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A 'window of opportunity' for preventing another wave of swine flu December 1, 2009 | 11:15 am With activity of the pandemic H1N1 influenza virus declining across the country and the availability of the vaccine against it growing, health authorities have "a window of opportunity" for preventing or minimizing another wave of infections in the coming months, said Dr. Thomas R. Frieden, director of the Centers for Disease Control and Prevention, at a news conference this morning. In planning for the short-term future, CDC officials conducted an informal poll of about a dozen internationally recognized flu experts, asking them if they thought there would be another wave of infection this winter. "About half said yes, half said no, and one said 'Flip a coin,' " Frieden said. "We don't know what the future will hold."
H1N1 Hospitalizations Hit All-Time High in California
by LA Times
Friday, 04 December 2009
Nearly 800 people in California were hospitalized with the H1N1 flu last week, the largest one-week total of hospitalizations since flu cases began escalating this fall, state officials said today.
The number indicates that H1N1 flu, also known as the swine flu, continues to be widespread throughout California and remains a significant threat to public health. Health experts have said that it is possible that there could be a second wave of cases in the coming months.
Concerns Grow Over Possible H1N1-H5N1 'Reassortment,' Other Mutations by Anthony L. Kimery Tuesday, 01 December 2009 'The obvious risk is of H5N1 combining with the pandemic [H1N1] virus' Virologists and influenza authorities are becoming increasingly concerned that the 2009 A-H1N1 flu virus could “reassort” with the highly virulent H5N1 avian flu that’s still prevalent in parts of the world like China, and that a mutation could occur resulting in a new strain that has the lethality of H5N1 and the human transmissibility of A-H1N1. The concerns have grown in the wake of revelations that mutations of the H1N1 flu virus had been found in Norway and elsewhere, leading experts to fear that it might just be a matter of time before there’s a reassortment of H1N1 and H5N1.
The Refik Saydam National Public Health Agency has released 29 HA sequences from Ankara, Turkey. Several were partial sequences, but 26 covered the receptor binding domain and 8 had D225E (see list below), while one had D225N, A/Ankara/26/2009. The outcomes of these patients were not given but media reports have described a rapid in increase in H1N1 fatalities in Turkey. A large number of HA sequences with D225E has been published from Spain, and recently released GISAID sequences from Sweden and the UK also haveD225E, including three fatal cases from Sweden. The prior reports of D225G and D225N associations with fatal cases has raised concerns that changes at position 225 could alter tissue tropism or aid in immune escape, leading to more severe and fatal cases. In addition, the first reported cases of H274Y in an H1N1 patient who had not been treated with Tamiflu also had D225E as did another H274Y isolate from Tennessee, raising concerns that H274Y would pair up with receptor binding domain changes and become fixed, as happened with H274Y in seasonal H1N1.
The three Hunan sequences (A/Hunan Changsha/SWL4346/2009, A/Hunan Furong/SWL4224/2009, A/Hunan Kaifu/SWL4142/2009) were collected in late November from sections of Changsha city (see map) and each was distinct. The Furong sequence has closely related to a series of sequences recently released from Changdu, to the west of Hunan, but the other two sequences were unique. The Kaifu sequence was collected on the date of hospital admission for the above patient, who may have been the source. It has a number of non-synonymous changes, including a receptor binding domain change S188N, which is also present in a number of isolates from the United States (primarily Texas, but also New York - see list here), as well as Mongolia, Japan, and Spain.