Posted on 10/30/2009 4:42:41 AM PDT by Uncle Ike
Commentary
WHO Mis-statements in D225G and H274Y Raise Concerns
Recombinomics Commentary 21:31
November 27, 2009
Http://www.recombinomics.com/News/11270905/WHO_Mis.html
Preliminary tests reveal no significant changes in the pandemic (H1N1) 2009 virus based on investigations of samples taken from patients in Ukraine. Analyses are being performed by two WHO influenza collaborating centres as part of the global influenza surveillance network.
Preliminary genetic sequencing shows that the virus is similar to the virus used for production of the pandemic influenza vaccine, reconfirming the vaccine’s efficacy at this time.
The above WHO comments in their latest Ukraine outbreak update are unfortunate. The comments were made after sequences had been generated which showed that four of four fatal cases in Ukraine had the receptor binding domain change D225G. This change had been predicted because it is the type of change expected for the large number of deaths which were linked to the rapid destruction of both lungs. D225G had been identified in 1918 and 1919 lung samples from fatal infections and analysis of the change identified a change in receptor binding specificity, which included alpha 2,3 receptors found on human lung epithelium. The failure of WHO to consider such a change significant raises serious concerns about the agency’s credibility and scientific underpinnings.
Moreover position 225 is in one of the known antigenic sites, so to declare a confirmation of vaccine efficiency was false. H1N1 sequences with three changes at position 225 (D225G, D225E, and D225N) had already been reported and D225N on H3N2 was associated with the fixing of S31N (Adamantane resistance) in seasonal H3N2. Thus, a change at that position did not confirm the efficiency of the vaccine and the characterization sheet for one of the four sequences from the fatal cases was just declared a “low reactor” indicating the efficacy of the vaccine was not confirmed and the cause was likely to be D225G since it is the only non-synonymous HA change on the Ukraine sequences from fatal cases.
The failure of WHO to correctly report on the receptor binding domain after the sequences had been generated destroys confidence in the agency at a most crucial time. In addition to targeting of the lungs and a reduction in vaccine efficiency,Tamiflu resistance is on the rise and one of the fatal D225G cases in France also has H274Y, raising concerns at a time when WHO is posting situation updates which are not credible.
They then compound this lack or credibility by claiming that the D225G, which is four unrelated cases in Western Ukraine are “spontaneous” which is also the characterization of oseltamivir resistance, H274Y. These claims have no scientific basis and are simply absurd.
These statements by WHO, at a time of extremely peril, are both scandalous and hazardous to the world’s health.
WHO Silence on D225G Vaccine Mismatch Confuses Media
Recombinomics Commentary 15:53
November 28, 2009
The vaccine can still prevent the virus from entering body cells to reproduce. These new changes should instead encourage all French to go to be vaccinated with adjuvant.
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 isolate 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 four. 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 match 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 responces 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.
http://www.recombinomics.com/News/11280902/WHO_D225G_Silence.html
Commentary
WHO Weather Report on Ukraine H1N1 D225G Required
Recombinomics Commentary 17:13
November 28, 2009
http://www.recombinomics.com/News/11280903/WHO_D225G_Weather.html
The question is whether this mutation again suggests that there is a fundamental change going on in viruses out there or whether there is a turn for the worse in terms of the severity. I think that the answer right now is that we are not sure. I want to answer why we are not sure in a way which explains why more investigations are needed. As you know these influenza viruses change frequently. Their gene properties change because these are viruses which frequently undergo mutations and so mutations in and of themselves are not necessarily important and in fact, if every mutation was reported out there, it would be like reporting changes in the weather -
The above comments from Keiji Fukuda at Thursday’s virtual press conference in context, which highlights the need for additional data on D225G. However there is a large body of evidence on this change and the Ukraine data is the most current and quite compelling. Ten samples were collected from ten patients and nine represented the same sub-clade. However, only four were from tissues from fatal cases, but all four had D225G. In contrast, nasopharyngeal washes were collected from the five surviving patients in western Ukraine and all sequences were the same sub-clade, but did not have D225G. The finding of D225G in 100% of the fatal cases raises concerns, but the number of such cases is small. However, well over 400 people have died in Ukraine, so additional samples from fatal cases should not be a problem, and collection of samples from both upper and respiratory tracts in the same patient would be useful.
An aggressive campaign on this change is warranted because the only reported tested sample for antigenicity was found to be a low reactor, and the only amino acid change in the HA sequence was D225G. Since the same sub-clade was found in earlier collections in Norway, and the cases positive forD225G were fatal or severe, more interest in the change has been generated, but media reports state that the vaccine is effective against D225G, when the data presented on the Mill Hill characterization sheet at GISAID cites the antigenicity as being “low reactor”, signaling a need for a new vaccine.
It has now been a month since the reported Ukraine samples were collected and hundreds have died there in the past month, so additional sequence data on fatal cases, including upper and lower respiratory tract origins from the same patient should be available at this time.
Therefore, release of these sequences and a statement on the initial results, including the low reactor status of isolates from fatal cases in Ukraine would be useful. Finding a receptor binding domain change which alters specificity in 100% of fatal cases is cause for concern, and release of additional sequence data is overdue, since some still need a weatherman to know which way the wind is blowing.
Foreign Policy: Ukraine’s Phantom Swine Flu
November 30, 2009
http://www.npr.org/templates/story/story.php?storyId=120943731
The global swine flu outbreak has become something of a political football in every country where the pandemic has spread, but Ukraine’s response to the virus has achieved a new level of blatant politicization. According to a campaign advisor to Yulia Tymoshenko, the Ukrainian prime minister and presidential candidate purposely inflated fears of an ongoing swine-flu epidemic to aid her presidential run.
“We had to create a phantom and then have a white knight riding in to save the day,” Taras Berezovets, a senior campaign advisor for Tymoshenko’s BYuT bloc, told me in a Kiev restaurant, confirming widespread suspicions among Ukrainian journalists.
Since October, Ukraine has been in the grips of a full-blown panic over swine flu, complete with quarantines, school closures, runs on pharmacies. The Ukrainian health system, already badly dilapidated, was caught off guard and almost 400 people died of the flu in just three weeks.
Tymoshenko flew into action, organizing a delivery of the antiviral drug Tamiflu — and the requisite press conference — at the Kiev airport in the early morning hours of Nov. 2. She quarantined nine regions of the country, closed all schools and universities, and petitioned the president for $125 million in emergency funds to fight what seemed to be “the plague of the 21st-century plague,” as one Ukrainian put it. Incidentally, she also banned all mass gatherings and political rallies — after she had already had hers.
Although the World Health Organization concluded that “the numbers of severe cases do not appear to be excessive when compared to the experience of other countries,” the call for calm was drowned out by Tymoshenko’s drumbeat of action. Pharmacies ran out of surgical masks and medicines as panicked Ukrainians dangerously hoarded supplies.
The fracas couldn’t have come at a better time for Tymoshenko, the self-styled heroine of the 2004 Orange Revolution, who was losing the race to the very man the revolution disgraced: Viktor Yanukovich, the Russian-backed candidate. Tymoshenko’s second term has been marred by vicious backbiting with her onetime Orange Revolution ally, President Victor Yushchenko, her perceived pandering to Russia on gas deals, and her apparent inability to save Ukraine from the absolute implosion of its economy.
As GDP contracted by over 15 percent in the third quarter of 2009 and Tymoshenko continued to bicker with Yushchenko, her approval ratings plummeted from a high of 47 percent in the spring of 2005 to just 14 percent in October. (And that was an improvement from her summer numbers.) Yanukovich, on the other hand, a man few Ukrainians trust because he twice did jail time for unclear reasons and who was suspected of poisoning Yushchenko, has seen his numbers climb to double that.
Thanks to her vigorous response to a swine-flu panic she herself manufactured, however, Tymoshenko has been steadily catching up, nearly halving the gap in the polls. Outfoxed, Yanukovich tried to return the parry by ordering more surgical masks, but the damage was already done.
But with the WHO concluding that there was nothing unusual about Ukraine’s flu outbreak and the government ending the quarantine, saying that the epidemic had peaked after just a few weeks, journalists and political observers have long been questioning whether the swine flu actually affected Ukraine disproportionately or if this was simply a campaign ploy used by the prime minister, a suspicion now confirmed by one of Tymoshenko’s top advisors.
When asked for comment on Berezovets’s statement, a Tymoshenko spokesperson said, “I have not heard any such information. All I know is that Yulia Volodymyrovna used all the government’s powers to prevent the spread of swine flu and the visiting WHO delegation which was here yesterday gave her high marks.”
Some observers — including the WHO — point out that, spin job or not, Tymoshenko’s energetic response did help put Ukraine’s failing health system in some order ahead of an oncoming second wave of swine flu.
But for Tymoshenko’s people, the one true benefit is clear. As Berezovets put it, “We won in the media.”
Commentary
H1N1 Evolution Outpacing Vaccine and Host Defenses
Recombinomics Commentary 13:32
November 30, 2009
http://www.recombinomics.com/News/11300901/225_Evolution.html
The designation of one of the Ukraine D225G isolates as a “low reactor” raises concerns that the H1N1 evolution is outpacing the vaccine as well as immune responses from unvaccinated hosts. This concern was present ealry when changes began to appear at position 225, a known antigenic site.
One of the highest profile isolates was the San Francisco traveler to Hong Kong, who was reported (in July) to have Tamiflu resistant H1N1, even though she had not taken Tamiflu. Her case was mild and she recovered without antiviral treatment, but the virus had a receptor binding domain change, D225E. A survey of D225E at the time demonstrated that it was first reported in the US in New Jersey, but not subsequently. However, it had spread to many other countries, raising concerns that the US surveillance was missing this widespread sub-clade.
Moreover, there were soon examples of D225G and D225N in other early samples supporting the use of position 225 to escape host defenses. The concern of multiple changes at the same position increased when sequences from fatal cases in Sao Paulo were releasd recently. The July/August collections had D225G in two of two fatal cases, and D225N in two of two other fatal cases, with 3 of 4 samples coming from lung.
These concerns increased when sequence data from Ukraine was released and 4 of 4 fatal cases had D225G.
The above data reinforced concerns that the changes at position 225 were becoming more prevalent, especially in samples collected from affected organs of fatal cases.
The concerns ratcheted up another notch when of the four cases was characterized antigenically, and was reported to be a “low reactor”. Since the low reactor had only one amino acid change in HA, the role of D225G in the reduced titers raised the level of concern higher.
However, WHO has yet to address this result. The “low reactor” status was quietly added to the characterization sheet at GISAID and there has been little comment in the mainstream media, other than a sentence in the New York Times on Friday.
Comment form WHO and other agencies, including Mill Hill and the CDC, who were conducting testing of the Ukrainian samples is long overdue.
November 30, 2009 press conference was held with participation of Minister of Health of Ukraine Vasily Knyazevich, chairman of the Parliamentary Committee of Ukraine for health Tatiana Bakhteyeva and Chief state sanitary doctor of Ukraine Alexander Bilovol. The event took place on the work of the Board of Health of Ukraine dealing with epidemic incidence of influenza and ARI, the results of the operations staff to overcome the epidemic of influenza and ARI, the problems of immunization and vaccination of the population, the use of budgetary funds allocated to fighting the epidemic, the main direction of reform .
In his speech, Vasily Knyazevich described the situation that currently prevailing in the medical field in the context of recent calls. He noted that life itself makes from the words of the reform finally move to the cases. "Every doctor and every patient today expect changes for the better, and line ministries are ready to offer clear transparent reform plan, which will occupy a worthy place of family doctors, which will act as the world, university clinics, where dorohovartisna develop highly specialized medical care. And most importantly - there a clear division between the volume of free medical services to ensure the state and the volume of paid services that patients themselves will determine whether or not to use "- said the board Vasily Knyazevich.
Informing the representatives of the regions on the situation in Ukraine and worldwide with the incidence of pandemic influenza on board once again reminded that the world most cases of pandemic influenza accounted for by young people, including pregnant women, due to their physiological immunosuppression, which naturally reduces the capacity of general immunity, including antiviral and antibacterial protection.
At November 27 this year, the number of persons ill with acute respiratory disease and influenza is 1 751 546.
By last night found 34 982 people are ill with acute respiratory infections and influenza. In recent days the trend is envisaged to stabilize and reduce the number of registered patients. Number of hospitalized children as at 27.11.09 increased to 1250 (25.11.09 - 1207).
Number of heavy patients across the country began to decline. Yes, today in the intensive care unit is 117 persons for 40 persons less than 25.11.09 with them on Ventilator - 18 (25.11.09 - 21 people).
Since the beginning of a flu epidemic in Ukraine just sick about 5000 pregnant women and mothers, a third of whom were hospitalized. About 150 pregnant women were in intensive care, of which about 63 - on artificial pulmonary ventilation. In total ill pregnant women and mothers - 35 died, representing 8% of the total number of deaths from complications of influenza in Ukraine.
The total number of deaths from the epidemic of 424 citizens of Ukraine.
Of the 35 deaths of pregnant women and mothers: pregnant women died - 15 (43%) women in the postnatal period have died - 20 (57%) women.
As on 30.11.2009, in intensive care and resuscitation is 29 and pregnant mothers, of which 10 are on the apparatus for artificial pulmonary ventilation.
Among the areas which recorded the largest number of dead remains Lviv region - 94 persons i.e. 22,7% of the total deaths since the beginning of the epidemic, Ivano-Frankivsk Oblast - 43 people (10.3%), Donetsk Oblast - 27 people (6, 5%). Number of patients in the Lviv region remains the largest in Ukraine and is 204 006 persons, including 10 768 children.
Thus, the epidemiological situation regarding the incidence of influenza and acute respiratory infections gradually stabilized. However, remains a significant number of hospitalized patients who are in intensive care, which require further mobilization of significant professional and organizational efforts at all levels of care.
Among the main features distinguish pandemic influenza three points. The first feature - the disease affects the younger working population. Age most of the dead ranges from 20 to 50 years, which is typical in general for the epidemic spread of influenza.
Complicated course of disease in the case of obesity related cardiovascular diseases, respiratory diseases, diabetes, weakening the immune system and so on.
The second feature - the rapid spread on the territory.
Third - fulminant course from beginning to the development of atypical pneumonia, in which case, it is very difficult to treat.
Ministry of Health of Ukraine since the announcement in the world of pandemic influenza A/H1N1 California is aimed at the appropriate regulatory documentation to address the problems of poverty and Pandemic Influenza in Ukraine.
In addition, a series of measures implemented in the regions, aimed at preventing the spread of influenza A (H1N1):
- In each region established operational headquarters round the clock vigil on staff who is coordinating work in this direction;
- In all regions of the training conducted by experts (in accordance with orders MH of Ukraine from 07.11.2009, № 813 and from 07.11.2009, number 814).
- In all regions of the Hospital prepared base to provide inpatient care to this category of patients (defined branch that can be transformed, ready reserve of medicines and medical products, disinfection equipment, personal protective equipment, agreed to transport personnel and support), outpatient service working in advanced mode (extended hours, work on weekends), prepared if necessary to deploy additional crews ambulance.
· Bedspace infectious beds is 20 708.
· Of them boxed - 8 708 (42%).
· In intensive care - 407 boxes.
Case of a second-level risk (group instances) will be transformed - 30 460 beds.
In case of entering the third level of risk (epidemic) will be transformed - 190 102 beds.
· For contact persons provided - 18 201 observation beds.
As discussed at the Board, the Ministry to improve the logistics of medical institutions quarantine areas supplied equipment and necessary drugs for the treatment of seasonal and influenza A (N1N1).
Equipment
Determine the range and quantity of equipment which is proposed to purchase, intended for treatment of emergency conditions in an intensive care unit, depending on the state procurement of health and treatment protocols and WHO recommendations: artificial pulmonary ventilation apparatus including transportation, fibrohastroskopy, heart , pulsoxymeters, oral, etc..
For billing information for the purposes of fighting the epidemic should be over 700 pieces of equipment, including: artificial pulmonary ventilation apparatus (including transportation), fibroskopy, heart, pulsoxymeters, oral, etc..
Medicines
The list of drugs recommended by WHO include antiviral drugs, particularly through oseltamivir that exhibit specific activity to influenza viruses A (H1 N 1). According to the treatment algorithm also provides procurement, antibiotics, sedative drugs, hormones, infusion solutions, etc..
Prepared according to indicative estimates calculated data Influenza Center of the required number of drugs to treat children and adults antiviral drugs in case of disease among the population of influenza A (N1N1).
Brought to the regions of interest on the preventive protection of medical workers in a pandemic influenza outbreak of type A N1N1 California in Ukraine.
In order to determine the capabilities of health facilities for vaccination against pandemic influenza analyzed the problems of preventive vaccination offices in the regions.
Prepared by the Ministry of Health draft order "On Approval of the Cabinet of vaccinations, which will be approved some of the organization of the cabinet vaccinations; Примірне logistics of the office of vaccines, some of the junior medical specialist medical education office vaccinations.
Today is the team to the vaccination for the prevention of pandemic influenza.
Duration of the epidemic rise will depend on the effectiveness of restrictive insulation, disinfection and prevention of cell.
If adequate anti ensuring total duration of the epidemic rise will be from 6 to 8 weeks.
According to experts, probably can expect at least two waves of epidemic rise.
The main risk groups are projected:
- Pregnant women (especially in the second and third trimester);
- Children younger age (particularly up to 2 years).
- Persons with chronic conditions following categories: chronic respiratory disease, chronic cardiovascular disease, chronic metabolic violation
Question prevent spread of disease to influenza A (H1N1 California) and acute respiratory viral infection among the population is in constant control of the Ministry of Health of Ukraine.
Press Service of the Ministry of Health of Ukraine
http://www.moz.gov.ua/ua/main/press/?docID=14229
New H1N1 Strain Identified in the Ukraine; Swineflu.org urges World Health November 16, 2009 12:02 PM
LONG BEACH, CA — (Marketwire) — 11/16/09 — Swine Flu.org, a community based website and discussion forum, has issued a warning regarding the potential emergence of a new H1N1 strain circulating in The Ukraine after a recent finding by Dr. Victor Bachinsky, M.D. and coroner in the Chernivtsi Region of the Ukraine. ‘’The virus is a Mixture of H1N1 and Parainfluenza,’’ said Dr. Bachinksy, discounting earlier claims that the Ukraine H1N1 outbreak was related to pneumonic plague.
The World Health Organization arrived in The Ukraine on November 2nd to determine if the H1N1 virus had mutated by sequencing the genes. Although the results were due to be announced on November 4th, The World Health Organization has not yet released their findings. ‘’I’m sure the WHO can understand the urgency and importance of releasing this type of information as quickly as possible,’’ said Ryan Evans, owner and founder of Swine Flu.org. ‘’An advanced notice that the virus has mutated is our best chance of dealing with the pandemic this winter,’’ said Evans. ‘’A new and more virulent strain could result in a global disaster as there would be no vaccine available.’’
Latest reports from The Ukraine indicate that over one million people have been infected by The Ukraine H1N1 in the last three weeks and experts fear that this enormous flu wave could be heading for North America.
For more information regarding this issue, and to see what people are saying about it online, please visit the website and online discussion forum located at www.swineflu.org.
Contact Information: Swine Flu.org P.O Box 1294 Stanton, CA 90680 714-381-1020
http://www.newspress.com/Top/Article/article.jsp?Section=LIFE&ID=565685886513512554
Swine flu vaccine ineffective against low reactor H1N1 influenza virus found in Ukraine flu outbreak
November 29, 1:09 PMLA Health Technology ExaminerVictoria Nicks
H1N1 Mutation Causes Swine Flu Vaccine Mismatch
AP Photo/Miguel Tovar
The New York Times reported on November 27th that the H1N1 influenza virus found in the Ukraine has likely changed to the point where the swine flu vaccine will no longer prevent infection. This is the result of the designation of this mutated form of H1N1as a “low reactor”.
Influenza virus changes
A change in the receptor binding domain for the H1N1 influenza virus to D225G causes the virus to attach to cells deep in the lungs, rather than in the upper respiratory tract. Not only does this prevent the virus from being detected by the typical nose swab, it also results in serious symptoms, including hemorrhaging of the lungs. The Ukraine patient with the D225G strain of H1N1 which was a “low reactor” had a fatal case.
Swine flu vaccine effectiveness
The swine flu vaccine was engineered to be effective against a specific strain of influenza infection. As the virus mutates, it becomes less likely that the vaccine will be effective against the new strain of influenza virus. One case in the Ukraine was tested, and designated as a “low reactor” to the swine flu vaccine. This means that the vaccine is unlikely to protect against that strain of the virus
INTENT ON CREATING A DEATH VIRUS
Swine flu and bird flu viruses are being mixed together by French professor , Bruno Lina, affiliated with WHO, potentially creating a lethal virus writes Ester Nordland on the internet news site Norway Health.
Lina and his team are carrying out this research into creating a lethal bioweapon under the pretext of having to predict the course of a future pandemic.
http://www.siste.no/Innenriks/helse/article4726428.ece
In one of the safest laboratories in the world, scientists are intent on mixing one of the most contagious viruses in this world with one of the most deadly ones, she writes.
The goal is to find out whether swine flu and bird flu can end up as a deadly mixture, writes the Norwegian news agency ANB.
Swine flu (H1N1) is very contagious, but ends up only killing a minority of the persons who actually get the flu.
Bird flu (H5N1), on the other hand, kills more than 60 percent of its human victims, but only in rare cases spreads from person to person.
Should those two viruses mix or mutate, a new horror virus might appear: A virus as devastating as the avian flu virus and as contagious as the swine flu virus.
At the Inserm laboratories biosecurity level 4 in Lyon in France deadly viruses like Ebola, Marburg and Hendra are locked in a safe. The laboratory is situated in a building that may withstand both earthquakes and explosions.
The researchers move around in protection equipment reminiscent of space suits withan inbuilt supply of oxygen.
Inserm is the national French institute for human health and medical research.
Now a team of researchers in Lyon intend to investigate whether the H1N1-virus will interfere with its more deadly relative H5N1 and become a virus with the most dreadful traits of both of them. If they discover what kind of mutations will occur, and what kind of influenza may appear, it might turn out to be a key to predict, how future pandemics will evolve.
Until now they have investigated, how H1N1 can develop resistancy towards the pharmaceutical product Tamiflu.
Now the primal investigator of the research team, Bruno Lina, hopes to be allowed to mix the two viruses. – It is a controversial study, but it is fundamental research which should be carried out, says Lina to the magazine Nature. – If you discover, what parts of the H5H1-virus is most prune to change, you are able to be more alert, if the virus change in those parts, says Lina.
Olav Hungnes coordinates the flu watch at Human Health Institute (Folkehelseinstituttet) in Norway. He says that it is a possibility, that the swine flu virus may change.
Hungnes explains that the genetic profile of the virus may chance in such a way, that it takes up genes from another virus.
The prerequisite of swine flu virus and avian virus mixing to a new and even more more dangerous virus is that they come together. But there are so few cases of avian flu among people, that the chances are low, says Hungnes.
Avian flu is most widespread in Southern Asia.
It is imagined that the pig may serve as a mixing pool for the two types of influenza. In those areas pigs, geese and human beings live together. But until now this has not happened, says senior medical doctor Bjørn Iversen, from Human Health Institute in Norway - Whether it will happen, nobody knows. What you belive in these questions, depends on whether you are an optimist or a pessimist. The optimist will say, that since it has not happened until now, it will never happen. The pessimist will say, that now it has tried so hard for such a long time, that it is just before it succeed. I believe that the possibility that it will actually happen is small. The avian flu virus has circulated since 1987. It came back in 2003, and in spite of the fact, that there has been a lot of normal seasonal influenza, it has not succeded in mixing with this, says Iversen.
According to Bjørn Iversen research in this area is taking place all over the world.
In an American laboratory, the researcher Jeffrey Taubenberger has managed to reconstruct the Spanish flu virus which laid the world waste at the beginning of the 20. century (1900-tallet). His team of researchers have cultivated a new live virus. (ANB)
Health Ministry confirms 431 deaths of flu (Ukraine)
http://www.kyivpost.com/news/nation/detail/54013/
The Health Ministry has confirmed 431 deaths of influenza and acute respiratory viral infections in 24 regions, the city of Kyiv, the city of Sevastopol, and in the Crimea from Oct. 29 through Nov. 30, according to the statement by the Health Ministry.
According to the statement, since Oct. 29, a total of 96 lethal cases have been registered in Lviv region, 44 lethal cases have been registered in Ivano-Frankivsk region, 25 cases in Chernivtsi region, 24 cases in Ternopil region, 29 cases in Donetsk region, 24 cases in the city of Kyiv, 22 cases in Khmelnytskyi region, 21 cases in Kyiv region, 19 lethal cases in Chernihiv region, 17 cases in Volyn region, and 12 cases have been registered in each Zakarpattia region and Poltava region.
11 people have died of influenza and acute respiratory viral infections in Rivne region since Oct. 29, nine people in Vinnytsia region, eight people in each Kharkiv region and in Cherkasy region, nine people in Dnipropetrovsk region, seven people in each Sumy region, Zhytomyr region, eight people in Kirovohrad region, five people in Kherson region, and four people in Zaporizhia region.
Seven person died of influenza and acute respiratory viral infections in each the Crimea, the city of Sevastopol, Mykolaiv region, Odesa region, and Luhansk region.
Seven people have died in the past 24 hours.
In general, 1,841,927 people have fallen ill with influenza and acute respiratory viral infections since Oct. 29, 30,992 people for the last 24 hours.
Since the epidemic 111,865 people have been taken to hospitals and 87,083 people have been discharged since the start of the flu epidemic.
Comment
The death rate for people hospitalised for the new H1N1 in the US is about 5 - 10%. If over 100,000 people have really been hospitalised for this in Ukraine, then we would expect 5 - 10 thousand deaths.
Commentary
446 Dead in Ukraine - D225G and Deaths Spread
Recombinomics Commentary 02:20
December 2, 2009
http://www.recombinomics.com/News/12030901/Ukraine_446.html
1,937,292 Influenza/ARI
116,982 Hospitalized
446 Dead
The above numbers represent the latest update from the Ukraine Ministry of Health. As the number of cases approach 2 million, the rate of increase has slowed and shifted to the east. The largest daily update was in Donetsk, which rose by 5892 cases to 127,584 (see map). However. Increases in deaths are being report across the eastern border in Russia, were there have been 30 deaths reported in Saratov. Similarly, almost 200 deaths have been reported in Turkey, raising concerns of D225G spread.
The initial data showed strong association of D225G with fatal cases. Of the 9 samples from western Ukraine, all four fatal cases had D225G. In contrast nasal washes from surviving cases were positive for the same sub-clade, but were wild type at position 225, suggesting that infections were mixtures and virus with D225G targeted the lung, while wild type remained in the upper respiratory tract.
This tissue tropism poses surveillance problems, because most sequences come from nasal pharyngeal swabs, which may not reflect D228G in the lung. Currently, only 1% of HA sequences have D225G, although it was present in April in the vaccine target, A/California/7/2009, as a mixture. The version with D225G was selected for the target in the attenuated carrier distributed as a flu mist. In contrast, the killed infected vaccine has the HA version of California/7 with wild type D at position 225, raising concerns that killed vaccine or natural immunity will select for D225G. This concern was increased when Mill Hill labeled Ukraine H1N1 with D225G a low reactor.
The reporting of D225G in all fatal cases in Ukraine should be followed up with additional sequence data on more of the 400+ fatalities. Collections from the upper and lower respiratory tract in fatal cases would help define the significance of D225G in fatal lung cases, and also determine the ratio of components of mixtures with and without D225G.
An increase in the D225G ratio would be cause for concern.
_________________
Tamiflu Resistance in Ukraine Sub-clade in Spain and US Georgia
Recombinomics Commentary 20:05
December 3, 2009
The CDC has released a series of US and foreign sequences at GISAID, which included several NA sequences with H274Y. One , A/Tennessee/17/2009, was the same sub-clade as the Hong Kong isolates from a traveler from San Francisco. Another, A/Georgia/23/2009 was the sub-clade that match the sequences from Ukraine, but the US sequence did not have D225G. Similarly, Spain release a new sequence at Genbank, A/Catalonia/S187/2009, which also matched the Ukraine sub-clade and also had H274Y.
The detection of H274Y in two isolates that matched the sub-clade in western Ukraine is cause for concern. Although D225G was not in the published sequence, its absence may have been linked to the tissue source of the viruses. The CDC isolate was collected on 9/11/2009 from a patient (7F) in Georgia. The tissue source was not listed, nor was the patient’s current status. The virus in Spain was isolated from a nasopharyngeal swab collected on 11/26/2009, which may explain why D225G was not detected. In Ukraine, five nasopharyngeal washes had the matching sub-clade, but D225G was not in the published sequence. Similarly, it is likely that many if not most of CDDC isolates are also from nasopharyngial swabs, so the associate of H274Y with D225G is unclear, although a recent case in France was said to have D225G and H274Y.
The spread of this combination would be cause for concern. Reported samples with H274Y has spiked in the past two weeks, adding to concerns that H274Y is transmitting and prior silent spread is becoming more visible
Sequence data of samples from the lower respiratory tract would be useful in general, and most useful for samples from patients with D225G.
http://www.recombinomics.com/News/12030902/H274Y_Spain_Georgia.html
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