Whole-Genome Analysis of Influenza A(H1N1)pdm09 Viruses in Cameroon (2019–2024) Using Nanopore Sequencing

Whole-Genome Analysis of Influenza A(H1N1)pdm09 Viruses in Cameroon (2019–2024) Using Nanopore Sequencing | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Whole-Genome Analysis of Influenza A(H1N1)pdm09 Viruses in Cameroon (2019–2024) Using Nanopore Sequencing Desmon Toutou Tsafack, Chavely Gwladys Monamele, Francioli Koro Koro, and 9 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7684927/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 09 Dec, 2025 Read the published version in BMC Infectious Diseases → Version 1 posted 29 You are reading this latest preprint version Abstract Background Since 2019, Cameroon has reported a high number of seasonal influenza cases caused by the A(H1N1)pdm09 subtype, which remained the predominant global strain as of 2024. Methods To characterize the evolutionary dynamics of circulating A(H1N1)pdm09 viruses, whole-genome sequencing was conducted using Oxford Nanopore Technologies, with multiplexing native barcode expansion kits. DNA repair and end preparation were performed using the NEBNext Ultra II End-Repair/dA-tailing kit. Phylogenetic trees for HA genes segments were inferred using the maximum likelihood (ML) method implemented in IQ-TREE v3.0.1( http://www.iqtree.org ) under the TVM + F + I + R2 substitutions models. Additionally, Mutation analysis was performed across all eight gene segments using MEGA with A/Wisconsin/67/2022 (A/H1N1pdm09) serving as the reference strain. Identified amino acid substitutions were annotated and their potential phenotypic effects were evaluated using FluSurver ( http://flusurver.bii.a-star.edu.sg . accessed on August10, 2025). Results All Cameroonian A(H1N1)pdm09 strains from 2019 to 2024 belonged to subclade 6B.1A.5a.2a. Phylogenetic analysis revealed annual divergence from Northern Hemisphere vaccine strains, suggesting a mismatch with locally circulating variants. Several mutations of functional interest were identified, including A3L, A214T, F12V, R159K, A267V, A241E, T137A, I42L, V7I, I84V and I33V across the HA, PA, M2, NS1 and PB1 genes, many of which are associated with increased virulence. Similarly, amino acid substitutions at sites V13I, S200N, L339S, S37T, V80M, and I163V in the NA protein were observed in the NA protein, relative to the 2024 vaccine strain A/Wisconsin/67/2022. Overall, the number of amino acid mutations between circulating strains and the vaccine strain was notably high, indicating that local viruses may be evolving away from the vaccine strain selected for the 2023–2024 season. Conclusions These findings underscore the ongoing genetic evolution of the influenza A(H1N1)pdm09 virus in Cameroon and highlight the importance of local genomic data into the selection of WHO vaccine candidate strains for the Northern Hemisphere. Influenza A(H1N1)pdm09 genetic drift whole-genome sequencing vaccine mismatch antiviral resistance Nanopore technology Cameroon Figures Figure 1 Figure 2 Introduction Seasonal influenza is an acute respiratory infectious disease caused by influenza viruses of type A (subtypes A(H1N1)pdm09 and A(H3N2)) or type B[ 1 ]. Each year, seasonal influenza affects approximately one billion individuals globally, with 3 to 5 million severe cases, resulting in 290,000 to 650,000 respiratory-related deaths [ 2 – 4 ]. In high-income countries, most influenza-associated fatalities occur among individuals aged ≥ 65 years, while nearly 99% of influenza-related deaths in children under five are concentrated in developing countries [ 5 , 6 ]. Pandemic influenza A viruses (IAV) can lead to even more devastating outcomes, as demonstrated by the 1918 "Spanish flu," which resulted in the deaths of approximately one in every 30 individuals worldwide within 18 months[ 3 ]. The A(H1N1)pdm09 virus replaced the seasonal A(H1N1) virus and continued to circulate in subsequent years alongside the A(H3N2) and B influenza viruses worldwide, causing annual seasonal epidemics[ 7 , 8 ]. The genome of the A(H1N1)pdm09 virus comprises eight negative-sense single-stranded RNA segments that encode eleven proteins, including haemagglutinin (HA), neuraminidase (NA), nucleoprotein (NP), polymerase proteins (PB1, PB2 and PA), matrix proteins (M1 and M2) and non-structural proteins (NS1 and NS2)[ 9 , 10 ]. Influenza viruses are divided into three types (influenza A, B and C viruses) on the basis of the antigenic specificity of the nucleoprotein (NP) and the matrix protein (M)[ 11 , 12 ]. Subtypes are further defined by the genetic diversity of surface glycoproteins: HA (18 subtypes) and NA (12 subtypes) [ 13 ]. Due to the absence of proofreading function in the viral RNA-dependent RNA polymerase, influenza viruses undergo frequent mutations (estimated at 2.3 × 10⁻⁵ per site per replication cycle) [ 14 ]. This, combined with host immune selection pressure, drives antigenic drift that can alter viral attachment to host cells and reduce immune recognition [ 15 , 16 ]. Intra-subtype reassortment events also contribute to viral evolution, making genome-wide surveillance essential for early detection of emerging variants, particularly in highly recombinogenic pathogens like influenza. Although prior studies conducted in Cameroon characterized circulating influenza subtypes between 2014 and 2019 using Sanger sequencing, this method only partially covered three of the virus's eight single-stranded negative-sense RNA segments[ 17 ]. Given this limitation, more advanced sequencing technologies such as MinION, which provides real-time sequencing and supports multiplex barcoding, have emerged as an innovative tools that enable more effective monitoring of the virus’ high mutational variability [ 18 ]. Given the extensive genetic diversity of the influenza virus and its significant public health threat, this study was conducted in Cameroon during the 2019–2024 seasons to better understand its local evolutionary dynamics. Material and methods Study population and case definition The Centre Pasteur of Cameroon (CPC) has operated an influenza surveillance system since November 2007. Initially, all six sentinel collection sites were in the Centre region of the country. In January 2009, the system was expanded to three additional regions, and the CPC was designated by the World Health Organization (WHO) as the National Influenza Reference Centre for Cameroon. Over time, the network of sentinel sites has been progressively expanded to cover all ten administrative regions of the country. These sentinel sites, represented by referral hospitals and district medical centers, are briefly presented in Table 1. Based on infection severity, referral hospitals were designated to manage severe acute respiratory infection (SARI) cases, while district medical centers were assigned to monitor influenza-like illness (ILI) cases. Each week, between 20 and 40 throat and/or nasopharyngeal swabs were collected from suspected outpatient cases presenting with fever (> 38 °C) and a cough or sore throat within seven days of symptom onset, as well as from hospitalized patients meeting the SARI case definition. All sampling procedures adhered to WHO-recommended standards for identifying ILI and SARI cases. Sample collection and Influenza Detection In accordance with authorization N°3971CEI-Udo/07/2023/M from the Ethical and Institutional Committee of the University of Douala, nasopharyngeal samples were collected using polyester swabs placed in 2mL of virus transport medium, stored at 4°C, and transported to the CPC under cold chain conditions. Upon arrival, samples were either processed immediately or stored at -80°C. RNA was extracted from 140μL of each nasopharyngeal specimen using the QIamp Viral RNA kit (Qiagen®, Hilden, Germany) following the manufacturer's instructions. Detection and subtyping of influenza A viruses were performed using the Superscript III Platinum One-Step Quantitative RT-PCR (qRT- PCR) System (Invitrogen, USA). All samples were tested using a multiplex kit targeting influenza A viruses. Positive samples were further subtyped to identify A(H1N1)pdm09. Amplifications were carried out on an ABI Prism® 7500 thermocycler (Applied Biosystem, Foster City, CA, USA). Each 20µL reaction contained: 12.5µL buffer (2X), 0.5µL enzyme reverse transcriptase/Taq polymerase, 2µL forward and 2µL reverse primers (10µM each), and 2µL probe (2.5µM), 1µL water, and 5 µL of extracted RNA or control (negative and positive). All testing was completed within 24 hours. Representative samples (n = 83), collected from various geographic regions over a six-year period, were selected for sequencing. Samples with Ct values < 25 from the years 2019 (n = 20), 2020 (n = 02), 2021 (n = 15), 2022 (n = 03), 2023 (n = 07) and 2024 (n = 36) were processed using Oxford Nanopore sequencing. After alignment with the reference strain A/Wisconsin/67/2022 using Bioedit software, the samples from 2020 and 2022, along with approximately 25% of those from 2024, were found to contain incomplete or unusable segments. As a result, nineteen samples were excluded from further analyses. The remaining 62 participants originated from all ten regions of Cameroon, with strong representation from the Centre region. The selected individuals ranged in age from 6 months to 75 years, with a median age of 37 years. Library preparation and sequencing of A(H1N1)pdm09 Strain The viral RNA segments of influenza A were simultaneously amplified using MB Tuni-12, MB Tuni-12.4 and MB Tuni-13 primers (Table 2), which targets highly conserved sequences located at the ends of each genome segment. The amplification protocol included an initial incubation at 42°C for 50 minutes (1 cycle), followed by denaturation at 94°C for 30 seconds. This was followed by four cycles of denaturation at 94°C for 30 seconds, annealing at 57°C for 30 seconds and extension at 68°C for 3 minutes and 30 seconds. Ten additional cycles were then performed using the same parameters. The process concluded with a final extension at 68°C for 10 minutes, followed by cooling to 4°C. Amplified products were generated using the SuperScript III One-Step RT-PCR System with Platinum Taq DNA Polymerase. Purification was carried out using the AMPure XP Beads Nucleic Acid Purification kit (Beckman Coulter, Life Sciences, US). After purification, nucleic acid quantification was performed using the Qubit 4 dsDNA HS Assay kit (Thermo Fisher Scientific). Library preparation was conducted using the Oxford Nanopore Technologies (ONT) Ligation Sequencing kit (SQK-LSK109). Native barcode expansion kits (EXP-NBD196) were used for multiplexing. DNA repair and end preparation were performed using the NEBNext Ultra II End-Repair/dA-tailing kit (New England Biolabs). To barcode the samples, 0.75 µl of initial cDNA was combined with the native barcodes and Blunt/TA Ligase Master Mix (New England Biolabs), and the reaction mixture was incubated at room temperature (15-25 °C) for 20 minutes. Samples were then pooled by combining 5µL from each sample, resulting in a final volume of 390 µl. The DNA library was loaded onto a primed MinION Spot-On Flow Cell (R9.4). Sequencing was performed over 48 hours using FLO-MIN106 flow cells on MinION MK1b sequencing equipment, with high-accuracy base calling enabled via MinKNOW software (version 23.04.6, Oxford Nanopore Technologies). During sequencing, a QScore threshold of 8 was applied, due to low concentration observed in some samples within the pool. Analysis of MinION data Sequencing data were basecalled and demultiplexed using Guppy v6.5.7 (https://community.nanoporetech.com/downloads). Low-quality reads (3,000 bp) were filtered with Chopper v2.5.0 (https://github.com/nanoporetech/pychopper), and adapter sequences were trimmed using Trimmomatic and Porechop v0.2.4 (https://github.com/rrwick/Porechop). The processed reads were then mapped to influenza reference sequences using minimap2 v2.17 (https://github.com/lh3/minimap2) for consensus reconstruction and quasi-species analysis via IRMA-FLU MinION v1.0.3 (IRMA: Iterative Refinement Meta-Assembler – CDC WONDER). Sequencing quality metrics were assessed with MinIONQC. Sequence Alignment and Phylogenetic Analysis Raw sequencing data were processed and edited using BioEdit v7.2.5. Reference sequences for the 2023–2024 Northern Hemisphere A/H1N1pdm09 vaccine strain (A/Wisconsin/67/2022) were retrieved from GenBank (https://www.ncbi.nlm.nih.gov/genbank.Multiple sequence alignment was performed with MAFFT (v6.864), based on the Multiple Alignment using Fast Fourier Transform algorithm. Phylogenetic trees for HA gene segments were inferred using the maximum likelihood (ML) method implemented in IQ-TREE v3.0.1. The HA phylogenetic tree was inferred under the TVM+F+I+R2 substitution model, as determined by ModelFinder . The TVM+F+I+R2 model accounts for unequal transversion rates (TVM), empirical base frequencies (+F), a proportion of invariable sites (+I), and rate heterogeneity across sites modeled using a Free Rate distribution with two categories (+R2). Branch support was evaluated with 1,000 ultrafast bootstrap replicates , with values ≥70% considered statistically significant. The resulting phylogenetic trees were visualized using FigTree v1.4.4 . Study sequences were compared with global reference strains and representative isolates from different geographic regions. All newly generated sequences have been deposited in the GenBank database, with accession numbers provided in Additional file 1. Additional file 1 . GenBank Isolate ID Mutation Analysis Mutation analysis was performed across all eight gene segments using MEGA, with A/Wisconsin/67/2022 (A/H1N1pdm09) serving as the reference strain. Identified amino acid substitutions were annotated, and their potential phenotypic effects were evaluated using FluSurver (http://flusurver.bii.a-star.edu.sg, accessed on August 10, 2025). Results Description of influenza A(H1N1)pdm09 positivity rates from 2019 to 2024 Between 21 January 2019 and 31 December 2024, a total of 7,453 samples were processed through the national influenza surveillance system in Cameroon. Of these, 727 tested positive for influenza A viruses, and 412 were confirmed as influenza A(H1N1)pdm09 subtype. Annual sample volumes and positivity rates varied across the surveillance period. In 2019, 1,072 samples were collected (897 ILI and 175 SARI), with 324 (30.2%) testing positive for influenza A and 100 (30.9%) of those identified as subtype A(H1N1)pdm09. In 2020, 362 samples were processed (244 ILI and 118 SARI), of which 37 (10.2%) were positive for influenza A and 08 (21.6%) for influenza A(H1N1) pdm09 subtype. In 2021, 443 samples were analyzed (377 ILI and 66 SARI), yielding 105 (23.7%) influenza A-positive cases, including 83 (79.04%) A(H1N1)pdm09 subtype. In 2022, 628 samples were processed (455 ILI and 173 SARI), with 91 (14.49%) testing positive for influenza A and 01 (1.09%) for A(H1N1)pdm09 subtype. In 2023, a total of 1,848 samples were collected (1,442 ILI and 406 SARI), of which 358 (19.37%) were positive for influenza A and 73 (20.4%) for A(H1N1)pdm09 subtype. In 2024, a total of 3,017 samples were processed (2,316 ILI and 701 SARI), with 490 (16.2%) testing positive for influenza A and 157 (32.0%) for A(H1N1)pdm09 subtype. Figure 1 illustrates monthly fluctuations in influenza A and A(H1N1)pdm09 subtype cases over the six-year study period. Distinct seasonal peaks were observed in influenza activity, typically occurring between October and March. Influenza A(H1N1)pdm09 subtype contributed variably to these peaks, with notable surges in early 2019, 2021, and 2024. Subclade Analysis by Amino Acid Substitutions and Phylogenetic Tree Analysis of HA genes All 62 A(H1N1)pdm09 strains from Cameroon collected between 2019 and 2024 belonged to clade 6B.1A, with the majority of 2023 and 2024 strains classified within subclade 6B.1A.5a.2a (n = 99%). They evolved separately from the reference vaccine strain for the 2023–2024 influenza season (Figure. 1), based on WHO-defined subclade criteria. These strains exhibited key amino acid substitutions in the HA2 region at positions: A3L, D111N, A267D, A241E, E277D, H468N, Q71K, A241V, R159K, T89K, I550V, and N147K, relative to the 2024 A/Wisconsin/67/2022 vaccine strain. The number of amino acid substitutions between the circulating strains and the vaccine strain was notably higher, further supporting the genetic divergence of Cameroon strains from the recommended vaccine strain. To assess global genetic relationships, a BLAST search was performed using the HA gene sequences of the 64 Cameroonian strains. The closest matches were to strains isolated in Algeria, Spain, Moscow, Venezuela, Ivory Coast, Kenya, Zambia and Serbia (Figure. 2). We also noted that the A(H1N1)pdm09 viruses from Cameroon, classified as subclades 5a.2a and 5a.2a.1, respectively, showed close genetic proximity to subclade 5b. Amino Acid Substitutions in Antigenic Sites of A(H1N1)pdm09 Viruses A comprehensive analysis of the 62 A(H1N1)pdm09 virus sequences revealed diverse amino acid substitutions across all eight gene segments. These mutations are summarized in Table 3, with several located in known antigenic regions of the HA and NA proteins. Notably, recurrent substitutions in HA—including A267D, D111N, E277D, and N147K—were observed in nearly all sequences, suggesting conserved evolutionary changes among circulating strains. In the NA segment, mutations such as E433R, S200N, P458S, and I264T were frequently detected. Some of these substitutions, have been previously associated with increased disease severity, or linked to antiviral resistance. Additional mutations were also identified in internal genes (M1, M2, NS1, NS2, NP, PA, PB1, PB2), indicating broader genomic variability beyond surface glycoproteins. Only mutations with a frequency of occurrence of at least 20% were included in the table 3 below. Discussions This study aimed to characterize the genetic diversity and antiviral resistance profiles of influenza A(H1N1)pdm09 viruses circulating in Cameroon between 2019 and 2024, using whole-genome sequencing and phylogenetic analysis. Since September 2023, A(H1N1)pdm09 viruses have circulated globally and remained predominant across most geographic regions. Between 2019 and 2024, 7,453 influenza A samples were analyzed, with A(H1N1)pdm09 remaining the predominant subtype, similar to several geographic regions worldwide[ 2 ]. The recent rise in clinical cases may be attributed both to reduced vaccine effectiveness [ 19 , 20 ] and declining population immunity. In Cameroon, this trend coincides with the integration of the influenza A vaccine into the Expanded Programme on Immunization (EPI) for high-risk groups, alongside continued adherence to government-implemented barrier measures following the end of the COVID-19 pandemic. Genetically characterized haemagglutinin (HA) genes from Cameroon predominantly belonged to clade 6B.1A.5a.2, with further diversification into subclades 6B.1A.5a.2a and 6B.1A.5a.2a.1, defined by specific amino acid substitutions. These results are consistent with reports from Australia, Indonesia and New Zealand [ 21 ]. These findings highlight the ongoing diversification of Cameroonian A(H1N1)pdm09 strains, which were previously assigned to subclade 6B.1a in 2019 as reported by Monamele et al . [ 22 ]. Our analysis further confirms the disappearance of clade 6C, which previously grouped some 2014 strain. Global comparisons showed similar evolutionary shifts, with recent viruses diverging from the WHO-recommended vaccine strain A/Wisconsin/67/2022[ 23 , 24 ], indicating limited protection by current formulations and reinforcing the need for annual vaccine updates [ 15 , 16 ]. All eight genomic segments were recovered with > 90% coverage. The D222G substitution in the HA1 subunit was detected in 50% of sequenced strains and has been associated with increased disease severity [ 25 ]. Analysis of the neuraminidase (NA) gene revealed resistance-linked mutations including H275Y,V106I and N284D [ 26 – 28 ], as well as novel substitutions I223V, I264T, P458S, which may confer mild resistance to neuraminidase inhibitors (NAIs). Additional NA mutations associated with antiviral resistance such as N200S, I223V, and V241I have also been reported in previous studies [ 29 , 30 ]. M2 protein substitutions (V7I, V27I) were identified in several strains, consistent with recent findings by Resende et al.[ 31 ] and earlier observations by Njouom et al ., in classical A(H1N1) viruses prior to the 2009 influenza pandemic [ 32 ]. These mutations, along with the previously documented S31N substitution, indicate persistent natural resistance to adamantanes in local strains. Genomic analyses indicate multiple independent introductions and subsequent dissemination of influenza strains in Cameroon. The sequences generated in this study show a high degree of genetic relatedness to strains reported from Algeria, Spain, Moscow (Russia), Venezuela, Côte d’Ivoire, Kenya, Zambia, and Serbia. Moreover, several amino acid substitutions identified in the Cameroonian isolates mirror those detected in Sicily (Italy), Kenya, and China[ 21 , 33 – 36 ], suggesting the occurrence of parallel evolutionary trajectories across distinct geographic regions. This genetic relatedness may reflect Cameroon’s strategic location in Central Africa and regional mobility patterns for trade, travel, and migration. Marked antigenic variability was detected in the HA gene of H1 influenza viruses, with half of the isolates carrying substitutions within the major head antigenic sites. Specifically, the mutations T137A, S154P, and R159K map to the 130-loop region of HA1 and are predominantly associated with the Sa antigenic site (with some studies suggesting overlap with Sb, depending on the alignment and strain context). Consistent findings were reported by Xu et al.[ 37 ], who identified 19 HA mutations in Wuhan strains, and by Su et al.[ 38 ], who described the fixation of substitutions conferring immune escape for instance, S220T within the Ca1/Ca2 sites and K180Q within the Sa site across multiple viral lineages. Moreover, the lack of 3′–5′ exonuclease proofreading activity in influenza viruses promotes frequent insertions and deletions, thereby accelerating antigenic drift and facilitating immune evasion[ 39 ]. Study limitations include restricted geographic representativeness and sample selection bias based on Ct values < 30, which may have excluded genetically informative strains. Future work should expand spatiotemporal genomic surveillance to monitor transmission dynamics, antigenic drift, and vaccine strain relevance in Cameroon and the region. Conclusion The considerable genetic variation observed among A(H1N1)pdm09 strains circulating in Cameroon between 2019 and 2024 highlights ongoing viral evolution and the need for adaptive public health strategies. These findings underscore the importance of sustained genomic surveillance to inform vaccine strain selection, monitor antiviral resistance, and strengthen pandemic preparedness in alignment with WHO recommendations. Abbreviations COVID-19: Coronavirus Disease 2019 CPC: Centre Pasteur Cameroon Ct: Threshold cycle GISAID: Global Initiative on Sharing Avian Influenza Data PCR: Polymerase Chain Reaction RNA: Ribonucleic Acid RT-PCR: Reverse Transcriptase Polymerase Chain Reaction WHO: World Health Organization PB2 : Polymerase Basic Protein 2 PB1 : Polymerase Basic Protein 1 PA : Polymerase Acidic Protein HA : Hemagglutinin NP : Nucleoprotein NA : Neuraminidase M : Matrix segment NS : Non-structural segment ILI : Influenza-Like Illness SARI : Severe Acute Respiratory Infection DNA : Deoxyribonucleic Acid . Declarations Ethics declarations Ethics approval and consent to participate The study protocol was approved by the Ethics and Institutional Committee of the University of Douala (CEI-Udo) (Approval No. 3971CEI-Udo/07/2023/M) and was conducted in accordance with the ethical principles of the 1975 Declaration of Helsinki. Prior to enrollment, written informed consent was obtained from the parents of each child. All personal and identifiable information was anonymized to ensure the protection of participants’ privacy. Informed consent was obtained from all participants, as well as from the legal guardians of those under 16 years of age, in accordance with Cameroonian regulations. Consent for publication Not applicable Clinical trial number Not applicable Data availability statement All genomic data generated and analyzed in this study are publicly accessible via the GenBank database. Researchers can access the data at https://www.ncbi.nlm.nih.gov/genbank using the listed accession numbers : PX446230 , PX446231 , PX446382 , PX446383 , PX446384 , PX446385 , PX446386 , PX446387 , PX446388 , PX446389 , PX446390 , PX446391 , PX446392 , PX446393 , PX446394 , PX446395 , PX446396, PX446397 , PX446398 , PX446399 , PX446400 , PX446401 , PX446402 , PX446403 , PX446404 , PX446405 , PX446406 , PX446407 , PX446408 , PX446409 , PX446410 , PX446411 , PX446412 , PX446413 , PX446414 , PX446415 , PX446416 , PX446417 , PX446418 , PX446419 , PX446420 , PX446421 , PX446422 , PX446423 , PX446424 , PX446425 , PX446426 , PX446427 , PX446428 , PX446429 , PX446430 , PX446431 , PX446432 , PX446433 , PX446434 , PX446435 , PX446436 , PX446437 , PX446438 , PX446439 , PX446440 , PX446441 (Additional file 1) Competing interests The authors declare that they have no competing interests. Financial support This research was funded by the U.S. Department of Health and Human Services, DHHS (grant number 6 DESP060001-01-01) and the Centers for Disease Control and Prevention (CDC Atlanta), through HEADA, Inc. Contract N° 2022-01-CDC Flu Surv. Authors' contributions R.N. designed the study. P.I.T., M.H.M.Y., A.M.N., L.L.M.E., M.R.N., R.M.N., J.L.M.N and D.T.T carried out the laboratory analysis and data curation. E.L., U.T., F.K.K and R.N. were involved in supervision and data validation. D.T.T., C.G.M., L.L.M.E., M.H.M.Y. and F.K.K. performed the data analysis. D.T.T. wrote the first draft of the manuscript. All authors revised and edited the manuscript. All authors are responsible for all aspects of the manuscript. Acknowledgments Our thanks go to the regional coordinators and the various focal points involved in sentinel influenza surveillance, and to the project promoters for facilitating the acquisition of the equipment needed to carry out the sequencing of the complete influenza A genome in Cameroon. Conflicts of interest: No potential conflict of interest was reported by the authors. References CISMeF CISMF, Rouen H. 2023 [cited 21 May 2024]. Available: https://www.cismef.org/page/grippe-humaine WHO launches new global influenza strategy. [cited 27 Jul 2023]. Available: https://www.who.int/news/item/11-03-2019-who-launches-new-global-influenza-strategy Hutchinson EC. Influenza Virus. Trends Microbiol. 2018;26:809–10. 10.1016/j.tim.2018.05.013 . Who. Grippe saisonnière. Oct 2023 [cited 21 May 2024]. Available: https://www.who.int/fr/news-room/fact-sheets/detail/influenza-(seasonal ). Thompson WW, Weintraub E, Dhankhar P, Cheng P-Y, Brammer L, Meltzer MI, et al. 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Tables Table 1 : Temporal and regional distribution of sentinel sites Region Name of Sentinel Site Distribution by year 2019 (14) 2020 (14) 2021 (14) 2022 (18) 2023 (18) 2024 (19) Centre (6) CMA of Nkomo - - - - - - CASS of Nkolndongo + + + + + + CMS Ambassade of France + + + + + + CSI of Etoudi + + + + + + Centre Hopitalier of Essos* + + + + + + Hospital Jamot of Yaoundé* + + + + + + Littoral (4) Hôspital Catholique Barcelone - - - - - - Hôspital d’Albert le Grand* + + + + + + Hôspital Catholique Log Pom + + + + + + Hospital district of Newbel - - - - - - West (4) CMA Koukouet Maloum - - - - - - CMA Djeleng - - - - - - CSI of Bandjoun - - - - - - CSI of Kueka (Foumban) + + + + + + North (9) Hôspital Provincial of Garoua - - - - - - CSI of Kolere - - - - - - CSI of Ourokanadi - - - - - - CSI of Poumpoure + + + + + + CSI of Souari - - - - - - CSI of Kotta Liddiri - - - - - - Hôspital of Foulbere + + + + + + CSI of Roumde Adjia + + + + + + Hospital regional of Garoua* + + + + + + Adamaoua (5) CSI of Boumdjere - - - - - - CSI of Marza - - - - - - CSI of Sabongari - - - - - - HôpitalProtestant Ngaoundere - - - - - - CSI of Gaba Mabanda - - - + + + south-west (2) Mount Mary Hospital Buea + + + + + + Hospital regional of Buea - - - - - + North-west Polyclinic St. Blaise Bamenda + + + + + + East Hospital regional of Bertoua* - - - + + + South Hospital regional of Ebolowa* - - - + + + Far North (2) Hôspital of Kolofata - - - - - - Hôspital regional of Maroua* - - - + + + CMA: ‘District Medical Centre ; CASS: ‘Social and Health Centre ;CMS : ‘Medical-Social Centre’ ; CSI : ‘Integrated Health Centre’, * SARI site (-) : absence from site (+) : Site Presence Table 2 : Influenza A Virus Primers Oligo Bases Sequences 5’-3’ µm / pool MB Tuni-12 22 ACGGTGATCAGCAAAAGCAGG 2 MB Tuni-12.4 22 ACGCGTGATCAGCGAAAGCAGG 3 MB Tuni-13 23 ACGGTGATCAGTAGAAACAAGG 5 Table 3 . Most common amino acid mutations observed in all eight segments of A(H1N1)pdm09 HA NA M1 M2 NS1 NS2 NP PA PB1 PB2 A3L V13I V7I V7I T56K G22E E14D V14I K57T I66V M8I T16A I42L V27A A57T R34Q E18D V30I S106A I81M M8L I29M R98K Q81R S74N A48T D21N R57Q S261C L475M F12V S37T E201D I81V Q85H T22A M61I I298V Q71K V80M E235T I84V Q96K T23A L63I N455D T89K P93H I84T I105L R31K K204R K757R R91K V106I T94A I33V R213K D111N I163V I111T G34D L226I T137A T188I C116F D53E R262K N147K N200S T143I R65K R262K S154P I223V T143I E81K P267S H155Q S247N F150L G86R S296N A158T R257K G154E G126S V330I R159K I264T V178I I136L T337A V169I M269I S205N T147P K339N K173N H275Y T151M T357S I178L N284D R152Q V438I D204A V321I I197V P534T A214T F322L N202S K576R S220T L329D V217I S616P D222G L339S M222I R626K T233A S366N L256I E688G A241E K386E R261Q N696S A241V I396M S314N A267V G404R R342K A267D E433R K351R K276R M454V N370I A277D P458S V371M A294T D375N R325K S392I H370Q N417S D373E A423T V435I S450N S468N S457F Y506F D523E I550V Blue Mutation : Associated with increasing disease severity, Red Mutation : Associated with antiviral resistance Additional Declarations No competing interests reported. Supplementary Files Additionalfile1.docx Additional file Additional file 1: GenBank Isolate ID Cite Share Download PDF Status: Published Journal Publication published 09 Dec, 2025 Read the published version in BMC Infectious Diseases → Version 1 posted Editorial decision: Revision requested 01 Nov, 2025 Reviews received at journal 31 Oct, 2025 Reviews received at journal 31 Oct, 2025 Reviewers agreed at journal 30 Oct, 2025 Reviews received at journal 29 Oct, 2025 Reviews received at journal 28 Oct, 2025 Reviews received at journal 28 Oct, 2025 Reviewers agreed at journal 27 Oct, 2025 Reviewers agreed at journal 26 Oct, 2025 Reviews received at journal 24 Oct, 2025 Reviews received at journal 24 Oct, 2025 Reviewers agreed at journal 24 Oct, 2025 Reviewers agreed at journal 24 Oct, 2025 Reviewers agreed at journal 23 Oct, 2025 Reviewers agreed at journal 23 Oct, 2025 Reviews received at journal 23 Oct, 2025 Reviewers agreed at journal 22 Oct, 2025 Reviews received at journal 22 Oct, 2025 Reviewers agreed at journal 22 Oct, 2025 Reviewers agreed at journal 22 Oct, 2025 Reviews received at journal 22 Oct, 2025 Reviewers agreed at journal 22 Oct, 2025 Reviewers agreed at journal 22 Oct, 2025 Reviewers agreed at journal 15 Oct, 2025 Reviewers agreed at journal 15 Oct, 2025 Reviewers invited by journal 14 Oct, 2025 Editor assigned by journal 06 Oct, 2025 Submission checks completed at journal 03 Oct, 2025 First submitted to journal 03 Oct, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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1","display":"","copyAsset":false,"role":"figure","size":60947,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eNumber of influenza cases in Cameroon by month and year (January 2019 to December 2024).\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7684927/v1/978f89e5367b2c9a5d13bc69.png"},{"id":94638428,"identity":"69d3e102-7321-4f6b-9f91-5d5fdffa25bf","added_by":"auto","created_at":"2025-10-29 07:29:32","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":322913,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eHA1 gene phylogeny of Influenza A(H1N1)pdm09 viruses detected in Cameroon during the 2019–2024 seasons.\u003c/strong\u003e The phylogenetic tree was constructed from \u003cstrong\u003eHA amino acid sequences\u003c/strong\u003e using the \u003cstrong\u003eMaximum Likelihood method\u003c/strong\u003e implemented in \u003cstrong\u003eIQ-TREE v2\u003c/strong\u003e under the \u003cstrong\u003eTVM+F+I+R2 substitution model. Bootstrap support values \u0026gt;70%\u003c/strong\u003e are shown at the corresponding nodes. Accession numbers for all sequences are available in the \u003cstrong\u003eGenBank database\u003c/strong\u003e. The \u003cstrong\u003enorthern hemisphere vaccine reference strain\u003c/strong\u003e is highlighted in \u003cstrong\u003ered\u003c/strong\u003e, while Cameroonian viruses detected between \u003cstrong\u003e2019 and 2024\u003c/strong\u003e are color-coded in \u003cstrong\u003eblue\u003c/strong\u003e. Amino acid substitutions in the HA1 subunit are indicated in green, as shown in the colour legend.\u003c/p\u003e","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-7684927/v1/593b35f8d07d674ed492d255.png"},{"id":98244816,"identity":"02e1cda2-f980-4726-b56d-0883d4f0db5a","added_by":"auto","created_at":"2025-12-15 16:15:28","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1971891,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7684927/v1/16486404-9fdf-4c4f-9a40-075012e1cc42.pdf"},{"id":94640398,"identity":"5c1433eb-9eee-4864-bcb7-2a71d33aa63c","added_by":"auto","created_at":"2025-10-29 07:49:23","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":35701,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eAdditional file\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAdditional file 1: GenBank Isolate ID\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Additionalfile1.docx","url":"https://assets-eu.researchsquare.com/files/rs-7684927/v1/1c9cf1d2d5dde05244f8585b.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Whole-Genome Analysis of Influenza A(H1N1)pdm09 Viruses in Cameroon (2019–2024) Using Nanopore Sequencing","fulltext":[{"header":"Introduction","content":"\u003cp\u003eSeasonal influenza is an acute respiratory infectious disease caused by influenza viruses of type A (subtypes \u003cem\u003eA(H1N1)pdm09\u003c/em\u003e and \u003cem\u003eA(H3N2))\u003c/em\u003e or type B[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Each year, seasonal influenza affects approximately one billion individuals globally, with 3 to 5\u0026nbsp;million severe cases, resulting in 290,000 to 650,000 respiratory-related deaths [\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. In high-income countries, most influenza-associated fatalities occur among individuals aged\u0026thinsp;\u0026ge;\u0026thinsp;65 years, while nearly 99% of influenza-related deaths in children under five are concentrated in developing countries [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Pandemic influenza A viruses (IAV) can lead to even more devastating outcomes, as demonstrated by the 1918 \"Spanish flu,\" which resulted in the deaths of approximately one in every 30 individuals worldwide within 18 months[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The A(H1N1)pdm09 virus replaced the seasonal A(H1N1) virus and continued to circulate in subsequent years alongside the A(H3N2) and B influenza viruses worldwide, causing annual seasonal epidemics[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe genome of the \u003cem\u003eA(H1N1)pdm09\u003c/em\u003e virus comprises eight negative-sense single-stranded RNA segments that encode eleven proteins, including haemagglutinin (HA), neuraminidase (NA), nucleoprotein (NP), polymerase proteins (PB1, PB2 and PA), matrix proteins (M1 and M2) and non-structural proteins (NS1 and NS2)[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Influenza viruses are divided into three types (influenza A, B and C viruses) on the basis of the antigenic specificity of the nucleoprotein (NP) and the matrix protein (M)[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Subtypes are further defined by the genetic diversity of surface glycoproteins: HA (18 subtypes) and NA (12 subtypes) [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eDue to the absence of proofreading function in the viral RNA-dependent RNA polymerase, influenza viruses undergo frequent mutations (estimated at 2.3 \u0026times; 10⁻⁵ per site per replication cycle) [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. This, combined with host immune selection pressure, drives antigenic drift that can alter viral attachment to host cells and reduce immune recognition [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Intra-subtype reassortment events also contribute to viral evolution, making genome-wide surveillance essential for early detection of emerging variants, particularly in highly recombinogenic pathogens like influenza.\u003c/p\u003e\u003cp\u003eAlthough prior studies conducted in Cameroon characterized circulating influenza subtypes between 2014 and 2019 using Sanger sequencing, this method only partially covered three of the virus's eight single-stranded negative-sense RNA segments[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Given this limitation, more advanced sequencing technologies such as MinION, which provides real-time sequencing and supports multiplex barcoding, have emerged as an innovative tools that enable more effective monitoring of the virus\u0026rsquo; high mutational variability [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Given the extensive genetic diversity of the influenza virus and its significant public health threat, this study was conducted in Cameroon during the 2019\u0026ndash;2024 seasons to better understand its local evolutionary dynamics.\u003c/p\u003e"},{"header":"Material and methods","content":"\u003cp\u003e\u003cstrong\u003eStudy population and case definition\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Centre Pasteur of Cameroon (CPC) has operated an influenza surveillance system since November 2007. Initially, all six sentinel collection sites were in the Centre region of the country. In January 2009, the system was expanded to three additional regions, and the CPC was designated by the World Health Organization (WHO) as the National Influenza Reference Centre for Cameroon. Over time, the network of sentinel sites has been progressively expanded to cover all ten administrative regions of the country. These sentinel sites, represented by referral hospitals and district medical centers, are briefly presented in Table 1. Based on infection severity, referral hospitals were designated to manage severe acute respiratory infection (SARI) cases, while district medical centers were assigned to monitor influenza-like illness (ILI) cases. Each week, between 20 and 40 throat and/or nasopharyngeal swabs were collected from suspected outpatient cases presenting with fever (\u0026gt; 38 \u0026deg;C) and a cough or sore throat within seven days of symptom onset, as well as from hospitalized patients meeting the SARI case definition. All sampling procedures adhered to WHO-recommended standards for identifying ILI and SARI cases.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSample collection and Influenza Detection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn accordance with authorization N\u0026deg;3971CEI-Udo/07/2023/M from the Ethical and Institutional Committee of the University of Douala, nasopharyngeal samples were collected using polyester swabs placed in 2mL of virus transport medium, stored at 4\u0026deg;C, and transported to the CPC under cold chain conditions. Upon arrival, samples were either processed immediately or stored at -80\u0026deg;C. RNA was extracted from 140\u0026mu;L\u0026nbsp;of each nasopharyngeal specimen using the QIamp Viral RNA kit (Qiagen\u0026reg;, Hilden, Germany) following the manufacturer\u0026apos;s instructions. Detection and subtyping of influenza A viruses were performed using the Superscript III Platinum One-Step Quantitative RT-PCR (qRT- PCR) System (Invitrogen, USA). All samples were tested using a multiplex kit targeting influenza A viruses. Positive samples were further subtyped to identify A(H1N1)pdm09. Amplifications were carried out on an ABI Prism\u0026reg; 7500 thermocycler (Applied Biosystem, Foster City, CA, USA). Each 20\u0026micro;L reaction contained: 12.5\u0026micro;L buffer (2X), 0.5\u0026micro;L enzyme reverse transcriptase/Taq polymerase, 2\u0026micro;L forward and 2\u0026micro;L reverse primers (10\u0026micro;M each), and 2\u0026micro;L probe (2.5\u0026micro;M), 1\u0026micro;L water, and 5 \u0026micro;L of extracted RNA or control (negative and positive). All testing was completed within 24 hours.\u0026nbsp;Representative samples (n = 83), collected from various geographic regions over a six-year period, were selected for sequencing. Samples with Ct values \u0026lt; 25 from the years 2019 (n = 20), 2020 (n = 02), 2021 (n = 15), 2022 (n = 03), 2023 (n = 07) and 2024 (n = 36) were processed using Oxford Nanopore sequencing. After alignment with the reference strain A/Wisconsin/67/2022 using Bioedit software, the samples from 2020 and 2022, along with approximately 25% of those from 2024, were found to contain incomplete or unusable segments. As a result, nineteen samples were excluded from further analyses. The remaining 62 participants originated from all ten regions of Cameroon, with strong representation from the Centre region. The selected individuals ranged in age from 6 months to 75 years, with a median age of 37 years.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLibrary preparation and sequencing\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eof\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eA(H1N1)pdm09\u003c/strong\u003e\u003cstrong\u003eStrain\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe viral RNA segments of influenza A were simultaneously amplified using MB Tuni-12, MB Tuni-12.4 and MB Tuni-13 primers (Table 2), which targets highly conserved sequences located at the ends of each genome segment. The amplification protocol included an initial incubation at 42\u0026deg;C for 50 minutes (1 cycle), followed by denaturation at 94\u0026deg;C for 30 seconds. This was followed by four cycles of denaturation at 94\u0026deg;C for 30 seconds, annealing at 57\u0026deg;C for 30 seconds and extension at 68\u0026deg;C for 3 minutes and 30 seconds. Ten additional cycles were then performed using the same parameters. The process concluded with a final extension at 68\u0026deg;C for 10 minutes, followed by cooling to 4\u0026deg;C. Amplified products were generated using the SuperScript III One-Step RT-PCR System with Platinum Taq DNA Polymerase. Purification was carried out using the AMPure XP Beads Nucleic Acid Purification kit (Beckman Coulter, Life Sciences, US). After purification, nucleic acid quantification was performed using the Qubit 4 dsDNA HS Assay kit (Thermo Fisher Scientific). Library preparation was conducted using the Oxford Nanopore Technologies (ONT) Ligation Sequencing kit (SQK-LSK109). \u0026nbsp;Native barcode expansion kits (EXP-NBD196) were used for multiplexing. DNA repair and end preparation were performed using the NEBNext Ultra II End-Repair/dA-tailing kit (New England Biolabs). To barcode the samples, 0.75 \u0026micro;l of initial cDNA was combined with the native barcodes and Blunt/TA Ligase Master Mix (New England Biolabs), and the reaction mixture was incubated at room temperature (15-25 \u0026deg;C) for 20 minutes. Samples were then pooled by combining 5\u0026micro;L from each sample, resulting in a final volume of 390 \u0026micro;l. The DNA library was loaded onto a primed MinION Spot-On Flow Cell (R9.4). Sequencing was performed over 48 hours using FLO-MIN106 flow cells on MinION MK1b sequencing equipment, with high-accuracy base calling enabled via MinKNOW software (version 23.04.6, Oxford Nanopore Technologies). During sequencing, a QScore threshold of 8 was applied, due to low concentration observed in some samples within the pool.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAnalysis of MinION data\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSequencing data were basecalled and demultiplexed using Guppy v6.5.7 (https://community.nanoporetech.com/downloads). Low-quality reads (\u0026lt;500 bp or \u0026gt;3,000 bp) were filtered with Chopper v2.5.0 (https://github.com/nanoporetech/pychopper), and adapter sequences were trimmed using Trimmomatic and Porechop v0.2.4 (https://github.com/rrwick/Porechop). The processed reads were then mapped to influenza reference sequences using minimap2 v2.17 (https://github.com/lh3/minimap2) for consensus reconstruction and quasi-species analysis via IRMA-FLU MinION v1.0.3 (IRMA: Iterative Refinement Meta-Assembler \u0026ndash; CDC WONDER). Sequencing quality metrics were assessed with MinIONQC.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSequence Alignment and Phylogenetic Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRaw sequencing data were processed and edited using BioEdit v7.2.5. Reference sequences for the 2023\u0026ndash;2024 Northern Hemisphere A/H1N1pdm09 vaccine strain (A/Wisconsin/67/2022) were retrieved from GenBank (https://www.ncbi.nlm.nih.gov/genbank.Multiple sequence alignment was performed with \u003cstrong\u003eMAFFT (v6.864),\u0026nbsp;\u003c/strong\u003ebased on the Multiple Alignment using Fast Fourier Transform algorithm. Phylogenetic trees for \u003cstrong\u003eHA gene segments\u003c/strong\u003e were inferred using the \u003cstrong\u003emaximum likelihood (ML) method\u003c/strong\u003e implemented in \u003cstrong\u003eIQ-TREE v3.0.1. The HA phylogenetic tree was inferred\u003c/strong\u003e under the \u003cstrong\u003eTVM+F+I+R2 substitution model,\u0026nbsp;\u003c/strong\u003eas determined by \u003cstrong\u003eModelFinder\u003c/strong\u003e. The \u003cstrong\u003eTVM+F+I+R2\u0026nbsp;\u003c/strong\u003emodel accounts for unequal transversion rates (TVM), empirical base frequencies (+F), a proportion of invariable sites (+I), and rate heterogeneity across sites modeled using a Free Rate distribution with two categories (+R2). \u003cstrong\u003eBranch support was evaluated with 1,000 ultrafast bootstrap replicates\u003c/strong\u003e, with values \u0026ge;70% considered statistically significant. The resulting phylogenetic trees were visualized using \u003cstrong\u003eFigTree v1.4.4\u003c/strong\u003e. Study sequences were compared with global reference strains and representative isolates from different geographic regions. All newly generated sequences have been deposited in the GenBank database, with accession numbers provided in Additional file 1.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eAdditional file 1\u003c/strong\u003e. GenBank Isolate ID\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMutation Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMutation analysis was performed across all eight gene segments using \u003cstrong\u003eMEGA,\u003c/strong\u003e with \u003cstrong\u003eA/Wisconsin/67/2022 (A/H1N1pdm09)\u003c/strong\u003e serving as the reference strain. Identified amino acid substitutions were annotated, and their potential phenotypic effects were evaluated using \u003cstrong\u003eFluSurver\u003c/strong\u003e (http://flusurver.bii.a-star.edu.sg, accessed on August 10, 2025).\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eDescription of influenza A(H1N1)pdm09 positivity rates from 2019 to 2024\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBetween 21 January 2019 and 31 December 2024, a total of 7,453 samples were processed through the national influenza surveillance system in Cameroon. Of these, 727 tested positive for influenza A viruses, and 412 were confirmed as influenza A(H1N1)pdm09 subtype. Annual sample volumes and positivity rates varied across the surveillance period. In 2019, 1,072 samples were collected (897 ILI and 175 SARI), with 324 (30.2%) testing positive for influenza A and 100 (30.9%) of those identified as subtype A(H1N1)pdm09. In 2020, 362 samples were processed (244 ILI and 118 SARI), of which 37 (10.2%) were positive for influenza A and 08 (21.6%) for influenza A(H1N1) pdm09 subtype. In 2021, 443 samples were analyzed (377 ILI and 66 SARI), yielding 105 (23.7%) influenza A-positive cases, including 83 (79.04%) A(H1N1)pdm09 subtype. In 2022, 628 samples were processed (455 ILI and 173 SARI), with 91 (14.49%) testing positive for influenza A and 01 (1.09%) for A(H1N1)pdm09 subtype. In 2023, a total of 1,848 samples were collected (1,442 ILI and 406 SARI), of which 358 (19.37%) were positive for influenza A and 73 (20.4%) for A(H1N1)pdm09 subtype. In 2024, a total of 3,017 samples were processed (2,316 ILI and 701 SARI), with 490 (16.2%) testing positive for influenza A and 157 (32.0%) for A(H1N1)pdm09 subtype. Figure 1 illustrates monthly fluctuations in influenza A and A(H1N1)pdm09 subtype cases over the six-year study period. Distinct seasonal peaks were observed in influenza activity, typically occurring between October and March. Influenza A(H1N1)pdm09 subtype contributed variably to these peaks, with notable surges in early 2019, 2021, and 2024.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSubclade Analysis by Amino Acid Substitutions and Phylogenetic Tree Analysis of HA \u0026nbsp;genes\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll 62 A(H1N1)pdm09 strains from Cameroon collected between 2019 and 2024 belonged to clade 6B.1A, with the majority of 2023 and 2024 strains classified within subclade 6B.1A.5a.2a (n = 99%). They evolved separately from the reference vaccine strain for the 2023\u0026ndash;2024 influenza season (Figure. 1), based on WHO-defined subclade criteria. These strains exhibited key amino acid substitutions in the HA2 region at positions: A3L, D111N, A267D, A241E, E277D, H468N, Q71K, A241V, R159K, T89K, I550V, and N147K, relative to the 2024 A/Wisconsin/67/2022 vaccine strain. The number of amino acid substitutions between the circulating strains and the vaccine strain was notably higher, further supporting the genetic divergence of Cameroon strains from the recommended vaccine strain. To assess global genetic relationships, a BLAST search was performed using the HA gene sequences of the 64 Cameroonian strains. The closest matches were to strains isolated in Algeria, Spain, Moscow, Venezuela, Ivory Coast, Kenya, Zambia and Serbia (Figure. 2). We also noted that the A(H1N1)pdm09 viruses from Cameroon, classified as subclades 5a.2a and 5a.2a.1, respectively, showed close genetic proximity to subclade 5b.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAmino Acid Substitutions in Antigenic Sites of A(H1N1)pdm09 Viruses\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA comprehensive analysis of the \u003cstrong\u003e62 A(H1N1)pdm09 virus sequences\u003c/strong\u003e revealed diverse amino acid substitutions across all eight gene segments. These mutations are summarized in \u003cstrong\u003eTable 3,\u0026nbsp;\u003c/strong\u003ewith several located in known antigenic regions of the HA and NA proteins. Notably, recurrent substitutions in HA\u0026mdash;including A267D, D111N, E277D, and N147K\u0026mdash;were observed in nearly all sequences, suggesting conserved evolutionary changes among circulating strains.\u003c/p\u003e\n\u003cp\u003eIn the NA segment, mutations such as E433R, S200N, P458S, and I264T were frequently detected. Some of these substitutions, have been previously associated with increased disease severity, or linked to antiviral resistance. Additional mutations were also identified in internal genes (M1, M2, NS1, NS2, NP, PA, PB1, PB2), indicating broader genomic variability beyond surface glycoproteins. Only mutations with a frequency of occurrence of at least 20% were included in the table 3 below.\u003c/p\u003e"},{"header":"Discussions","content":"\u003cp\u003eThis study aimed to characterize the genetic diversity and antiviral resistance profiles of influenza A(H1N1)pdm09 viruses circulating in Cameroon between 2019 and 2024, using whole-genome sequencing and phylogenetic analysis. Since September 2023, A(H1N1)pdm09 viruses have circulated globally and remained predominant across most geographic regions. Between 2019 and 2024, 7,453 influenza A samples were analyzed, with A(H1N1)pdm09 remaining the predominant subtype, similar to several geographic regions worldwide[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The recent rise in clinical cases may be attributed both to reduced vaccine effectiveness [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] and declining population immunity. In Cameroon, this trend coincides with the integration of the influenza A vaccine into the Expanded Programme on Immunization (EPI) for high-risk groups, alongside continued adherence to government-implemented barrier measures following the end of the COVID-19 pandemic.\u003c/p\u003e\u003cp\u003eGenetically characterized haemagglutinin (HA) genes from Cameroon predominantly belonged to clade 6B.1A.5a.2, with further diversification into subclades 6B.1A.5a.2a and 6B.1A.5a.2a.1, defined by specific amino acid substitutions. These results are consistent with reports from Australia, Indonesia and New Zealand [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. These findings highlight the ongoing diversification of Cameroonian A(H1N1)pdm09 strains, which were previously assigned to subclade 6B.1a in 2019 as reported by Monamele et \u003cem\u003eal\u003c/em\u003e. [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Our analysis further confirms the disappearance of clade 6C, which previously grouped some 2014 strain. Global comparisons showed similar evolutionary shifts, with recent viruses diverging from the WHO-recommended vaccine strain A/Wisconsin/67/2022[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e], indicating limited protection by current formulations and reinforcing the need for annual vaccine updates [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAll eight genomic segments were recovered with \u0026gt;\u0026thinsp;90% coverage. The D222G substitution in the HA1 subunit was detected in 50% of sequenced strains and has been associated with increased disease severity [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Analysis of the neuraminidase (NA) gene revealed resistance-linked mutations including H275Y,V106I and N284D [\u003cspan additionalcitationids=\"CR27\" citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e], as well as novel substitutions I223V, I264T, P458S, which may confer mild resistance to neuraminidase inhibitors (NAIs). Additional NA mutations associated with antiviral resistance such as N200S, I223V, and V241I have also been reported in previous studies [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. M2 protein substitutions (V7I, V27I) were identified in several strains, consistent with recent findings by Resende et al.[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e] and earlier observations by Njouom \u003cem\u003eet al\u003c/em\u003e., in classical A(H1N1) viruses prior to the 2009 influenza pandemic [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. These mutations, along with the previously documented S31N substitution, indicate persistent natural resistance to adamantanes in local strains.\u003c/p\u003e\u003cp\u003eGenomic analyses indicate multiple independent introductions and subsequent dissemination of influenza strains in Cameroon. The sequences generated in this study show a high degree of genetic relatedness to strains reported from Algeria, Spain, Moscow (Russia), Venezuela, C\u0026ocirc;te d\u0026rsquo;Ivoire, Kenya, Zambia, and Serbia. Moreover, several amino acid substitutions identified in the Cameroonian isolates mirror those detected in Sicily (Italy), Kenya, and China[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan additionalcitationids=\"CR34 CR35\" citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e], suggesting the occurrence of parallel evolutionary trajectories across distinct geographic regions.\u003c/p\u003e\u003cp\u003eThis genetic relatedness may reflect Cameroon\u0026rsquo;s strategic location in Central Africa and regional mobility patterns for trade, travel, and migration. Marked antigenic variability was detected in the HA gene of H1 influenza viruses, with half of the isolates carrying substitutions within the major head antigenic sites. Specifically, the mutations T137A, S154P, and R159K map to the 130-loop region of HA1 and are predominantly associated with the Sa antigenic site (with some studies suggesting overlap with Sb, depending on the alignment and strain context).\u003c/p\u003e\u003cp\u003eConsistent findings were reported by Xu et al.[\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e], who identified 19 HA mutations in Wuhan strains, and by Su et al.[\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e], who described the fixation of substitutions conferring immune escape for instance, S220T within the Ca1/Ca2 sites and K180Q within the Sa site across multiple viral lineages. Moreover, the lack of 3\u0026prime;\u0026ndash;5\u0026prime; exonuclease proofreading activity in influenza viruses promotes frequent insertions and deletions, thereby accelerating antigenic drift and facilitating immune evasion[\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eStudy limitations include restricted geographic representativeness and sample selection bias based on Ct values\u0026thinsp;\u0026lt;\u0026thinsp;30, which may have excluded genetically informative strains. Future work should expand spatiotemporal genomic surveillance to monitor transmission dynamics, antigenic drift, and vaccine strain relevance in Cameroon and the region.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe considerable genetic variation observed among A(H1N1)pdm09 strains circulating in Cameroon between 2019 and 2024 highlights ongoing viral evolution and the need for adaptive public health strategies. These findings underscore the importance of sustained genomic surveillance to inform vaccine strain selection, monitor antiviral resistance, and strengthen pandemic preparedness in alignment with WHO recommendations.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eCOVID-19: Coronavirus Disease 2019\u003c/p\u003e\n\u003cp\u003eCPC: Centre Pasteur Cameroon\u003c/p\u003e\n\u003cp\u003eCt: Threshold cycle\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eGISAID: Global Initiative on Sharing Avian Influenza Data\u003c/p\u003e\n\u003cp\u003ePCR: Polymerase Chain Reaction\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eRNA: Ribonucleic Acid\u003c/p\u003e\n\u003cp\u003eRT-PCR: Reverse Transcriptase Polymerase Chain Reaction\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWHO: World Health Organization\u003c/p\u003e\n\u003cp\u003ePB2 \u0026nbsp; : Polymerase Basic Protein 2\u003c/p\u003e\n\u003cp\u003ePB1 : \u0026nbsp; Polymerase Basic Protein 1\u003c/p\u003e\n\u003cp\u003ePA\u0026nbsp;: Polymerase Acidic Protein\u003c/p\u003e\n\u003cp\u003eHA\u0026nbsp;: Hemagglutinin\u003c/p\u003e\n\u003cp\u003eNP\u0026nbsp;: Nucleoprotein\u003c/p\u003e\n\u003cp\u003eNA\u0026nbsp;: Neuraminidase\u003c/p\u003e\n\u003cp\u003eM\u0026nbsp;: Matrix segment\u003c/p\u003e\n\u003cp\u003eNS : Non-structural segment\u003c/p\u003e\n\u003cp\u003eILI :\u0026nbsp;Influenza-Like Illness\u003c/p\u003e\n\u003cp\u003eSARI :\u0026nbsp;Severe Acute Respiratory Infection\u003c/p\u003e\n\u003cp\u003eDNA : \u003cstrong\u003eDeoxyribonucleic Acid\u003c/strong\u003e.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics declarations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study protocol was approved by the Ethics and Institutional Committee of the University of Douala (CEI-Udo) (Approval No. 3971CEI-Udo/07/2023/M) and was conducted in accordance with the ethical principles of the 1975 Declaration of Helsinki. Prior to enrollment, written informed consent was obtained from the parents of each child. All personal and identifiable information was anonymized to ensure the protection of participants\u0026rsquo; privacy. Informed consent was obtained from all participants, as well as from the legal guardians of those under 16 years of age, in accordance with Cameroonian regulations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll genomic data generated and analyzed in this study are publicly accessible via the GenBank database. Researchers can access the data at https://www.ncbi.nlm.nih.gov/genbank using the listed accession numbers : PX446230 , PX446231 , PX446382 , PX446383 , PX446384 , PX446385 , PX446386 , PX446387 , PX446388 , PX446389 , PX446390 , PX446391 , PX446392 , PX446393 , PX446394 , PX446395 , PX446396, PX446397 , PX446398 , PX446399 , PX446400 , PX446401 , PX446402 , PX446403 , PX446404 , PX446405 , PX446406 , PX446407 , PX446408 , PX446409 , PX446410 , PX446411 , PX446412 , PX446413 , PX446414 , PX446415 , PX446416 , PX446417 , PX446418 , PX446419 , PX446420 , PX446421 , PX446422 , PX446423 , PX446424 , PX446425 , PX446426 , PX446427 , PX446428 , PX446429 , PX446430 , PX446431 , PX446432 , PX446433 , PX446434 , PX446435 , PX446436 , PX446437 , PX446438 , PX446439 , PX446440 , PX446441 (Additional file 1)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFinancial support\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research was funded by the U.S. Department of Health and Human Services, DHHS (grant number 6 DESP060001-01-01) and the Centers for Disease Control and Prevention (CDC Atlanta), through HEADA, Inc. Contract N\u0026deg; 2022-01-CDC Flu Surv.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eR.N. designed the study. P.I.T., M.H.M.Y., A.M.N., L.L.M.E., M.R.N., R.M.N., J.L.M.N and D.T.T carried out the laboratory analysis and data curation. E.L., U.T., F.K.K and R.N. were involved in supervision and data validation. D.T.T., C.G.M., L.L.M.E., M.H.M.Y. and F.K.K. performed the data analysis. D.T.T. wrote the first draft of the manuscript. \u0026nbsp;All authors revised and edited the manuscript. All authors are responsible for all aspects of the manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOur thanks go to the regional coordinators and the various focal points involved in sentinel influenza surveillance, and to the project promoters for facilitating the acquisition of the equipment needed to carry out the sequencing of the complete influenza A genome in Cameroon.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of interest:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo potential conflict of interest was reported by the authors.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eCISMeF CISMF, Rouen H. 2023 [cited 21 May 2024]. 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J Virol. 1999;73:7343\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1128/JVI.73.9.7343-7348.1999\u003c/span\u003e\u003cspan address=\"10.1128/JVI.73.9.7343-7348.1999\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1\u003c/strong\u003e: Temporal and regional distribution of sentinel sites\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRegion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eName of Sentinel Site\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"6\" valign=\"top\" style=\"width: 356px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDistribution by year\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2019\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(14)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2020\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(14)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; 2021\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; (14)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2022\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(18)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2023\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(18)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2024\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(19)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"6\" valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCentre\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(6)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eCMA of Nkomo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eCASS of Nkolndongo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eCMS Ambassade of France\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eCSI of Etoudi\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eCentre Hopitalier of Essos*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eHospital Jamot of Yaound\u0026eacute;*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLittoral\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(4)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eH\u0026ocirc;spital Catholique Barcelone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eH\u0026ocirc;spital d\u0026rsquo;Albert le Grand*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eH\u0026ocirc;spital Catholique Log Pom\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eHospital district of Newbel\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWest\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(4)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eCMA Koukouet Maloum\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eCMA Djeleng\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eCSI of Bandjoun\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eCSI of Kueka (Foumban)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"9\" valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNorth\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(9)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eH\u0026ocirc;spital Provincial of Garoua\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eCSI of Kolere\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eCSI of Ourokanadi\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eCSI of Poumpoure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eCSI of Souari\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eCSI of Kotta Liddiri\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eH\u0026ocirc;spital of Foulbere\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eCSI of Roumde Adjia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp;Hospital regional of Garoua*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdamaoua\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eCSI of Boumdjere\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eCSI of Marza\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eCSI of Sabongari\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eH\u0026ocirc;pitalProtestant \u0026nbsp;Ngaoundere\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eCSI of Gaba Mabanda\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u003cstrong\u003esouth-west (2)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eMount Mary Hospital Buea\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eHospital regional of Buea\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNorth-west\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003ePolyclinic St. Blaise Bamenda\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEast\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eHospital regional of Bertoua*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSouth\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eHospital regional of Ebolowa*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFar North (2)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eH\u0026ocirc;spital of Kolofata\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eH\u0026ocirc;spital regional of Maroua*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eCMA: \u0026lsquo;District Medical Centre ; CASS: \u0026lsquo;Social and Health Centre ;CMS : \u0026lsquo;Medical-Social Centre\u0026rsquo; ; CSI : \u0026lsquo;Integrated Health Centre\u0026rsquo;, * SARI site (-) : absence from site \u0026nbsp; (+) : Site Presence\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2\u003c/strong\u003e: Influenza A Virus Primers\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOligo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBases\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 261px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSequences 5\u0026rsquo;-3\u0026rsquo;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026micro;m / pool\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003eMB Tuni-12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 261px;\"\u003e\n \u003cp\u003eACGGTGATCAGCAAAAGCAGG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003eMB Tuni-12.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 261px;\"\u003e\n \u003cp\u003eACGCGTGATCAGCGAAAGCAGG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003eMB Tuni-13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 261px;\"\u003e\n \u003cp\u003eACGGTGATCAGTAGAAACAAGG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3\u003c/strong\u003e. Most common amino acid mutations observed in all eight segments of A(H1N1)pdm09\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" class=\"fr-table-selection-hover\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHA\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNA\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eM1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eM2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNS1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNS2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNP\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePA\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePB1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePB2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eA3L\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eV13I\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eV7I\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eV7I\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eT56K\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eG22E\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eE14D\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eV14I\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eK57T\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eI66V\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eM8I\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eT16A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eI42L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eV27A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eA57T\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eR34Q\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eE18D\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eV30I\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eS106A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eI81M\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eM8L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eI29M\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eR98K\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eQ81R\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eS74N\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eA48T\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eD21N\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eR57Q\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eS261C\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eL475M\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eF12V\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eS37T\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eE201D\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eI81V\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eQ85H\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eT22A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eM61I\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eI298V\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eQ71K\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eV80M\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eE235T\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eI84V\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eQ96K\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eT23A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eL63I\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eN455D\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eT89K\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eP93H\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eI84T\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eI105L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eR31K\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eK204R\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eK757R\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eR91K\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eV106I\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eT94A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eI33V\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eR213K\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eD111N\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eI163V\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eI111T\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eG34D\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eL226I\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eT137A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eT188I\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eC116F\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eD53E\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eR262K\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eN147K\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eN200S\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eT143I\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eR65K\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eR262K\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eS154P\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eI223V\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eT143I\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eE81K\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eP267S\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eH155Q\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eS247N\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eF150L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eG86R\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eS296N\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eA158T\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eR257K\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eG154E\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eG126S\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eV330I\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eR159K\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eI264T\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eV178I\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eI136L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eT337A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eV169I\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eM269I\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eS205N\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eT147P\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eK339N\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eK173N\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eH275Y\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eT151M\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eT357S\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eI178L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN284D\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eR152Q\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eV438I\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eD204A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eV321I\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eI197V\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eP534T\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eA214T\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eF322L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eN202S\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eK576R\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eS220T\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eL329D\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eV217I\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eS616P\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eD222G\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eL339S\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eM222I\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eR626K\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eT233A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eS366N\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eL256I\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eE688G\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eA241E\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eK386E\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eR261Q\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eN696S\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eA241V\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eI396M\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eS314N\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eA267V\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eG404R\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eR342K\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eA267D\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eE433R\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eK351R\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eK276R\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eM454V\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eN370I\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eA277D\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eP458S\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eV371M\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eA294T\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eD375N\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eR325K\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eS392I\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eH370Q\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eN417S\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eD373E\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eA423T\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eV435I\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eS450N\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eS468N\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eS457F\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eY506F\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eD523E\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eI550V\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eBlue Mutation\u003c/strong\u003e: Associated with increasing disease severity, Red\u003cstrong\u003e\u0026nbsp;Mutation\u003c/strong\u003e: Associated with antiviral resistance\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-infectious-diseases","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"infd","sideBox":"Learn more about [BMC Infectious Diseases](http://bmcinfectdis.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/infd","title":"BMC Infectious Diseases","twitterHandle":"#bmcinfectdis","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Influenza A(H1N1)pdm09, genetic drift, whole-genome sequencing, vaccine mismatch, antiviral resistance, Nanopore technology, Cameroon","lastPublishedDoi":"10.21203/rs.3.rs-7684927/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7684927/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eSince 2019, Cameroon has reported a high number of seasonal influenza cases caused by the A(H1N1)pdm09 subtype, which remained the predominant global strain as of 2024.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eTo characterize the evolutionary dynamics of circulating A(H1N1)pdm09 viruses, whole-genome sequencing was conducted using Oxford Nanopore Technologies, with multiplexing native barcode expansion kits. DNA repair and end preparation were performed using the NEBNext Ultra II End-Repair/dA-tailing kit. Phylogenetic trees for HA genes segments were inferred using the maximum likelihood (ML)\u003c/p\u003e\u003ch2\u003emethod\u003c/h2\u003e\u003cp\u003eimplemented in IQ-TREE v3.0.1(\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.iqtree.org\u003c/span\u003e\u003cspan address=\"http://www.iqtree.org\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e) under the TVM\u0026thinsp;+\u0026thinsp;F\u0026thinsp;+\u0026thinsp;I\u0026thinsp;+\u0026thinsp;R2 substitutions models. Additionally, Mutation analysis was performed across all eight gene segments using MEGA with A/Wisconsin/67/2022 (A/H1N1pdm09) serving as the reference strain. Identified amino acid substitutions were annotated and their potential phenotypic effects were evaluated using FluSurver (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://flusurver.bii.a-star.edu.sg\u003c/span\u003e\u003cspan address=\"http://flusurver.bii.a-star.edu.sg\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. accessed on August10, 2025).\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eAll Cameroonian A(H1N1)pdm09 strains from 2019 to 2024 belonged to subclade 6B.1A.5a.2a. Phylogenetic analysis revealed annual divergence from Northern Hemisphere vaccine strains, suggesting a mismatch with locally circulating variants. Several mutations of functional interest were identified, including A3L, A214T, F12V, R159K, A267V, A241E, T137A, I42L, V7I, I84V and I33V across the HA, PA, M2, NS1 and PB1 genes, many of which are associated with increased virulence. Similarly, amino acid substitutions at sites V13I, S200N, L339S, S37T, V80M, and I163V in the NA protein were observed in the NA protein, relative to the 2024 vaccine strain A/Wisconsin/67/2022. Overall, the number of amino acid mutations between circulating strains and the vaccine strain was notably high, indicating that local viruses may be evolving away from the vaccine strain selected for the 2023\u0026ndash;2024 season.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eThese findings underscore the ongoing genetic evolution of the influenza A(H1N1)pdm09 virus in Cameroon and highlight the importance of local genomic data into the selection of WHO vaccine candidate strains for the Northern Hemisphere.\u003c/p\u003e","manuscriptTitle":"Whole-Genome Analysis of Influenza A(H1N1)pdm09 Viruses in Cameroon (2019–2024) Using Nanopore Sequencing","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-29 07:29:28","doi":"10.21203/rs.3.rs-7684927/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision 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Infectious Diseases","date":"2025-10-04T03:01:04+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-infectious-diseases","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"infd","sideBox":"Learn more about [BMC Infectious Diseases](http://bmcinfectdis.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/infd","title":"BMC Infectious Diseases","twitterHandle":"#bmcinfectdis","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"dcf5d2a3-f5a8-4945-88cf-c419752e4ee1","owner":[],"postedDate":"October 29th, 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