New Strain of Influenza a Virus (H5N1), Thailand
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LETTERS New Strain of lows: A/chicken/Thailand/PC-168/ was clustered into the same group 2006 (DQ999879–86) and A/chicken/ with viruses isolated from southeast Influenza A Virus Thailand/PC-170/2006 (DQ999887– People’s Republic of China, including (H5N1), Thailand 94) from Phichit and A/chicken/ Zhejiang, Shantou, Hunan, Fujian, Thailand/NP-172/2006 (DQ999871– Guangxi, and Lao People’s To the Editor: During 2004– 8) from Nakhon Phanom. Democratic Republic (7) with the dif- 2005, 3 major waves of avian influen- Whole genome analysis showed ferences in the cleavage site, SPLR- za outbreaks occurred in Thailand (1). that all 3 samples had undergone ERRRK-R/G (underline and dash The first wave was reported in early minor mutations that are typical of indicate differences), which had never January 2004, the second in July circulating influenza A viruses. been found in Thailand. The N-link 2004, and the third in October– Unexpectedly, this outbreak was asso- glycosylation sites (positions December 2005. In total, 22 persons ciated with 2 strains of the virus. The 154–156) of the Pichit isolates were were infected and 14 died. Recently, a 2 samples from Phichit closely resem- NST residues, whereas in the Nakhon fourth wave began on July 23, 2006. bled H5N1 strains that had circulated Phanom isolate, NNT residues were The Thai Ministry of Public Health in Thailand during 2004 and 2005. observed. However, the receptor- reported that avian influenza A The sample from Nakhon Phanom binding site of HA (positions 222 and (H5N1) virus killed 2 infected per- was newly observed in Thailand and 224) was unchanged. sons. The first patient, a 17-year-old more closely related to H5N1 strains In the neuraminidase (NA) gene, man in Phichit Province, began to that had been circulating since 2005 in the new isolates contain 20 amino experience symptoms on July 15, southeast People’s Republic of China. acid deletions within the stalk region, 2006, and died on July 24, 2006 (2). The whole genome phylogenetic the same as previously described (1). The second patient, a 27-year-old man analysis also showed that the viruses The ESEV residues in the C-terminal in Uthai Thani Province, began to isolated from Phichit belonged to and Asp92 of NS1 were observed in experience symptoms on July 24, genotype Z, whereas virus isolated the 2006 isolates and in viruses that 2006, and died on August 3, 2006 (3). from Nakhon Phanom belonged to have been isolated from Thailand, The fourth wave of these out- genotype V, which differs from geno- Vietnam, and People’s Republic of breaks involved chickens and encom- type Z in the PA gene (6) (Figure, China. This finding indicates that the passed 2 distinct areas: Phichit panel A). new isolates were highly virulent but Province, identified on July 23, 2006 The phylogenetic tree of the sensitive to treatment with interferon (4), and Nakhon Phanom Province, hemagglutinin (HA) gene (Figure, and tumor necrosis factor-α (8). The identified on July 28, 2006 (5). We panel B) showed that the Phichit sam- 2006 isolates contain Glu627 of PB2, sequenced all 8 gene segments of the 2 ples were similar to the cluster of identical to the previous isolates from viruses isolated from Phichit and 1 samples isolated during 2004 and Thailand and Indonesia, which may virus isolated from Nakhon Phanom 2005 in Thailand and Vietnam. In indicate that the new isolates had less and then submitted to GenBank as fol- contrast, the Nakhon Phanom sample efficient replication capability in Figure. A) Phylogenetic rela- tionships of the polymerase acid protein gene comparing genotype Z, Z+, and V. B) Hemagglutinin gene of influenza A (H5N1) viruses in Thailand 2006 compared with several other strains worldwide. For a larger reproduction of the phyloge- netic relationships, see online figure available at www.cdc.gov/EID/content/ 13/3/506-G. htm 506 Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 13, No. 3, March 2007 LETTERS mammalian hosts (9). Drug resistance Acknowledgment influenza outbreaks in Japan. Virology. or sensitivity is based on sequences of We thank the Division of Research 2005;332:167–76. 7. Boltz DA, Douangngeun B, Sinthasak S, M2 and NA. Substitution within Affairs of the Chulalongkorn University Phommachanh P, Rolston S, Chen H, et al. residues including L26I, V27A/I, Faculty of Medicine for manuscript H5N1 influenza viruses in Lao People’s A30S, and S31N of the M2 ion chan- review. Democratic Republic. Emerg Infect Dis. nel protein was used to predict aman- 2006;12:1593–5. This study was supported by Thailand 8. Krug RM. Virology. Clues to the virulence tadine-resistant mutants, and H274Y Research Fund (Senior Research Scholar); of H5N1 viruses in humans. Science. of the NA was used to predict for Royal Golden Jubilee PhD Program; 2006;311:1562–3. oseltamivir resistance (10). The virus 9. Shinya K, Hamm S, Hatta M, Ito H, Ito T, Center of Excellence in Viral Hepatitis observed in 2006 isolates from Phi- Kawaoka Y. PB2 amino acid at position 627 Research, Chulalongkorn University; and affects replicative efficiency, but not cell chit was resistant to amantadine but National Research Council. tropism, of Hong Kong H5N1 influenza A sensitive to oseltamivir, whereas the viruses in mice. Virology. 2004;320: isolate from Nakhon Phanom was 258–66. sensitive to amantadine and Salin Chutinimitkul,* 10. Scholtissek C, Quack G, Klenk HD, Thaweesak Songserm,† Webster RG. How to overcome resistance oseltamivir, which implies that infect- of influenza A viruses against adamantane ed patients received different antiviral Alongkorn Amonsin,* derivatives. Antiviral Res. 1998;37:83–95. drugs. Sunchai Payungporn,* 11. World Health Organization Global According to previous World Kamol Suwannakarn,* Influenza Program Surveillance Network. Sudarat Damrongwatanapokin,‡ Evolution of H5N1 avian influenza viruses Health Organization reports, the HA in Asia. Emerg Infect Dis. 2005;11: sequences of most influenza (H5N1) Arunee Chaisingh,‡ 1515–21. viruses that circulated in avian species Bandit Nuansrichay,‡ during the past 3 years are separated Thaweesak Chieochansin,* Address for correspondence: Yong into 2 distinct phylogenetic clades. Apiradee Theamboonlers,* Poovorawan, Center of Excellence in Viral Clade 1 viruses that circulated in and Yong Poovorawan* Hepatitis Research, Department of Pediatrics, Cambodia, Thailand, and Vietnam *Chulalongkorn University, Bangkok, Faculty of Medicine, Chulalongkorn were responsible for human infections Thailand; †Kasetsart University, Nakorn University, Bangkok 10330, Thailand; email: Pathom, Thailand; and ‡National Institute [email protected] in those countries during 2004 and of Animal Health, Bangkok, Thailand 2005. Clade 2 viruses that circulated in birds in People’s Republic of China References and Indonesia during 2003–2004 and 2005–2006 spread westward to the 1. Amonsin A, Chutinimitkul S, Pariyothorn N, Songserm T, Damrongwantanapokin S, Middle East, Europe, and Africa. This Puranaveja S, et al. Genetic characteriza- latter genetic group of viruses has tion of influenza A viruses (H5N1) isolated been principally responsible for from 3rd wave of Thailand AI outbreaks. human infections during late 2005 Virus Res. 2006;122:194–9. 2. Hopp M. Avian influenza situation in and 2006 (11). The latest wave of the Thailand. ProMed. July 26, 2006. Accessed Kala-azar Control, outbreaks in Thailand was caused by at http://www.promedmail.org, archive viruses closely related to those that number: 20060726.2056. Uganda caused outbreaks in Thailand in 3. Gale J. Avian influenza, human (112): Thailand. ProMed. August 6, 2006. To the Editor: Much of the leish- 2004–2005 and to viruses recently Accessed at http://www.promedmail.org, maniasis in Africa is concentrated in circulating in southeast People’s archive number: 20060806.2180. East Africa. In this region, visceral Republic of China and other South- 4. Dudley JP. Avian flu disease returns after 8 leishmaniasis (kala-azar) is caused by east Asian countries. This finding months H5N1 virus outbreak confirmed in Phichit. ProMed. July 24, 2006. Accessed Leishmania donovani and is endemic raises concern for development of at http://www.promedmail.org, archive in remote parts of Somalia, Sudan, new candidate influenza (H5N1) vac- number: 20060724.2042. Ethiopia, Kenya, and Uganda (1). cine strains. Geographic spreading, 5. Marshall M. New bird flu outbreak con- In Uganda, kala-azar is transmit- epidemiology, and genetic properties firmed along Thai-Lao border. ProMed. July 30, 2006. Accessed at http://www. ted by the sandfly Phlebotomus marti- of recently circulating influenza promedmail.org, archive number: ni, and transmission is thought to be (H5N1) viruses should be considered 20060730.2104. anthroponotic. Studies in Sudan and when developing candidate H5N1 6. Mase M, Tsukamoto K, Imada T, Imai K, Kenya have detected L. donovani in strains of influenza vaccine. Tanimura N, Nakamura K, et al. Characterization of H5N1 influenza A domestic animals (2,3), but whether viruses isolated during the 2003–2004 these play a role in Uganda is Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 13, No. 3, March 2007 507.