Commentary
D225G Ukraine Norway Link and China Spread
Recombinomics Commentary 14:15
November 25, 2009
http://www.recombinomics.com/News/11250902/D225G_Norway_China.html
The same mutation has been found in both fatal and mild cases elsewhere, including in Brazil, Japan, Mexico, Ukraine, and the United States, said the WHO.
WHO’s spokeswoman in Beijing, Vivian Tan, said the agency is aware of three such cases in China that occurred in June and July that were similar to the cases being investigated in Norway. Tan said WHO had no information on the cases mentioned in the Xinhua report Wednesday.
There is no evidence the mutated swine flu virus is circulating widely in the world, Tan said, but since it has been linked to deaths in Norway and elsewhere, investigators are focusing on whether this mutation could be a marker for more severe disease.
The above comments are associated with a report of eight D225G isolates with in China. Genbank has three of the sequences, as noted earlier. The increase in examples to eight is not surprising since D225G was in four of four fatal cases in Ukraine and reports from Norway cited detection in three isolates, 2 fatal and 1 severe case who had recovered.
However, 25 HA sequences deposited at Genbank had an HA sequence that contained D225G, A/Norway/2924/2009, but also had the wild type sequence, raising concerns that D225G was circulating as a mixture that was most easily detected in lung samples because the D225G was more than a “marker”. It is a polymorphisms that was found in 1918 and 1919 samples which were well characterized for receptor binding properties which indicated the change conferred increased binding to gal 2,3 receptors which are present in lung.
Concern that this receptor binding domain change was widely circulating were increased because an HA marker on the Norway isolate with D225G was found on additional isolates in Norway and worldwide (see list here). This marker was also in the HA sequences from the fatal cases in Ukraine. Full sequences from one of the Norway isolates, A/Norway/3364-2/2009, were deposited, and a marker on the NA sequence matched isolates with the HA marker, linking this broader set of isolate from Norway with the Ukraine sequences, which also had the NA marker, as did multiple other isolates (see list here).
These associations link Ukraine to Norway, but the D225G polymorphism has jumped onto multiple genetic backgrounds, which are widespread, increasing concerns the D225G is circulating undetected because it is concentrated in lung tissues and is poorly represented in nasopharyngeal swabs.
Release of full sequences from China, as well as Norway, would be useful.
Swine flu pandemic peaks in Ukraine
1.6 million fall ill, while 388 die in three weeks
Peter Goodspeed, National Post
Published: Wednesday, November 25, 2009
http://www.nationalpost.com/news/story.html?id=2262341
After three weeks of panic, pandemonium and politics, the initial swine flu pandemic in Ukraine has peaked.
Today the government is expected to end a nationwide ban on public gatherings, lift travel restrictions and order the reopening of parliament, schools and universities in all but 11 regions.
But the country, with its anemic health-care system, is still reeling from having 1.6 million people fall sick with the flu, resulting in the hospitalization of 97,000 people and the deaths of 388 in three weeks.
At the height of the frenzy, tens of thousands were becoming ill each day, dozens were dying and the Ukraine navy said it could not carry out combat duty because of a lack of manpower.
The National Security & Defence Council said there were constitutional prerequisites to declare a state of emergency and politicians briefly talked of postponing presidential elections, scheduled for Jan. 17.
A rising death toll added fear to the emotions rattling Ukraine as it ran out of essential medicines and supplies.
Pharmacies looked like Soviet-era shops with long lines of customers queuing for nonexistent surgical masks and cold medicines. The Health Ministry’s stock of Tamiflu, an anti-viral designed to slow the spread of influenza, was used up in days and people began to hoard lemons and garlic for homemade cures.
Ukraine’s fragile health system was soon paralyzed and rumours proliferated that people were dying of a new, more lethal strain of influenza virus.
As the World Health Organization rushed a nine-member outbreak assessment team to Ukraine in early November, politicians rounded on each other, predicting mass illness and death.
President Viktor Yushchenko declared his country had been hit simultaneously by two seasonal flus and the “California” (swine) flu, and blamed his political arch-rival, Prime Minister Yulia Tymoshenko for failing to prepare for the outbreak.
Ms. Tymoshenko, who is running for president, provided daily television updates on the pandemic and appeared in public swathed in hospital gowns and wearing a surgical mask. She criticized her rivals for hindering her efforts to end the pandemic.
When parliament voted to spend US$125-million to fight the flu, Mr. Yushchenko refused to authorize it, saying it would fuel inflation. Instead, he launched his own appeal for foreign aid.
Not to be outdone, presidential frontrunner Viktor Yanukovich, a former prime minister and leader of the Regions’ Party, pledged to use election campaign donations to buy flu medicine and 20 million surgical masks.
“Ukrainian politicians, including the two main presidential candidates, do not really care about the fate of their people,” columnist Kateryna Grushenko wrote in the Kyiv Post. “They allowed themselves to turn the H1N1 epidemic into a PR show during days when educational, medical, and society-oriented coverage should have been provided to the population.”
As the pandemic entrenched itself, straining hospitals and emergency rooms to the breaking point, Ukraine’s panic grew. With no authoritative explanation for what was happening, bloggers and conspiracy theorists suggested the country was in the grip of a mysterious, more lethal virus.
The government and WHO were deliberately playing down the pandemic’s death toll, some suggested.
When Norwegian scientists announced they had found a mutated form of the swine flu virus that could infect deeper into the airways and cause more severe disease, Ukraine’s news media began reporting that doctors conducting postmortems on some patients had found their lungs had virtually disintegrated.
The WHO tried to temper the sensational reports saying “viruses with similar mutations had been detected in several other countries, including Brazil, China, Japan, Mexico, Ukraine and the United States.”
“No links between the small numbers of patients infected with the mutated virus have been found and the mutation does not appear to spread,” it added.
By last week, the WHO said its preliminary analysis of Ukraine’s pandemic showed “the virus is very similar to other strains causing the current influenza A(H1N1) pandemic elsewhere in Europe.”
This virus is the main cause of Ukraine’s problems and current pandemic vaccines will provide protection, it added.
Only Ukraine doesn’t have any vaccine. Short of cash and hoping to combat any pandemic with Tamiflu, it did not order vaccine.
Now, it is appealing to foreign countries, including Canada, for vaccine donationsy.
The United States has already volunteered to deliver one million vaccine doses in December.
But the WHO is recommending 10% of Ukraine’s 46 million people be inoculated by January.