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Commentary
WHO Silence on
D225G Vaccine Mismatch Confuses Media
Recombinomics
Commentary 15:53
November 28, 2009
The above translation is from a French story on the discovery of D225G in two fatal French cases, one of which was also Tamiflu resistant. Because of the failure of WHO to disclose the "low reactor" status of Ukraine H1N1 with D225G, media reports are distributing the false information, stating that the activity of the vaccine is unaffected by D225G.
This misinformation is fueled by the WHO update on Ukraine, which stated that the vaccine appeared to be unaffected based on the sequence. For the "low reactor" the HA only had one amino acid difference, which was D225G.
As has been noted daily in new media reports, D225G is widespread, and phylogenetic analysis shows that the sub-clade in Norway and Ukraine is even more widespread than reported isolates with D225G, raising concerns that the D225G is circulating undetected because most samples are collected from the upper respiratory tract, while D225G is largely in the low respiratory tract.
The designation of a "low reactor" means that the titer of a reference anti-sera is reduced by at least 4 fold. A four fold reduction in titer is typically called a mis-match and mismatched vaccines are a concern because a vaccination will not eliminate the new changes that reduced the titer, but will eliminate the wild type that competes with the variant. Therefore the use of a poorly matched vaccine leads to increased vaccine resistance and in this case would select for D225G.
The failure of WHO to address this issue is the height of irresponsibility. Although the NY Times noted the Ukraine low reactivity due to D225G, it is not clear that the WHO comments were in response to the vaccine failure, since similar statements were made at the WHO virtual press conference and the reactivity of the vaccine was not addressed in statements or answers to questions, although the weatherman comment was in responce to questions about D225G..
Therefore a statement by WHO is long overdue to end that false information distributed through media reports and the WHO needs to address plans to deal with the vaccine failure against D225G and potential similar failures against D225E and D225N which are also widespread.
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