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Paradigm Shift Intervention Monitoring
Recently released European H1N1
sequences by Mill Hill and United States H1N1 sequences by the CDC
provide additional support for the fixing of the S188T sub-clade in the
northern hemisphere in 2011. Earlier data provided a trend for
S188T in the UK,
The Mill Hill sequences provided more support for Iran and the UK, but
also added Luxembourg, La Reunion, and Spain to the list of countries
with a dominant or expanding S188T sub-clade in December
isolates. Although the CDC has not released December isolates, a
recent series collected in mid or late November was heavily populated
by the S188T sub-clade.
All of the December UK sequences had S188T, raising concerns that this emerging sub-clade easily escapes from immune recognition generated by prior H1N1 infections or vaccinations. This escape as supported by the low reactor status of an isolate from India that was wild type at positions 156-159, but had S188T and S186P. Similarly, a Kenya sequence, A/Kenya/2708/2010, released by the CDC had a mixed signal at position 158, but also had S188T and was designated a low reactor.
The fixing of S188T raises concerns that increasing frequencies of S188T will lead to an increase in severe and fatal cases as was seen in the UK. Increases in H1N1 infections are being reported in Europe and the United States, as hospitalizations and deaths begin to increase.
It is likely that S188T levels will continue to increase in these regions, leading to significant jumps in severe and fatal H1N1 cases.