The identity between the samples collected in Russia and Greece 11 days apart provides compelling evidence that the H1N1 is transmitting with D225G and is not due to spontaneous mutations, which is the WHO working hypothesis. Transmission is also supported by sequences from autopsy lung in Ukraine, where 27/37 samples had D225G, D225N, or both. The same association of these changes with fatal cases was seen in the Duke death cluster where 3 of 4 samples from the first three patients, who were on the same ward, had D225G or D225N.
The three D225G cases in 2010 is the largest number reported to date from a single country this year and the nine cases from 2010 is also the largest number of sequences from a given country. D225G has been reported in a 2010 Russian isolate, but thus far there have been few 2010 sequences made public. However, the finding that D225G is in a Ukraine low reactor raises concerns that the frequency of D225G in 2010 cases will be markedly higher than 2009.
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