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Commentary
pH1N1 D225G In 2010 North Carolina and Wyoming Sequences
Recombinomics
Commentary 13:24
April 7, 2010
These isolates represent an increase in D225G frequencies in more recent cases. The first 2010 sequence, A/Karasuk/01/2010, had D225G and three 2010 isolates from Greece had D225G (A/Thessaloniki/206/2010, A/Thessaloniki/225/2010, A/Kavala/291/2010). These increases were expected, based on the report from Mill Hill indicating D225G created a low reactor.
Last fall, D225G was found in isolates (A/North Carolina/39/2009 and A/North Carolina/49/2009) from the index case of the Duke death cluster, as well as another isolate collected in the same time frame, but had the Ukraine marker, A1281G. This marker is fairly widespread and was also in the 2010 isolate from North Carolina.
The CDC has discounted the strong linkage of D225G to severe and fatal cases, and has yet to acknowledge D225G or D225N in the Duke death cluster were 3 of the 4 patients died, and 3 of the four sequences from these patients had D225G or D225N. The Duke cluster sequences had H274Ym as well as a rare HA polymorphism, Y233H, and represents yet another genetic background with D225G. The number of genetic backgrounds with D225G is large, signaling recombination.
Anecdotal reports have described sever cases of H1N1 in younger patients in Georgia, and the P&I deaths for Atlanta had a spike in deaths a month ago.
The latest sequences increase concerns that D225G will be more common in 2010 and will be linked to more severe and fatal cases.
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