H1N1 Possible next wave?

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rocketgirl1's picture
rocketgirl1
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H1N1 Possible next wave?

We may be at the start of the next wave just as traditional flu season is beginning.

 

Spike In Severe H1N1 in Memphis Tennessee Children
Recombinomics Commentary 17:45
January 27, 2010

Doctors at Le Bonheur Children's Medical Center are on high alert tonight after a spike in the number of children with flu-like symptoms. Right now, they believe all cases to be the novel H1N1 swine flu virus.

"Over the past 3 weeks or so, we've had about 17 or 18 admissions to Le Bonheur with confirmed influenza. I should say that we believe all or almost all of these will prove to be the novel H1N1 influenza virus."

Infectious disease doctors believe its the only virus circulating in significant amounts in the community right now.

"I think 7 of the 17 or 18 have been admitted to the ICU. So that's a bit of a shift of what we saw before."

The above comments describe an increase in sever H1N1 cases in children in Tennessee.  The Children’s Medical Center (see map) had seen high numbers of patients in the fall, which led to the use of tents to cover the overload.  The current spike is well below earlier levels, but the frequency of cases admitted to the ICU is higher.

The increase in severe cases represents the concerns linked to the H1N1 evolution and increased reports of D225G/N, which have been tightly associated with severe and fatal cases.  In the fall, the number of exposed to H1N1 was high, leading to protective immunity and a sharp decline in cases.  However, there current is virtually no seasonal influenza A in circulation in the United States, but the traditional flu season is beginning, whicj will likely lead to emergence of a new swine H1N1 strain.  Mill Hill has reported a Ukraine isolate with D225G as a low reactor, raising concerns that immunity generated bu infection with wild type H1N1 or protection from the H1N1 killed vaccine will select for D225G/N variants, leading to a higher frequency of severe or fatal cases.

Consequently, the increase of ICU cases in Tennessee children is cause for concern.

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docmims
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Re: H1N1 Possible next wave?

Yes.  Now would be a prime time to a spike.  Curious how the pols and CDC aren't screaming about this after their fall failure..

rocketgirl1's picture
rocketgirl1
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Re: H1N1 Possible next wave?

US Wave 3 Start Confirmed By H1N1 Increases in Region 4
Recombinomics Commentary 23:03
February 05, 2010

Region 4: AL, FL, GA, KY, MS, NC, SC, TN;

The latest CDC report shows an overall rise (from 8.9% to 13%) in samples positive for H1N1 in Region 4 in the week 4 report, providing additional evidence for the start of wave 3 in the United States.  Earlier media reports had described increases in various states in region 4.  Le Boehner children’s hospital in Memphis had seen an increase in hospitalized patients and a high frequency were being admitted to the ICU, where at least 2 of the 7 died.  One was from MS while then other was from TN.  University of North Carolina hospital also reported an increase in confirmed H1N1 in college students, and the North Carolina website showed an increase in samples testing positive for H1N1 to 25%, the  highest level since mid-November when wave 2 was declining.

These sharp increases in region 4 raise concerns that these cases will spread.  Region 4 led the nation at the beginning of the fall wave, which largely followed school openings.  Many of the schools in region 4 opened in August.  The rise in positive patients in region 4 raises concerns that wav 3 will be more severe, with an associated increase in deaths.

Tamiflu resistant H1N1 with D225G/N was found in the Duke fatal cluster in October/November increased concerns for more fatalities. The three fatalities at Duke were in the same ward and infected with the same H1N1, which had H274Y in NA and Y223H in HA.

Release of sequences from the severe cases in TN and NC would be useful.

rocketgirl1's picture
rocketgirl1
Status: Silver Member (Offline)
Joined: Feb 11 2009
Posts: 230
Re: H1N1 Possible next wave?

Well, it's about 4 weeks after my predicted timeline but whose counting?  BTW, seasonal flu vaccine decisions for 2010 are being made right now and since there's about 75 million doses left over from this yrs. H1N1 why include current mutations in the new vaccine? says the CDC, in so many words.

More Signals On H1N1 Wave 3 Start in United States
Recombinomics Commentary 02:02
February 25, 2010

Some of the nation's emergency departments are noting increases in flu-like illness cases that appear to be pandemic H1N1, and colleges are reporting the first increase in flu-like illness since the end of November, but it's not clear if these are early signs of a third pandemic flu wave.

The American College of Emergency Physicians (ACEP) said today in a Twitter post that some of its members were anecdotally reporting a new wave of pandemic H1N1 patients coming to emergency departments and asked if other physicians were seeing similar patterns.

Carl Schultz, MD, professor of emergency medicine at the University of California at Irvine, told CIDRAP News that the increase in the number of influenza-like illnesses appears to be real, but he cautioned that many of the cases have not been confirmed as the pandemic H1N1 strain, because many departments stopped specifically testing for it because of low flu activity. Schultz chairs ACEP's disaster preparedness and response committee.

The above comments provide additional data that a third wave in the United States has begun.  Reports on flu at universities has increased 52% over last week, which is supported by anecdotal reports from emergency room physicians.  The largest number of new student cases was again in North Carolina.

These developments parallel the start of the fall wave.  The initial cases were in region 4 and this area has had the highest percent of samples being H1N1 positive.  Similarly, state reports showed recent increases in North Carolina and Alabama, while earlier reports describe more severe cases in hospitals in Tennessee and North Carolina.

The initial reports from region 4 may signal the emergence of a more evolved H1N1 since the time between the current outbreak and cases reported in the fall would be greatest.  A recent report on Allegheny County, location of metropolitan Pittsburgh found H1N1 antibody in 45% of patients age 10-17.  If this population is again being targeted, it is likely that there are re-infections and the new virus has escaped the immune response generated against the fall wave.

Recently released sequences from low reactors indicated that a single nucleotide change could move a sequence into the low reactor category, and recombination was creating new sequences with multiple low reactor polymorphisms, which if additive would lead to widespread vaccine failure and frequent infections of patients infected last year.

Sequence data on new cases, including severe and fatal cases would be useful, as would H1N1 history of these new patients.

 

 

 

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