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D225N in Ukraine Raises Pandemic Concerns
Recombinomics Commentary 00:05
December 9, 2009

New sequences from Ukraine have been placed on deposit at GISAID by the CDC.  Although the sequences are partials, the receptor binding domain is covered in all 5 HA sequences.  Three of the sequences have numbers and ages of patients which match three of the surviving patients tested by Mill Hill and these three sequences have a wild type receptor binding domain.  However, the other two, A/Ukraine/01/2009 and A/Ukraine/02/2009 do not match ages on Mill Hill samples and are likely samples from two fatal cases.  Both of these sequences have a receptor binding domain change at position 225, but both have D225N, while the Mill Hill sequences were D225G.  Moreover, one of the D225N sequence is a mixture with the wild type sequence.

All sequences are the same sub-clade and collected within a day of each other.  They are likely from six fatal cases, once again highlighting the significance of the receptor binding domain and arguing for transmission, since each change is in at least two samples and a change at position 225 is found in 100% of the fatal samples.  Both of these changes had been identified in fatal lung infections in Sao Paulo, further linking recent changes (D225G and D225N) to severe and fatal cases.

More detail on the status of these patients and sample source would be useful, as would sequence data from multiple sites in the same patient.

However, it is increasingly clear that the receptor binding domain changes are transmitting and are associated with severe and fatal infections.

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