The CDC has released a small series of H1N1 sequences at GISAID. One isolate, A/Kentucky/09/2010 (KY/09), had G158E and D225G in addition the S188T. The isolate was collected November 1, 2011 and was closely related to A/Kentucky/08/2010, as well as a well defined sub-clade in the United Kingdom.
KY/09 was most closely related to the two sequences from the UK, (A/England/488-378/2010 and A/England/4940476/2010), which had D225G and were from severe cases. These two sequences were identical, but collected more than one month apart.
All of these sequences have S188T, which is in a rapidly expanding sub-clade and was present in the majority of the recent sequences from the UK (22/41). Similarly, S188T was in 3/5 recent H1N1 sequences from the US.
The presence of D225G in two identical sequences from the UK suggested that it was transmitting. The presence of D225G in the US on a closely related sequence similarly supports transmission.
Transmission of D225G could create serious problems due to its tight association with severe and fatal cases.
More information on the cases in Kentucky as well as the two cases in the UK would be useful.
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