Manchester
© UnknownManchester, UK
A man from Trafford, a patient from Tameside, and a teenage boy, from Oldham, have died after suffering from swine flu and health bosses believe it also contributed to the death of a younger child, from Bury. Their deaths are expected to bring the death toll from H1N1 in Greater Manchester to twelve out of 36 nationally.

And 27 people, with serious complications caused by flu, are fighting for life in intensive care or high dependency wards in the region's hospitals. This is putting pressure on the region's hospitals - at times this week there have been no intensive care beds available at some of the region's flagship hospitals including the Manchester Royal Infirmary and the Royal Manchester Children's Hospital.

The above comments describe four more H1N1 deaths in the Greater Manchester area, increasing the number of reported H1N1 deaths to 12, or 1/3 of the UK total. Moreover, there are 27 additional patients with severe disease. This type of cluster signals a more aggressive H1N1, and sequences from such patients would be useful.

The number of severe cases has spiked to 738, from 460 a week ago, and as indicated above, this has significantly pressured health care for H1N1 patients.

The sequences from these patients are critical. Earlier sequences released by the Health Protection Agency demonstrated drift linked to recombination, and raised serious questions regarding vaccine escape.

Moreover, Tamiflu resistance was in the rise, which would add to the increasing burden associated with severe and fatal case.

ECMO machines are already stretched to the limit, and the dramatic increases in severe cases signal a major pandemic concern that requires aggressive action.