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 Post subject: New H1N1 Pandemic Wave
PostPosted: Fri Apr 01, 2011 4:48 pm 
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As news continues to come out of Mexico, it is becoming increasingly clear that a new H1N1 pandemic wave has begun.

The 2011 outbreak parallels to 2009 outbreak. Initial cases were characterized as atypical pneumonia and H1N1 confirmation was problematic. Therefore, the confirmed H1N1 cases currently being reported represent a small subset of severe and fatal cases.

The changes will be obvious when the sequences are released. Current US sequences have been withheld, and sequences from Mexico and Venezuela are still being analyzed.

I have started this thread to discuss the related news and issues.

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PostPosted: Fri Apr 01, 2011 4:59 pm 
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Media in Mexico is beginning to mention genetic changes

"Well I think that the outbreak of epidemic type we had in 2009 left us much (...), the principal is not to be complacent, because this is a condition of acquiring epidemiological impact levels may have a rapid evolution. "

http://dk1250.com/local/30272-increment ... exico.html

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PostPosted: Fri Apr 01, 2011 5:01 pm 
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Hiigh frequency of severe and fatal cases:

The official reported that 17 of these cases have tested positive for H1N1 influenza virus, 9 of which have occurred in Ciudad Juárez and 8 more in the city of Chihuahua, while 21 cases tested negative.

As a result cases are 17 pending cases that are being analyzed while in 25 cases it has not taken the sample must be sent to the laboratory.

Of the 80 total cases these belong to 38 women and 42 men, 4 are in people 15 to 24 years of age, 8 of 25 to 44 years and 5 cases of people aged 45 to 64 years of age.


http://translate.google.com/translate?h ... rmd%3Divns

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PostPosted: Fri Apr 01, 2011 5:02 pm 
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Clustering of severe and fatal cases at traffic station:

Corners, head of the Sanitary District, announced that it raised the rate of people with human influenza virus H1N1 positive nine people, including also became known unofficially as 3 elements of the Municipal Traffic Division are hospitalized due to be infected the virus, while it was mentioned that one of them is in intensive care fighting for his life.

It should be noted that the information unofficially, he explained that the three elements, besides the two who lost their lives, are assigned to East Station.


http://www.oem.com.mx/elmexicano/notas/n2024991.htm

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PostPosted: Fri Apr 01, 2011 5:08 pm 
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Approaching Mexico City:

The Mexican state of Puebla, east of the capital, three cases of influenza A H1N1, officials said.

Chedraui Jorge Aguilar, head of the state Health Department confirmed the cases as part of a resurgence of the disease.


http://espanol.upi.com/Noticias-destaca ... 301630742/

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PostPosted: Fri Apr 01, 2011 5:18 pm 
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I've been pouring over the isolates data from State websites since the beginning of the year. I have noticed that in some states, mostly on the east coast, a certain percentage of samples have been identified as pH1N1 and that it has been co-circulating with Flu B and H3N2 since early in the season. In these states, severe cases and deaths have been low. Even in North Carolina, where they had a number of deaths (an unusually high number of pediatric deaths), many of those deaths were attributed to Flu B and H3N2. Some deaths were attributed to pH1N1 and, based on the isolates data, it was the dominant strain; however, they have experienced the classic peak and flu season appears to be over there, just like in Mexico. I suspect that the strain circulating in NC is closer to A/California/7/2009.

Also, although Ontario had a bad flu season (with over 175 fatalities), when you look at the age range of fatalities, it has a seasonal flu signature - high on the ends and low in the middle. Then, if you look at the isolates data, Ontario has had very little pH1N1.

There have been some anomalies, though. We've been discussing the outbreak in the Pittsburg area (and Pennsylvania still hasn't posted Week 12 results). There have also been 20 fatalities each in LA and San Diego Counties. Furthermore, Texas has reported the highest number of pediatric deaths this season (13), which is nearly one-third the total they experienced in the 2009-10 season (47). From April 2009 through August 2010 they had, by far, the largest number of pediatric deaths per capita (54 deaths, or 2.1 deaths per million); only second behind California (57) in the actual number of pediatric deaths. So, based solely on the number of pediatric deaths and the fact that most (9 deaths) occurred recently (in Weeks 7 through 10), we should suspect that something is up in Texas.

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PostPosted: Fri Apr 01, 2011 5:26 pm 
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Jim wrote:
I've been pouring over the isolates data from State websites since the beginning of the year. I have noticed that in some states, mostly on the east coast, a certain percentage of samples have been identified as pH1N1 and that it has been co-circulating with Flu B and H3N2 since early in the season. In these states, severe cases and deaths have been low. Even in North Carolina, where they had a number of deaths (an unusually high number of pediatric deaths), many of those deaths were attributed to Flu B and H3N2. Some deaths were attributed to pH1N1 and, based on the isolates data, it was the dominant strain; however, they have experienced the classic peak and flu season appears to be over there, just like in Mexico. I suspect that the strain circulating in NC is closer to A/California/7/2009.

Also, although Ontario had a bad flu season (with over 175 fatalities), when you look at the age range of fatalities, it has a seasonal flu signature - high on the ends and low in the middle. Then, if you look at the isolates data, Ontario has had very little pH1N1.

There have been some anomalies, though. We've been discussing the outbreak in the Pittsburg area (and Pennsylvania still hasn't posted Week 12 results). There have also been 20 fatalities each in LA and San Diego Counties. Furthermore, Texas has reported the highest number of pediatric deaths this season (13), which is nearly one-third the total they experienced in the 2009-10 season (47). From April 2009 through August 2010 they had, by far, the largest number of pediatric deaths per capita (54 deaths, or 2.1 deaths per million); only second behind California (57) in the actual number of pediatric deaths. So, based solely on the number of pediatric deaths and the fact that most (9 deaths) occurred recently (in Weeks 7 through 10), we should suspect that something is up in Texas.

Yes, I think it is a bit trickier to see activity in the US because of other viruses, including the more standard pH1N1.

I think the new sequences will be quite obvious however, which is why I am very suspicious of the delay in release by the CDC. They usually release H1N1, H3N2, and influenza B in three sets within a day or two of each other. H3N2 and influenza B were released over a week ago, but no H1N1.

Rumor has it that sequences from Mexico will be released next week, and the problems will be quite clear.

Until the sequences come out, I think most of the analysis will be indirect, as you have done above.

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PostPosted: Fri Apr 01, 2011 5:35 pm 
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I also think that the high number of influenza A but unsubtyped is odd, especially for pediatric deaths. As you know pediatic deaths are beginning to climb (12 reported this week on a delayed basis) and the failure to identify the "influenza A" as H1N1 or H3N2 is odd. There has also been a record number of trH3N2 cases for 2010, which has also been on a delayed basis.

Right now the P&I death rate has been at or above the epidemic threshold for 9 weeks, yet the pandemic target was unchanged. For H1N1, leaving the target unchanged would make sense if a new and different H1N1 has emerged because the new sequences have not been made public.

The CDC's failure to release H1N1 sequences since February 2 continues to remain suspect.

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PostPosted: Fri Apr 01, 2011 5:43 pm 
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Image
A child wears a face mask while visiting a relative at a jail in Ciudad Juarez March 29, 2011. Local health authorities have reported the reappearance of the influenza A (H1N1) virus, or swine flu, in the state of Chihuahua.

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PostPosted: Fri Apr 01, 2011 5:47 pm 
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Image
A man receives a dose of influenza A (H1N1) vaccine in a jail in Ciudad Juarez March 29, 2011. Local health authorities have reported the reappearanceof the influenza A (H1N1) virus, or swine flu, in the state of Chihuahua.

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