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D225G and Q226R Driving H1N1 Deaths?
Recombinomics Commentary 01:15
December 27, 2013

A teenager from the Houston area died from H1N1, according to the City of Houston Health Department.

As of Thursday, there were 12 confirmed deaths from the H1N1 Flu in the greater Houston area. Katy Barton with the City of Houston Health Houston Health Department confirmed the death on Thursday.

The above comments note that confirmed H1N1 deaths in the Houston area (Jefferson, Montgomery, and Harris counties) have increased to 13 (see map).  Although the teenage above is the first confirmed pediatric death in Texas, 7 Houston area children were in Texas Children’s Hospital, including 3 in the ICU.  These cases are in addition to the two fatal cases in Austin (both pregnant) as well as the five adults and one child on ECMO machines.
These numbers were generated prior to the spike in cases widely reported in the Texas media, which raises concerns that the H1N1 in circulation is quite virulent in young and middle aged adults.

The CDC has been releasing a small number of sequences every 2-3 weeks (most recent were released at GISAID on December 13), which include collection dates through the 3rd week in November.  Two of the sequences from Mississippi
(A/Mississippi/09/2013 and A/Mississippi/10/2013) have Q226R, which targets gal 2,3 receptors which are well represented in the human lower respiratory tract. 

These sequences were found in isolates grown on eggs.  The sequences for the three reported gene segments (H1, N1 MP) were identical when grown on mammalian cells, but position 226 was wild type, raising concerns that the infections were mixed and could use the wild type sequence to transmit, and Q226R to accelerate growth in lung, leading to severe pneumonia, EMCO requirements, and/or death.

The vast majority of public H1N1 sequences are from isolates grown on mammalian cells, raising concerns that the number of infections with Q226R may be significantly higher than the two sequences from Mississippi, and the same concerns apply to D225G, which was also detected through growth on eggs in one of the Florida isolates,

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