Medical Emergency in Buenos Aires Raises Pandemic Concerns

Commentary

Recombinomics Commentary 23:43
June 27, 2009

Some hospitals began to strengthen measures, including the case of Posadas Hospital, one of the largest hospitals in the province of Buenos Aires that concentrates a large number of internees from the flu. Through a press release, the hospital reported that it declared a state of emergency by the Institution that "all staff will be available to the agency needs to be addressed" after the epidemic of influenza A.

In addition, the Posadas created through Resolution No. 640/09 an Internal Crisis Committee itself, with the aim of ensuring compliance and monitoring of the actions that the hospital must develop to deal with the situation posed by an outbreak of Influenza A .

Meanwhile, health authorities in Buenos Aires and Buenos Aires have some alternatives to strengthen the system, including the use of military hospital in Campo de Mayo, the release of bed in the hospital's intensive care Malvinas Argentinas, the installation of sanitary units in campaign Buenos Aires and mobile primary care close to railway stations and Eleven Constitution.

The above translation describes the declaration of a medical emergency in Buenos Aires. The Buenos Aires Ministry of Health website lists 15 confirmed fatalities, 180 confirmed cases, and 559 suspect cases as of Friday (see Buenos Aires map), but media reports suggest the actual number of cases is higher. Recent reports out of Argentina also described the rapid decline of relative young patients (15-50), with descriptions similar to those used to describe dying patients in 1918. In addition, there has been an outbreak of H1N1 at a pig farm northwest of Buenos Aires (see map).

The sudden jump in cases and fatalities are cause for concern. In the country the number of confirmed fatal cases rose to 27, but there are reports of 15 more fatalities that are suspect. There have also been reports of travelers from Argentina testing positive at airport checks in multiple countries. These travelers should provide multiple samples for sequencing studies to determine if there have been changes in the virus.

Recently PB2 E627K was reported in a traveler from the United States. However, the sequence suggested the change was acquired in China. Although the E627K was present in the original samples and confirmed in the initial clone, and subsequent sub-clone had reverted back to the wild type sequence, raising concerns that some key changes may not be stable under certain culture conditions, and important changes could be lost especially if the virus is cultured in chicken eggs, which could select against important changes associated with adaptation to human hosts.

Therefore, analysis by multiple labs of these sequences would be useful. The flu season is just beginning in the southern hemisphere, providing a favorable environment for rapid adaptive changes. The movement of a swine H1N1 into a human host parallels the 1918 pandemic, which also was associated with mild infections in the later spring, followed by a much more virulent and lethal H1N1 in the fall.

The rapid developments in Buenos Aires bear close scrutiny and active sequence analysis as H1N1 increases its gene pool transmitting through human hosts. Many countries worldwide, including those in the southern hemisphere are experiencing explosive growth, and the developments in Buenos Aires may signal a new wave of Pandemic H1N1.