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Fatal H1N1 RBD Change S188N in Hunan China?
Recombinomics Commentary 15:39
January 3, 2010

November 21 evening 7:30 Xiu Zhang boy was admitted to hospital in Shaoyang city, the hospital in critical condition on the next notice, right chapter Xiu oxygen, infusion, and ECG. "7:30 admitted to hospital after my son and I have been chatting, chat to 10:30, when he suddenly froth at the mouth, unconscious."

"People from normal to death is only about half an hour." Lijun Ze said the son died suddenly so suddenly, the hospital 23:30 began to organize rescue, It was found that Xiu Zhang digestive tract, lungs or brain hemorrhage, the body appears black spots, had no blood pressure, no heartbeat, "the time to save a child is already dead."

He died a hospital at 4:45 on the 22nd Xiu Zhang declared dead. Shaoyang City CDC blood samples confirmed as Influenza A H1N1 influenza testing. Family belongs to at 10 o'clock on the 23rd to see the hospital medical records issued reads, "preliminary diagnosis" is "influenza, encephalitis, pulmonary hemorrhage, and a stream."

The above translation describes the rapid death of a 10 year old boy in Shaoyang city in Hunan, China.  Recent media reports have warned of the rapid spread of H1N1 in the Chinese countryside and three HA sequences from Hunan were just released at Genbank by the Changsha CDC, which is slightly northeast of Shaoyang city.  The three Hunan sequences (A/Hunan Changsha/SWL4346/2009, A/Hunan Furong/SWL4224/2009, A/Hunan Kaifu/SWL4142/2009) were collected in late November from sections of Changsha city (see map) and each was distinct.  The Furong sequence has closely related to a series of sequences recently released from Changdu, to the west of Hunan, but the other two sequences were unique. 

The Kaifu sequence was collected on the date of hospital admission for the above patient, who may have been the source.  It has a number of non-synonymous changes, including a receptor binding domain change S188N, which is also present in a number of isolates from the United States (primarily Texas, but also New York - see list here), as well as Mongolia, Japan, and Spain.

The co-circulation of multiple H1N1 sequences in a small region in Changsha is cause for concern.  A full set of sequences and more information on patients associated with these sequences would be useful.

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