The Montgomery Tx health department released an update on the four still living mystery flu patients, but no word on the results of those who died. Of the four, one has tested positive for H1N1 influenza, two have been reported to have tested negative for all flu (not sure how broad that is), and the last victim is still awaiting results. The H1N1 result should not be surprising as it is pandemic in the Caribbean; it has this kind of killing pattern, and it seemingly likes the lower latitudes. Its possible and maybe even probable that all these cases are H1N1, BUT we have noticed a few correlations that make us not rule out the possibility of avian influenza H7N9.
The first thing that jumped out at us is that this part of Texas is duck hunting country.And, that part of Texas has had an abnormally wet and cool season leading to "what has been an impressive first 30 days of duck season." We expect the odds are low that North American ducks are carrying Pandemic H7N9 in 2013, but this exact area between Houston and New Orleans is where we would expect H7N9 to show up from natural transmission.
The second thing that jumped out at us is the reports of kidney and organ failure in the afflicted individuals, similar reports were made when H7N9 was also a "mystery flu". (its also known in to happen in critically ill H1N1 patients)
The third thing that caught our attention is the negative detections for influenza. H7N9 also seems prone to evading detection, but that might also just be a function of the antiviral and testing regimes the Chinese are using.
The fourth thing that popped out at us that the primary H7N9 outbreak locations in China are in areas surrounding river deltas; Houston certainly fits this pattern.
It is possible that this may be H7N9 avian influenza, but we still think the risk is low. However, we also know that the authorities would be dragging their feet with any such information until they felt they were in a more positive response situation. For that reason, this is an Alert worthy event, especially if you live in the Houston area, as you'll be the first to face travel restrictions. If its not H7N9, at least its a good preparatory dry run.
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