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RBD Changes In 2011 H5N1 Fatal Case In Indonesia
Recombinomics Commentary 12:20
November 3, 2011

The National Institute of Health Research in Jakarta, Indonesia has released the HA sequence (at GISAID), A/Indonesia/NIHRD11073/2011, from a fatal H5N1 case (2M) from West Java, Indonesia collected on January 28, 2011. 

This is the first public human H5N1 sequence from Indonesia since 2008 and the release is to be commended.

The closest demographic match from WHO reported cases is a fatal case (2M) in Depok City, West Java who developed symptoms on February 3, 2011 and died February 6 (an unusually short time frame).

The HA has two significant receptor binding domain (RBD) changes, Q226K and R193M. 

Position 226 is one of the two positions (the other is 228), which change binding preferences from avian gal 2,3 to mammal gal 2,6 which is dominant  in the upper respiratory tract of humans, facilitating transmission.

Position 193 changes (H3 numbering) have been noted in the establishment of adamantine resistance in seasonal H3N2 (S193F) or oseltamivir resistance is seasonal H1 (A193T).

Thus, these two important RBD changes may facilitate H5N1 transmission and emergence in humans.  Release of H5N1 from more recent fatal human cases in Indonesia, such as the Bali cluster would be useful.

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