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Paradigm Shift Intervention Monitoring
So far, There have been nine severe flu
cases confirmed with AnH1N1 between weeks 19-25/2010
The above translation is from a week 25, 2010 report from the Galicia Public Health Department in Spain and describes severe H1N1 cases between May 9 and June 26, 2010. Recently partial sequences from Galicia, Spain collected in the above time frame were deposited at GISAID by the Instituto de Salud Carlos III in Majdahonda, and one isolate, A/Galicia/RR6669/2010, was collected April 11, 2009 from a 56 year old male (patient described here). This sequence was related to the novel sub-clade currently circulating in Chihuahua, Mexico, and has D225G (as a mixture). Anecdotal reports indicate addition sequences identified D225G in five patients and D255N in another, signaling transmission.
This earlier sub-clade also had S165N, A189T, and V275I, which matched the sequence from A/Pennsylvania/07/2010, collected in August, 2010 and the novel sub-clade in Chihuahua, Mexico. Anecdotal reports describe D225N in the same sub-clade (in late 2010 or 2011) in the United States and multiple countries in South America.
Moreover, the recently released partial sequence from Chihuahua, Mexico from a 41M, A/Mexico/InDRE2195/2011, also has D225G (as a mixture) in a sample collected from the upper respiratory tract. The presence of D225G and D225N was also seen in autopsy lung samples from the Ukraine in 2009, as well as the Duke Medical Center death cluster, demonstrate the ability of this combination to jump from one genetic background to another, signaling recombination. Moreover, anecdotal reports describe the detection of D225A in Chihuahua, Mexico, which was also identified in the Ukraine cluster.
However, the current outbreak of the novel sub-clade includes detection of D225G and D225N in pharyngeal swabs, signaling more efficient transmission, which is supported by a much wider distribution in North and South America where the flu season is ending in North America and has not begun in South America.
The prior history of this sub-clade in Spain, and more efficient spread in the current outbreak continues to increase pandemic concerns.