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Commentary
H1N1
Death Cluster In Bury Near Manchester Raises Concerns
Recombinomics
Commentary 17:00
December 21, 2010
A woman, from Bury, died at Rochdale Infirmary after being struck down with the H1N1 bug. NHS chiefs said she had underlying health problems.
A man, also from Bury, died around two weeks ago but tests have only just shown that the cause was swine flu. As previously reported in the M.E.N, a Manchester man, a woman from Bolton, two men from Oldham and a man from Rochdale have died after contracting swine flu in recent weeks.
A child from Bury, who was described as being critically ill last week, is still being treated for the H1N1 virus.
The above comments describe a death cluster in Greater Manchester area, centered in Bury. In the past such H1N1 death clusters have been linked to D225G, including Ukraine, Russia, and Duke Medical Center. Last year the H1N1 in the UK as well as other western European countries, including Spain had a high frequency of another change at position 225, D225E. In the early fall of 2009 as many as 40% of sequences released by the Health Protection Agency (HPA) from England and Scotland had D225E, which was not associated with severe and fatal cases.
Last years results raised concern that a new wave with an increased concentration of D225G would produce a dramatic rise in severe and fatal cases as is being reported in the UK. The number of deaths in media reports fro the UK have spike to more than 40, compared to 10 for the entire season as of last Thursday. Similarly, the numer of ICU cases has spiked from 100 last week to over 300 this week, straining health care delivery in areas requiring a high number of ECMO machines.
The HPA has released 4 sets of sequences from recent patients, but none of the collections were from December or the Manchester area. Instead the three most recent collections were from the London (Whitechapel) or Cambridge areas.
The WHO has issued an update and noted that recent severe and fatal cases had amino acid changes that had been seen in cases previously, but these changes were not named. D225G would certainly meet the criteria for the changes cited by WHO.
Therefore release of December sequences from severe and fatal cases, including those from the Manchester area would be useful. In the past such sequences have primarily come from HPA or Mill Hill.
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