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The use of good judgement during the discussion of controversial issues would be greatly appreciated.

IS H1N1 Mutating?????

by: Walrus

Thu Nov 05, 2009 at 14:47:11 PM EST

I'm starting to wonder if H1N1 mutations are appearing right now.

Clawdia said in the news thread:

That's what I keep wondering, Mary.

There's a post over at PFI today about a CDC call (restricted info, apparently) that made reference to the virus having mutated away from the vax.
by: Clawdia @ Thu Nov 05, 2009 at 11:05:20 AM EST

I followed that up and discussion is in PFI's Rumours V thread.

Now Plan For Pandemic's Hope4us has found an unrelated article about cases in Pune, India which refers to 35 deaths from an untyped ILI at the Sassoon Hospital that did not react to the common or garden H1N1 test.

This article contained the statement:

On October 28, doctors at Sassoon shared the data on these deaths with the Center for Disease Control, Atlanta, USA, and virologists across the world in a videoconference.


I wonder if the PFI rumour and this event are connected??

I also note that the Ukrainian samples tested in London showed H1N1 in half of them,....what was in the other half?

I also note a Doctors claim to have caught H1N1 twice.

Is there a pattern here?

Walrus :: IS H1N1 Mutating?????
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Or maybe not
Moreover, while in western countries all influenza cases turn out to H1N1 flu, in India there are cases of seasonal influenza also along with H1N1 influenza cases.

These were some of the interesting inputs exchanged, along with tips of clinical management of the H1N1 influenza, between experts of the Centre for Disease Control, Atlanta and the John Hopkins Centre for Clinical Global Health, Baltimore, and experts of the B.J. medical college and Sassoon general hospital via a video-conference held on Wednesday.
"The aim of the Indo-US video-conference was to review the latest information on the clinical management of severe H1N1 flu in adults and children," said Arun Jamkar, dean of the B.J. medical college and Sassoon general hospital.

Doctor - Confirmed H1N1 X 2
I think this report, posted here at FW, is perhaps the most disturbing of all the reports out today.

This doctor had two confirmed cases of H1N1.

The implications of that are staggering - it's long been suspected that more than one strain of H1N1 may be circulating, thereby accounting for the bad cases vs. the terrible cases (I refuse to use the word "mild" in connection with any influenza).

If the virus is mutating - or has already mutated - away from the CA strain used to make the vax, the phraae "Houston, we have a problem" may be a most unprecedented understatement . . .  

[ Parent ]
Yeah, that one's an eye-opener.
There've been anecdotal reports of multiple infections, but this one seems tested out and proven. There have been all kinds of speculations about why it might happen - the first case not serious enough to generate strong antibody reactions, leaving a person still susceptible to the virus. Some of the discussion about temperature variations, and the fact that many don't get a fever might apply - no fever, no resistance the next time? And, of course, is it mutating? This is definitely a story to keep an eye on.

[ Parent ]
To quote Dr. Niman on this topic:
Currently there is only ONE pandemic H1N1, and the claim by the Dr that the H1N1 infections were different has no scientific basis.

The clinical trial in Australia showed that initial infections with H1N1 produce a weak immunological response, which was increased by vaccination.

Reinfection is just a numbers game. If there is more virus than antibody, there will be reinfections. Weak response = reinfection if subsequent exposure is significant.


Personally I do believe that I've had it twice.  

[ Parent ]
I also believe that I had the virus twice.
The first case lasted 8 weeks, the second only about 5 days with much less severe cough and other symptoms, which I attribute not to any change in the virus but simply to the fact that I had some antibodies from the first infection that allowed my body to fight it off more efficiently the second time. So I'm kind of on Niman's page with that one.

Always have a plan B.

[ Parent ]
Recurrant Infections
I think if you get out into the community you will find it quite common, though there are no tests to prove it. I've been seeing a FLI without fever at work for at least a month and a half now. As local DR. aren't acknowledging FLIs without fever as actual flu here, it will be pretty hard to get a handle on how often it is happening.

[ Parent ]
But one wouldn't expect a mutation to be "everywhere at once."
It would start in one place and gradually spread globally. It would be in competition with the original pandemic form for awhile, so one would expect both strains to be found in a given area. But gradually - if the mutation conferred some advantage - it would become the predominant strain.

Always have a plan B.

[ Parent ]
a lot of rumor
and little fact.

no complaint about posting this
I'm just saying there's not a lot to go by.

[ Parent ]

Yep, it sure is hard to trust those sneaky doctors nowadays.....

 Who knows when they are telling the truth or not?  Heck, they might not even understand the test results they are giving out!


/end snark

 Now I'm the first one that since April has been the voice of reason and I am still sticking by the .006%  to .0006% CFR I calculated back in May.  And that strident calls for "man made virus" and "vaccines are bad" are just asinine...

However, I get cranky when there is a lot of anecdotal information that is validated over and over again by disparate sources is rejected or dismissed out of hand because.....

"it just doesn't happen that way".

How many influenza memes have been destroyed so far?


Less See...

1.  Influenza doesn't have a gastro component.  WRong.  Heck, now gastro symptoms are now almost a critical determinant.

2.  Influenza always causes a fever.  Wrong, Heck, up to 30% of presentations to HOSPITALS show no fever.

3.  Influenza isn't passed to pets...  Wrong, We've got cats, and I bet if we looked we would get dogs too.

4.  Influenza only kills the very young or very sickly old.... Wrong, we've got healthy kids and young adults dying.

5.  Influenza only occurs in deep winter....  Wrong, we had clusters of outbreaks in summer camps, and the only requirement seemed to be not temp, but close contact.

6.  Influenza deaths are the result of bacterial secondary infections.... Wrong, we've seen influenza being the primary cause of death in case after case....

7.  Influenza only infects nasal and lung tissues.....  Wrong, we see heart and muscle tissue involvement, as well as viruses being found in other tissues.

And I'm not cherry picking these memes.  We've seen doctor after doctor repeat these historical "facts", and many still believe them today...

And if I've missed any, let me know.

Here are a couple that I am sure are correct as well.

1.  Influenza can sometimes infect the lymphatic system

2.  Influenza can sometimes not generate a strong antibody response and cause reinfections without having to undergo antigenic changes.

3.  Influenza can hide within the lymphatic system for weeks and months, making it hard to clear from the body.

4.  Influenza can cause the body to run below normal body temperatures by a yet undiscovered mechanism.

5.  Influenza can cause "brain fog", implying a low grade neural involvement of some sort.

There are a few others, but they are probably less probable, and I'll keep those out of the comments.



Just rolling along, making waves and causing trouble...

[ Parent ]
Is H1N1 mutating???? I dunno
it'd take more than anecdote to address that. it would take genetic analysis. And since up to now, everything we've heard is that it isn't mutating via genetic analysis, I don't see where there's anything to say.

As for the doc, can't say a thing because I don't know what the referral is to. I know a lot of docs use the rapid test that is not very accurate. it has both false negatives and false positives.  In fact when compared to PCR, some of our rapid positive flus in MD offices turn out to be rhinovirus.

Just sayin' why I'm a bit of a skeptic. As far as your list, helen branswell lists more.


Flu dogma being rewritten by a strange virus no one pegged to trigger a pandemic

But they can be true and unrelated to the topic of this diary.

[ Parent ]

Dang, she beat me by 24 hours.  Thanks for the link, I like her list too....


Great minds think alike!


As for the question of H1N1 mutating?  I'm with Dem.  A lot more data would have to  be presented before I beleive that, and I'm sticking with the theory that the most widely circulating strain is the same one from April.  Just no data yet that would lead to an alternative conclusion.....

Just rolling along, making waves and causing trouble...

[ Parent ]
I think that data may be presenting itself in the Ukraine
Niman points out that while the WHO announcements thus far have not indicated any "major" changes, small mutations can result in increased viral load, thus increased transmission and death.


What are your thoughts on what is happening in the Ukraine?


[ Parent ]
here's Keiji Fukuda today
"We remain quite concerned about the patterns that we're seeing," Fukuda said during a press briefing Thursday.

He said the swine flu virus appeared to be fairly stable, and that samples from around the world remained very similar to when the virus was first identified in April.


[ Parent ]
Denver Dr. Said You Can Get H1N1 Twice
Just talked to my friend from her H1N1 sick bed.  Her doctor told her she could get H1N1 again.  His practice is seeing people coming in with H1N1 a second time.  So I believe that some of you are correct, if you get a mild case you can get H1N1 again.  

I just hope that if you get H1N1 and use Tamiflu that does not mean you can get H1N1 again!!  Tamiflu does keep the flu symptoms mild but my teen did run a 104 temp even on Tamiflu!

My friend that is sick has had H1N1 for 9 days now...she has been very sick.  Tonight she said, "I wonder if my doctor had given me Tamiflu if I would not have been so very sick?"   This is sad that doctors are not giving scripts of Tamiflu to people.  This lady has been very ill and she is still not well.

I still say if you can get your hand on Tamiflu hold it like gold and use it only if you have Flu...but Use It! Tamiflu can save people from a lot of sickness and maybe death. I am very angry about this subject!

I don't know what this means
Just talked to my friend from her H1N1 sick bed.  Her doctor told her she could get H1N1 again.  His practice is seeing people coming in with H1N1 a second time. I understand that's what the doc said, but that doesn't automatically make it true. The first question is how is H1N1 being diagnosed to know that it was present more than once? How many people? The more it seems 'common' the more skeptical I am.

[ Parent ]
Dem, a post yesterday here at FW
reported a doctor who had had confirmed H1N1 twice.

I'm not saying it's 'common', but this was one instance in which the patient was a physician who had two confirmed bouts of H1N1, separated by weeks/months.

Here's the story that first appeared at FW yesterday:

Thursday November 5, 2009

Area doctor says she tested positive for H1N1 twice

by Zack Harold
Daily Mail staff

CROSS LANES, W.Va.--A Cross Lanes pediatrician says she came down with swine flu twice in two months, and she's among the medical professionals who are puzzled by the occurrence.

Dr. Debra Parsons, a pediatrician at Kid Care West in Cross Lanes, said both she and her son came down with identical flu-like symptoms in August.
Figuring they had the same disease, Parsons swabbed herself and sent the specimen off to a lab. She tested positive for Influenza A, which includes several strains of the flu.

Health officials say that in this region more than 99 percent of people who have been testing positive for Influenza A are later confirmed to have swine flu.
Parsons said that was the case with her family; a more specific follow-up "sub-typing" test at the state lab confirmed she had H1N1.

Parsons and her son recovered from the symptoms but in October they struck again and were much worse, she said. Both had body aches, fever, chills, wheezing, and shortness of breath.

This time Parsons swabbed both herself and her son, and both tests came back positive for Influenza A. She said she pushed for further testing to determine the strain, and the lab ran an immunofluorescence test on the specimens. They again tested positive for H1N1, she said.

Parsons' second swab was sent to the state lab Wednesday for even further testing and results should be returned in a couple of days or sent to the Centers for Disease Control for follow-up tests, she said.


[ Parent ]
that seems pretty definitive n/t

[ Parent ]
Having H1N1 twice
I had my kids in to their pediatrician this past week to get some booster shots and the seasonal flu vaccine. When I asked him about H1N1 vaccine availability, he said that the vaccine was only available in our area (suburban Chicago) through the county health department. When I asked his opinion about getting the vaccine, given that my entire family almost certainly had H1N1 in the spring, he stated that we should definitely get the vaccine and that he was aware of at least 5 cases of people who tested positive for influenza A over the summer who were infected a second time recently. I didn't think to ask whether these kids were in a high risk group, but the fact that he recommended that my healthy kids get vaccinated suggests that he felt they were at risk.

[ Parent ]
the influenza A test
unfortunately gives both false + and false -, so it's not reliable. Good answer from the doc in terms of advice to patients, but the test doesn't really answer the question.

The other report listed elsewhere seems to have had 2 PCR confirmations in the same patient.

[ Parent ]
I Agree, However,
If a Doctor is seeing patients having "flu", which we all know is H1N1 now, more than once, it may be true.  The sad thing DemFromCT the pubic is not being given good information from our Government.  One of the reasons has been the decision by TPTB not to test for H1N1 and all the false neg on the A flu tests.

I hope that getting H1N1 two times is false.

[ Parent ]
see, the point is
there are many flu like illnesses and doctors (I am one) can't always tell what's flu and what's not without good testing. PCR testing, which is very reliable, is only now coming on line for availability to docs. It wasn't available in the spring.

[ Parent ]
CDC says it's not mutating in any significant way.

Reporter: We know up to this point, theH1N1 virus has shown no signs of mutation.  Can you quantify the risk of this happening in the future?  It is unlikely or something you expect with happen with this virus?

Anne Schuchat:Well, influenza viruses change.  That's inevitable.  Mutations with occur.  The key part is will we see something in the near future that makes it change markedly to something more severe than what we are seeing or is there a change that would occur to leave the virus to escape the vaccine?  Both of those changes are possible.  Fortunately, we haven't seen any of those, yet.  We have been testing many of the viruses.  It hasn't changed genetically or the immune characteristics.  The vaccines we are making available are very good matches with the virus.  It is -- it has been seen with pandemics in the past that over the couple years after a new strain emerges, it starts to change a bit.  It starts to drift and become something that would need a change in vaccine formulation, so that's one of the reasons we make up new vaccines every year for seasonal flu.  Viruses may change from year to year and we may need to modify the vaccine.  Another question from the phone.  


Instead of mutation, is it possible...
...that some people are not developing antibodies against H1N1? That would explain getting ill more than once. Could it be that humans don't develop an immunity to this particular strain?

Or, more likely, is it that the first time, the virus doesn't embed itself as deeply in the person's ability to fight it off, thus allowing it to return and infect those people again?

Since I'm not a doctor, nor a scientist, my wording may be wrong, but I know what I mean...

[ Parent ]
Especially in those who didn't have fevers? n/t

"The truth does not change according to our ability to stomach it."  Flannery O'Connor

[ Parent ]
can't say impossible. But I don;t think there's much evidence of widespread double infections, even with the one citation to show it can happen.

[ Parent ]
If H1N1 isn't mutating, why hasn't Mill Hill released Ukraine sequences?
henry is always (appropriately) asking for transparency
and release of sequences, but sometimes countries send samples with the express request not to release. labs honor that. So, lack of release does not equal "therefore there must be a mutation they are hiding'.

[ Parent ]
No, of course not
But I believe that that in combination with a)the possible mutations as outlined and b)evidence from "on the ground" there it does beg the question.

[ Parent ]
it does, indeed
we do have CDC and WHO statements that nothing significant is seen (I believe them,), but that's not the same as having the sequences.

[ Parent ]
The way words are used . . .
means a lot, too.

Remember - these are the same people who said this flu was "mild".  If they're using "significant" in the same offhand manner, there may indeed be something that others would find very much not insignificant.

[ Parent ]
the simpler explanation
is that they heard us when we said 'mild pandemic' is an oxymoron.

[ Parent ]
Dem, can you give us an example or two
of why a country would request that sequences not be released?  

United we stand: Divided we fall

[ Parent ]
political reasons, mostly
for a country to declare their first case or even documented case is a hit on tourism, prestige, commerce, internal happiness and domestic tranquility, not to mention pressure on the govt. to address the issue and fix it. Ever since SARS caused a Canadian recession, govts are wary. Not saying it's good or right, but it is what it is.

[ Parent ]
and even those that do announce
want to do it themselves which is reasonable.

[ Parent ]
FYI: Geneticist blog post on 225E expectation
(225E is linked to hemorrhagic cases in Brazil and elsewhere)


225E Expectation in the Ukraine

PF11 SNP geographic analysis suggests that the Ukraine cases in the next two weeks may show a very similar genetic pattern to South America in August and the Mediterranean and Adriatic FlightPath in the past 8 weeks.  

If the trend toward a higher infectivity of medical personnel continues as reported today of 687 doctors and 1,500 young specialists being ill, we would expect a higher death count in the coming days.  Between 0.5% and 1.3% of all doctors in the country are ill (by region).  Higher transmissibility is certain.

If a database of 100 sequences were to exist on the Ukraine, accurately cataloging a cross-reference of regions over 14 days of recent death and recovery cases, including major cities, rough expectations would indicate:


in moderate concentration (95% probability) with 206T

206T/225E/300S triplet
potential for introduction (1 sequence) (75% probability)

2E/206T/225E/298V quad combo
potential for appearance in very low count (1 to 2 sequences) (>25% probability)

2E/206T/225G/298V quad combo
potential for introduction (1 sequence) (<10% probability)

potential, but certainly not widespread under current clinical reports (75% probability) with 206T

2E/206S/296H triplet
in low concentration (95% probability)

potential for introduction (1 sequence) (25% probability)

potential for introduction (1 sequence) (7% probability)

potential for appearance in very low count (1 to 3 sequences) (>25% probability)

212 movement
potential for introduction (1 sequence) (7% probability)

potential for introduction (1 sequence) (33% probability)

188/189/190 movement
potential for introduction (1 sequence) (>50% probability)

potential for appearance in very low count (1 to 3 sequences) (>25% probability)

potential for introduction (1 sequence) (>25% probability)

potential for appearance in moderate count (<20% probability)


106I, 248N pairing
potential in very low count (<20% probability)

106I, 248N, 286G triplet
potential for introduction (7% probability until the 8th week of the flashfire)

Comment - this person is obviously not talking about "major changes", i.e. reassortment, but small changes that do affect virulence.


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