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Commentary
Critical
H1N1 Cases In India
Recombinomics
Commentary 23:53
July 15, 2010
West Bengal Water Resources Minister Nandagopal Bhattacharya has been diagnosed with the infection, state health department's nodal officer for swine flu Asit Biswas said here.
Health Minister Suryakanta Mishra said the throat swab of Bhattacharya, already admitted in a city clinic with respiratory distress and brain haemorrhage, has tested positive.
The minister's office in the state secretariat said his condition was critical. "His swab was found positive by the National Institute of Cholera and Enteric Diseases," his office said.
Five of those infected in the city proper and Dum Dum in the northern outskirts have been admitted to various hospitals including the state-run I D hospital at Beliaghata.
In 2009, 135 persons were affected by swineflu, but no one died.
The above comments describe confirmed H1N1 cases in West Bengal, including the Water Resources Minister (25M). These confirmed cases are likely to be a small set of H1N1 infections in West Begal, which represent a small sub-set of cases in India. The clinical picture of the minister raises concerns that the first confirmed H1N1 fatality in West Bengal will be reported soon. These early critical cases have raised concern that the next H1N1 wave may be more virulent.
Sequence analysis of H1N1 in later 2009 or early 2010 identified an increased frequency of sequences with D225G, including several fatal cases in India. A handful of sequences had D225G along with G158E, a change that facilitates escape of immune responses against wild type H1N1.
A recent sequence (collected June 30, 2010) had D225G and G158E in Nanjing, China. Neither marker was present in the vast majority of 2010 sequences collected throughout China in the winter / spring.
A increased frequency of D225G could have catastrophic effects. Two of the five HA sequences from fatal cases in 1918/1919 had D225G, which is frequently found in swine sequences. Pandemic H1N1 is transmitting swine to swine in the United States, as is G158E. Further increases in the frequency of G158E or D225G/N would be cause for concern.
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