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Paradigm Shift Intervention Monitoring
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Spike to 698 - One Day Total 23
The above update is the latest report from the Ukraine Ministry of Health. The increase of 23 dead in the past 24 hours is similar to the prior two days, bringing the three day total for this week to 65, which is similar to the rate at the beginning of the outbreak in October. The largest jump in the past 24 hours was in Donetsk, where the five fatalities raised the season total to 85 (see map). Although cases and deaths are decline across much of the northern hemisphere, the high death rate in Ukraine provides support for another wave of H1N1 in early 2010.
The high death rate also raises concerns about receptor binding domain changes. Sequences released from four fatal cases by Mill Hill had D225G. Two more sequences, released by the CDC had D225N and were also likely from fatal cases. Recent reports of D225G and D225N in the same patients raise concerns that both changes were in these patients and sample selection or virus isolation procedures led to detection of one of the two receptor binding domain changes.
However, the high death rate associate with either or both of these receptor binding domain changes raises concerns of the emergence of the changes at a higher frequency. Therefore, release of additional sequences from early as well as recent fatalities would be useful.