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CDC Issues H1N1 Advisory
Recombinomics Commentary 20:30
December 25, 2013

While CDC has not detected any significant changes in pH1N1 viruses that would suggest increased virulence or transmissibility, the agency is continuing to monitor for antigenic and genetic changes in circulating viruses, as well as watching morbidity and mortality surveillance systems that might indicate increased severity from pH1N1 virus infection.

The above comments from the December 24 CDC H1N1 Health Advisory suggests the sequences from the recent cluster in Conroe or the confirmed cases in the greater Houston area are similar to the H1N1 sequences which have been recently released by the CDC.

The advisory follows the December 20 alert by the Texas Department of Health, as suggested.  The Texas alert was largely in response to media reports of a mystery illness in Conroe Texas involving 8 cases with textbook swine flu symptoms who tested negative on a rapid test, which may have delayed treatment.  Four of the cases died, so the Texas and CDC releases instruct physicians to treat patients based on the symptoms and condition rather than rapid test results and they should not delay treatment due to pending re-test results.

To date, the CDC has released one set of sequences,
A/Texas/36/2013, from a Texas case infected this season.  The severity of a subset of cases in eastern Texas has raised concerns that the sequences have receptor binding domain changes, such as D225G or D225N, which was predicted for severe and fatal cases in Ukraine in November, 2009.  These changes were subsequently identified in severe and fatal cases in other countries, although the CDC noted the early appearance of these changes in milder cases in the spring of 2009.

D225G has not been seen in any US cases this season, but was present in an August collection in Utah (A/Utah/08/2013) as well as two Florida cases with June collection dates (A/Florida/13/2013 and A/Florida/16/2013).  Therefore, release of sequences from severe of fatal H1N1 cases in Texas, as well as Florida, or other areas would be useful.

Similarly, oseltamivir resistance (H274Y) has been seen in four cases in Louisiana
(A/Louisiana/07/2013, A/Louisiana/08/2013, A/Louisiana/10/2013, A/Louisiana/13/2013) as well as a case in Mississippi, A/Mississippi/11/2013, and Utah, A/Utah/10/2013, which is a concern given the proximity to eastern Texas as well as anecdotal reports of resistance in Texas.  H274Y would seriously impact the utility of Tamiflu treatment.

Therefore, the immediate release of sequences from late November and early December would be useful.

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