The Mutation Hunt Begins

There have been recent reports of mutations in the H1N1 virus that may be associated with more severe symptoms in Ukraine and Norway. Similar mutations have been observed in other countries as well. The following is a typical example of how the WHO explains the situation and what they plan to do about it in English language media:

From: Radio Australia News, November 27, 2009

The World Health Organisation says it’s investigating reports of mutations in the swine flu virus, after half-a-dozen countries recorded cases in which the virus was transforming.

The Geneva-based organisation says it’s following up on data received from China, Japan, Europe and the United States to see if there is any turn for the worse in terms of severity.

What, exactly, does “following up” mean in this context?

To get an answer, we need to switch to a Spanish language media outlet, Milenio, a Mexican news site (November 26, 2009).

En México se detectó el primer caso de mutación del virus de influenza humana A(H1N1), que corresponde a los reportes y las defunciones de abril, cuando inició la epidemia en el país, señaló la directora del Indre, Celia Alpuche Aranda.

La titular del Instituto de Diagnóstico y Referencia Epidemiológicos precisó que la próxima semana iniciarán una metodología que diseñó ese organismo para secuenciar rápidamente y poder determinar si hay más casos con la mutación del virus, y si son graves o leves.

En entrevista, Alpuche Aranda explicó esa investigación fue solicitada a todos los países por la Organización Mundial de la Salud, puesto que además de México también se han encontrado casos en Brasil, China y Estados Unidos.

El ocurrido en México corresponde al segundo paciente grave que fue atendido en el Instituto Nacional de Enfermedades Respiratorias, que se comparó con otros tres casos que se registraron en Estados Unidos, pero en enfermos leves.

En esa ocasión la OMS determino que no se trataba de una situación particular, pero en días pasado en Noruega se reportaron casos graves de personas que contrajeron la enfermedad con el virus mutado, por lo que todos los países empezarán a buscar detenidamente si hay más registros.

Celia Alpuche explicó que no se ha llegado a consenso alguno en la OMS que verdaderamente pueda confirmar una mayor virulencia del A(H1N1), porque se ha encontrado en pacientes graves pero también en enfermos leves.

“La indicación de la OMS es que a partir del 20 de noviembre empecemos a buscar detenidamente en un muestreo aleatorio si esto está verdaderamente asociado. Nos lo pidió a todos los países”, comentó la directora del Indre.

English translation

The first case of of mutation in pandemic H1N1 in Mexico was detected when the pandemic begain in the country in April, said the Director of INDRE, Celia Alpuche Aranda.

The Institute for Diagnosis and Reference Epidemiologists will begin rapid sequencing methods next week to determine if there are cases of mutated virus and if these are severe or mild.

In the interview, Alpuche Aranda explained that the investigation was requested of all countries by the WHO because cases have been detected in other countries besides Mexico including Brazil, China and the United States.

The case that occurred in Mexico corresponds to the second patient with severe symptoms who was treated at the National Institute of Respiratory Diseases and was compared to three patients in the United States who had mild sickness.

Originally, the WHO had determined that this was not a special circumstance, but in recent days severe cases in Norway with the mutated virus is the reason why all countries will begin to look with greater attention to see if there are more cases.

Celia Alpuche explained that there is no consensus at the WHO as to whether there is a more virulent H1N1 because it [the mutation] has been observed in patients with both severe and mild symptoms.

“The instructions from the WHO is that from November 20, we should begin to look extensively at random samples to see if there is an association. This has been requested of all countries”, said the Director of INDRE.

So, as of November 20, 2009, the WHO has apparently instructed all countries of the world to commence a program of rapid sequencing of random samples to look for mutations in the pandemic H1N1 virus that may be associated with increased virulence. Further, it would appear that such mutant strains may have been present since April, but that it took the more recent data from Norway (and possibly Ukraine) to prompt them to begin the mutant search.

I have been arguing for such a program of extensive sequencing since the beginning of the pandemic. Such sequencing is now cheap and relatively easy due to recent advances in the technology. Comparing large numbers of samples from “mild” and severe cases is the only way to determine if a more virulent strain exists and if it is increasing in frequency. The WHO, the CDC and other public health agencies have squandered valuable time in starting this program.

I suppose I should say: better late than never, but one wonders what finally got the WHO to take this obvious step.




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