PAHO rejects report of resistant H1N1 cases on US-Mexico border

[Shiloh]

Source: http://www.google.com/hostednews/afp...GE3KnYOs5DuTtA

Tamiflu-resistant swine flu found on US-Mexico border

(AFP) – 1 hour ago

LA JOLLA, California — A strain of swine flu that is resistant to treatment with the drug Tamiflu has been discovered near the US-Mexican border, the Pan-American Health Organization (PAHO) said on Monday.

"We have found resistance to Tamiflu on the border. We have observed some cases, few to be sure, in El Paso and close to McAllen, Texas," said Maria Teresa Cerqueira, head of the local PAHO office.

Cases of A(H1N1) that were resistant to the anti-viral medicine have now been found in the United States, Canada, Denmark, Hong Kong and Japan.

Experts gathered in La Jolla, California on Monday to discuss the response to the outbreak, said the resistance was likely due to overuse of antivirals like Tamiflu.

"In the United States Tamiflu is sold with a prescription, but in Mexico and Canada it is sold freely and taken at the first sneeze. Then, when it is really needed, it doesn't work," said Cerqueira.

Roche, the manufacturer of Tamiflu, has said it expects a 0.5 percent rate of case resistance based on clinical trials.

Cerquiera said one patient diagnosed with a Tamiflu-resistant strain had been treated with Zanamivir -- an anti-viral made by GlaxoSmithKline -- and another was given no alternative medication. Both survived.

Since the swine flu outbreak emerged earlier this year it has killed 353 people in the United States and 146 in Mexico, according to authorities from each country.

A large proportion of nearly 1,000 recorded deaths around the world since the virus was first identified in Mexico in April have involved people with underlying medical conditions.

World Health Organization chief Margaret Chan has urged countries to boost their drug stockpiles amid warnings of the virus's continued spread.

"Manufacturing capacity for influenza vaccines is finite and woefully inadequate for a world of 6.8 billion people, nearly all of whom are susceptible to infection by this entirely new and highly contagious virus," Chan said on July 14.

A vaccine against the disease is currently being tested for safety and effectiveness, and is expected to be ready in the next two to four months, although the precise date is unclear.

US officials have recommended that children and pregnant women be among the groups first in line for swine flu shots, but said they were unlikely to have enough vaccine for everyone once the drug is ready to be rolled out.

Greece has announced it will vaccinate all its 11-million-strong population, the first country to introduce such a broad measure amid the current pandemic.

With such pledges emerging, developing nations have expressed concerns they will be left out, as richer nations race to build stock piles.

UN Secretary General Ban Ki-moon has said developing countries could need about one billion dollars by the end of the year to fund measures against the swine flu pandemic, especially vaccines.

[Snicklefritz]

Cerquiera said one patient diagnosed with a Tamiflu-resistant strain had been treated with Zanamivir -- an anti-viral made by GlaxoSmithKline -- and another was given no alternative medication. Both survived.

So much 'spin' here, I'm getting dizzy.

[HenryN]

Originally Posted by Snicklefritz

So much 'spin' here, I'm getting dizzy.

TWO more cases isn't spin. It is the tip of a VERY large iceberg.

[HenryN]

Originally Posted by Snicklefritz

So much 'spin' here, I'm getting dizzy.

These cases are a two VERY distinct locations on US Mexico border where there have been recent outbreaks in Mexico. The fact that two cases are being reported simultaneously is SIGNIFICANT.

[HenryN]

Originally Posted by Shiloh

Source: http://www.google.com/hostednews/afp...GE3KnYOs5DuTtA

Tamiflu-resistant swine flu found on US-Mexico border

"We have found resistance to Tamiflu on the border. We have observed some cases, few to be sure, in El Paso and close to McAllen, Texas," said Maria Teresa Cerqueira, head of the local PAHO office.

These two locations are at opposite ends of the Texas border with Mexico. It is unclear if these patients had been treated with Tamiflu. I strongly suspect that the one that recovered without "alternative" (instead of "additional") treatment was NOT treated with Tamiflu.

[wotan]

Originally Posted by niman

These two locations are at opposite ends of the Texas border with Mexico. It is unclear if these patients had been treated with Tamiflu. I strongly suspect that the one that recovered without "alternative" (instead of "additional") treatment was NOT treated with Tamiflu.

Check the wording again. They said "few cases" not two cases. Perhaps I am reading the text too closely, but the way it was written implies it may be more than 2. Also:

Cerquiera said one patient diagnosed with a Tamiflu-resistant strain had been treated with Zanamivir -- an anti-viral made by GlaxoSmithKline -- and another was given no alternative medication. Both survived.

Again, I may be reading plain English too literally, but they said "another", not "the other." People speaking in an official capacity really ought to be more careful with their wording.

[HenryN]

Originally Posted by wotan

Check the wording again. They said "few cases" not two cases. Perhaps I am reading the text too closely, but the way it was written implies it may be more than 2. Also:



Again, I may be reading plain English too literally, but they said "another", not "the other." People speaking in an official capacity really ought to be more careful with their wording.

I think that the wording is deliberately mushy because there are more than two, but they don't want to say that yet.

[HenryN]

Originally Posted by wotan

Check the wording again. They said "few cases" not two cases. Perhaps I am reading the text too closely, but the way it was written implies it may be more than 2. Also:



Again, I may be reading plain English too literally, but they said "another", not "the other." People speaking in an official capacity really ought to be more careful with their wording.

This is sounding MUCH like the initial cases in California, which were more than 100 miles apart, had NO linkage, and were reported SIMULTANEOUSLY.

[Jeremy]

Originally Posted by wotan

Check the wording again. They said "few cases" not two cases. Perhaps I am reading the text too closely, but the way it was written implies it may be more than 2. Also:



Again, I may be reading plain English too literally, but they said "another", not "the other." People speaking in an official capacity really ought to be more careful with their wording.

Correct. Few is more than 2!

[wotan]

Originally Posted by Jeremy

Correct. Few is more than 2!

Textual analysis from all the way back in High School English finally has a use.

[HenryN]

Originally Posted by wotan

Check the wording again. They said "few cases" not two cases. Perhaps I am reading the text too closely, but the way it was written implies it may be more than 2. Also:



Again, I may be reading plain English too literally, but they said "another", not "the other." People speaking in an official capacity really ought to be more careful with their wording.

It also says the other patient had "diagnosed" Tamiflu resistance and was treated with Relenza. It doesn't say that the patient developed Tamiflu resistance. I suspect that testing is up because FIT Tamiflu resistance has been found.

[Jeremy]

Originally Posted by Shiloh

Roche, the manufacturer of Tamiflu, has said it expects a 0.5 percent rate of case resistance based on clinical trials.

Niman,

Correct me if I am wrong but didn't the previous strain of H1N1 from last year have close to 100% Tamiflu Resistance?

If that is the case, this statement can't really be true can it?

[wotan]

Originally Posted by Jeremy

Niman,

Correct me if I am wrong but didn't the previous strain of H1N1 from last year have close to 100% Tamiflu Resistance?

If that is the case, this statement can't really be true can it?

I think that refers to de novo development.

[HenryN]

Originally Posted by Jeremy

Niman,

Correct me if I am wrong but didn't the previous strain of H1N1 from last year have close to 100% Tamiflu Resistance?

If that is the case, this statement can't really be true can it?

The seasonal flu was at 100% resistant (had H274Y) but NOT linked to Tamifu use (which I suspect is the case in these patients).

[HenryN]

Commentary

.

[AlaskaDenise]

Originally Posted by niman

Commentary

Commentary

Tamiflu Resistant Pandemic H1N1 Cases in Texas

Recombinomics Commentary 03:14
August 4, 2009

"We have found resistance to Tamiflu on the border. We have observed some cases, few to be sure, in El Paso and close to McAllen, Texas," said Maria Teresa Cerqueira, head of the local PAHO office.

Cerquiera said one patient diagnosed with a Tamiflu-resistant strain had been treated with Zanamivir -- an anti-viral made by GlaxoSmithKline -- and another was given no alternative medication. Both survived.

The above comments describe at least two oseltamivir resistant patients along the Texas / Mexico border. The cases are at opposite ends of the border (see map) and raise concerns that the resistance developed in the absence of Tamiflu treatment. One patient had "diagnosed" resistance and was treated with Zanamivir, while the other wasn't treated with Zanamivir, leaving open the possibility that neither were treated with oseltamivir. Moreover, the wording left open the possibility that there were more than two patients, suggesting fit swine H1N1 with H274Y was circulating over a wide area.

The emergence of fit swine H1N1 with H274Y is not a surprise. A case has already been reported in Hong Kong in a traveler from San Francisco. The precursor for this strain has been reported worldwide, although the only case reported in the US was in April in New Jersey, raising concerns that the fit strain was circulating silently, in part because the cases were mild and not being tested. The patient in Hong Kong, like one of the patients recovered without treatment with Relenza, indicating the cases were relatively mild.

The fact that these cases were reported simultaneously also raises concerns that a fit H274Y is circulating in the area.

Details on the number of cases, and release of sequences, would be useful.

.

[Snowy Owl]

I will repeat what the medical autorithy says up here in Quebec;

Before this case we found only 4 resistant on probably 1 millions cases

SNOWY

[HenryN]

(Google translation)

Several patients were found to be resistant to antiviral near the border. "This is not a surprise, there was no worry," says Roche, which estimated that 0.5% rate of resistance.


Boxes of Tamiflu (Sipa)
Cases of resistance to Tamiflu, the main antiviral drug used against influenza A (H1N1), were found near the border between the United States and Mexico, said Monday 3 August the Pan American Health Organization (PAHO). "We found cases of Tamiflu resistance to the border. We have seen some cases, few of which we are confident, El Paso and around McAllen, Texas," said Dr. Maria Teresa Cerqueira, responsible local office of PAHO, at a conference on influenza A. The persons concerned cross the border regularly and were automédicamentées, says the doctor.


Cases "isolated"
"In the U.S., Tamiflu is a prescription but it is widely available in Mexico and Canada and took the first sneeze. And when it is really useful, it does not work anymore", said Maria Teresa Cerqueira. She explained that a patient with a strain of influenza A (H1N1) viruses resistant to Tamiflu has been treated positively to Zanamivir, another antiviral drug, and another patient received no other treatment. Both patients survived, she argued.
In July, a case of resistance to Tamiflu had been found in Canada. It was the first case in North America, according to Dr. Guy Boivin, Center hospitalier de l'Université Laval (CHUL) in Quebec, who had discovered this resistant strain. Cases of resistance to antiviral therapy were also recorded in Denmark, Japan and Hong Kong.
The World Health Organization (WHO) has estimated that these cases are "isolated" and that it maintains its recommendation for Tamiflu and Relenza.


"There is no worry for the moment"
The laboratory Roche, Tamiflu seller, said he expected at 0.5% of its antiviral resistance from the results of clinical trials.
"This is not a surprise," says the director of the pharmaceutical division of Roche, William Burns: "in the case of the flu season, about 0.4% of the organisms may be resistant. There not worried at the moment. " "We do not increase in these cases of resistance," adds the CEO of Roche Severin Schwan.
"It is not excluded that in a community where people are treated with Tamiflu, there are few cases of viruses that develop resistance and spread," explains Dr. Thierry Buclin, a medical assistant in the office clinical pharmacology and toxicology at the CHUV of Lausanne. "The real question is: who should take Tamiflu?" Dr. Buclin nuance. "What you win to deal with Tamiflu, if one can be cured with paracetamol?" Hits there.

http://tempsreel.nouvelobs.com/actua...e_america.html

[HenryN]

Originally Posted by niman

(Google translation)

"We found cases of Tamiflu resistance to the border. We have seen some cases, few of which we are confident, El Paso and around McAllen, Texas," said Dr. Maria Teresa Cerqueira, responsible local office of PAHO, at a conference on influenza A. The persons concerned cross the border regularly and were automédicamentées, says the doctor.




http://tempsreel.nouvelobs.com/actua...e_america.html

This version of the AFP story suggest that resistance might have been linked to self-prescribed tamiflu. However, it doesn't state that it was, and also does state that the resistance was discovered because the patients received Tamiflu treatment from a doctor. Thus, the number of patients and details surrounding the "diagnosis" remain murky.

[HenryN]

Commentary

[Hogweed]

Originally Posted by niman

Commentary

Commentary

Spread of Tamiflu Resistant Pandemic H1N1 in Texas
Recombinomics Commentary 13:46
August 4, 2009

We have seen some cases, few of which we are confident, El Paso and around McAllen, Texas," said Dr. Maria Teresa Cerqueira, responsible local office of PAHO, at a conference on influenza A. The persons concerned cross the border regularly and were automédicamentées, says the doctor.

The above translation adds to the uncertainty associated with the oseltamivir resistance report on the Texas / Mexico border (see map). Since the report cites self-treatment of Tamiflu, it is unclear if and when the resistant cases were treated. In previously announced cases worldwide, five were on prophylactic treatment because of exposure , and at least two developed symptoms on the fifth day of Tamiflu treatment, raising concerns that H274Y was present at reduced levels in these patients and the treatment allowed for the detection of the H274Y, which may be the case for some of the patients on the Texas border.

However a traveler from San Francisco was tested in Hong Kong and had H274Y in the absence of Tamiflu treatment, which may also be the case for some of the patients along the Texas border. More aggressive testing and release of these sequences would be useful.

However, these sequences should be tested more thoroughly for the presence of H274Y as a mixture. A recent report on Relenza resistance (Q136K) indicated the polymorphism was only detected after culture on MDCK cells, indicating the levels in the clinical sample were below detection. In addition to the nine examples in southeast Asia / Australia, which were in the report, a sequence from Nicaragua has been published (see list here) and a mixture from Pennsylvania was published a year ago, although agency reports claim no Relenza resistance in the US in the 2007/2008 season. The Q136K was in patients who were not being treated with Relenza, and more widespread treatment of swine flu patients will likely lead to more detected cases, which is the likely situation for H274Y also.

The failure to provide more concrete information and sequences from the resistant patients along the Texas border increases concerns that resistant pandemic H1N1 is widespread, but grossly under-represented in the limited number of public sequences released at Genbank or GISAID.


====

My Bolding - not Dr Niman's. The obvious question is what other polymorphisms might be gaining ground below the radar.

[HenryN]

Originally Posted by Hogweed

Commentary

Spread of Tamiflu Resistant Pandemic H1N1 in Texas
Recombinomics Commentary 13:46
August 4, 2009

We have seen some cases, few of which we are confident, El Paso and around McAllen, Texas," said Dr. Maria Teresa Cerqueira, responsible local office of PAHO, at a conference on influenza A. The persons concerned cross the border regularly and were automédicamentées, says the doctor.

The above translation adds to the uncertainty associated with the oseltamivir resistance report on the Texas / Mexico border (see map). Since the report cites self-treatment of Tamiflu, it is unclear if and when the resistant cases were treated. In previously announced cases worldwide, five were on prophylactic treatment because of exposure , and at least two developed symptoms on the fifth day of Tamiflu treatment, raising concerns that H274Y was present at reduced levels in these patients and the treatment allowed for the detection of the H274Y, which may be the case for some of the patients on the Texas border.

However a traveler from San Francisco was tested in Hong Kong and had H274Y in the absence of Tamiflu treatment, which may also be the case for some of the patients along the Texas border. More aggressive testing and release of these sequences would be useful.

However, these sequences should be tested more thoroughly for the presence of H274Y as a mixture. A recent report on Relenza resistance (Q136K) indicated the polymorphism was only detected after culture on MDCK cells, indicating the levels in the clinical sample were below detection. In addition to the nine examples in southeast Asia / Australia, which were in the report, a sequence from Nicaragua has been published (see list here) and a mixture from Pennsylvania was published a year ago, although agency reports claim no Relenza resistance in the US in the 2007/2008 season. The Q136K was in patients who were not being treated with Relenza, and more widespread treatment of swine flu patients will likely lead to more detected cases, which is the likely situation for H274Y also.

The failure to provide more concrete information and sequences from the resistant patients along the Texas border increases concerns that resistant pandemic H1N1 is widespread, but grossly under-represented in the limited number of public sequences released at Genbank or GISAID.


====

My Bolding - not Dr Niman's. The obvious question is what other polymorphisms might be gaining ground below the radar.

PB1 E627K. It was in the original and first clone from Shanghai, but was absent in the second clone. This is another important change which may be flying below the radar, especially at this time in the northern hemisphere.

In the fall, the story will be quite different.

[GennieF]

Dr. Niman,

Do you have any sort of rough outline as to what you think will happen in the fall and when things will start to become noticeable as far as severe sickness/death?

Gennie

[HenryN]

PA G1761A

 
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gb|FJ520075.1|  Influenza A virus (A/northern pintail/Californ...  44.1    0.006
gb|FJ520076.1|  Influenza A virus (A/northern pintail/Californ...  44.1    0.006
gb|FJ520077.1|  Influenza A virus (A/northern pintail/Californ...  44.1    0.006
gb|CY039308.1|  Influenza A virus (A/unknown/New York/78436/20...  44.1    0.006
gb|CY038245.1|  Influenza A virus (A/ruddy turnstone/New Jerse...  44.1    0.006
gb|CY038235.1|  Influenza A virus (A/ruddy turnstone/New Jerse...  44.1    0.006
gb|CY038230.1|  Influenza A virus (A/ruddy turnstone/New Jerse...  44.1    0.006
gb|CY038195.1|  Influenza A virus (A/ruddy turnstone/Delaware/...  44.1    0.006
gb|CY038185.1|  Influenza A virus (A/ruddy turnstone/New Jerse...  44.1    0.006
gb|CY038175.1|  Influenza A virus (A/ruddy turnstone/New Jerse...  44.1    0.006
gb|CY038165.1|  Influenza A virus (A/ruddy turnstone/New Jerse...  44.1    0.006
gb|CY038160.1|  Influenza A virus (A/ruddy turnstone/New Jerse...  44.1    0.006
gb|CY038155.1|  Influenza A virus (A/ruddy turnstone/New Jerse...  44.1    0.006
gb|CY038150.1|  Influenza A virus (A/ruddy turnstone/New Jerse...  44.1    0.006
gb|CY038135.1|  Influenza A virus (A/ruddy turnstone/New Jerse...  44.1    0.006
gb|CY038130.1|  Influenza A virus (A/ruddy turnstone/New Jerse...  44.1    0.006
gb|CY038125.1|  Influenza A virus (A/ruddy turnstone/New Jerse...  44.1    0.006
gb|CY038120.1|  Influenza A virus (A/ruddy turnstone/New Jerse...  44.1    0.006
gb|CY038110.1|  Influenza A virus (A/ruddy turnstone/New Jerse...  44.1    0.006
gb|CY038100.1|  Influenza A virus (A/ruddy turnstone/New Jerse...  44.1    0.006
gb|CY038085.1|  Influenza A virus (A/ruddy turnstone/New Jerse...  44.1    0.006
gb|CY038080.1|  Influenza A virus (A/ruddy turnstone/New Jerse...  44.1    0.006
gb|CY038075.1|  Influenza A virus (A/red knot/New Jersey/Sg-00...  44.1    0.006
gb|CY038070.1|  Influenza A virus (A/ruddy turnstone/New Jerse...  44.1    0.006
gb|CY038055.1|  Influenza A virus (A/red knot/New Jersey/Sg-00...  44.1    0.006
gb|CY038045.1|  Influenza A virus (A/ruddy turnstone/New Jerse...  44.1    0.006
gb|CY038030.1|  Influenza A virus (A/ruddy turnstone/Delaware/...  44.1    0.006
gb|FJ686719.1|  Influenza A virus (A/mallard/Ohio/362/2003(H2N...  44.1    0.006
gb|FJ686735.1|  Influenza A virus (A/mallard/Ohio/365/2003(H2N...  44.1    0.006
gb|FJ686743.1|  Influenza A virus (A/mallard/Maryland/897/2004...  44.1    0.006
gb|CY037012.1|  Influenza A virus (A/blue-winged teal/Manitoba...  44.1    0.006
gb|CY036764.1|  Influenza A virus (A/mallard/Wisconsin/944/198...  44.1    0.006
gb|CY036756.1|  Influenza A virus (A/environment/New York/1165...  44.1    0.006
gb|FJ517299.1|  Influenza A virus (A/mallard/Minnesota/354/199...  44.1    0.006
gb|FJ517303.1|  Influenza A virus (A/mallard/Minnesota/371/199...  44.1    0.006
gb|FJ517307.1|  Influenza A virus (A/mallard/Minnesota/192/199...  44.1    0.006
gb|FJ517324.1|  Influenza A virus (A/guinea fowl/NJ/14190-23/1...  44.1    0.006
gb|FJ517339.1|  Influenza A virus (A/mallard/Ohio/338/1986(H4N...  44.1    0.006
gb|CY036631.1|  Influenza A virus (A/duck/Massachusetts/Sg-004...  44.1    0.006
gb|CY036579.1|  Influenza A virus (A/chicken/Pennsylvania/Sg-0...  44.1    0.006
gb|CY036039.1|  Influenza A virus (A/Muscovy duck/New York/620...  44.1    0.006
gb|CY035856.1|  Influenza A virus (A/northern shoveler/Califor...  44.1    0.006
gb|CY035848.1|  Influenza A virus (A/northern pintail/Californ...  44.1    0.006
gb|EU557478.1|  Influenza A virus (A/northern pintail/Alaska/4...  44.1    0.006
gb|EU557477.1|  Influenza A virus (A/northern pintail/Alaska/4...  44.1    0.006
gb|EU557453.1|  Influenza A virus (A/northern pintail/Alaska/4...  44.1    0.006
gb|EU557456.1|  Influenza A virus (A/northern pintail/Alaska/4...  44.1    0.006
gb|CY035798.1|  Influenza A virus (A/mallard/Interior Alaska/2...  44.1    0.006
gb|CY035699.1|  Influenza A virus (A/unknown/New York/Sg-00327...  44.1    0.006
gb|CY035695.1|  Influenza A virus (A/unknown/New York/Sg-00326...  44.1    0.006
gb|CY035660.1|  Influenza A virus (A/chuckar/New Jersey/Sg-003...  44.1    0.006
gb|CY035656.1|  Influenza A virus (A/waterfowl/New Jersey/Sg-0...  44.1    0.006
gb|CY035652.1|  Influenza A virus (A/duck/New Jersey/Sg-00315/...  44.1    0.006
gb|CY035641.1|  Influenza A virus (A/turkey/New Jersey/Sg-0031...  44.1    0.006
gb|CY035583.1|  Influenza A virus (A/guinea fowl/New Jersey/Sg...  44.1    0.006
gb|CY035515.1|  Influenza A virus (A/guinea fowl/New York/Sg-0...  44.1    0.006
gb|CY035508.1|  Influenza A virus (A/chicken/New Jersey/Sg-002...  44.1    0.006
gb|CY035498.1|  Influenza A virus (A/guinea fowl/New York/Sg-0...  44.1    0.006
gb|CY035490.1|  Influenza A virus (A/chicken/New York/Sg-00270...  44.1    0.006
gb|CY035488.1|  Influenza A virus (A/duck/Pennsylvania/Sg-0026...  44.1    0.006
gb|CY035485.1|  Influenza A virus (A/chicken/New Jersey/Sg-002...  44.1    0.006
gb|CY035483.1|  Influenza A virus (A/chicken/New Jersey/Sg-002...  44.1    0.006
gb|CY035481.1|  Influenza A virus (A/duck/New Jersey/Sg-00266/...  44.1    0.006
gb|CY035473.1|  Influenza A virus (A/guinea fowl/New York/Sg-0...  44.1    0.006
gb|CY035458.1|  Influenza A virus (A/chicken/New York/Sg-00256...  44.1    0.006
gb|CY035450.1|  Influenza A virus (A/blue-winged teal/Texas/Sg...  44.1    0.006
gb|CY035390.1|  Influenza A virus (A/mallard/Minnesota/Sg-0021...  44.1    0.006
gb|CY035374.1|  Influenza A virus (A/mallard/Minnesota/Sg-0021...  44.1    0.006
gb|CY035370.1|  Influenza A virus (A/blue-winged teal/Texas/Sg...  44.1    0.006
gb|CY035367.1|  Influenza A virus (A/blue-winged teal/Texas/Sg...  44.1    0.006
gb|CY035347.1|  Influenza A virus (A/blue-winged teal/Minnesot...  44.1    0.006
gb|CY035345.1|  Influenza A virus (A/mallard/Minnesota/Sg-0020...  44.1    0.006
gb|CY035337.1|  Influenza A virus (A/northern pintail/Minnesot...  44.1    0.006
gb|CY035333.1|  Influenza A virus (A/mallard/Minnesota/Sg-0019...  44.1    0.006
gb|CY035330.1|  Influenza A virus (A/mallard/Minnesota/Sg-0019...  44.1    0.006
gb|CY035327.1|  Influenza A virus (A/mallard/Minnesota/Sg-0019...  44.1    0.006
gb|CY035311.1|  Influenza A virus (A/mallard/Minnesota/Sg-0018...  44.1    0.006
gb|CY035307.1|  Influenza A virus (A/mallard/Minnesota/Sg-0017...  44.1    0.006
gb|CY035302.1|  Influenza A virus (A/mallard/Minnesota/Sg-0017...  44.1    0.006
gb|CY035291.1|  Influenza A virus (A/mallard/Minnesota/Sg-0017...  44.1    0.006
gb|CY035284.1|  Influenza A virus (A/mallard/Minnesota/Sg-0016...  44.1    0.006
gb|CY035267.1|  Influenza A virus (A/mallard/Minnesota/Sg-0016...  44.1    0.006
gb|CY035260.1|  Influenza A virus (A/blue-winged teal/Texas/Sg...  44.1    0.006
gb|CY035256.1|  Influenza A virus (A/blue-winged teal/Texas/Sg...  44.1    0.006
gb|CY035252.1|  Influenza A virus (A/blue-winged teal/Texas/Sg...  44.1    0.006
gb|FJ357125.1|  Influenza A virus (A/mallard/MD/41/2003(H1N1))...  44.1    0.006
gb|FJ357133.1|  Influenza A virus (A/mallard/MD/42/2003(H1N1))...  44.1    0.006
gb|FJ349252.1|  Influenza A virus (A/mallard/ZhaLong/88/2004(H...  44.1    0.006
gb|EU500859.1|  Influenza A virus (A/chicken/SK/HR-00011/2007(...  44.1    0.006
gb|EU500851.1|  Influenza A virus (A/American black duck/NB/25...  44.1    0.006
gb|EU500843.1|  Influenza A virus (A/Canada goose/BC/3752/2007...  44.1    0.006
gb|CY034665.1|  Influenza A virus (A/mallard duck/Minnesota/Sg...  44.1    0.006
gb|CY034637.1|  Influenza A virus (A/mallard duck/Minnesota/Sg...  44.1    0.006
gb|CY034633.1|  Influenza A virus (A/mallard duck/Minnesota/Sg...  44.1    0.006
gb|CY034631.1|  Influenza A virus (A/mallard duck/Minnesota/Sg...  44.1    0.006
gb|CY030992.1|  Influenza A virus (A/turkey/England/N28/1973(H...  44.1    0.006
gb|EU636683.1|  Influenza A virus (A/turkey/England/N28/73(H5N...  44.1    0.006
gb|EU798892.1|  Influenza A virus (A/swine/Korea/CAS09/2006(H3...  44.1    0.006
gb|EU798891.1|  Influenza A virus (A/swine/Korea/CAS07/2005(H3...  44.1    0.006
gb|EU798890.1|  Influenza A virus (A/swine/Korea/CAN04/2005(H3...  44.1    0.006
gb|EU980506.1|  Influenza A virus (A/mallard/MD/185/2003(H5N2)...  44.1    0.006
gb|EU980513.1|  Influenza A virus (A/mallard/MD/11/2003(H1N1))...  44.1    0.006
gb|EU982321.1|  Influenza A virus (A/turkey/TX/4-1-81/1981(H9N...  44.1    0.006
gb|CY034172.1|  Influenza A virus (A/cinnamon teal/California/...  44.1    0.006
gb|CY034150.1|  Influenza A virus (A/northern shoveler/Califor...  44.1    0.006
gb|EU880825.1|  Influenza A virus (A/turkey/CA/358533/2005(H4N...  44.1    0.006
gb|CY033783.1|  Influenza A virus (A/mallard duck/Minnesota/Sg...  44.1    0.006
gb|CY033778.1|  Influenza A virus (A/mallard duck/Minnesota/Sg...  44.1    0.006
gb|CY033769.1|  Influenza A virus (A/mallard duck/Minnesota/Sg...  44.1    0.006
gb|CY033753.1|  Influenza A virus (A/mallard duck/Minnesota/Sg...  44.1    0.006
gb|CY033738.1|  Influenza A virus (A/cinnamon teal/Texas/Sg-00...  44.1    0.006
gb|CY033725.1|  Influenza A virus (A/blue-winged teal/Texas/Sg...  44.1    0.006
gb|CY033705.1|  Influenza A virus (A/mallard duck/Minnesota/Sg...  44.1    0.006
gb|CY033694.1|  Influenza A virus (A/mallard duck/Minnesota/Sg...  44.1    0.006
gb|CY033686.1|  Influenza A virus (A/blue-winged teal/Minnesot...  44.1    0.006
gb|CY033683.1|  Influenza A virus (A/blue-winged teal/Minnesot...  44.1    0.006
gb|CY033679.1|  Influenza A virus (A/blue-winged teal/Minnesot...  44.1    0.006
gb|CY033670.1|  Influenza A virus (A/blue-winged teal/Minnesot...  44.1    0.006
gb|CY033666.1|  Influenza A virus (A/blue-winged teal/Minnesot...  44.1    0.006
gb|CY033659.1|  Influenza A virus (A/blue-winged teal/Minnesot...  44.1    0.006
gb|CY033435.1|  Influenza A virus (A/American wigeon/Californi...  44.1    0.006
gb|CY033419.1|  Influenza A virus (A/American wigeon/Californi...  44.1    0.006
gb|CY033411.1|  Influenza A virus (A/American wigeon/Californi...  44.1    0.006
gb|CY033403.1|  Influenza A virus (A/ring necked duck/Californ...  44.1    0.006
gb|CY033395.1|  Influenza A virus (A/American wigeon/Californi...  44.1    0.006
gb|CY033387.1|  Influenza A virus (A/American wigeon/Californi...  44.1    0.006
gb|CY033355.1|  Influenza A virus (A/American wigeon/Californi...  44.1    0.006
gb|CY033339.1|  Influenza A virus (A/northern shoveler/Califor...  44.1    0.006
gb|EU871841.1|  Influenza A virus (A/green-winged teal/LA/9GW/...  44.1    0.006
gb|EU871881.1|  Influenza A virus (A/mallard/MN/160/1999(H4N6)...  44.1    0.006
gb|EU871897.1|  Influenza A virus (A/mallard/MN/323/1999(H4N8)...  44.1    0.006
gb|EU871911.1|  Influenza A virus (A/mallard/MN/479/2000(H5N3)...  44.1    0.006
gb|EU743024.1|  Influenza A virus (A/chicken/NJ/17169/1993(H5N...  44.1    0.006
gb|EU743278.1|  Influenza A virus (A/turkey/TX/1-40-82/1982(H5...  44.1    0.006
gb|EU742966.1|  Influenza A virus (A/chicken/PA/19241/1997(H7N...  44.1    0.006
gb|EU743032.1|  Influenza A virus (A/chicken/NY/14009/1993(H5N...  44.1    0.006
gb|EU743103.1|  Influenza A virus (A/chicken/FL/25717/1993(H5N...  44.1    0.006
gb|EU743111.1|  Influenza A virus (A/rhea/TX/39923/1993(H5N2))...  44.1    0.006
gb|EU743172.1|  Influenza A virus (A/turkey/SD/7034/1986(H1N1)...  44.1    0.006
gb|EU743200.1|  Influenza A virus (A/chicken/NY/11602-12/1998(...  44.1    0.006
gb|EU743207.1|  Influenza A virus (A/guinea fowl/NJ/8848-18/19...  44.1    0.006
gb|EU743222.1|  Influenza A virus (A/environment/NY/19019-6/19...  44.1    0.006
gb|EU743298.1|  Influenza A virus (A/mallard/WI/42/1975(H5N2))...  44.1    0.006
gb|EU743311.1|  Influenza A virus (A/blue winged teal/LA/B228/...  44.1    0.006
gb|EU743462.1|  Influenza A virus (A/mallard/MN/42/2000(H11N9)...  44.1    0.006
gb|EU743521.1|  Influenza A virus (A/mallard/MN/330/1999(H3N1)...  44.1    0.006
gb|EU743541.1|  Influenza A virus (A/mallard/MN/259/1999(H3N6)...  44.1    0.006
gb|EU743565.1|  Influenza A virus (A/pintail/MN/479/1999(H3N6)...  44.1    0.006
gb|EU743038.1|  Influenza A virus (A/emu/TX/39924/1993(H5N2)) ...  44.1    0.006
gb|EU743068.1|  Influenza A virus (A/turkey/MN/10734-2/1995(H5...  44.1    0.006
gb|EU743096.1|  Influenza A virus (A/chicken/PA/13609/1993(H5N...  44.1    0.006
gb|EU743303.1|  Influenza A virus (A/mallard/WI/169/1975(H5N3)...  44.1    0.006
gb|EU743527.1|  Influenza A virus (A/mallard/MN/351/1999(H3N1)...  44.1    0.006
gb|EU743050.1|  Influenza A virus (A/pheasant/NJ/1355/1998(H5N...  44.1    0.006
gb|EU743226.1|  Influenza A virus (A/chicken/NY/51375/2000(H5N...  44.1    0.006
gb|CY032923.1|  Influenza A virus (A/ring-necked duck/Californ...  44.1    0.006
gb|CY032883.1|  Influenza A virus (A/northern shoveler/Califor...  44.1    0.006
gb|CY032872.1|  Influenza A virus (A/mallard duck/Minnesota/Sg...  44.1    0.006
gb|CY032870.1|  Influenza A virus (A/mallard duck/Minnesota/Sg...  44.1    0.006
gb|CY032855.1|  Influenza A virus (A/blue-winged teal/Minnesot...  44.1    0.006
gb|CY032817.1|  Influenza A virus (A/mallard duck/Minnesota/Sg...  44.1    0.006
gb|CY032773.1|  Influenza A virus (A/mallard duck/Minnesota/Sg...  44.1    0.006
gb|CY032753.1|  Influenza A virus (A/blue-winged teal/Minnesot...  44.1    0.006
gb|CY032749.1|  Influenza A virus (A/blue-winged teal/Minnesot...  44.1    0.006
gb|CY032743.1|  Influenza A virus (A/blue-winged teal/Minnesot...  44.1    0.006
gb|CY032741.1|  Influenza A virus (A/blue-winged teal/Minnesot...  44.1    0.006
gb|CY032739.1|  Influenza A virus (A/blue-winged teal/Minnesot...  44.1    0.006
gb|CY032737.1|  Influenza A virus (A/blue-winged teal/Minnesot...  44.1    0.006
gb|CY032735.1|  Influenza A virus (A/blue-winged teal/Minnesot...  44.1    0.006
gb|CY032719.1|  Influenza A virus (A/northern pintail/Californ...  44.1    0.006
gb|CY032711.1|  Influenza A virus (A/northern shoveler/Califor...  44.1    0.006
gb|CY032703.1|  Influenza A virus (A/American wigeon/Californi...  44.1    0.006
gb|CY032687.1|  Influenza A virus (A/northern shoveler/Califor...  44.1    0.006
gb|CY032663.1|  Influenza A virus (A/gadwall/California/HKWF10...  44.1    0.006
gb|EU735807.1|  Influenza A virus (A/quail/IN/38685/1993(H1N1)...  44.1    0.006
gb|EU742633.1|  Influenza A virus (A/pheasant/NJ/9804568/1998(...  44.1    0.006
gb|EU742657.1|  Influenza A virus (A/duck/NY/6874/1978(H3N2)) ...  44.1    0.006
gb|CY031041.1|  Influenza A virus (A/environment/Maryland/1189...  44.1    0.006
gb|EF597425.2|  Influenza A virus (A/migratory duck/Hong Kong/...  44.1    0.006
gb|CY031019.1|  Influenza A virus (A/turkey/Minnesota/1729/198...  44.1    0.006
gb|CY031017.1|  Influenza A virus (A/turkey/Minnesota/1630/198...  44.1    0.006
gb|CY031015.1|  Influenza A virus (A/turkey/Minnesota/500/1978...  44.1    0.006
gb|CY031013.1|  Influenza A virus (A/turkey/Minnesota/1812/198...  44.1    0.006
gb|CY031009.1|  Influenza A virus (A/turkey/Minnesota/1700/198...  44.1    0.006
gb|CY029846.1|  Influenza A virus (A/muscovy duck/New York/212...  44.1    0.006
gb|EF530048.1|  Influenza A virus (A/mallard/ON/499/2005(H5N1)...  44.1    0.006
gb|EF210571.1|  Influenza A virus (A/mallard/Manitoba/458/2005...  44.1    0.006
gb|EU182308.1|  Influenza A virus (A/turkey/MN/3397-3/1992(H5N...  44.1    0.006
gb|EU182252.1|  Influenza A virus (A/chicken/CA/431/2000(H6N2)...  44.1    0.006
gb|EU182321.1|  Influenza A virus (A/chicken/NY/13237-6/1998(H...  44.1    0.006
gb|EU182317.1|  Influenza A virus (A/chicken/NY/14677-13/1998(...  44.1    0.006
gb|CY025082.1|  Influenza A virus (A/chicken/Victoria/224/1992...  44.1    0.006
gb|EU084955.1|  Influenza A virus (A/Avian/NY/31588-3/2000(H5N...  44.1    0.006
gb|EU084947.1|  Influenza A virus (A/chukar/MN/14591-7/1998(H5...  44.1    0.006
gb|EU084938.1|  Influenza A virus (A/Duck/NY/44018-1/2000(H5N2...  44.1    0.006
gb|EU084934.1|  Influenza A virus (A/Avian/NY/53726/2000(H5N2)...  44.1    0.006
gb|EU026115.1|  Influenza A virus (A/duck/NJ/7717-70/1995(H1N1...  44.1    0.006
gb|EU026107.1|  Influenza A virus (A/duck/NY/13152-13/1994(H1N...  44.1    0.006
gb|EU026087.1|  Influenza A virus (A/mallard/MD/403/2002(H1N1)...  44.1    0.006
gb|EF597401.1|  Influenza A virus (A/duck/Hong Kong/698/1979(H...  44.1    0.006
gb|EF597399.1|  Influenza A virus (A/duck/Hong Kong/342/1978(H...  44.1    0.006
gb|EF597397.1|  Influenza A virus (A/goose/Hong Kong/23/1978(H...  44.1    0.006
gb|CY022610.1|  Influenza A virus (A/green-winged teal/Ohio/12...  44.1    0.006
gb|EF554802.1|  Influenza A virus (A/mallard duck/Minnesota/19...  44.1    0.006
gb|CY021874.1|  Influenza A virus (A/green-winged teal/Ohio/34...  44.1    0.006
gb|CY021682.1|  Influenza A virus (A/canada goose/Ohio/127/198...  44.1    0.006
gb|CY021658.1|  Influenza A virus (A/black duck/Ohio/161/1999(...  44.1    0.006
gb|CY021650.1|  Influenza A virus (A/green-winged teal/Ohio/39...  44.1    0.006
gb|CY021642.1|  Influenza A virus (A/mallard/Delaware/418/2005...  44.1    0.006
gb|CY021626.1|  Influenza A virus (A/mallard/Ohio/421/1987(H7N...  44.1    0.006
gb|CY021618.1|  Influenza A virus (A/black duck/Ohio/239/1986(...  44.1    0.006
gb|CY021578.1|  Influenza A virus (A/mallard/Ohio/81/1986(Mixe...  44.1    0.006
gb|CY021474.1|  Influenza A virus (A/mallard/Maryland/1124/200...  44.1    0.006
gb|CY020882.1|  Influenza A virus (A/pintail/Alaska/49/2005(H3...  44.1    0.006
gb|CY021386.1|  Influenza A virus (A/turkey/Italy/1980(H5N2)) ...  44.1    0.006
gb|CY021354.1|  Influenza A virus (A/green-winged teal/Ohio/12...  44.1    0.006
gb|CY021338.1|  Influenza A virus (A/mallard/Maryland/1241/200...  44.1    0.006
gb|CY021330.1|  Influenza A virus (A/green-winged teal/Ohio/13...  44.1    0.006
gb|CY021322.1|  Influenza A virus (A/green-winged teal/Ohio/12...  44.1    0.006
gb|CY021250.1|  Influenza A virus (A/american black duck/Ohio/...  44.1    0.006
gb|CY021242.1|  Influenza A virus (A/green-winged teal/Ohio/13...  44.1    0.006
gb|CY021210.1|  Influenza A virus (A/mallard/Ohio/123/1989(H6N...  44.1    0.006
gb|CY021202.1|  Influenza A virus (A/green-winged teal/Ohio/80...  44.1    0.006
gb|CY021186.1|  Influenza A virus (A/mallard/Ohio/1851/2005(H1...  44.1    0.006
gb|CY021178.1|  Influenza A virus (A/green-winged teal/Ohio/18...  44.1    0.006
gb|CY021170.1|  Influenza A virus (A/green-winged teal/Ohio/17...  44.1    0.006
gb|CY021138.1|  Influenza A virus (A/mallard/Ohio/399/1987(H11...  44.1    0.006
gb|CY020994.1|  Influenza A virus (A/mallard/Ohio/81/1986(H6N2...  44.1    0.006
gb|CY020978.1|  Influenza A virus (A/mallard/Ohio/115/1989(H6N...  44.1    0.006
gb|CY020954.1|  Influenza A virus (A/mallard/Ohio/209/1998(H11...  44.1    0.006
gb|CY017416.2|  Influenza A virus (A/mallard/Ohio/424/1988(H3N...  44.1    0.006
gb|CY020938.1|  Influenza A virus (A/northern shoveler/Ohio/35...  44.1    0.006
gb|CY020930.1|  Influenza A virus (A/mallard/Ohio/122/1989(H10...  44.1    0.006
gb|CY020922.1|  Influenza A virus (A/environment/Ohio/1007/200...  44.1    0.006
gb|CY020914.1|  Influenza A virus (A/common scoter/Maryland/29...  44.1    0.006
gb|CY020866.1|  Influenza A virus (A/blue-winged teal/Ohio/907...  44.1    0.006
gb|CY020850.1|  Influenza A virus (A/pintail/Ohio/73/1989(H6N2...  44.1    0.006
gb|CY020842.1|  Influenza A virus (A/mallard/Ohio/653/2002(H6N...  44.1    0.006
gb|CY020834.1|  Influenza A virus (A/mallard/Ohio/648/2002(H6N...  44.1    0.006
gb|CY020826.1|  Influenza A virus (A/mallard/Maryland/172/2002...  44.1    0.006
gb|CY020794.1|  Influenza A virus (A/mallard/Ohio/668/2002(H4N...  44.1    0.006
gb|CY020786.1|  Influenza A virus (A/mallard/Ohio/666/2002(H6N...  44.1    0.006
gb|CY020762.1|  Influenza A virus (A/mallard/Ohio/649/2002(H3N...  44.1    0.006
gb|CY020746.1|  Influenza A virus (A/mallard/Ohio/654/2002(H3N...  44.1    0.006
gb|CY011061.2|  Influenza A virus (A/mallard/Ohio/275/1987(H4N...  44.1    0.006
gb|CY018922.1|  Influenza A virus (A/snow goose/Maryland/364/2...  44.1    0.006
gb|CY018914.1|  Influenza A virus (A/snow goose/Maryland/353/2...  44.1    0.006
gb|CY018906.1|  Influenza A virus (A/blue-winged teal/Ohio/658...  44.1    0.006
gb|CY018020.1|  Influenza A virus (A/mallard/Ohio/102/1986(H11...  44.1    0.006
gb|CY018012.1|  Influenza A virus (A/green-winged teal/Ohio/20...  44.1    0.006
gb|CY017850.1|  Influenza A virus (A/green-winged teal/Ohio/81...  44.1    0.006
gb|CY017842.1|  Influenza A virus (A/green-winged teal/Ohio/46...  44.1    0.006
gb|CY017786.1|  Influenza A virus (A/mallard/Ohio/99/1989(H10N...  44.1    0.006
gb|CY017746.1|  Influenza A virus (A/pintail/Alaska/310/2005(H...  44.1    0.006
gb|CY017738.1|  Influenza A virus (A/pintail/Alaska/102/2005(H...  44.1    0.006
gb|CY017714.1|  Influenza A virus (A/mallard/Ohio/156/1990(H3N...  44.1    0.006
gb|CY017706.1|  Influenza A virus (A/mallard/Ohio/324/1988(H4N...  44.1    0.006
dbj|AB286878.1|  Influenza A virus (A/duck/Hokkaido/120/2001(H...  44.1    0.006
dbj|AB286118.1|  Influenza A virus (A/duck/Pennsylvania/10218/...  44.1    0.006
gb|CY016185.1|  Influenza A virus (A/pintail/Alaska/211/2005(H...  44.1    0.006
gb|DQ997080.1|  Influenza A virus (A/swine/Anhui/cb/2004(H5N1)...  44.1    0.006
gb|DQ997160.1|  Influenza A virus (A/chicken/Hubei/wo/2003(H5N...  44.1    0.006
gb|CY016624.1|  Influenza A virus (A/mallard/Ohio/64/1989(H6N8...  44.1    0.006
gb|CY016400.1|  Influenza A virus (A/mallard/Ohio/264/1986(H3N...  44.1    0.006
gb|DQ997321.1|  Influenza A virus (A/chicken/Jilin/hj/2003(H5N...  44.1    0.006
gb|DQ997223.1|  Influenza A virus (A/chicken/Henan/wu/2004(H5N...  44.1    0.006
gb|CY016177.1|  Influenza A virus (A/green-winged teal/Ohio/59...  44.1    0.006
gb|CY016169.1|  Influenza A virus (A/green-winged teal/Ohio/86...  44.1    0.006
gb|CY016137.1|  Influenza A virus (A/pintail/Ohio/351/1987(H6N...  44.1    0.006
dbj|AB274965.1|  Influenza A virus (A/Duck/Hokkaido/8/80 (H3N8...  44.1    0.006
gb|CY015497.1|  Influenza A virus (A/mallard/Alaska/256/2005(H...  44.1    0.006
gb|CY015489.1|  Influenza A virus (A/mallard/Ohio/170/1999(H6N...  44.1    0.006
gb|CY015481.1|  Influenza A virus (A/mallard/Ohio/249/1998(H6N...  44.1    0.006
gb|CY013252.1|  Influenza A virus (A/mallard/Ohio/338/1986(H4N...  44.1    0.006
gb|CY015472.1|  Influenza A virus (A/mallard/Ohio/83/1986(H4N6...  44.1    0.006
gb|CY015175.1|  Influenza A virus (A/duck/Alaska/702/1991(H8N2...  44.1    0.006
gb|CY015150.1|  Influenza A virus (A/shorebird/Delaware/224/19...  44.1    0.006
gb|CY015132.1|  Influenza A virus (A/ruddy turnstone/Delaware/...  44.1    0.006
gb|CY015011.1|  Influenza A virus (A/Canada/rv504/2004(H7N3)) ...  44.1    0.006
gb|CY015003.1|  Influenza A virus (A/environment/Canada/av41/2...  44.1    0.006
gb|CY014973.1|  Influenza A virus (A/mallard duck/New York/686...  44.1    0.006
gb|CY014958.1|  Influenza A virus (A/mallard duck/New York/90/...  44.1    0.006
gb|CY014950.1|  Influenza A virus (A/wood duck/New York/60/198...  44.1    0.006
gb|CY014934.1|  Influenza A virus (A/mallard duck/New York/194...  44.1    0.006
gb|CY014914.1|  Influenza A virus (A/chicken/New York/28263/19...  44.1    0.006
gb|CY014893.1|  Influenza A virus (A/duck/New York/16873/1999(...  44.1    0.006
gb|CY014885.1|  Influenza A virus (A/chicken/New York/14677-13...  44.1    0.006
gb|CY014877.1|  Influenza A virus (A/black duck/New York/184/1...  44.1    0.006
gb|CY014862.1|  Influenza A virus (A/mallard duck/New York/180...  44.1    0.006
gb|CY014854.1|  Influenza A virus (A/mallard duck/New York/189...  44.1    0.006
gb|CY014834.1|  Influenza A virus (A/guinea fowl/New York/2022...  44.1    0.006
gb|CY014811.1|  Influenza A virus (A/mallard duck/Tennessee/11...  44.1    0.006
gb|CY014803.1|  Influenza A virus (A/turkey/Minnesota/1012/199...  44.1    0.006
gb|CY014797.1|  Influenza A virus (A/turkey/Minnesota/3/1992(H...  44.1    0.006
gb|CY014791.1|  Influenza A virus (A/turkey/Minnesota/1/1988(H...  44.1    0.006
gb|CY014776.1|  Influenza A virus (A/turkey/Minnesota/501/1978...  44.1    0.006
gb|CY014730.1|  Influenza A virus (A/duck/Minnesota/1525/1981(...  44.1    0.006
gb|CY014714.1|  Influenza A virus (A/duck/Germany/1215/1973(H2...  44.1    0.006
gb|CY014606.1|  Influenza A virus (A/mallard duck/Astrakhan/26...  44.1    0.006
gb|CY014589.1|  Influenza A virus (A/mallard/Alberta/34/2001(H...  44.1    0.006
gb|CY014553.1|  Influenza A virus (A/mallard duck/Alberta/331/...  44.1    0.006
gb|CY014566.1|  Influenza A virus (A/mallard/Alberta/267/1996(...  44.1    0.006
gb|CY013868.1|  Influenza A virus (A/green-winged teal/Ohio/17...  44.1    0.006
gb|CY013268.1|  Influenza A virus (A/pintail/Alaska/53/2005(H3...  44.1    0.006
gb|CY013260.1|  Influenza A virus (A/pintail/Ohio/226/1998(H6N...  44.1    0.006
gb|DQ376830.1|  Influenza A virus (A/duck/Kingmen/E322/04(H6N2...  44.1    0.006
gb|CY012845.1|  Influenza A virus (A/pintail/Alaska/20/2005(H1...  44.1    0.006
gb|CY012837.1|  Influenza A virus (A/pintail/Ohio/294/1988(H6N...  44.1    0.006
gb|CY011253.1|  Influenza A virus (A/wigeon/Ohio/379/1988(H5N2...  44.1    0.006
gb|CY012813.1|  Influenza A virus (A/mallard/Ohio/298/1987(H4N...  44.1    0.006
gb|CY012805.1|  Influenza A virus (A/mallard/Ohio/171/1990(H1N...  44.1    0.006
gb|DQ366305.1|  Influenza A virus (A/duck/Vietnam/1/2005(H5N1)...  44.1    0.006
gb|AY724260.1|  Influenza A virus (A/chicken/Hebei/1/2002(H7N2...  44.1    0.006
gb|AY724254.1|  Influenza A virus (A/African starling/England-...  44.1    0.006
gb|DQ017512.1|  Influenza A virus (A/mallard/Alberta/24/01(H7N...  44.1    0.006
gb|DQ017508.1|  Influenza A virus (A/mallard/Alberta/24/01(H7N...  44.1    0.006
gb|AY616764.1|  Influenza A virus (A/chicken/British Columbia/...  44.1    0.006
gb|AY648292.1|  Influenza A virus (A/GSC_chicken_B/British Col...  44.1    0.006
gb|AY646083.1|  Influenza A virus (A/chicken/British Columbia/...  44.1    0.006
gb|AF257207.1|  Influenza A virus (A/Hong Kong/507/97(H5N1)) R...  44.1    0.006
gb|AF257206.1|  Influenza A virus (A/Hong Kong/503/97(H5N1)) R...  44.1    0.006
gb|AF257205.1|  Influenza A virus (A/Hong Kong/491/97(H5N1)) R...  44.1    0.006
gb|AF257203.1|  Influenza A virus (A/Hong Kong/485/97(H5N1)) R...  44.1    0.006
gb|AF257202.1|  Influenza A virus (A/Hong Kong/97/98(H5N1)) RN...  44.1    0.006
gb|AF257201.1|  Influenza A virus (A/Hong Kong/542/97(H5N1)) R...  44.1    0.006
gb|AF257200.1|  Influenza A virus (A/Hong Kong/538/97(H5N1)) R...  44.1    0.006
gb|AF257199.1|  Influenza A Virus (A/Hong Kong/532/97(H5N1)) R...  44.1    0.006
gb|AF257196.1|  Influenza A virus (A/Hong Kong/486/97(H5N1)) R...  44.1    0.006
gb|AF257194.1|  Influenza A virus (A/Hong Kong/482/97(H5N1)) R...  44.1    0.006
gb|AF257193.1|  Influenza A virus (A/Hong Kong/481/97(H5N1)) R...  44.1    0.006
gb|AF508664.1|  Influenza A virus (A/Chicken/Pakistan/5/99(H9N...  44.1    0.006
gb|AF457716.1|  Influenza A virus (A/chicken/California/1002a/...  44.1    0.006
gb|AF457707.1|  Influenza A virus (A/chicken/California/139/01...  44.1    0.006
gb|AF457699.1|  Influenza A virus (A/chicken/California/431/00...  44.1    0.006
gb|AF457691.1|  Influenza A virus (A/chicken/California/465/00...  44.1    0.006
gb|AF457674.1|  Influenza A virus (A/chicken/California/905/01...  44.1    0.006
gb|AF523459.1|  Influenza A virus (A/Duck/Hong Kong/86/76(H9N2...  44.1    0.006
gb|AY950266.1|  Influenza A virus (A/Chicken/Henan/210/2004 (H...  44.1    0.006
gb|CY004754.1|  Influenza A virus (A/mallard/Alberta/300/1977(...  44.1    0.006
gb|CY004431.1|  Influenza A virus (A/red knot/Delaware/2561/87...  44.1    0.006
gb|CY003860.1|  Influenza A virus (A/pintail/Alberta/293/1977(...  44.1    0.006
gb|CY003852.1|  Influenza A virus (A/mallard/Alberta/77/1977(H...  44.1    0.006
emb|AJ289874.1|  Influenza A virus (A/Hong Kong/156/97(H5N1)) ...  44.1    0.006
gb|DQ351869.1|  Influenza A virus (A/chicken/Hebei/718/2001(H5...  44.1    0.006
gb|CY005622.1|  Influenza A virus (A/dk/Hong Kong/293/1978(H7N...  44.1    0.006
gb|CY005587.1|  Influenza A virus (A/goose/Hong Kong/23/1978(H...  44.1    0.006
gb|CY005557.1|  Influenza A virus (A/duck/Hong Kong/7/1975(H3N...  44.1    0.006
gb|CY005355.1|  Influenza A virus (A/green-winged teal/ALB/199...  44.1    0.006
gb|CY005309.1|  Influenza A virus (A/mallard/ALB/124/1991(H11N...  44.1    0.006
gb|CY005278.1|  Influenza A virus (A/mallard duck/ALB/797/1983...  44.1    0.006
gb|CY005229.1|  Influenza A virus (A/mallard/ALB/5/1995(H10N1)...  44.1    0.006
gb|CY005192.1|  Influenza A virus (A/blue-winged teal/ALB/778/...  44.1    0.006
gb|CY005158.1|  Influenza A virus (A/mallard/ALB/17/1991(H9N2)...  44.1    0.006
gb|CY005151.1|  Influenza A virus (A/mallard/Alberta/11/1991(H...  44.1    0.006
gb|CY005131.1|  Influenza A virus (A/ruddy turnstone/DE/2731/1...  44.1    0.006
gb|CY005124.1|  Influenza A virus (A/laughing gull/DE/2718/198...  44.1    0.006
gb|CY005118.1|  Influenza A virus (A/ruddy turnstone/DE/2576/1...  44.1    0.006
gb|CY005069.1|  Influenza A virus (A/laughing gull/DE/2838/198...  44.1    0.006
gb|CY005032.1|  Influenza A virus (A/mallard duck/ALB/279/1977...  44.1    0.006
gb|CY005027.1|  Influenza A virus (A/widgeon/ALB/284/1977(H7N3...  44.1    0.006
gb|CY005020.1|  Influenza A virus (A/blue-winged teal/ALB/295/...  44.1    0.006
gb|CY005013.1|  Influenza A virus (A/mallard duck/ALB/224/1977...  44.1    0.006
gb|CY004992.1|  Influenza A virus (A/pintail duck/Alberta/114/...  44.1    0.006
gb|CY004986.1|  Influenza A virus (A/mallard/Alberta/283/1977(...  44.1    0.006
gb|CY004965.1|  Influenza A virus (A/mallard duck/ALB/291/1977...  44.1    0.006
gb|CY004908.1|  Influenza A virus (A/blue-winged teal/ALB/293/...  44.1    0.006
gb|CY004865.1|  Influenza A virus (A/ruddy turnstone/DE/512/19...  44.1    0.006
gb|CY004835.1|  Influenza A virus (A/mallard duck/ALB/630/1984...  44.1    0.006
gb|CY004822.1|  Influenza A virus (A/ruddy turnstone/NJ/47/198...  44.1    0.006
gb|CY004781.1|  Influenza A virus (A/pintail duck/ALB/220/1977...  44.1    0.006
gb|CY004774.1|  Influenza A virus (A/mallard duck/ALB/161/1977...  44.1    0.006
gb|CY004760.1|  Influenza A virus (A/mallard duck/ALB/210/1977...  44.1    0.006
gb|CY004740.1|  Influenza A virus (A/redhead duck/ALB/74/1977(...  44.1    0.006
gb|CY004654.1|  Influenza A virus (A/mallard duck/ALB/635/1983...  44.1    0.006
gb|CY004618.1|  Influenza A virus (A/pintail duck/ALB/462/1979...  44.1    0.006
gb|CY004565.1|  Influenza A virus (A/herring gull/DE/712/1988(...  44.1    0.006
gb|CY004455.1|  Influenza A virus (A/herring gull/NJ/782/1986(...  44.1    0.006
gb|CY004417.1|  Influenza A virus (A/knot/DE/2552/1987(H9N5)) ...  44.1    0.006
gb|CY004396.1|  Influenza A virus (A/herring gull/NJ/402/1989(...  44.1    0.006
gb|CY004343.1|  Influenza A virus (A/pintail/Alberta/49/2003(H...  44.1    0.006
gb|CY004126.1|  Influenza A virus (A/mallard duck/ALB/676/1979...  44.1    0.006
gb|CY003899.1|  Influenza A virus (A/herring gull/DE/475/1986(...  44.1    0.006
gb|CY005906.1|  Influenza A virus (A/domestic duck/MN/1086/198...  44.1    0.006
gb|CY005825.1|  Influenza A virus (A/shearwater/Australia/1/19...  44.1    0.006
gb|CY005734.1|  Influenza A virus (A/duck/NZL/31/1976(H4N6)) s...  44.1    0.006
gb|CY005650.1|  Influenza A virus (A/duck/Hong Kong/562/1979(H...  44.1    0.006
gb|CY005616.1|  Influenza A virus (A/duck/Hong Kong/d134/1977(...  44.1    0.006
gb|CY005580.1|  Influenza A virus (A/duck/Hong Kong/342/1978(H...  44.1    0.006
gb|CY005418.1|  Influenza A virus (A/semi-palmated sandpiper/B...  44.1    0.006
gb|CY005400.1|  Influenza A virus (A/mallard duck/AST/266/1982...  44.1    0.006
gb|CY005390.1|  Influenza A virus (A/herring gull/DE/660/1988(...  44.1    0.006
gb|CY005385.1|  Influenza A virus (A/laughing gull/DE/554/1988...  44.1    0.006
gb|CY005374.1|  Influenza A virus (A/shorebird/NJ/840/1986(H13...  44.1    0.006
gb|CY005315.1|  Influenza A virus (A/mallard/ALB/126/1991(H11N...  44.1    0.006
gb|CY005302.1|  Influenza A virus (A/ruddy turnstone/NJ/842/19...  44.1    0.006
gb|CY005284.1|  Influenza A virus (A/ruddy turnstone/Delaware/...  44.1    0.006
gb|CY005272.1|  Influenza A virus (A/mallard duck/ALB/763/1983...  44.1    0.006
gb|CY005268.1|  Influenza A virus (A/redhead duck/ALB/357/1983...  44.1    0.006
gb|CY005216.1|  Influenza A virus (A/redhead duck/ALB/767/1984...  44.1    0.006
gb|CY005197.1|  Influenza A virus (A/mallard duck/ALB/742/1981...  44.1    0.006
gb|CY005036.1|  Influenza A virus (A/blue-winged teal/ALB/221/...  44.1    0.006
gb|CY005000.1|  Influenza A virus (A/mallard duck/ALB/7/1987(H...  44.1    0.006
gb|CY004974.1|  Influenza A virus (A/herring gull/NJ/406/1989(...  44.1    0.006
gb|CY004944.1|  Influenza A virus (A/mallard/Alberta/30/2001(H...  44.1    0.006
gb|CY004916.1|  Influenza A virus (A/mallard/ALB/49/1995(H4N6)...  44.1    0.006
gb|CY004889.1|  Influenza A virus (A/blue-winged teal/ALB/67/1...  44.1    0.006
gb|CY004872.1|  Influenza A virus (A/knot/DE/541/1988(H4N6)) s...  44.1    0.006
gb|CY004828.1|  Influenza A virus (A/laughing gull/NJ/72/1985(...  44.1    0.006
gb|CY004767.1|  Influenza A virus (A/pintail duck/ALB/159/1977...  44.1    0.006
gb|CY004719.1|  Influenza A virus (A/mallard duck/ALB/299/1977...  44.1    0.006
gb|CY004707.1|  Influenza A virus (A/mallard/Alberta/156/2001(...  44.1    0.006
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[wotan]

Originally Posted by niman

PA G1761A

Should that have been in the Sao Paolo thread, and do you have any information on what significance G1761A might have?

[HenryN]

Originally Posted by wotan

Should that have been in the Sao Paolo thread, and do you have any information on what significance G1761A might have?

It just provides more evidence that these changes were due to recombination. There now are three polymorphisms from the Canadian swine that are in the same sequences from Argentina.

[HenryN]

Originally Posted by GennieF

Dr. Niman,

Do you have any sort of rough outline as to what you think will happen in the fall and when things will start to become noticeable as far as severe sickness/death?

Gennie

The CDC has said they expect outbreaks like NYC to be widespread in the US in the fall. I think this is an optimistic projection. In the northern hemisphere the fall will signal the start of flu season and cases increase simply because the cooler temperature allows the virus to remain viable longer. Thus there is more transmission just because there is more virus laying around.

However, the species jump is significant, and major changes are possible with minor changes. I expect H274Y to be widespread as well as PB2 E627K. These two changes alone could have a significant impact because the virus will be able to grow faster at lower temperatures and will be resistant to Tamiflu (and Relenza resistance may follow).

Some signals will come out of sequences from the southern hemisphere, although those sequences lag. There is at least one marker for Argentina, and the Sao Paulo change may be significant. There may be more sequences released this week, which could make these initial onservations on fatal cases easier to evaluate.

In addition, there are more people living in the northern hemisphere, so issues in the southern hemisphere could be magnified in the north. I suspect some time in September the picture will be clearer and I expect results to indicate that the CDC projection is VERY optimistic.

[HenryN]

'Swine flu could become drug resistant'

August 04 2009 at 07:13PM

Health workers were on Tuesday warned against overprescribing a drug used to treat swineflu, called Tamiflu, as the illness could become drug-resistant. This is according to Dr Chuma Makunga, from the National Institute of Communicable Diseases, who was speaking at a Pharmacy Conference at Sun City. She said there were already four countries, identified by the World Health Organisation, in which some strains of swineflu were resistant to Tamiflu. "It is not to be given to everyone," she told conference delegates. "It is up to individual clinicians to read the information that is sent to them and to ensure they know what they were doing." She added that doctors were informed of how the drug should be prescribed. South Africa's first fatality from the H1N1 virus, in the Western Cape, was reported on Monday. The government was no longer trying to contain the virus but working to ensure its pandemic protocols were in place, Makunga said. "What we are doing is collecting information about the virus so that we know as much as we can about the way it works." Pregnant women were a risk group for complications due to swineflu and the illness seems to affect mostly young people, up to the age of 49, while the elderly appeared to be showing some immunity to it, the conference heard. - Sapa http://www.iol.co.za/index.php?set_i...1145999C120467

[wotan]

In addition, there are more people living in the northern hemisphere, so issues in the southern hemisphere could be magnified in the north. I suspect some time in September the picture will be clearer and I expect results to indicate that the CDC projection is VERY optimistic.

Let me reiterate something from my conversation with our daughter's pulmonary doctor yesterday. He first thought we would get by until roughly December (referring to Houston specifically) before we experienced a severe outbreak. After seeing how many cases the hospital has had this summer (10,000% more flu than normal in the summer) he expects a bad flu season beginning essentially this month when the kids return to school.

[St Michael]

Originally Posted by niman

I suspect some time in September the picture will be clearer and I expect results to indicate that the CDC projection is VERY optimistic.

Are the CDC and Dept of Homeland Security on the same page?

Homeland Secretary Napolitano predicts severe flu epidemic for fall

By Steve Sternberg, USA TODAY
U.S. Secretary of Homeland Security Janet Napolitano asserted Tuesday that pandemic flu is likely to flare up soon after schools open in the fall, well before any vaccine is available.

Napolitano also acknowledged that there would not be enough pandemic flu vaccine for everyone, at least in the early stages of the flu season. "There will be prioritization of vaccinations," she told members of the USA TODAY editorial board.

The flu strain causing the pandemic, a new strain of H1N1 flu that is also known as swine flu, is especially dangerous because it is genetically different from virtually every other known flu virus. As a result, most people are defenseless against it — making vaccine the keystone of any effort to prevent illness and save lives.

Napolitano said the flu epidemic is likely to be severe, but not as severe as the 1918 pandemic, the world's worst. In 1918, flu killed at least 675,000 people in the USA and up to 50 million worldwide. She said it's more likely that the pandemic would mirror 1957, when flu killed about 70,000 people in the USA and more than one million people worldwide, according to the Centers for Disease Control and Prevention.

...