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Paradigm Shift Intervention Monitoring
The first published 2011 H1N1
sequence has been released at Genbank by the National Center of
Communicable Disease in Ulaanbaatar, Mongolia. The HA sequence, A/Ulaanbaatar/190/2011,
was collected on January 11, 2011 and has S188T.
This sequence is most closely related to the sequence from Iran, A/Karaj/5327/2010, and supports the fixing of the S188T sub-clade in 2011. It was present in all ten December, 2010 sequences from the United Kingdom, and in four of six December sequences from Iran (the other two had S186P). Similarly, it was in the only December sequence from Japan. This fixing of S188T was also seen in November sequences from the UK, where 10/17 sequences had S188T (6 others had S186P) and the US, where all October and November sequences had S188T or S186P. Moreover, the most recent sequence from Russia (collected in October) also had S188T.
This sub-clade was likely responsible for the pressure on ICU beds in the UK, as well as the over-subscription for ECMO machines in the UK, leading to export ofd patients to neighboring countries for treatment.
The presence of S188T in the most recent sequences from Mongolia, Iran, Japan, United Kingdom, United States, and Russia indicates the current season will produce similar pressure on health care delivery in many countries in the northern hemisphere.
The dominance of this sub-clade provides strong evidence fro immunological escape and raises serious questions about the H1N1 vaccine, which targets A/Califonia/7/2009, an isolate from the spring of 2009.
Release of December 2010 and January, 2011 sequences would be useful.
Mongolia is to be commended for its prompt release of these important sequences.