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Paradigm Shift Intervention Monitoring
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Recently released sequences (at GISAID) from the WHO Collaborating Centre for Reference and Research on Influenza in Australia have included samples collected in November, including A/VICTORIA/670/2010 which was collected on November 14, 2010.
These recent sequences can provide insight into the pH1N1 currently in circulation. The above isolate contains S188T as well as T1056C and G1403A (S454N) which is also in multiple recently released sequences (see list here and here), signal spread via clonal expansion.
S188T is near to position 190 and such flanking changes were seen in seasonal H1N1 associated with the global expansion of oseltamivir resistance, H274Y, where sequences had A193T plus one of more additional changes at flanking positions.
The emergence of pH1N1 with changes flanking position 190 raise concerns that such isolate will escape immunological detection and produce a new round of pH1N1 infections. Such vaccine breakthrough cases were noted in Australia and New Zealand in 2010. Recent data from the UK has noted the emergence of severe and fatal pH1N1 in previously healthy young adults.
Timely release of sequences from recent pH1N1 isolates, including severe cases in the UK would be useful.