Evidence on H1N1 D225G in Lung Cases in Norway and Ukraine
Recombinomics Commentary 11:29
November 21, 2009

The WHO said the mutation does not appear to spread and the public health significance of the finding is unclear.

“Although further investigation is under way, no evidence currently suggests that these mutations are leading to an unusual increase in the number of H1N1 infections or a greater number of severe or fatal cases,” the agency said.

The above WHO comments on the receptor binding domain change D225G (cited as position 222 in some reports using H1 numbering) is curious.  Although WHO claimed that there were no significant changes in the sequences from Ukraine, none of the Ukraine situation updates excluded a receptor binding domain change, and when 10 HA sequences were published at GISAID by WHO regional lab Mill Hill, there was clear evidence of an association of D225G with fatal cases.  Of the 10 sequences released, four were listed as deceased, and all four had D225G.  None of the six samples which came from patients that were labeled with age and gender but had no deceased designation had D225G.  Moreover, three of the four samples from deceased patients were lung samples and all three lung samples had D225G.  The samples which had closely related sequences but lacking D225G were predominantly nasal washes, which also presented concerns that the swine H1N1 was differentially detected, due in part to changes in receptor binding specificity.

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