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Paradigm Shift Intervention Monitoring
After confirmation of the death of a
policeman and stay in intensive care at least eight people in this
population, the Health Ministry issued a warning of a new outbreak of
influenza A/H1N1 in the states of Veracruz, Chiapas, Campeche, Nuevo
León, Oaxaca and Chihuahua, among others, and confirmed that
there are more than 240 cases.
The above translation notes the number of severe and fatal cases and extends the warning to multiple states throughout Mexico where over 240 cases have been confirmed. This warning comes almost exactly 2 years after similar warnings were issued for severe and fatal pneumonia cases which were diagnosed as atypical pneumonia, due in part to difficulties in sub-typing the virus. The target population was previously healthy young adults in both outbreaks, and flu vaccinations were recommended.
In 2009, the sub-typing difficulties were due to a lack of reactivity with human sub-typing reagents because the H1N1 was of swine origin. In 2011, these difficulties are likely linked to further evolution which lowered sensitivity of current reagents and raised concerns that the current vaccines may have limited effect. Moreover, the recent report of a cluster of Tamiflu resistant H1N1 in Delaware, raises concerns that H1N1 with H274Y is now efficiently transmitting.
The rapid spread of the H1N1, which has generated sub-typing issues and severe illness, requires sequencing of isolates from these severe cases. The report that on of the cases came from El Paso, Texas raises concerns that similar changes are also widespread in the United States. The most recent H1N1 sequences from the United States were released by the CDC on February 2. This week 2011 H3N2 and influenza B sequences were released. A similar release of 2011 H1N1 is overdue.
More detail on patients in the additional states in Mexico, as well as sequences from the more severe and fatal cases would be useful