title: Frequency of D222G haemagglutinin mutant of pandemic (H1N1) pdm09 influenza virus in Tunisia between 2009 and 2011.
abstract: BACKGROUND
  The novel pandemic A (H1N1) pdm09 virus was first identified in Mexico in April 2009 and since then it spread worldwide over a short period of time. Although the virus infection is generally associated with mild disease and a relatively low mortality, it is projected that mutations in specific regions of the viral genome, especially within the receptor binding domain of the haemagglutinin (HA) protein could result in more virulent virus stains, leading to a more severe pathogenicity.
  
  
  METHODS
  To monitor the genetic polymorphisms at position 222 of Haemagglutinin of influenza A(H1N1)pdm09 viruses from both outpatients with mild influenza and individuals with severe disease requiring hospitalization, during 2009-2010 and 2010-2011 seasons, a sequence-based genotypic assessment of viral populations to understand the prevalence of D222G mutation.
  
  
  RESULTS
  The D222G was identified in clinical specimens from 3 out of 42 cases analyzed in Tunisia with severe outcome (7%). Interestingly, in one fatal case out of four viruses taken from fatal cases studied (25%). Also this mutation was found in one mild case out of 8 mild cases studied (0.1%). D222E substitution was found in virus taken from one patient with severe clinical syndrome (2%) out of 42 severe cases analyzed and E374K substitution was found in two severe cases (4%) out of 42 severe cases studied.
  
  
  CONCLUSIONS
  A specific mutation in the viral haemagglutinin (D222G) was found in fatal, severe and mild case. Further virological, clinical and epidemiological investigations are needed to ascertain the role of this and other mutations that may alter the virulence and transmissibility of the pandemic influenza A (H1N1)pdm09.
  The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1027334947811255.
authors.affiliation: National Influenza Centre-Tunis, Unit Virology, Microbiology Laboratory, Charles Nicolle’s Hospital, Tunis, Tunisia.
authors.forename: Awatef El
authors.initials: AE
authors.lastname: Moussi
authors.forename: Mohamed Ali Ben Hadj
authors.initials: MA
authors.lastname: Kacem
authors.forename: Francisco
authors.initials: F
authors.lastname: Pozo
authors.forename: Juan
authors.initials: J
authors.lastname: Ledesma
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Cuevas
authors.forename: Inmaculada
authors.initials: I
authors.lastname: Casas
authors.forename: Amine
authors.initials: A
authors.lastname: Slim
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D005787:Gene Frequency; D005838:Genotype; D019267:Hemagglutinin Glycoproteins, Influenza Virus / Q000235:genetics*; D006760:Hospitalization; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype / Q000235:genetics* / Q000472:pathogenicity; D007251:Influenza, Human / Q000175:diagnosis / Q000453:epidemiology / Q000235:genetics* / Q000635:transmission / Q000821:virology; D008297:Male; D008875:Middle Aged; D009154:Mutation; D058873:Pandemics; D010641:Phenotype; D012720:Severity of Illness Index; D013997:Time Factors; D014416:Tunisia / Q000453:epidemiology; D014774:Virulence
chemical_list: C543345:H1N1 virus hemagglutinin; D019267:Hemagglutinin Glycoproteins, Influenza Virus
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