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D225G and H274Y in Illinois Case
Recombinomics Commentary 18:13
December 13, 2009

Recent reports of increased Tamiflu resistance, coupled with a strong associate of two receptor binding domain changes, D225G and D225N, has raised concerns that the two polymorphisms may be recombining to generate a lethal H1N1 that is Tamiflu resistant. Interest in the two receptor binding domain changes was increased dramatically by results from Ukraine which had one of these changes in six of six fatal cases.  The reports on D225G led France to check prior cases and D225G was found in two fatal cases.  Of concern was the finding of H274Y in one of those cases.

A review of recently released sequences has found the same combination in sequences deposited by the CDC at GISAID.  The isolate, A/Illinois/10/2009, was collected on July 31, which is during the same time frame as the train ride in Vietnam that led to at least seven cases of H274Y.  In July/August the receptor binding domain changes were noted in fatal cases in Sao Paulo.

The increases in detection of H274Y have been reported by the WHO and CDC in recent weeks.  In the US, four of ten cases were fatal, while in the Netherlands, four of eleven cases were fatal.  However most of these sequences as well as those from the Vietnam train in July have not been released.

An increase in surveillance for these markers as well as the prompt release of sequences would be useful.

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