Paradigm Shift Intervention Monitoring
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Commentary
Severe
H1N1 Cases Threaten UK Health Care Delivery
Recombinomics
Commentary 19:30
December 29, 2010
The above comments increase concerns that the continuing increases of severe H1N1 cases will significantly impact health care delivery in the UK. Last week the number of severe cases rose to 460, compared to a peak of 180 last season. Although the number of severe cases has not been updated, the ILI rate has risen to 124 from 86 last week. Many of the severe cases need EMCO machines to oxygenate their blood, but only 20 such machines exist for the entire country, and each patient requires 5 days to 3 weeks of use.
The situation is compounded by an abysmal vaccine uptake rate. Agency reports have focused on the 43% rate in those at risk under 65, but most of the severe cases do not have an underlying condition, and the vaccine uptake in those patients is likely to be much lower. One reported cited a rate of 19% in pregnant women without additional risk factors and one hospital reported a rate of 7.1% among its staff. The rate for the general population under 65 and without risk factors is likely lower than the above abysmal rates.
The recent sequence data suggests that the vaccine may be far from ideal because it uses California/7 which was isolated in the spring of 2009. Recent sequence data from the UK, as well as Iran, Japan, and Taiwan demonstrates an evolution away from last season’s strain. Novel sequences generated by recombination are clearly present in the small number of sequences released, which leads to vaccine escape and spikes in cases, as described above. However, there will be no new vaccines this season, so the current vaccine is the only viable prevention measure that directly attacks the H1N1 causing the severe cases in young adult patients without risk factors.
The rapid rise in recent cases will blunt vaccine efforts because the vaccine works best when taken weeks in advance of infection.
The low vaccine uptake was almost certainly impacted by WHO pronouncements of the end of the H1N1 pandemic, which was not scientifically based. Pandemics always produce an ebb and flow of cases, and a return of a more virulent strain in the second season is not unusual.
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