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Pastimes : SARS - what next? -- Ignore unavailable to you. Want to Upgrade?

To: Maurice Winn who wrote (699)	8/27/2003 8:45:51 PM
From: Henry Niman	Read Replies (1) \| Respond to of 1070

Yes, its the same Country and its still in denial. The mutation I previously described below is in the N gene at position 28268, but the region listed below for the N gene was 28768 - 29357 which would miss the mutation. However, there is another Frankfurt 1 mutation in the area. This one is at position 26600 which is in the M gene. The paper below indicated that 235 bp were sequenced in the M gene from 26427 - 26192, but usually the numbers are listed going up, so if the sequencing began at 26427 and went up 235 bp it would go to 26662 and would include the Frankfurt 1 mutation in the M gene. I suspect that this is the mutation and although the details are different, the story is the same - the mutation traces back to the Metropole Hotel through the Singapore index case. Both Frankfurt 1 and FRA have the mutation at 26600. It is also shared with HKU-39849 which was isolated from the brother-in-law of the Metropole Hotel index case. The mutation is also found in TWC which was from a Taiwanese patient who had visited Amoy Gardens. The mutation is also in an unpublished isolate from a patient in Hong Kong. Thus, the mutation at 26600 actually has two ties to the Metropole Hotel (the Singapore index case and the brother-in-law of the Metropole Hotel index case) and is found in 5 SARS CoV isolates. Thus, the story is the same. The Winnipeg labs have found two sequences that trace back to the Metropole Hotel, The Frankfurt 1 mutation does so through two who were at the Metropole Hotel or went on a shopping spree with the Metropole Hotel index case and Tor2 was from the son of the Toronto index case who also stayed at the Metropole Hotel. Lab error for two SARS CoV sequences tracing back to the Metropole Hotel is hard to envision and the exact matches clearly did not come from OC43 and any other cold virus. They are clearly SARS CoV sequences and the likelihood of 2 SARS CoV sequences in 13 samples being reported because of lab error is several steps beyond remote.

To: Maurice Winn who wrote (699)	8/27/2003 11:57:09 PM
From: Henry Niman	Read Replies (2) \| Respond to of 1070

Surrey SARS Cov Analysis and Implications With the limited amount of data presented, quite a bit can be learned about the SARS CoV sequences found in patients in Surrey, BC. Assuming that the positions sequenced were 26427-26662 and 28768-29357 the following is true for the two or more SARS CoVs identified: The sequence range crossed over 5 positions of common polymorphisms. The sequence of the SARS CoVs in Surrey is not consistent with CUHK-Su10, the virus isolated from the mother of the Prince of Wales index case, because they do not have T26477G. For the same reason they are not another unpublished isolate from Hong Kong or a series of isolates from Taiwan (TC1, TC2, TWJ, TWK, TWS, TWY, TWH, TWC2, TWC3). The SARS CoVs are more closely related to two masked palm civet isolates (SZ1, SZ3)than another masked palm civet isolate (SZ16) or a raccoon dog isolate (SZ13). The sequence is not consistent with several unpublished early isolates from Guangzhou (GZ43, GZ60) or the initial GZ01 isolate. One of the SARS CoV from Surrey has the mutation C26600T that is also found in Frankfurt 1, FRA, TWC, HKU39849, and another unpublished sequence from Hong Kong. Thus, there are at least two SARS CoVs in the Surrey patients and they have mutations that are in common with more recent isolates, including several closely tied to the Metropole Hotel. The profile of these two or more SARS CoVs in Surrey, BC suggests the following: The SARS CoVs causing SARS in the spring are not "back in the box". The recent SARS transmissions did not involve a re-emergence from an animal reservoir. The SARS CoVs are easily transmitted by patients with "summer cold" symptoms. Reliance on symptoms associated with the SARS CoVs in the winter and spring does not identify cases in the summer. The ratio of the two SARS CoV subtypes suggests they may be be traced back to more than two sources in Hong Kong. Seasonal cofactors may be required for the SARS presentation seen last winter and spring. Two of five antibody tests failed to detect antibodies to the virus. One of the failed tests is used by the CDC which only detected 8 SARS cases in the US this year. Nursing home cases in the Toronto area that initially tested positive for SARS CoV may be true positives, although they were declared negative by health officials. PCR test by Vancouver groups produce false negatives. The SARS CoVs have been transmitted undetected in Vancouver in May and June. Detection in July and August was met with comments on OC43 detection and a number of false negative tests. In spite of SARS CoV detection by 3 antibody tests, PCR tests, and exact matches for regions of four SARS CoV genes, health officials lifted the quarantine on the two nursing homes and allowed visitors. The officials also refused to identify one of the nursing homes with "summer cold" transmission. Press releases trying to spin the data don't stop transmission. The SARS CoV is quite happy with health officials in denial. It is going to be a VERY long fall and winter.