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Commentary
UK
H1N1 Death Undercount Raises Pandemic Concerns
Recombinomics
Commentary 17:30
January 10, 2011
"We all spent a nice family Christmas together at my sister's, and the last time we were all together was Boxing Day. I remember him saying he had flu-like symptoms, but he thought it was just a chest infection and didn't bother going to the doctors.
A post-mortem examination has taken place and he is understood to have died from natural causes. It is believed he was suffering from pneumonia.
The above comments describe another likely H1N1 death that is not included in the official HPA number, which has the H1N1 death toll at 45 as of January 5, 2011, a number without credibility.
The above case is a classical H1N1 fatality involving an adult under 65 who develops flu-like symptoms followed by pneumonia and death. In the above case the victim died without see a doctor or receiving treatment, which is not unusual. That is why seasonal flu deaths are extrapolated numbers. Most deaths are in patients over 65 who are not tested and frequently are not hospitalized. In contrast, and official H1N1 requires lab confirmation as well as a declaration that the death was caused by H1N1. These requirements greatly reduce the number of confirmed and reported H1N1 cases, which helps to create a low number like the most recent report by they HPA.
Those weekly reports not only grossly under-report the number of H1N1 deaths, but now they are selectively releasing the data on patients with underlying conditions and creating ratios that are quite different than the initial reports. The latest numbers create statistics that are more in line with agency comments on vaccinations, which are recommended for at risk groups, and ignore the large percentage of H1N1 in previously healthy young adults.
These young adults have filled up the ICU beds and maxed out ECMO machine usage. The vast majority have not been vaccinated, but the latest sequence data suggests that the newly emerging H1N1 will generate vaccination breakthrough and will be able to infect those who were vaccinated or infected last season.
The latest sequence data demonstrate two receptor binding domain changes in 36 of the 41 sequences. 22 of the HA sequences have S188T, while 14 more have S186P. These changes are adjacent to positions targeted by seasonal H1N1 when H274Y was fixed in 2009. In those sequences virtually all had A193T plus at least one additional change at positions 187 (N187S or N187D), 189 (G189A, G189N, G189S, G189V) or 196 (H196H, H196N), which created vaccine breakthroughs. Thus, the high frequency of changes in the UK at positions 186 and 188 indicate a similar immunological escape strategy is in place for pandemic H1N1.
Two changes in pandemic H1N1 have severely taxed the UK health care delivery system, and more genetic changes in pandemic H1N1 are likely. The reaction of the HPA to these changes is to reduce transparency by reporting significant undercounts in cases and imposing a media gag order on additional cases. Moreover, they withhold key demographic data from the scientific community, without real justification.
It is time for increased transparency in reports on H1N1 deaths and sequences. The current policy of withholding data and publishing partial data which lacks credibility is hazardous to the world’s health.
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