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Fatal H1N1 D225G In India Raises Concerns
Recombinomics Commentary 10:59
January 20, 2010

The number of throat swabs of critical patients being sent to the National Institute of Virology (NIV) for testing H1N1 infection has witnessed a two-fold increase in the last one month .

Commenting on the point genetic mutation seen in throat swabs of three patients who succumbed to the virus, Chadha said, "We didn't see any change in the genetic make-up of the virus after that." Of the three patients, two were from Pune and one from Nashik, said Chadha. The mutation was detected in the haemagglutinin (HA) region of the virus' gene, she added.

The above comments strongly suggest that D225G is linked to fatal cases in India.  Earlier reports had described the detection of D225G in India and the CDC recently released an HA sequence at GISAID with D225G.  However, earlier reports did not include outcomes.  The above would confirm that D225G is in 3 of 3 fatal cases.  Although the above report describes the change as a point mutation, phylogenetic analysis indicates the D225G is spread via recombination.  Cases are cluster on preferred backgrounds and the recombination involves adjacent polymorphisms.

The above comments also cite an increase in swabs from critical cases, raising concerns that D225G is not only being detected at a higher rate, but is representing a high frequency in severe or fatal cases.

Release of the sequences from the D225G positive cases would be useful.

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