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Fifth, he fails to account for the possibility that live virus vaccines may have contributed to the development within swine herds.
Originating Laboratory
provider of clinical specimen(s)
and/or virus isolate(s) [Ukraine, Kiev] Ministry of Health of Ukraine
Address: Central Sanitary Epidemiological Station 41 Yaroslavskaya str. 04071 Kiev Ukraine
Sample ID given by the sample provider
Submitting Laboratory
generator of data [UK, London] WHO Collaborating Centre
Address: The National Institute for Medical Research (NIMR) The Ridgeway - Mill Hill London NW7 1AA, UK
Sample ID given by the sequencing lab:
Antigenic characterisation: A/California/7/2009 like. Low reactor
Isolate ID: EPI_ISL_62012
Isolate name: A/Lviv/N6/2009
Passage details/history: throat swab
Type: A / H1N1
Lineage: swl
The above isolate has been designated a low reactor by Mill Hill.
Worldwide Transmission of D225G
Recombinomics Commentary 06:45 November 27, 2009
The recently released sequences from patients in Ukraine provided valuable insight into the pathogenicity of H1N1 and the genetic change associated with the total destruction of both lungs in fatal cases.
The description of the patients and the spread of receptor binding domain change, D225G, to multiple genetic bakgrounds via recombination led to the prediction that D225G would be found in the lung samples from fatal cases.
The release of the sequences by Mill Hill confirmed the prediction. Sequences from 10 isolates were released and all four fatal cases had D225G. Moreover, all 9 cases from western Ukraine, which were from three Oblasts (Ternipol, Lviv, and Khmelnitsy) were from the same sub-clade as the fatal cases, but the samples from the upper respiratory tract did not have D225G. The absence of D225G from the upper respiratory tract is not a surprise because the specificity of D225G included alpha 2,3 receptors which are present in the lungs. Thus, the sub-clade with D225G can expand and cause a cytokine storm which destroys the lungs. Moreover, sequences with D225G have been designated as low reactors by Mill Hill, raising concern that immune responses and vaccine will select for D225G.
Although D225G transmits from patient to patient, only the samples from the fatal cases, which were from lung and throat samples were positive for D225G. The sequences from Ukraine led other countries to more fully investigate samples. Norway, which had seen an increase in fatalities announced the detection of D225G in two fatal and one severe case. Although those sequences have not been released, 25 HA sequences were subsequently released and one sequence had D225G as a mixture, confirming the mixed nature of samples with D225G.
Moreover, the sequence with D225G was the same sub-clade as Ukraine, and several matching sub-clades were in subsequent samples, but those samples did not contain D225G, again pointing to a requirement for sampling of appropriate tissues.
The implication of this sub-clade in the increase in deaths in Norway was the finding that the first fatality was also linked to the same sub-clade. The patient, 43F, was in previously good health and given a prescription for Tamiflu after visiting the hospital. However, she was sent home and died two days later. This type of rapid death had been noted for many of the Ukraine cases. Full sequences were generated confirming that the NA sequence was closely related to the NA sequences from western Ukraine, but the sample was from the trachea and did not have the D225G. However, the association of this sub-clade with the first patients death and the finding of D225G in the first isolate matching this sub-clade support D225G transmission as a mixture, with detection in appropriate sampling of the lower respiratory tract.
Phylogenetic analysis of public sequences indicate that the Norway/Ukraine is widespread, strong suggesting that D225G has sread worldwide. However, detection of D225G, as was seen in Ukraine requires that the proper samples are tested.
The finding of D225G in four of four fatal cases in Ukraine leaves little doubt that the polymorphism is transmitting and the recent classification of Ukraine sequences carrying D225G suggests the spread will accelerate. The finding of the same change in unlinked patients in two Oblasts in western Ukraine is similar to the finding of swine H1N1 in two counties in southern California in April. The fact that the two California cases had no link to swine or each other, and were collected from patients over 100 miles apart conclusively demonstrated that the swine H1N1 was efficiently transmitted human-to-human and many more cases would be identified. The data from Ukraine conclusively demonstrate that D225G is efficiently transmitting and the transmission traces back to earlier isolates from Norway of the same sub-clade with D225G.
Since D225G is frequently not detected in samples from the upper respiratory tract, another method of tracking is through phylogenetic analysis, which shows that the Norway/Ukraine sub-clade is widespread, even though all HA sequences do not have D225G, as was seen in Ukraine.
The worldwide transmission of the Norway/Ukraine sub-clade, or other sub-clades with D225G raises concerns that associate hospitalizations and fatalities will have a significant uptick as an increasing number of patients get exposed to this sub-clade linked to D225G.
More surveillance of low respiratory tract infections would be useful.
D225G and H274Y in Fatal Infection in France Recombinomics Commentary 17:30 November 27, 2009 In a statement, the Institute suggests "Reference of mutations in the genome of influenza virus A-H1N1" from these two people who had no relationship and were hospitalized in two different cities. InVS was that for one of these patients, in addition to this mutation, another known mutation that is resistant to Tamiflu, the drug used to treat people infected with the virus.
The above translation describes two fatal cases in France with D225G. Moreover, one of the two cases also had Tamiflu resistance, presumably H274Y.
The presence of D225G in unrelated patients at distinct locations mirrors the results in southern California in April, when swine H1N1 was initially reported in the United States. The same strain in two patients who had no link to swine or each other signaled efficient transmission. The same is true for D225G. It is in multiple patients in multiple countries and appearing at increasing frequencies at the same time.
The finding of Tamiflu resistance in one of the fatal infections raises additional concerns. The circumstances surround the resistance would be useful. The number of reports of H274Y have spiked in the past week, suggesting it too is efficiently spreading at a detectable level.
H1N1 linked to rise in bacterial pneumonia cases by Rita Uplend on November 26, 2009
ATLANTA, Ga. — The Centers for Disease Control issued a warning Nov. 25 that catching the H1N1 virus can put patients at risk, not only of developing complications, but also serious bacterial pneumonia.
Influenza infections can reduce the lining of the respiratory tract and set a person up for pneumonia. Common bacteria like pneumoccocus that live in the nose and throat can invade the lungs when there's a viral infection like influenza.
As H1N1 cases are rising, so are bacterial pneumonia cases, health officials are finding.
They're seeing an increase in flu complications leading to pneumonia. At the same time, the flu is at record levels because of the pandemic H1N1 virus.
Originally posted by dreamseeker
Is there anyone in Iowa who can give us a first hand account. Is it business as usual there or confusion/panic?
Originally posted by ofthepeople . . .
From Dr. Niman’s site:
“However, even though this change is drawing additional attention daily, WHO has taken a position that the vaccine failure against H1N1 with this D225G is not worthy of an announcement.
This mindset is significant cause for concern and is hazardous to the world's health.”
www.recombinomics.com...
Originally posted by frugal
P.S. Can you get that flu twice?