US P&I Death Rate Jumps To 8.8%

Friday, January 31, 2014
By Paul Martin
January 31, 2014

Today’s CDC week 4 FluView will show a jump in the P&I Death rate to 8.8% (from 8.1% in week 3). This rise ensures a second severe flu season in a row in the United States. Last season (2012/2013) generated a P&I peak of 9.8%, which was largely due to the dominance of H3N2, which historically takes a toll on the elderly, who usually account for 95% of the flu deaths.

However, this season pH1N1 dominates, and since its emergence in 2009, the number of deaths has been blunted by cross protection of seasonal H1N1 in older patients. Consequently, the P&I death arte was unexpectedly low in the 2009/2010 season when pH1N1 crowded out competing serotypes, leading to a low death rate in the elderly.

In contrast to to 2009 however, this season the number of deaths has been unexpectedly high since most elderly still have cross protection and younger targets would have immunity due to natural infections by pH1N1 as well as vaccination formulas which have had a pH1N1 target for the past five years.

The domination of pH1N1 this season suggests it has evolved away from the natural immunity or immunity due to vaccinations, which may have been impacted by use of the same pH1N1 target (A/California/07/2009).
The high P&I rate this season raises serious questions about the methods and assumption used in the selection of vaccine targets.

Earlier indicators, such as the severe and fatal H1N1 cases reported in Dallas County or California will be reflected throughout the country because of the increase in polymorphisms that target human lungs. L194I, D225G, and Q226R were noted in initial sequences released by the CDC (largely in egg isolates), and the evidence for a higher level of these changes was supported by the recently released sequences from China, where most of the sequences were from egg isolates and the vast majority of these isolates had at least one of the changes that target human lung.

Below are US cities with a P&I rate of more than 10% and at least 5 P&I deaths in week 4.

Gary IN 35.7%
Pasadena CA 25.0%
Corpus Christi TX 21.7%
Long Beach CA 20.4%
Lowell MA 20.0%
Spokane WA 20.0%
Indianapolis IN 19.1%
Lansing MI 17.3%
Canton OH 16.7%
Fresno CA 16.6%
Worcester MA 15.6%
St Petersburg FL 15.3%
Glendale CA 15.0%
Montgomery AL 14.9%
Memphis TN 14.0%
Honolulu HI 14.0%
Minneapolis MN 13.9%
South Bend IN 13.6%
Los Angeles CA 13.1%
San Diego CA 13.1%
Albany NY 12.8%
Albuquerque NM 12.8%
San Antonio TX 12.7%
Omaha NE 12.5%
San Francisco CA 12.2%
St Louis MO 12.1%
Dallas TX 11.6%
Boston MA 11.5%
Springfield MA 11.4%
Tacoma WA 11.3%
Peoria IL 11.1%
St Paul MN 10.9%
Lincoln NE 10.9%
Mobile AL 10.8%
Charlotte NC 10.5%
Fort Wayne IN 10.5%
Dayton OH 10.3%
Nashville TN 10.3%
Rochester NY 10.3%
Sacramento CA 10.1%

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