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Dr. Niman: Is D225G in severe swine flu?

Concerning the surge in severe suspected swine flu cases in parts of Europe, Dr. Henry Niman suggests it may indicate that D225G or other receptor binding domain changes are on the rise. Last season the acquisition of D225G was linked to severe and fatal cases, but the level of D225G in circulation was relatively low. However, the virus with D225G was deemed a "low reactor" and there were concerns that, once global immunity to wild type pH1N1 was established, the level of D225G could increase substantially in a variant that emerged between seasons.

From Dr. Niman:

The increased targeting of healthy young adults, as well as the rapid rise in severe and fatal cases, when the H1N1 levels in the entire population are relatively low, raises concerns that the H1N1 has changed and become more virulent in the UK and Spain, with similar results to follow in other countries in the northern hemisphere.

This increased virulence has been noted previously for H1N1 with the receptor binding domain change D225G, which was strongly associated with severe and fatal cases last season. A change in the frequency of H1N1 with D225G could dramatically increase the frequency of severe and fatal cases.