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There is no obvious explanation for the explosion in toddler cases this year. In the prior three years there were only six toddler cases, which represented 12% of H5N1 confirmed cases. The frequency in 2009 is almost 10 fold higher. Moreover, since these cases are mild, and are largely limited to those with known poultry links, the number of actual infections is likely much higher.
The 10 fold jump in toddler cases this year raises concerns that undetected cases are also 10 fold higher than prior outbreaks, signaling a major spread of H5N1 in the human population