Result: All 2009-2010 Brazilian swine and human isolates contained residues of the swine lineage in the receptor-binding pockets, with no substitutions in those sites relative to the A/Mexico/4108/09 strain, except for the substitutions
A134T and
D222N in isolates A/swine/Brazil/19/2010 and A/swine/Brazil/20/2010.
Discussion: It has been demonstrated that pandemic H1N1 2009 evolved and shifted from an initial mixed clade pattern to a clade 7-predominant pattern.34 The subsequent selection and evolution of clade 7 resulted in the circulation of variants
D222G/N or E.35 Mutation
D222G in the
hemagglutinin protein has been correlated with the clinical onset of disease, and it was frequently found in severe/fatal cases of the pandemic influenza in humans.36 Likewise, the substitution
D222