Hong Kong: Detection of human swine influenza virus resistant to Tamiflu in person from USA

HenryN · Jul 3, 2009

Re: Hong Kong: Detection of human swine influenza virus resistant to Tamiflu in person from USA

DeniseMc said:
Niman, I know that in the past you have expressed the opinion that this pandemic will follow the pattern of the 1918 Spanish flu pandemic. I believe that the spring/summer outbreak in 1918 died down in August and peaked again in October and February. Do you envision that happening again, or do you believe that this novel H1N1 will be one continuous wave rather than the herald wave followed by subsequent second and third waves?

Also, what is your opinion regarding the virus circulating in Argentina and New Zealand and elsewhere in the southern hemisphere? Do you believe that it is a strain that has adapted to spread faster in humans (temperature adjustment) or the original strain? Do you think they are circulating simultaneously, one on the southern hemispehre and one in the northern? Have there been enough sequences published to determine which one is dominant now?

Thanks for your opinions.

The virus has a lot to work with and although sequences are being deposited promptly, there are many holes in the database as well as delays. Although H274Y has now been reported in Denmark, Japan, and Hong Kong (in a patient who arrived from San Francisco and didn't take tamiflu), the number of pandemic H1n1 sequences with H274Y remains are ZERO (as of this morning). The PB2 E627K was in the original and first clone from Shanghai, but not the second clone.
There are a lot of open issues with teh sequences.

Most deatsh in South America, including Argentina, were in the past week, so these sequences are not available.

The rapid rise in deaths in the southern hemisphere signals a change, but its not obvious in the database yet.

I expect the virus to evolve, and to evolve more rapidly as the flu season grows in the soiuthern hemisphere and more of the population develops antibodies to the current strain.

The virus is just starting to roll and one or two minor changes can have a MAJOR effect.

Right now it still looks like a 1918 train wreck between trains on the same track which are gathering speed and heading towards each other.

AlaskaDenise · Jul 3, 2009

Re: Hong Kong: Detection of human swine influenza virus resistant to Tamiflu in person from USA

.....not only was in Hong Kong, but was also in San Francisco, the origin of the traveler.

I don't see any reports saying she was a resident of California. She could have been from HK and was visiting San Francisco. If she traveled with a group, someone else in that group could have infected her.

For that matter she could have been from anywhere and simply had a layover in San Francisco before traveling to HK.

.

wotan · Jul 3, 2009

Re: Hong Kong: Detection of human swine influenza virus resistant to Tamiflu in person from USA

AlaskaDenise said:
I don't see any reports saying she was a resident of California. She could have been from HK and was visiting San Francisco. If she traveled with a group, someone else in that group could have infected her.

For that matter she could have been from anywhere and simply had a layover in San Francisco before traveling to HK.

.

Those may all be true, but there is a strong implication that the resistance at the least had its origins in the western hemisphere. Something tells me you don't fly from Berlin to HK by way of San Francisco.

AlaskaDenise · Jul 3, 2009

Re: Hong Kong: Detection of human swine influenza virus resistant to Tamiflu in person from USA

It's highly probable she could be traveling HK to CA to HK. Also, Toronto to SF to HK, or Cancun to SF to HK. Or HK to west coast cruise to SF to HK.

.

HenryN · Jul 3, 2009

Re: Hong Kong: Detection of human swine influenza virus resistant to Tamiflu in person from USA

AlaskaDenise said:
I don't see any reports saying she was a resident of California. She could have been from HK and was visiting San Francisco. If she traveled with a group, someone else in that group could have infected her.

For that matter she could have been from anywhere and simply had a layover in San Francisco before traveling to HK.

.

Lost of woulda couldas shoulda's but ZERO sequences. Although Denmark, Japan, and Hong Kong have all described the resistance, none have sequences on deposit. San Francisco to Kong Kong is a long plane ride and others could have been infected in flight.

It is past time to step up sequencing and data release. California sequences from CDC seem to be from patients infected in April.

There is a serious data lag with MAJOR database holes, even in the US.

I STRONG suspect H274Y is widespead and silently spreading in mild cases, including the US where mild cases are NOT even tested at this point.

HenryN · Jul 3, 2009

Re: Hong Kong: Detection of human swine influenza virus resistant to Tamiflu in person from USA

Here;s data for Hawaii at Genbank. One NA sequence that was just deposited from a collection in April

LOCUS GQ338360 1410 bp cRNA linear VRL 01-JUL-2009
DEFINITION Influenza A virus (A/Hawaii/09/2009(H1N1)) segment 6 neuraminidase
(NA) gene, complete cds.
ACCESSION GQ338360
VERSION GQ338360.1 GI:243031419
DBLINK Project:37813
KEYWORDS .
SOURCE Influenza A virus (A/Hawaii/09/2009(H1N1))
ORGANISM Influenza A virus (A/Hawaii/09/2009(H1N1))
Viruses; ssRNA negative-strand viruses; Orthomyxoviridae;
Influenzavirus A.
REFERENCE 1 (bases 1 to 1410)
AUTHORS Garten,R.
TITLE Direct Submission
JOURNAL Submitted (01-JUL-2009) Centers for Disease Control and Prevention,
NCIRD/Influenza Division/VSDB, Centers for Disease Control and
Prevention, Atlanta, 1600 Clifton Road, N.E., Atlanta, GA 30333,
USA
COMMENT Swine influenza A (H1N1) virus isolated during human swine flu
outbreak of 2009. For more information, see http://www.cdc.gov/.

Some of the information does not have GenBank feature identifiers
and is being provided in the comment section.

##EpifluData-START##
Isolate A/Hawaii/09/2009
Subtype H1N1
Segment_name NA
Host_gender F
Host_age 37
Passage_history C1
Antigen_character A/California/07/2009-LIKE (H1N1)V
Adamantane_resistance resistant
Zanamivir_resistance sensitive
Oseltamivir_resistance sensitive
Country USA
State/Province Hawaii state
Collection_day 30
Collection_month 4
Collection_year 2009
Isolate_note Comment: Human case of 2009 H1N1 swine
influenza.
EPI_accession EPI184367
Lineage swl
##EpifluData-END##
FEATURES Location/Qualifiers
source 1..1410
/organism="Influenza A virus (A/Hawaii/09/2009(H1N1))"
/mol_type="viral cRNA"
/strain="A/Hawaii/09/2009"
/serotype="H1N1"
/host="Homo sapiens; gender F; age 37"
/db_xref="taxon:656491"
/segment="6"
/country="USA: Hawaii state"
/collection_date="30-Apr-2009"
gene 1..1410
/gene="NA"
CDS 1..1410
/gene="NA"
/codon_start=1
/product="neuraminidase"
/protein_id="ACS94509.1"
/db_xref="GI:243031420"
/translation="MNPNQKIITIGSVCMTIGMANLILQIGNIISIWISHSIQLGNQN
QIETCNQSVITYENNTWVNQTYVNISNTNFAAGQSVVSVKLAGNSSLCPVGGWAIYSK
DNSVRIGSKGDVFVIREPFISCSPLECRTFFLTQGALLNDKHSNGTIKDRSPYRTLMS
CPIGEVPSPYNSRFESVAWSASACHDGINWLTIGISGPDNGAVAVLKYNGIITDTIKS
WRNNILRTQESECACVNGSCFTVMTDGPSNGQASYKIFRIEKGKIVKSVEMNAPNYHY
EECSCYPDSSEITCVCRDNWHGSNRPWVSFNQNLEYQIGYICSGIFGDNPRPNDKTGS
CGPVSSNGANGVKGFSFKYGNGVWIGRTKSISSRNGFEMIWDPNGWTGTDNNFSIKQD
IVGINEWSGYSGSFVQHPELTGLDCIRPCFWVELIRGRPKENTIWTSGSSISFCGVNS
DTVGWSWPDGAELPFTIDK"
ORIGIN
1 atgaatccaa accaaaagat aataaccatt ggttcggtct gtatgacaat tggaatggct
61 aacttaatat tacaaattgg aaacataatc tcaatatgga ttagccactc aattcaactt
121 gggaatcaaa atcagattga aacatgcaat caaagcgtca ttacttatga aaacaacact
181 tgggtaaatc agacatatgt taacatcagc aacaccaact ttgctgctgg acagtcagtg
241 gtttccgtga aattagcggg caattcctct ctctgccctg ttggtggatg ggctatatac
301 agtaaagaca acagtgtaag aatcggttcc aagggggatg tgtttgtcat aagggaacca
361 ttcatatcat gctccccctt ggaatgcaga accttcttct tgactcaagg ggccttgcta
421 aatgacaaac attccaatgg aaccattaaa gacaggagcc catatcgaac cctaatgagc
481 tgtcctattg gtgaagttcc ctctccatac aactcaagat ttgagtcagt cgcttggtca
541 gcaagtgctt gtcatgatgg catcaattgg ctaacaattg gaatttctgg cccagacaat
601 ggggcagtgg ctgtgttaaa gtacaacggc ataataacag acactatcaa gagttggaga
661 aacaatatat tgagaacaca agagtctgaa tgtgcatgtg taaatggttc ttgctttact
721 gtaatgaccg atggaccaag taatggacag gcctcataca agatcttcag aatagaaaag
781 ggaaagatag tcaaatcagt cgaaatgaat gcccctaatt atcactatga ggaatgctcc
841 tgttatcctg attctagtga aatcacatgt gtgtgcaggg ataactggca tggctcgaat
901 cgaccgtggg tgtctttcaa ccagaatctg gaatatcaga taggatacat atgcagtggg
961 attttcggag acaatccacg ccctaatgat aagacaggca gttgtggtcc agtatcgtct
1021 aatggagcaa atggagtaaa aggattttca ttcaaatacg gcaatggtgt ttggataggg
1081 agaactaaaa gcattagttc aagaaacggt tttgagatga tttgggatcc gaacggatgg
1141 actgggacag acaataactt ctcaataaag caagatatcg taggaataaa tgagtggtca
1201 ggatatagcg ggagttttgt tcagcatcca gaactaacag ggctggattg tataagacct
1261 tgcttctggg ttgaactaat cagagggcga cccaaagaga acacaatctg gactagcggg
1321 agcagcatat ccttttgtgg tgtaaacagt gacactgtgg gttggtcttg gccagacggt
1381 gctgagttgc catttaccat tgacaagtaa

</PRE></P>

gjs47 · Jul 3, 2009

Re: Hong Kong: Detection of human swine influenza virus resistant to Tamiflu in person from USA

At this time there appears to be one reliable and accessible source of correct information on what's really going on. If that's really the case, protecting that source and supply would be a priority.

We watched the spread of the current version, even as it affected your school district and locale. You kept an continuous update on the current status at that time.

Are you prepared to sip? If so, and knowing the changing situation and it's pending possibilities and/or probabilities, at what point are you going to sip? Are you going to send an advisory to notify others that you have made that decision?

Thank you for all you do and say.

HenryN · Jul 3, 2009

Re: Hong Kong: Detection of human swine influenza virus resistant to Tamiflu in person from USA

The seventh imported case involved a 10-year-old girl. She returned to Hong Kong from San Francisco by taking a flight of Singapore Airlines (flight no. SQ1) on June 11. She sat in row 50 of the flight.

http://www.chp.gov.hk/content.asp?lang=en&info_id=17467&id=116

HenryN · Jul 3, 2009

Re: Hong Kong: Detection of human swine influenza virus resistant to Tamiflu in person from USA

The seventh case is a 15-year-old girl studying in the United States. She returned to Hong Kong via Tokyo on June 11 by taking a flight of Northwest Airlines (flight no. NW7). She sat in row 33 of the flight.

She developed sore throat on June 11 and fever on the next day. She was admitted to UCH on June 12 for isolation.

http://www.chp.gov.hk/content.asp?lang=en&info_id=17457&id=116

HenryN · Jul 3, 2009

Re: Hong Kong: Detection of human swine influenza virus resistant to Tamiflu in person from USA

niman said:
The seventh case is a 15-year-old girl studying in the United States. She returned to Hong Kong via Tokyo on June 11 by taking a flight of Northwest Airlines (flight no. NW7). She sat in row 33 of the flight.

She developed sore throat on June 11 and fever on the next day. She was admitted to UCH on June 12 for isolation.

http://www.chp.gov.hk/content.asp?lang=en&info_id=17457&id=116

Flight Schedule 1 
Flight: NW 344 
<LABEL><FORM style="MARGIN-BOTTOM: 0px" method=post name=FlifoForm0 action=/cgi-bin/flifo2.pro><INPUT value=344 type=hidden name=flight> <INPUT value=02JUL type=hidden name=day> </FORM>View Flight Status </LABEL>

Departs: San Francisco-Int'l, CA (SFO) at 12:30AM 
Arrives: Detroit-Wayne County Int'l, MI (DTW) at 07:56AM 
 Flight: NW 25 
<LABEL><FORM style="MARGIN-BOTTOM: 0px" method=post name=FlifoForm1 action=/cgi-bin/flifo2.pro><INPUT value=25 type=hidden name=flight> <INPUT value=02JUL type=hidden name=day> </FORM>View Flight Status </LABEL>

Departs: Detroit-Wayne County Int'l, MI (DTW) at 03:20PM 
Arrives: Tokyo-Narita, Japan (NRT) at 05:05PM 
 Flight: NW 29 
<LABEL><FORM style="MARGIN-BOTTOM: 0px" method=post name=FlifoForm2 action=/cgi-bin/flifo2.pro><INPUT value=29 type=hidden name=flight> <INPUT value=02JUL type=hidden name=day> </FORM>View Flight Status </LABEL>

Departs: Tokyo-Narita, Japan (NRT) at 06:50PM 
Arrives: Hong Kong-Int'l, Hong Kong (HKG) at 10:20PM +1

HenryN · Jul 3, 2009

Re: Hong Kong: Detection of human swine influenza virus resistant to Tamiflu in person from USA

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