Recombinomics Commentary 17:15
January 26, 2010

In the USA outbreak, which involved four severely immuno-compromised patients, cases occurred in a two-week period between mid-October and early November. Three of the four cases were fatal, but the role of H1N1 infection in contributing to these deaths is uncertain.

The above comments describe a fatal H1N1 cluster with H274Y at Duke Medical Center.  Although the outbreak was in October / November, it was not announced until December.  Fatal clusters of H1N1 cases, especially with H274Y are cause for concern.  The clustering of deaths raised concerns that the patients had D225G and/or D225N, which has been linked to fatal cases.  In Ukraine D225G, D225N or both have been found in 30 patients and 29 were fatal.

The CDC has released sequences (at GISAID) from the above cluster, which had H274Y.  One HA sequence, A/North Carolina/39/2009, had D225G (as a mixture with wild type).  Another sequence, A/North Carolina/42/2009, had D225N (as a mixture with wild type), raising concerns of coupling of H274Y with receptor binding domain changes, which was a precursor to the fixing of H274Y in H1N1 seasonal flu through hitchhiking and recombination.

NOTE:  A third sequence, A/North Carolina/49/2009, has D225G (and H274Y).  It is likely that the three sequences with D225G/N were from the three fatal cases.


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•  ProMED: WHO Statement To Council Of Europe (Link)
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