Paradigm Shift Intervention Monitoring
twitter
Live feed of underlying pandemic map data here
Commentary
Rapid Death in Malaysia H1N1 Cluster Linked To D225G/N?
Recombinomics
Commentary 19:55
April 4, 2010
''However, the relatively stable condition and quarantined in a special ward HM but he looked healthy.
The above translation indicates the first fatality (54F) in the Malaysia death cluster was admitted to the hospital a few days after flu symptoms became more noticeable, and “looked healthy” upon admission. She died the next day. Her pregnant (36 weeks) daughter (29F) was admitted at the same time and died two days after her mother.
Although the ministry of health initially tried to claim that neither died from the confirmed H1N1 infections, it is widely known and described in the literature that H1N1 infections can lead to kidney failure (as seen in the mother) or Acute Respiratory Distress Syndrome (ARDS), as seen in the daughter. Although diabetes and pregnancies create increased risk, the vast majority of H1N1infections in these risk groups do not lead to hospitalization or death. The rapid death of two members of the same household raises concerns that the H1N1 virus has become more virulent, leading to more severe cases and deaths, as seen in H1N1 that has acquired D225G/N.
The denial of an H1N1 cause of death in the cluster is much like the repeated WHO statements regarding a death cluster at Duke Medical Center last fall. Four patients on the same ward were infected with the same H1N1 and three died within 2 days of each other. Three of the four patients were in adjacent rooms, and the fourth was on the same floor. Sequences from isolates from five collections from the four patients had H274Y, even though samples from three were collected prior to treatment. All four also had a rare HA polymorphism, Y233H, leaving little doubt that all four patients were infected with the same H1N1. Moreover, HA from four isolates from the three fatal cases was sequenced and D225G/N was found in three of the four isolates.
Thus, there was little doubt that the October deaths were due to the H1N1, but the WHO press briefing of December 2 noted the Tamiflu resistance in all four patients, but claimed that the role of H1N1 in the three deaths had not been determined. Moreover, the report failed to mention the finding of D225G and D225N. A February 5 WHO WER also claimed that the cause of the three October deaths had not been determined, and again failed to mention D225G and D225N.
These reports by WHO lead to the types of statements by the Malaysian health ministry associated with the mother/daughter death cluster, and severely impact agency credibility. The statements appear to be counter-productive attempts to control panic, and such absurd positions raise concerns that the more absurd the statements are, the greater the underlying concern.
D225G has been designated a “low reactor” by Mill Hill, and therefore is expected to become more prevalent. In five 1918/1919 fatal lung sequences, D225G was found twice, including the only 1919 sample. It has also been highly associated with severe or fatal cases, with Ukraine and Norway cases being among the more notable examples. The death cluster at Duke however has increased concerns of an association of D225G/N with death clusters, so sequences from these fatal cases would be useful.
An emerging and expanding D225G/N remains a serious concern.
Media Links
Recombinomics
Presentations
Recombinomics
Publications
Recombinomics
Paper
at Nature Precedings