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Spike to 675 - Two Day Total 42
The above figures are from the Ukraine Ministry of Health and represent a spike of 42 fatalities in the past 48 hours. Oblast reporting 5 or more fatalities in the past 2 days includes Donetsk (7 to 80), Kharkiv (6 to 29), Dnipropetrovsk (5 to 32), Cherkasy (5 to 25) and Crimea (5 to 13). The increases to 20 fatalities per day are close to the levels when the outbreak was first reported in late October (see map).
Samples collected from the fatal cases had two receptor binding domain changes, D225G and D225N, which have also been associated with fatality rates of 100% in Brazil, Mexico, and France. However, the results from the first 6 cases in Ukraine represents the largest number from any country and additional examples are expected since the six cases were from at least two Oblast and were in individuals who were not contacts of each other.
A preliminary report by WHO and ECDC has suggested that the presence of D225G and D225N in the fatal cases is due to random copy errors, even though the cases in Ukraine involve two different changes, which represent the only non-synonymous HA differences between the fatal and recovered cases, and recently patients with both changes have been identified in the United States (Utah), Sweden (Stockholm), and Mexico (San Luis Potosi). The samples from the two cases in San Luis Potosi were collected within a day of each other. The same clustering in time and space was seen Ukraine, but on a different H1N1 genetic background.
The recent surge in fatal cases should allow for additional sample collection over a two moth time frame to allow for more extensive analysis, which will highlight the failure of random mutations to explain the dangerous polymorphisms, D225G and D225N, on multiple genetic backgrounds.