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Influenza Virus A/h1n1 Resistant To Oseltamivir: W.h.o. Preliminary Summary
Occasional resistance was reported earlier, but maybe the sequences
weren't submitted. I'm not sure whether/(how much) we had H274Y earlier
2006/2007 was a different genetical background.
Something created this resistant strain in ~ early 2007
Or maybe created a strain in which genetical background H274Y
can survive and spread better than before - and then the mutation
happened several times independently.
Let's see .
Do you have examples of Japanese/other different "clades" with and
without H274Y ?
I may go through that phylo-tree in the japan.pdf later too
---edit1----
of course, drug usage having created the resistance is also a possibility,
we haven't ruled this out yet. But not much evidence for this, except
timing with increased Tamiflu-usage.
There actually are three Brisbayne/59 branches in the US representing 3 independent intoductions onto the Brisbayne/59 backbone. In addition to the large branch and the Hawaiian branch, there is a Florida branch
---edit1----
of course, drug usage having created the resistance is also a possibility,
we haven't ruled this out yet. But not much evidence for this, except
timing with increased Tamiflu-usage.
The reason the influenza "experts" were "startled" was the lack of an association with Tamiflu usage. You have ZERO evidence to support the above "possibility" and have many comments from experts indicating that your "possibilty" is at odds with the facts.
Please avoid speculation that is in clear conflict with the data. This story has been quite clear since Norway first reported the explosion of H274Y cases several months ago, and now the data from Japan clearly shows that your "possibility" has no merit, and although you may not have ruled out selection by Tamiflu, the influenza "experts" have.
Last edited by sharon sanders; July 11, 2008, 03:01 PM.
Reason: typo
Re: _|INFLUENZAVIRUS A/H1N1 RESISTANT TO OSELTAMIVIR: W.H.O. PRELIMINARY SUMMARY|_
As noted in the commentary, the data from Japan has many examples of independent introductions of H274Y into multiple genetic backgrounds this season. This pattern, and associated lack of Tamifly usage, causes major problems for random mutations, and is easily explained by the homologous recombination described in the two recent papers in J Virology (no lab error required - or remotely suggested).
---edit1----
of course, drug usage having created the resistance is also a possibility,
we haven't ruled this out yet. But not much evidence for this, except
timing with increased Tamiflu-usage.
From Norway report
Oseltamivir use:
Generally, oseltamivir use before specimen collection in persons with resistant virus or in their prior contacts has been very uncommon. None of the 208 patients for which we have data both on resistance profile and antiviral use had received antivirals before sampling; 7 patients received
Re: _|INFLUENZAVIRUS A/H1N1 RESISTANT TO OSELTAMIVIR: W.H.O. PRELIMINARY SUMMARY|_
Apparently we have humor-challenged members. Message removed.
I do seem to remember reading reports that Norwegian nursing homes had been hit hard by seasonal influenza and that Tamiflu was being doled out like candy in an attempt to stop institutional epidemics.
Maybe in the elderly, it's very easy to select for drug resistance when tamiflu is used and drug resistant recombination quasi-strains are in circulation within the susceptible (in this case, geriatric) cases. They have been identified as high risk patient group for spreading influenza in the community (as have infants/toddlers).
However, tamiflu use in the latter age cohort was constrained by questions of correct dosing and toxicity (EU approved changes in dosing for young children, late 07).
---edit1----
of course, drug usage having created the resistance is also a possibility,
we haven't ruled this out yet. But not much evidence for this, except
timing with increased Tamiflu-usage.
From the Netherlands
Oseltamivir use: For the sentinel patients data on oseltamivir use was available for all 41 patients sampled. None of the sentinel patients (41) or their household contacts (40) reported the use of oseltamivir in the two weeks prior to the date of specimen collection. For the non-sentinel patients, data on oseltamivir use was available for 15 patients (further data are currently being collected). None of the non-sentinel patients reported the use of oseltamivir in the two weeks prior to the date of specimen collection. Household contacts of one patient with an oseltamivir sensitive A(H1N1) virus had used oseltamivir in the two weeks prior to the date of specimen collection.
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