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Commentary
Mexico Initiates H1N1 ICU Training Courses
Recombinomics
Commentary 02:15
April 10, 2011
Inaugurating the course, Dr. Angel Villaseñor Benavides, director general of Chihuahua Health Services said the Ministry of Health acted immediately and according to the protocol to control the outbreak that began in Ciudad Juarez.
The above translation describes the initiation of training courses on ICU care of H1N1 patients based the lessons learned from the Chihuahua outbreak. This training is in response to the rapid spread of severe and fatal H1N1 cases throughout Mexico. A red alert was issued for another northern state, Tamaulipas, due to the report of 120 patients with H1N1 symptoms.
The recently released sequences from three patients, including two fatal cases, signaled transmission of D225N on a novel H1N1 genetic background. This novel sub-clade was also reported in vaccinated patients in New Jersey and Arizona, earlier this year. The current distribution of this sub-clade in the United States is unclear because 2011 H1N1 sequences have been withheld by the CDC.
However, multiple countries in Central and South America, including Honduras, El Salvador, and Venezuela have reported recent increases in H1N1 activity, and anecdotal reports indicate the novel sub-clade has spread beyond the countries listed above, and the frequency of D225N is uncommonly high.
These outbreaks are happening at the end of the 2010/2011 flu season for the northern hemisphere, and prior to the start of the 2011 flu season for the summer hemisphere, as was seen for the spread of the pandemic H1N1 in 2009.
Release of sequences from the above and neighboring countries is overdue. The three sequences from Chihuahua define an emerging novel sub-clade with receptor binding domain changes A189T and D225N, as well as the acquisition of a new glycosylation site due to S165N.
In addition more detail on the clinical and epidemiological aspects of this expanding and alarming outbreak would be useful.
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