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Paradigm Shift Intervention Monitoring
H5N1 Recombination and RBD Changes
Although this case was from a different sub-clade than the Shenzhen case, it also had a number of receptor binding domain changes flanking position 190 (A188E, A189T, T199I, I202V). In addition the sequence has S133L, which has been found in prior severe and fatal cases in China and southeast Asia (see list here). However, the current HA sequence had a cluster of changes (C434T, A435G, G438A, T445G), which produced S137A in addition to S133L. This cluster of synonymous and non-synonymous was found in clade 2.2.1 F sequences in Egypt, clade 2.1 sequences in Indonesia, and recent sequences in clade 188.8.131.52 and 184.108.40.206 in China and Vietnam (see list here) strongly supporting recombination, since all isolates had the identical cluster of acquisitions on multiple genetic backgrounds.