impact local health care delivery.

Sequences from isolates collected in these areas in December would be useful.

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