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Commentary
H1N1 Fatality Confirmed In El Paso Texas
Recombinomics
Commentary 13:40
April 24, 2011
The man was suffering from other conditions, but the cause of death was listed as "influenza pneumonia," said Armando Saldivar, spokesman for the city of El Paso Department of Public Health.
The number of reported cases has declined sharply in the past several weeks, officials said. In January, there were 357 reported cases; in February, 302 cases; in March, 136 cases; and so far in April, 18 cases.
H1N1 influenza, or swine flu, was listed as a secondary cause of death for a 76-year-old man who died in February, Saldivar said.
The above comments describe a recent H1N1 confirmed fatality in El Paso, Texas, consistent with the dramatic jump in Pneumonia and Influenza (P&I) deaths reported for El Paso in weeks 14 and 15. The 24 deaths reported for week 15 is the highest in the past 15 years. The CDC maintains a website with weekly totals for the past 15 years for the 122 largest cities in the US, and prior to last week the highest number of weekly deaths reported for El Paso was 20 in week 5, 2000. Moreover, in week 14, 2011 there were 19 deaths, providing a two week total of 43 for weeks 14 and 15. In the past 15 years the highest 2 week total for weeks 14 and 15 in El Paso was 17 in 2007.
The spike in P&I deaths in El Paso in weeks 14 and 15 was associated with a spike in influenza like illness (ILI) in Juarez (CAAPS Aguilas), where the number of cases jumped from 7 in week 13 to 335 in week 14 (week 15 data has not been released), representing 64.3% of all doctor visits.
The one confirmed H1N1 case in El Paso represents a tiny sub-set of actual deaths. Only pediatric deaths are reportable, so samples are not collected on most patients. Moreover, El Paso uses the rapid test for lab detection of influenza and the CDC has warned that the test has a sensitivity as low as 10% for H1N1 (9 of 10 samples with H1N1 produce a false negative). Similarly, fatal cases can have high levels of H1N1 in the lower respiratory tract and undetectable levels in the upper respiratory trat, the source of most samples. Consequently many patients are repeatedly negative for H1N1, but are positive at autopsy when lung samples are tested.
Thus, the number of H1N1 deaths in El Paso is more reflective of the record number of P&I deaths recorded by weeks 14 and 15, and not the one confirmed H1N1 case described above. Moreover, this spike in deaths is in April, when overall levels of H1N1 have dramatically declined from the peak levels in January, raising concerns that the rate of severe and fatal cases is markedly higher than earlier H1n1 infections.
More information on the 43 P&I deaths in El Paso would be useful.
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