Media Myths Cloud Joint Hearings on Pandemic Vaccine Recombinomics Commentary 17:17 November 19, 2009
Look at Ukraine, for example, where public awareness went from "zero" this summer to "panic" this autumn. Late last month, politicians began to speak of mass illness and mass death. The government quarantined several provinces, shut down parliament and banned mass gatherings. When the dust began to settle last week, it appeared that, yes, there had been a small outbreak of swine flu, but also that, no, most of the people who got sick didn't have the H1N1 virus. Swine flu death rates in Ukraine are no higher than those for flu or pneumonia in other years.
The above Ukraine comments are from a Washington Post story cited by Senator Joe Lieberman on the first day of joint hearings on the pandemic vaccine shortfall. He was "surprised" that there were an estimated 22 million cases in the United States and the emphasis was on shortfalls linked to over promises on delivery dates and amounts of vaccine.
However, the hearings failed to capture the events in Ukraine, which was deemed a "non-event" in the above piece by op-ed writer Anne Applebaum, even though the importance of Ukraine was hard to miss. Even the most casual observer could look at the WHO H1N1 updates and see that some in Ukraine was attracting significant attention. WHO began issuing updates last April, when H1N1 was discovered in patients in Mexico and the United States. Thus the first two updates named the two countries in the title. However, subsequent updates were just number, with no county named. Initially these updates came out daily and then settle down to one update a week. The 72nd update was on Oct 30, but two days later a new update was issued on Ukraine. Another Ukraine update was issued on Nov 3 Two days later a second Ukraine update was released and on Nov 17, the date of the above article a third Ukraine update was issued.
In addition to media reports quoting WHO spokesperson, Ukraine also came up in WHO weekly teleconferences on Nov 5 and 12. These notices were carefully worded to exclude large changes in the virus, but left open small changes, including receptor binding domain changes. Such changes were of interest because hundreds of patients had died at a rate and level markedly higher than any other European country, and the descriptions of the fatal cases were detailed, noting severe hemorrhage, as well as the total destruction of both lungs. Patients had been arriving at emergency departments coughing up blood and dying within a few days. Moreover, most of the patients were previously healthy young adults.
The gruesome descriptions and the large number of fatal cases led to wild speculation by conspiracy theorists on one hand and media and political reports such as the one above, claiming that the Ukraine outbreak was small and not unusual.
However, the careful wording of WHO updates clearly left open the possibility of small changes including the receptor binding domain and the D225G change had been predicted, based on the high number of fatalities involving lung hemorrhaging and disintegrating.
Yesterday, the sequences from 10 isolates were released at GISAID by Mill Hill and the predicted change, D225G was confirmed. This change had been "in play" and was appearing on multiple H1N1 genetic backgrounds signaling recombination and selective advantage. The recent update of demographics for the 10 patients demonstrated that the four isolates with D225G were the four patients who had died, further raising concerns that D225G on a Ukrainian H1N1 background, or other H1N1 backgrounds could lead to more severe cases and deaths. Moreover the same change had been observed during the 1918-1919 pandemic, which also involved swine H1N1 jumping and adapting to humans.
Thus, the genetic change(s) in H1N1 in Ukraine is of considerable concern, media reports and Senator comments, notwithstanding.
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