novel A/H1N1 changes - symptom/outcome tracking

[AlaskaDenise]

While the researchers are monitoring the genetic sequences for changes, the first awareness of those changes may come from "boots on the ground", i.e., knowledgeable HCW, "flubies", or media reports - days or weeks before any sequence test can define & confirm any changes.

What symptoms/outcomes will the various highly-probably changes produce?
Compiling a list may prove useful.

---------------------------------------------------

PB2/627K (replication temperature switch):
- more agressive infections - fewer "mild cases"

NA/274Y or 294S - (anti-viral oseltamivir-tamilfu- resistance)
- no response to anti-viral therapy, with more serious infections & deaths

(for now, I won't list the high-path NS1 or poly-basic cleavage site, as hopefully they're less probable in the near future)

Are there any other specific symptom or outcome changes?

---------------------------------------------------------

Specific changes to watch for:

1 - non-response to anti-viral therapy.

2 - increase in % of cases with serious illness

3 - increase in expected death rates

others?

.

[gsgs]

Re: novel A/H1N1 changes - symptom/outcome tracking

Pb1-f2
s31n(8) (?)

[AlaskaDenise]

Re: novel A/H1N1 changes - symptom/outcome tracking

gs:

What symptoms are caused by those mutations?

.

[kent nickell]

Re: novel A/H1N1 changes - symptom/outcome tracking

I think a quicker progression to severe disease and death is worth watching...

This is from May 4th quoting Marc-Alain Widdowson, a medical epidemiologist from the U.S. Centers for Disease Control and Prevention

http://www.salon.com/wires/ap/scitech/2009/05/04/D97VNVAO0_med_swine_flu/print.html

""""We've seen in many of the cases in Mexico, there's been sometimes five to seven days of being mildly ill with increasing respiratory distress and then being hospitalized, and then spending five days or a week in hospital, so that's a timeline of two weeks," he said."""

[HenryN]

Re: novel A/H1N1 changes - symptom/outcome tracking

Pb1-f2
s31n(8) (?)

S31N is in all M2 sequences (resistance to adamantines).

[HenryN]

Re: novel A/H1N1 changes - symptom/outcome tracking

While the researchers are monitoring the genetic sequences for changes, the first awareness of those changes may come from "boots on the ground", i.e., knowledgeable HCW, "flubies", or media reports - days or weeks before any sequence test can define & confirm any changes.

What symptoms/outcomes will the various highly-probably changes produce?
Compiling a list may prove useful.

---------------------------------------------------

PB2/627K (replication temperature switch):
- more agressive infections - fewer "mild cases"

NA/274Y or 294S - (anti-viral oseltamivir-tamilfu- resistance)
- no response to anti-viral therapy, with more serious infections & deaths

(for now, I won't list the high-path NS1 or poly-basic cleavage site, as hopefully they're less probable in the near future)

Are there any other specific symptom or outcome changes?

---------------------------------------------------------

Specific changes to watch for:

1 - non-response to anti-viral therapy.

2 - increase in % of cases with serious illness

3 - increase in expected death rates

others?

.

I did a quick look at PB2 sequences at GISAID which were not at Genbank and failed to find E627K. So far it is only in the one sequence from Shanghai/71T.

[HenryN]

Re: novel A/H1N1 changes - symptom/outcome tracking

While the researchers are monitoring the genetic sequences for changes, the first awareness of those changes may come from "boots on the ground", i.e., knowledgeable HCW, "flubies", or media reports - days or weeks before any sequence test can define & confirm any changes.

What symptoms/outcomes will the various highly-probably changes produce?
Compiling a list may prove useful.

---------------------------------------------------

PB2/627K (replication temperature switch):
- more agressive infections - fewer "mild cases"

NA/274Y or 294S - (anti-viral oseltamivir-tamilfu- resistance)
- no response to anti-viral therapy, with more serious infections & deaths

(for now, I won't list the high-path NS1 or poly-basic cleavage site, as hopefully they're less probable in the near future)

Are there any other specific symptom or outcome changes?

---------------------------------------------------------

Specific changes to watch for:

1 - non-response to anti-viral therapy.

2 - increase in % of cases with serious illness

3 - increase in expected death rates

others?

.

Death clusters. I am still suspicious of the two on Long Island (Brookhaven). Salt Lake city area also has 8 recent deaths.

[wotan]

Re: novel A/H1N1 changes - symptom/outcome tracking

Death clusters. I am still suspicious of the two on Long Island (Brookhaven). Salt Lake city area also has 8 recent deaths.

Three in Waterbury, CT. Two of them last week I believe.

[AlaskaDenise]

Re: novel A/H1N1 changes - symptom/outcome tracking

(revised list)

What symptoms/outcomes will the various highly-probably changes produce?
Compiling a list may prove useful.

---------------------------------------------------

PB2/627K (replication temperature switch):
- more agressive infections - fewer "mild cases"

NA/274Y or 294S - (anti-viral oseltamivir-tamilfu- resistance)
- no response to anti-viral therapy, with more serious infections & deaths


(for now, I won't list the high-path NS1 or poly-basic cleavage site, as hopefully they're less probable in the near future)

Are there any other specific symptom or outcome changes?

---------------------------------------------------------

Specific changes/outcomes to watch for:

1 - non-response to anti-viral therapy (any or all)

2 - increase in % of cases with serious illness

3 - quicker progression to severe disease and death

4 - increase in death rates

5 - death clusters

[The Mountains Voice]

Re: novel A/H1N1 changes - symptom/outcome tracking

5 - death clusters

My money is on the above as the main indicator that will finally raise the red flag. You see a sudden grouping of deaths all with common infection chain - and absent some sort of genetic similarity/predisposition - that's where you're going to find your mutation.

[HenryN]

Re: novel A/H1N1 changes - symptom/outcome tracking

My money is on the above as the main indicator that will finally raise the red flag. You see a sudden grouping of deaths all with common infection chain - and absent some sort of genetic similarity/predisposition - that's where you're going to find your mutation.

Exactly right.

[AlaskaDenise]

Re: novel A/H1N1 changes - symptom/outcome tracking

My money is on the above as the main indicator that will finally raise the red flag. You see a sudden grouping of deaths all with common infection chain - and absent some sort of genetic similarity/predisposition - that's where you're going to find your mutation.

The question is which mutation will cause which symptom/outcome?

Some mutations could increase virulence, but not necessarily death. Those types might indicate a need for procedural changes - more PPE in health care settings, more school closures, more cleaning of public surfaces, more anti-viral distribution, etc.

Death clusters would indicate the need for rapid containment - strict quarantines, etc. The speed at which they are identified will directly relate to their success.

Boots on the ground reports might be the decisive factor - IF people are aware of the implications.

.

[Thornton]

Re: novel A/H1N1 changes - symptom/outcome tracking

The above has me convinced that death clusters will be the most obvious and verifiable epidemiologic clue. Unfortunately, some areas, like Florida, there is a lag of almost a week from death to confirmation of H1N1. The media will need to search for clusters of hospital deaths with or without the diagnosis.

[Science Teacher]

Re: novel A/H1N1 changes - symptom/outcome tracking

I'd also watch for an increase in the % of cases with no underlying

medical conditions.

[AlaskaDenise]

Re: novel A/H1N1 changes - symptom/outcome tracking

.......... there is a lag of almost a week from death to confirmation of H1N1. The media will need to search for clusters of hospital deaths with or without the diagnosis.

And they need to know exactly what all to look for!

.