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Paradigm Shift Intervention Monitoring
Case In Shenzhen China
The above comments describe a confirmed H5N1 case in critical condition in Shenzhen, which is in Guangdong province and adjacent to Hong Kong and Fujian Province. The absence of poultry contact heightens concerns on human transmission which can be most effective addressed by the sequences of the H5N1.
Sequence data has been of note lately because of recent experiments which achieved airborne transmission through the introduction of five changes in two genes as well as selection via passage in ferrets. Publication of this critical information is long overdue.
The timing of this controversy with the above case and location is of note. The first cases of H5N1 in humans were in Hong Kong in 1997, and one of the key pieces of information centered on the role of PB2 E627K, which has been researched by one of the labs that generated airborne H5N1, which almost certainly involves PB2 E627K as one of the changes.
Hong Kong was also the center of two additional outbreaks. One began in Guangdong province in late 2002 and then spread internationally from the Metropole Hotel in Hong Kong by an infected physician who had treated Guangdong cases and came to Hong Kong for a wedding. He infected those on the 9th floor when he vomited outside his room (911) and guest and visitors to the ninth floor the spread the mystery virus to Hong Kong, Singapore, Hanoi, and Toronto. An international team of investigators identified the SARS coronovirus as the etiological agent and published sequences at their websites, which led to the rapid development of diagnostic test to monitor the spread.
In early 2003 there was a smaller by instructive cluster of H5N1 in a Hong Kong fanily who travel to Fujian province. The daughter died in China, while the father and sone returned to Hong Kong where H5N1 was isolated from each. The father also died but the son survived and both sets of sequences were identical and had the HA receptor binding domain change S227N, which is aother likely change leading to enhanced transmission. Other adjacent changes are already circulating in clade 2.3.2 in the area. These changes, V223I and M230I are also of concern, as are changes at positions 226 and 228, all of which are well known and are additional candidates, as are changes flanking position190. These changes are also well known and studied by the labs who achieved the efficient transmission in ferrets.
On a somewhat related note, the movie Contagion also involved an infectious agent that jumped species in Guangdong province and the isolates were stored in liquid nitrogen adjacent to SARS CoV and H1N1pdm09, which are well know pathogens which have been sequenced thousands of times.
Thus, the release of the sequences from the above patient, as well as key changes associated with airborne H5N1 should be released or published immediately.