Recombinomics Commentary 17:48
December 29, 2009
After considering the current available virological, epidemiological and clinical findings and following discussions on an earlier draft with WHO and its European-based Collaborating Centre ECDC has come to a preliminary formulation namely that the G222D/N variants exist in a small proportion of sporadic severe, as well as mild cases of 2009 pandemic
influenza A(H1N1) infection and that these represents natural variation of the virus with no special association with severity of the disease course. As such and while they do not transmit they should have a minimal impact on public health and pandemic response. Current data suggests that the cases involving variant viruses in different parts of the world are unrelated and the underlying mutation events probably occurred independently from each other in the infected individuals as a consequence of the natural variability of influenza viruses and their inability to correct random coding
errors. However because of that inherent variability and ability to surprise the 2009 A(H1N1) will need on-going combined virological, epidemiological and clinical surveillance and study.


Recombinomics: D225G / D225N H1N1 in Case from Sweden

Recombinomics Commentary 23:54
December 28, 2009
The Swedish Institute for Infectious Disease Control has released a series of H1N1 sequences at GISAID.  Included was an isolate, A/Stockholm/92/2009, which has an HA sequences with mixed signal at adjacent codons allowing for the synthesis of D225G and D225N.  The same chnages were reported previously for a fatal case in Utah, A/Utah/42/2009, as well as two fatal cases (25M and 40M) in San Luis Potosi, A/Mexico/InDRE50625/2009 and A/Mexico/InDRE50617/2009) which were collected a day apart.  The same mixture was also in a swine sequence, A/swine/4/Mexico/2009 in the adjacent province, Quertaro.

The outcome of the infection in Sweden is unclear, but the patient was on ECMO, indicating it was a severe case.  Thus, all 4 cases with the tandem polymorphisms are from fatal or severe cases, even though the markers are on different H1N1 backgrounds.

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