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Recently released sequences from Singapore support transmission of D225G. One isolate, A/Singapore/SS003/2010 was from a fatal case (45M), while the other, A/Singapore/SS004/2010 was from an ICU case (37M). Both were collected in April, 2010, and the sequential sample numbers raise the possibility that the two patients were contacts/relatives. Sharing of additional polymorphisms by the two sequences supports human to human transmission.
Recent sequences (collected June 30, 2010) from Nanjing, China also support transmission of D225G and raise concerns this polymorphism is become more common and more easily transmitted. HA with D225G can bind to 2,3 receptors which are found on human lung cells, which may lead to increased concentrations of H1N1 in lung and an unfavorable outcome, as seen in severe and fatal cases.
WHO has maintained that D225G did not transmit, based on a lack of clustering in time and space. However, the recent sequences from Singapore and Nanjing, China show such clustering, as did prior sequences from Ukraine and Russia.
A revised WHO and CDC “working hypothesis” on D225G is long overdue.
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The influenza virus H1N1 is an acute viral disease that is highly contagious.
The co-circulation of a human adapted H1N1 with a swine H1N1 raises concerns sequences with extensive recombination will emerge in 2010, as happened in 1918.
More aggressive surveillance of H1N1 in swine worldwide is warranted, as is increased sequencing of human H1N1, since PCR testing may not distinguish between the two swine H1N1 strains.
Despite the threat of further introduction of dengue into the mainland United States, as well as the risk of introduction of additional vector-borne diseases, President Obama's 2011 fiscal budget reduces to zero the funding to support the vector-borne infectious disease program at the Centers for Disease Control and Prevention (CDC), the only national program that focuses of detection and outbreak control of vector-borne diseases including dengue, plague, viral encephalitis and Lyme disease.