Flu viruses are known to be imprecise when they replicate, with the result being mutations or changes in the genetics of the "offspring" viruses. When a change like this happens, a copy of the virus suddenly has a new trait. The new trait may be good for the virus (makes it better able to thrive, spread, reproduce). Or it may be bad for the virus, making it less "fit" for survival and reproduction.
Of course, when you're talking about a virus that causes flu in humans, what's good for the virus is bad for people ... and what's bad for the virus is good for people.
For example, there have been a few cases where the H1N1 virus causing the current flu pandemic has developed (mutated) a resistance to Tamiflu, one of the antivirals used to treat the flu. That's bad for people because if the virus won't respond to Tamiflu we've lost an important medical treatment. So far, this mutation has only happened on rare occasions. The hope is that those particular viruses don't begin to "take hold" and reproduce/spread widely.
There's another particular mutation which, in the opinion of some, is much more troubling. This is a change in an amino acid at position 225 in the hemagglutinin (HA) protein on the surface of the virus. (Hemagglutinin is the "H" in "H1N1".) This change in the "receptor binding domain" in the HA protein causes the virus to prefer to attach to a different type of cell in the human body. While flu viruses usually attach to cells in the nasal/throat "upper respiratory" area, these mutated "D225G" viruses prefer to attach to cells down in the lungs. This is not typical and is not good because it often results in severe disease in the lungs ... and I'm talking SEVERE. Many cases result in hemorrhagic pneumonia and death, as high concentrations of the D225G virus triggers a so-called "cytokine storm" reaction in lung cells.
Due to the location of the virus, an unfortunate consequence is that it's difficult to know when a person has the D225G version of H1N1. That's because when the sick person is tested, the sample is obtained by swabbing the nose or throat, where the D225G H1N1 isn't - it's down in the lungs. So the test shows either no flu or the regular H1N1 (if some of that original version happens to be in the nose/throat while the D225G version is in the lungs).
The existence of this D225G mutation first got the spotlight in late October in the Ukraine. There was a real spike in H1N1 cases there ... and reports that some H1N1 fatalities reportedly were young people who had severe hemorrhagic pneumonia.
One regular flu blogger, Dr. Henry Niman, wondered if the Ukraine H1N1 had changes in the receptor binding domain in the HA protein.
On November 19, receptor binding domain change D225G was confirmed in H1N1 samples from the Ukraine. The World Health Organization released genetic sequence information from 10 Ukraine H1N1 samples.
Of the 10 Ukraine cases, there were four fatalities ... and all four had receptor binding domain change D225G. Furthermore, the virus was found in the lungs/throat, not in the upper respiratory nasal area.
On Nov. 20, scientists in Norway said they'd found mutated D225G H1N1 swine flu in two dead patients and one severely ill. The scientists noted that the virus could "infect deeper in the airways."
At the same time, piecing together information, the WHO said "a similar mutation in viruses" had been detected as early as last April in seven countries: Brazil, China, Japan, Mexico, Norway, Ukraine, and the United States.
These are still isolated cases and, for the record, WHO says "the public health significance of this finding is thus unclear." The mutation has been seen in mild cases, as well as fatal cases. And "numerous fatal cases have not shown the mutation," WHO says.
In addition, some observers, such as virology Professor Vincent Racaniello who publishes the Virology Blog, says it's not a concern - and, in fact, the D225G mutation makes it more difficult for H1N1 swine flu to spread.
Nonetheless, the fact that a change in some H1N1 could make the virus more likely to infect deeper in the airways and cause more severe disease is leaving many observers with an uneasy feeling.
It's something that bears watching.
A couple of related thoughts:
- Remember that the greater the number of severe flu cases, the greater the load on hospitals.
- Since viruses mutate readily, if this D225G mutation doesn't prove to be a major problem, there's always the chance that some other mutation will. Flu viruses are not ones to be trusted, so to speak.