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Spike in Pennsylvania Fatalities Raises Concerns
Recombinomics Commentary 13:02
September 23, 2009

A 27-year-old Allegheny County man with swine flu has died, state health department officials said yesterday.

The health department would not release the man's name but said he died several weeks ago and had "underlying health conditions." A spokeswoman would not disclose those conditions.

The above comments describe the first confirmed fatality (27M) in western Pennsylvania, as indicated in local media reports and the Pennsylvania Health Department daily update.  Pennsylvania is one of the few states that still provide daily county by county updates and the death in Allegheny was not unexpected, based on the explosion of confirmed Allegheny County cases this month.  This death is in addition to the first suspect fatality (45F) in western PA, which is under investigation in Butler County.

Confirmed cases in Allegheny Country have increased dramatically this month, although the source of these cases remains unclear.  In the Spring Allegheny county had 83 cases which were due in part to outbreaks at the end of the school year.  Many of the confirmed cases came from an outbreak in the North Allegheny school district, which is one of the largest in the area.  There were also multiple smaller school outbreaks in the area.  The number of cases slowly increased over the summer to 93, but then began to rise dramatically at the start of the school year.

However, testing is currently limited to hospitalized or cluster cases, so the source of the explosion in cases (see map) remains unclear.  There was a large outbreak at a Ringgold Middle School that was associated with almost 200 absentees at the beginning of the school year.  However, that school is in Washington County, and only 1 or 2 cases were confirmed by the local health department.  Similarly, large outbreaks were reported at the Carnegie Mellon University and the University of Pittsburgh, but usually such outbreaks only increase the number of confirmed cases by 1 or 2 per location because the students have similar symptoms and 1 or 2 confirmed cases signals H1N1 in the vast majority of symptomatic patients.  The number of confirmed cases in Allegheny more than doubled to 201 last Thursday, and then Friday the number spiked to 268.  It has continued to rise this week and is currently at 281.  The increase of almost 200 confirmed cases this month accounts for the vast majority of recent confirmed cases in Pennsylvania.

Many schools in the area have also reported 1 or 2 confirmed cases, and several have reported suspect cases, based on symptoms, or private physician reports.  Many of the students have had mild symptoms without fever and these cases have not been tested or reported.  However, increases in confirmed cases through the flu surveillance network is possible, because the week 36 flu report from Pennsylvania has over 50 cases in Allegheny and similar numbers were in prior weeks (although the 60 cases in Westmoreland County in the week 34 report are not reflected in current confirmed or probable cases.).  Thus, it seems that many of the cases in western Pennsylvania are being identified through the flu surveillance sentinel providers.

However, the most recent daily update also has two fatalities in eastern Pennsylvania (Lehigh County and Philadelphia) raising concerns of a new wave of fatalities (prior to yesterday's report, there were no confirmed fatal cases in Pennsylvania since early summer). 

As noted above, the Allegheny report is on a case who died weeks ago, raising concerns that the recent upsurge in confirmed cases and school reports will signal a spike in Pennsylvania and across the northern hemisphere.

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