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Reported Ukraine Cases Approach One Million
Recombinomics Commentary 18:08
November 8, 2009

936,804 Influenza/ARI

43,762 Hospitalized

144 Deaths

The above figures are from the latest update in Ukraine.  The increase in the reported cases slowed and have not quite broken 1 million, but the increases in the latest report put all reporting locations above or near the epidemic threshold (see map).  Moreover, deaths have now been reported at most locations, although the Lviv Oblast still has a significant lead in each of the above, with 152,242 cases, 6,313 hospitalized, and 61 deaths.

Although these numbers are well above historical blimps in cases in Ukraine at this time of year, the local media is still focused on confirmed cases and a role for seasonal flu in the numbers.  However, as has been reported throughout Europe, levels of seasonal influenza A are near zero.  Moreover, the decline in H3N2 in eastern Asia suggests that swine H1N1 may crowd out seasonal H1N1 and H3N2 and swine H1N1 may be the only influenza A remaining in circulation in humans worldwide.

Anecdotal reports indicate there is also significant levels of virus and deaths in Belarus and other countries in the region, raising concerns that the death toll will rapidly increase, which leaves open the possibility of a genetic change.

Although Mill Hill has reported at least 15 positive samples, no sequences have been released and comments on the sequences have been sketchy.  The isolates are said to be anti-viral sensitive and have no "large changes". 

However, changes in the receptor binding domain position 225 have been reported, with D225E being most dominant (see list here).  However, other changes have also been noted, including D225G (see list here) and D225N (see list here).  D225N was linked to the global expansion of seasonal H3N2, so changes at this position can have significant effects on transmission.

Release of sequences from Ukraine is now overdue.

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