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Paradigm Shift Intervention Monitoring
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Spreading H1N1 Ukraine
Sequences in Russia Raise Concerns
Earlier Mill Hill and the CDC had deposited sequences at GISAID from patients in western Ukraine. The nine HA sequences deposited by Mill Hill fell into two closely related sub-clades. The largest sub-clade had 6 samples from Ternopil and one from Khelnitsy. Two of the seven were deceased and both had D225G. All seven had the same marker, which was not in the other sub-clade, defined by two sequences from Lviv. Both were from deceased Lviv patients and both had D225G. The CDC deposited sequences from five patients, but three were from the five survivors sequenced by Mill Hill. The two unique sequences were also from the large sub-clade and were likely fatal cases. Both had D225N, one of which was a mixed signal with wild type.
The 9 HA sequences from the larger sub-clade shared one marker which was in three other sequences at Genbank. All three (A/Salekhard/01/2009, A/Russia/178/2009, A/Russia/190/2009) had just been deposited at Genbank, two were from Novouralsk, which is adjacent to Ukraine's eastern border (see map). The Salekhard, which is north of Moscow and it had D225G. Other isolates in the broader sub-clade include A/Bryansk/IIV2871/2009, which has D225G, and A/Orenburg/IIV2974/2009, which has D225N. Thus, in Russia and Ukraine there are 9 isolates which are likely fatal, and all 9 have D225G or D225N.
This association of D225G/N with fatal cases in this sub-clade is cause for concern. These sequence support transmission of this sub-clade over a large area in Russia and Ukraine, which could prodiced a marked jump in severe and fatl cases if these changes become more common, and tracking of this sub-clade should receive a high priority.
Release of recent sequences from Ukraine and other eastern European countries like Poland and Bulgaria would be useful.