masks N95 for children against the swine flu, influenza and other viruses airborne.

Mum tells how she survived horror swine flu ordeal

A MUM has told how she fought back from the brink of death after catching swine flu.

Victoria Fleming's family feared she would die after she suffered multiple organ failure.

The 40-year-old - who has no underlying health problems - was put into a coma and flown to England for vital life support.

She spent weeks in intensive care and had to use a walking frame after finally being able to get out of bed.

Victoria, from Carluke, Lanarkshire, said: "I am lucky to be alive.

" I was as ill as I could possibly be without dying."

Trade union organiser Victoria, mum to six-year-old Amy, was given Tamiflu after she fell ill at work.

But she became seriously sick within days and was rushed to Wishaw General Hospital with breathing difficulties.

Her vital organs began to fail and doctors took the decision to put her into a coma.

Her terrified parents and husband Frankie were told there was nothing more medics could do to save her.

But hours later doctors secured a place at Glenfield Hospital in Leicester for treatment on a special machine which gives the blood oxygen.

Victoria was flown south where she had 75 hours of treatment.

She was later returned to Wishaw where she was in intensive care for three weeks.

Victoria said: "The treatment in Leicester made all the difference.

"The machine takes your blood through a tube and adds oxygen and removes carbon dioxide before replacing it via another tube. Luckily, I responded really quickly. My dad and husband never thought for a moment that I might not recover, but my mum still gets upset sometimes thinking about the day they were told that my organs were shutting down."

Victoria talked of her ordeal after the Daily Record exclusively revealed that Gayle Cassidy, Scotland's longestsuffering swine flu victim, had lost her battle with the killer virus.

Insurance worker Gayle died at Glasgow's Western Infirmary last month.

Victoria said: "I got so emotional when I read about Gayle Cassidy. Our stories are the same but have a very different ending. I couldn't stop crying."

Victoria has been able to return to work gradually - but it could be up to a year before she recovers fully.

She said: "I can't do any proper exercise because of open sores on my feet.

"My toes and heels went black because of the illness. My fingernails and patches of my hair have fallen out.

"I have scars in my neck from the treatment but I wear them with pride because it's a reminder of the treatment that saved my life."

The swine flu outbreak has killed 69 Scots but cases continue to fall.

H1N1 Low Reactor G158E In Athens Greece

Dr Henry Niman

Recombinomics Commentary 11:13
March 10, 2010
Recently released sequences from Mill Hill at GISAID included a sequence, A/Athens/16606/2009, from Greece collected on December 26, 2009.  The sequence contained G158E, which was found in low reactors designated by Mill Hill and the CDC.  Although only a partial sequence was released, it contained E377K, which was also in the Hyogo/1597/2009 isolate from Japan, indicating G158E was transmitting.  Similarly, four of the G158E sequences from Japan also had A200T including one sample with H274Y.  Another sample in Japan had D225N, while samples in Italy and Russia had D225G.

These various combinations signal movement of G158E from genetic background via recombination, which was also seen for D225G, D225N, and H274Y.  D225G has also been designated a low reactor marker, leading to concerns that these markers will be more common in upcoming waves, including the wave which may be beginning now.

Increases in these markers would lead to more severe and fatal cases as indicated by the association of D2225G/N in Ukraine, Norway, and Greece.  Although current approaches has yielded high frequencies of D225G, the detection of D225G in egg isolates from mild cases raises concerns that low levels of D225G may be widespread, and increases may be missed with current assays which focus on direct sequencing and growth of virus in mammalian cells, which failed to identify D225G in milder cases, which had D225G in egg isolates.  However, this failure may be linked to mixtures in these samples, which may be less common as immune responses reduce the level of wild type receptor binding domains

H1N1 Tamiflu Resistance and D225G In 2010 Greek Case

Recombinomics Commentary 9:44
March 10, 2010
Recently released HA sequences from the Aristotle University of Thessaloniki at Genbank in a report entitled “Molecular and phylogenetic analysis of the haemagglutinin gene of pandemic influenza H1N1 2009 viruses associated with severe and fatal infections” includes 9 sequences from 2010 and 3 have D225G.  One (8F) of the three, A/Thessaloniki/225/2010, was also Tamiflu resistant (H274Y).  Although the clinical status of each patient was not included, the title of the submission suggests that these samples were from severe and fatal cases.

In addition to the three cases from 2010, three additional cases, had D225G in samples collected in mid-November, again pointing toward higher frequencies of D225G in more recent cases. Late October through mid November collections form autopsy lung in Ukraine had 27/37 samples positive for D225G. D225N, or both.  The sequences from Greece were from upper respiratory tract collections.  D225G in lung samples may have been detected at a higher frequency.

In Norway, samples with D225G were exclusively found in severe (3) or fatal (8) patients, which were statistically significant.

The three samples positive for D225G in 2010 represents the highest number reported from one country in 2010, which includes the first report in 2010 of D225G and H274Y in the same patients.  Last year D225G with H274Y was reported in patients in France and the United States, including the Duke death cluster.

Specific patient outcomes and testing of samples from the lower respiratory tract would be useful.

G158E H1N1 Low Reactor In South Korea

Recombinomics has the story

Recombinomics Commentary 23:54
March 9, 2010
Recently released NIID sequences at GISAID include A/GYEONGGI/4478/2009, which has G158E and was collected on 9/11.  When G158E was reported in sequences from Germany, the CDC and Mill Hill independently determined that the isolates were low reactors, which was linked to G158E since it was the only non-synonymous HA change.  NIID also released a series of more recently collected isolates in Japan which also had G158E, which dramatically increased the number of public sequences with G158E.  Included in the isolates from Japan were sequences with D225N or H274Y.  These low reactors with clinically significant markers were in addition to isolates with the combination of G158E and D225G found in Italy and Russia.

The jump in these low reactor markers in Asia adds to the jump reported in the United States.  In the latest CDC report, the number of low reactors increased from 2 to 5.  An increase in low reactors was expected, as more of the target population develops immunity against wild type H1N1.  However, the low reactor, receptor binding domain, and anti-viral markers have been actively jumping from one genetic background to another via recombination, which increases the number of different combinations on different genetic backgrounds.

This rapid evolution raises concerns that there will be widespread vaccine failure against isolates that have resistance to anti-virals and cause more severe and fatal infections.

Low Reactor Tamiflu Resistant H1N1 Recombinant In Japan

Recombinomics Commentary 18:44
March 9, 2010
NIID has released a series of sequences from Japan at GISAID. Most of these sequences are from December collections, including A/FUKUI/159/2009. Many, like the Fukui sequence, have G158E as a clean signal or as mixtures with wild type. The Fukui sequence also has H274Y and is on the same branch as several other isolates with G158E, including Yamagata/752, Iwate/1093, and Ishikawa/566. These other sequences with G158E also have A200T.  However, only the Fukui sequence has H274Y.

The G158E has been seen in sequences from Germany that have been designated as low reactors by the CDC and Mill Hill.  Since the only non-synonymous change in the German isolates was G158E, it is likely that the sequences above are also low reactors.

The sequences in Japan and South Korea have G158E on multiple genetic backgrounds, most of which are distinct from the German sequences (which do not have A200T).  One sequence had D225N, which is similar to another D225N sequence in Japan.

G158E has also been reported on sequences with D225G in Italy and Russia, which represent additional genetic backbones.

The appearance of G158E on multiple backgrounds signals recombination, and the large number of recent sequences (most in Japan were collected in December) indicates G158E is “in play”.  Such changes will be selected for because of immunity against wild type H1N1.  G158E as well as N159G are in the same antigenic site and these changes may facilitate immunological escape.

The sharp and sudden rise in diverse sequences with G158E is cause for concern.

Circulation of human influenza viruses and emergence of Oseltamivir-resistant A(H1N1) viruses in Cameroon, Central Africa

While influenza surveillance has increased in most developing countries in the last few years, little influenza surveillance has been carried out in sub-Saharan Africa and no information is available in Central Africa. The objective of this study was to assess the prevalence of influenza viruses circulating in Yaounde, Cameroon and determine their antigenic and genetic characteristics. Methods: Throat and/or nasal swabs were collected from November 2007 to October 2008 from outpatients with influenza-like illness (ILI) in Yaounde, Cameroon and analyzed by two different techniques: a one-step real time reverse transcription-polymerase chain reaction (RT-PCR) and virus isolation in MDCK cells. Typing and subtyping of virus isolates was performed by hemagglutination inhibition (HI), and viruses were sent to the WHO Collaborating Centre in London, UK for further characterization and analyses of antiviral resistance by enzyme inhibition assay and nucleotide sequencing. Results: A total of 238 patients with ILI were sampled. During this period 70 (29%) samples were positive for influenza by RT-PCR, of which only 26 (11%) were positive by virus isolation. By HI assay, 20 of the 26 isolates were influenza type A (10 H3N2 and 10 H1N1) and 6 were influenza type B (2 B/Victoria/2/87 lineage and 4 B/Yagamata/16/88 lineage). Seven (70%) of the H1N1 isolates were shown to be resistant to oseltamivir due to a H275Y mutation. Conclusions: This study confirmed the circulation of influenza A(H1N1), A(H3N2) and B viruses in the human population in Central Africa and describes the emergence of oseltamivir-resistant A(H1N1) viruses in Central Africa. Author: Richard NjouomSerge Sadeuh MbaDominique Noah NoahVictoria GregoryPatrick CollinsPierre CappyAlan HayDominique Rousset Credits/Source: BMC Infectious Diseases 2010, 10:56

H1N1 Low Reactor G158E D225N Recombinant In Japan

Recombinomics Commentary 07:44
March 9, 2010
The recently released sequence, A/Yamagata/721/2009, represents a new recombinant with the low reactor polymorphism G158E and D225N.  This sequence follows release of recombinant sequences with G158E and D225G in Russia and Italy.  A Ukraine sequence with D225G has also been designated a low reactor by Mill Hill, which when recombined with G158E raises concerns of serious vaccine failure.

D225G has been found to be strongly associated with severe and fatal cases in Norway as well as Ukraine.  Egg isolates from milder cases have also been found to contain D225G, which was not seen in direct sequencing of the clinical samples or isolates grown in mammalian cells.  However, D225G, has affinity for gal 2,3 receptors found in chicken embryos in eggs, so the egg isolates may represent selection of isolates with D225G and may be a more sensitive assay for samples with low levels of D225G.  recent statements by the CDC on the number of patients testing positive for D225G do not include patients with D225G detection limited to egg isolates, indicating the CDC is using the negative data from assays that select against D225G, to nullify detection of D225G in eggs which selective for the change.  The use of a negative result from a less sensitive assay to trump positive results from more sensitive assays raises serious concerns on the generation and interpretation of sequence data.  This concern is increased when the above “logic” is applied to an important marker like D225G.

Thus, the D225G may be circulating widely but silently because of the minimal use of eggs to expand H1N1 isolates.  D225G appears to be on the rise, and this increase may accelerate because of the possibility that D225G confers low reactor status, and D225G recombination which adds another low reactor polymorphism, G158E.

These recent results raise serious question about H1N1 surveillance represented by public sequences, and continue to be hazardous to the world’s health.

H1N1 G158E Low Reactors In Japan Raise Vaccine Concerns

Recombinomics Commentary 06:58
March 9, 2010
NIID released a small series of sequences at GISAID, including two from Japan. Both had G158E, the polymorphism found in two isolates from Germany, which were designated low reactors by the CDC and Mill Hill. A/YAMAGATA/721/2009 was collected Dec 8 and had a mixed signal at position G158E. The other was A/IWATE/1093/2009 and collected Oct 27.

The presence of G158E in both sequences from Japan raises concerns that low reactors are becoming more prevalent.  In the two isolates from Germany, the only non-synonymous change is G158E.  This change has also been found in two isolates with D225G, one in Italy and one in Russia.  Mill Hill has also designated D225G as a low reactor.  Moreover, the Yamagata isolate also has D225N, which like D225G has been linked to severe and fatal H1N1 cases.

The release of the sequences from Japan follows the CDC week 8 report on H1N1 in the United States, which increased the number of low reactors reported by the CDC in the US from 2 to 5.  The two earlier reactors had changes at the adjacent position, N159D.  Moreover, sequences released from the Air Force had N159K and N159S.  The three changes at position 159 (N159D, N159K, N159S) as well as G158E all map to the same antigenic site, which is distinct from D225G or D225N, raising concerns of multiple low reactor polymorphisms aggregating via recombination to produce additive effects leading to widespread vaccine failure.

CDC Comments Raise H1N1 D225G/N Surveillance Concerns

Recombinomics Commentary 15:46
March 8, 2010
Referring to the Norwegian report, she commented, "It's intriguing, and there could be some association, but it's certainly not as clear as they've painted it."

"I think additional work needs to be done before we conclude that there is a causal relationship," she said.

The above comments by the CDC on the significant correlation between D225G and D225N with severe and fatal cases in Norway reflects the current position of CDC and WHO, even after overwhelming numbers have been made public in Ukraine.  In Norway, 8/27 fatal cases had D225G and 1/27 had D225N, but the 33% rate of D225G/N in fatal cases in Norway was dwarfed by the detection of D225G/N in 73% (27/37) of autopsy lung samples in Ukraine.  Like Norway, which failed to find D225G in mild cases, the Ukraine sequences with D225G/N were almost exclusively limited to fatal cases. 

After the initial release of HA sequences which indicatd D225G was limited to the four fatal cases in the first nine sequences from western Ukraine, Mill Hill released sequences from 12 Dniprpetrovsk isolates grown on mammalian cells and only one had D225G (as a mixture with wild type).  Another 6 isolates from Cherkasy grown in eggs had a wild type receptor binding domain (RBD), indicating that D225G/N was rarely detected in milder cases.  Virus from lung autopsy samples also contained D225G/N when grown on mammalian cells.  Only one sample that had a mixture of D225G with wild type based on direct sequencing lacked D225G in the sequence from the mammalian cell isolate.

Thus, the Mill Hill data demonstrated that almost all D225G/N positive samples were from fatal cases, and the RBD changes could be found in direct sequencing, as well as in isolates grown on mammalian cells.  In contrast, direct sequencing, or growth on mammalian cells or eggs rarely found D225G (one sample) when milder cases were tested.

Although the positive samples in Ukraine are clearly not linked to lab growth of virus, detection of lower levels of D225G may require selection via grown in eggs, which have gal 2,3 receptors, which is also true for human lung.  Early isolates from mild cases in the United States had D225G when grown in eggs, but not when sequences were direct or from virus grown in mammalian cells.  As indicated in CDC remarks on the number of cases with D225G, samples with D225G limited to egg isolates are not included in CDC totals.  Other labs have followed suit and use of various mammalian cells are increasing, limiting detection of these lower levels of D225G.

The Norway and Ukraine data clearly demonstrate the linkage of D225G to severe and fatal cases, and the worldwide levels of D225G/N are a high priority surveillance target.  In 1918/1919, 40% of sequences from fatal lung samples had D225G, including the only 1919 sample.

The above comments by the CDC, which were made after the Ukraine sequences have been made public, raises serious concerns about current surveillance approaches, which includes a trend away from creation of egg isolates, which may be the most sensitive method for detection of D225G.

More Bird Flu cases in Egypt

CAIRO: The Egyptian Ministry of Health announced five new cases of human H5N1 avian influenza infection.

The first case is a 53-year-old male from Shobra Elkhima district, Qaliobia Governorate. According to the ministry, the man developed symptoms on February 27 and was hospitalized the same day, where he received oseltamivir treatment.

He is currently in a critical condition.

The second case is a one-year-old boy from Banha district of the Qalyubia Governorate. He experienced symptoms on February 22 and was hospitalized the following day, where he also received oseltamivir treatment. He is in a stable condition, the ministry said.

The third case is a 10-year-old male from Meet Ghamr district, Dakaliya Governorate. He developed symptoms on February 10 and was hospitalized on February 14, where he received oseltamivir treatment. He is in a good condition.

The fourth case is a 30-year-old female from Kellin District, Kafr El-Sheik Governorate. She developed symptoms on February 11 and was hospitalized the following day, receiving similar treatment. She is in stable condition.

The fifth case is a 13-year-old male from Kafr El-Sheik District, Kafr El-Sheik Governorate. He developed symptoms on February 10 and was hospitalized on February 14 to receive the treatment. He is in stable condition.

The cases were confirmed by the Egyptian Central Public Health Laboratories, a National Influenza Center of the WHO Global Influenza Surveillance Network (GISN).

Of the 104 laboratory confirmed cases of Avian influenza reported in Egypt, 30 have been fatal since the virus first appeared in the country in early 2005.