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D225G/N In Fatal H1N1 in Chernihiv Ukraine
Recombinomics Commentary 13:20
January 28, 2010

Mill Hill released five more HA sequences (at GISAID) from autopsy lung patients in Chernihiv (see map), and four had D225G.  Three were mixtures with wild type and one was a mixture with D225N.  All four were most closely related to earlier isolates from Ukraine, as well as isolates from Russia.  The five new sequences raise the number of autopsy tissues sequenced to 41 and 33 had D225G/N, clearly demonstrating strong clustering in time, space, and phylogeny. 

However, the sequences were from multiple sub-clades which included sequences lacking D225G/N, indicating the sequences with D225G/N required multiple independent introductions, as was seen with H275Y in seasonal and pandemic H1N1.  These large number of introductions of the same polymorphisms in the same area over a short time frame is most easily explained by recombination, and is inconsistent with sporadic, spontaneous, or random mutations, as postulated by WHO and consultants.  They are once again surprised by the actual data, which renders the tired old paradigm of random mutation untenable.

However, while the WHO bases actions and policies on the obsolete tenet of random mutation, the striking association between D225G/N acquisitions and fatal outcomes becomes more ominous.  The reported frequency is highest in Ukraine and adjacent countries, but the release of sequences from the fatal and transmissible Tamiflu resistant infections at Duke Medical Center highlights the speed at which the polymorphism can span the globe, which raises concerns that the wild type and D225E changes which have been dominant, will be replaced by D225G/N, leading to much more severe illness and deaths.

In the eastern oblast on Donetsk, schools are closing as the H1N1 infections spread.  Daily Ministry of Health reports for the country have yet to be released this week, raising concerns that information flow from Ukraine will slow or cease.  This month the case fatality rate in Donetsk has increased almost four fold, raising concerns that the level of D225G/N is on the rise.

Similarly, reports of more severe and lethal infections in Memphis have recently surfaced.  A high frequency of admitted children are moving into the ICU and dying, putting the hospital on high alert and encouraging vaccinations.

These recent events in Donetsk and Memphis raise concerns that a more deadly H1N1 wave has begun.

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