http://www.recombinomics.com/News/01050608/H5N1_Turkey_Explosion.htmlRecombinomics Commentary
January 5, 2006
The human cases have been alarming because of the sudden appearance of cases, the size of the clusters, and the severity of the disease. The bird cases have also suddenly appeared and significantly extended a geographic reach over significant portions of Turkey.
The simultaneous appearance of the human sequences suggests the H5N1 has change and become more efficient at infecting humans. The widespread nature of the human cases suggest this change has happened and has been amplified in birds.
These types of changes could be explained by the acquisition of HA S227N. This polymorphism was identified in H5N1 Z_+ genotype isolates from two Hong King residents who had visited Fujian Province in 2003. The polymorphism led to a decreased affinity for avian receptors and an increased affinity for human receptors. Although the affinity for the avian receptors was reduced, the HA still had a significant affinity. Similarly, although the affinity for human receptors increased, the affinity was significantly lower than the affinity of human influenza sero-types.
These changes would allow the H5N1 to spread in birds, yet have a significant increase in efficiency of infecting humans. The H5N1 in the wild bird sequences also have the PB2 polymorphism, E627K, which increases virulence in mammals and favors viral replication at lower temperatures.
The increased virulence could explain the severity of the infections in humans. Many have pneumonia and are on ventilators and many are bleeding from the mouth.
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And:
http://www.recombinomics.com/News/01050604/H5N1_Kurgan_Recombinant.htmlThese newly acquired polymorphisms indicate the wild bird sequences evolve via a series of recombinations. Although the new polymorphisms appear as point mutation, the polymorphisms are not unpredictable random mutations. They are acquired via recombination with a limited number of parental strains that are recent ands localized.
As H5N1 expands its geographical reach, the genetic complexity of H5N1 sequences has increased and. led to additional acquisition of novel polymorphisms. This increased complexity has been evident in recent OIE reports on H5N1 on the Crimea peninsula and the Volga Delta.
The increase in efficient transmission of H5N1 to humans in Turkey and Indonesia suggests that these acquisitions via recombination are presenting increasing challenges and the H5N1 gene reservoir becomes more diverse and unstable.
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If I understand the articles correctly, H5N1 has made a large step toward human-to-human contagion, but isn't fully there yet. We don't have a good picture on the lethality in Turkey yet, but the data should be far superiour to earlier SouthEast Asian data.