Severe H1N1 Cases in North Carolina Raise Concerns

From North Carolina -

During the first 3 weeks of January 17-18 patients were admitted to the Le Bonheur Children’s hospital and at least seven required intensive care and at least two died. Concerns were expressed by physicians at the hospital, which has also happened in North Carolina. Moreover, Friday's week 3 influenza report had a sharp spike in pneumonia and influenza deaths, and the cause remains a mystery.

North Carolina is of particular concern because of an outbreak at Duke Medical Center in the adjacent Raleigh / Durham region. Last October at least four patients had H1N1 with H274Y. Recently released sequences at GISAID included five sequences from North Carolina with H274Y and the rare HA marker Y233H. Moreover, 3 of the HA sequences had D225G or D225N, suggesting they came from the three fatal cases. Moreover, an additional North Carolina was just released and it also had D225G and was also collected in October. However, this isolate did not have H274Y or the rare HA marker, but did have an HA marker which matched the sub-clade seen in Ukraine. Thus, the presence of D225G/N in multiple cases and sub-clades raises concerns that a new wave in North Carolina would have more severe or fatal cases.