Announcement

**HenryN** · January 14, 2009, 08:16 AM

Re: H1N1 - Influenza Warning Issued Nationwide (South Korea)

http://dis.cdc.go.kr/influenza/Download/NewsFile/1주%20인플루엔자표본감시%20소식지.pdf

**HenryN** · January 14, 2009, 09:21 AM

Re: H1N1 - Influenza Warning Issued Nationwide (South Korea)

Commentary

Explosion of H1N1 Tamiflu Resistance in Korea Continues

http://www.recombinomics.com/News/01140901/H274Y_Korea_Explodes_More.html

Recombinomics Commentary

**tropical** · January 14, 2009, 09:58 AM

Re: H1N1 - Influenza Warning Issued Nationwide (South Korea)

Thank you Dr. Niman:

#17: "The explosion of H1N1 cases in Korea, in association with the fixing of H274Y is cause for concern. The sequence data from Japan and the United States identifies three receptor binding domain changes, G189V, A193T, H196R, which is likely associated with the rapid spread as well as the escape from prior immunity. None of these three changes is represented in the current H1N1 vaccine and the increased reservoir of H274Y in seasonal flu raises concerns of recombination between the N1 on H1N1 and the N1 of H5N1 to produce Tamiflu resistant H5N1. Both Korea and Japan had H5N1 in the spring of 2008, and one culler in Korea was H5 PCR confirmed."

**HenryN** · January 14, 2009, 10:28 AM

Re: H1N1 - Influenza Warning Issued Nationwide (South Korea)

FluNet
<TABLE cellSpacing=0 cellPadding=0 width="100%" border=0><TBODY><TR><TD class=content vAlign=top>451.</TD><TD class=content vAlign=top width=161>Republic of Korea</TD><TD class=content vAlign=top>A (H1)</TD><TD class=content vAlign=top align=middle>48</TD><TD class=content vAlign=top align=middle>2008</TD><TD class=content vAlign=top align=middle>16</TD><TD class=content vAlign=top align=middle>view</TD></TR><TR><TD class=content vAlign=top>452.</TD><TD class=content vAlign=top width=161>Republic of Korea</TD><TD class=content vAlign=top>A (H1)</TD><TD class=content vAlign=top align=middle>49</TD><TD class=content vAlign=top align=middle>2008</TD><TD class=content vAlign=top align=middle>36</TD><TD class=content vAlign=top align=middle>view</TD></TR><TR><TD class=content vAlign=top>453.</TD><TD class=content vAlign=top width=161>Republic of Korea</TD><TD class=content vAlign=top>A (H1)</TD><TD class=content vAlign=top align=middle>50</TD><TD class=content vAlign=top align=middle>2008</TD><TD class=content vAlign=top align=middle>164</TD><TD class=content vAlign=top align=middle>view</TD></TR><TR><TD class=content vAlign=top>454.</TD><TD class=content vAlign=top width=161>Republic of Korea</TD><TD class=content vAlign=top>A (H1)</TD><TD class=content vAlign=top align=middle>51</TD><TD class=content vAlign=top align=middle>2008</TD><TD class=content vAlign=top align=middle>398</TD><TD class=content vAlign=top align=middle>view</TD></TR><TR><TD class=content vAlign=top>455.</TD><TD class=content vAlign=top width=161>Republic of Korea</TD><TD class=content vAlign=top>A (H1)</TD><TD class=content vAlign=top align=middle>52</TD><TD class=content vAlign=top align=middle>2008</TD><TD class=content vAlign=top align=middle>153</TD><TD class=content vAlign=top align=middle>view</TD></TR><TR><TD class=content vAlign=top>456.</TD><TD class=content vAlign=top width=161>Republic of Korea</TD><TD class=content vAlign=top>A (H3)</TD><TD class=content vAlign=top align=middle>48</TD><TD class=content vAlign=top align=middle>2008</TD><TD class=content vAlign=top align=middle>4</TD><TD class=content vAlign=top align=middle>view</TD></TR><TR><TD class=content vAlign=top>457.</TD><TD class=content vAlign=top width=161>Republic of Korea</TD><TD class=content vAlign=top>A (H3)</TD><TD class=content vAlign=top align=middle>49</TD><TD class=content vAlign=top align=middle>2008</TD><TD class=content vAlign=top align=middle>7</TD><TD class=content vAlign=top align=middle>view</TD></TR><TR><TD class=content vAlign=top>458.</TD><TD class=content vAlign=top width=161>Republic of Korea</TD><TD class=content vAlign=top>A (H3)</TD><TD class=content vAlign=top align=middle>50</TD><TD class=content vAlign=top align=middle>2008</TD><TD class=content vAlign=top align=middle>11</TD><TD class=content vAlign=top align=middle>view</TD></TR><TR><TD class=content vAlign=top>459.</TD><TD class=content vAlign=top width=161>Republic of Korea</TD><TD class=content vAlign=top>A (H3)</TD><TD class=content vAlign=top align=middle>51</TD><TD class=content vAlign=top align=middle>2008</TD><TD class=content vAlign=top align=middle>17</TD><TD class=content vAlign=top align=middle>view</TD></TR><TR><TD class=content vAlign=top>460.</TD><TD class=content vAlign=top width=161>Republic of Korea</TD><TD class=content vAlign=top>A (H3)</TD><TD class=content vAlign=top align=middle>52</TD><TD class=content vAlign=top align=middle>2008</TD><TD class=content vAlign=top align=middle>5</TD><TD class=content vAlign=top align=middle>view</TD></TR><TR><TD class=content vAlign=top>461.</TD><TD class=content vAlign=top width=161>Republic of Korea</TD><TD class=content vAlign=top>A (not suptyped)</TD><TD class=content vAlign=top align=middle>48</TD><TD class=content vAlign=top align=middle>2008</TD><TD class=content vAlign=top align=middle>0</TD><TD class=content vAlign=top align=middle>view</TD></TR><TR><TD class=content vAlign=top>462.</TD><TD class=content vAlign=top width=161>Republic of Korea</TD><TD class=content vAlign=top>A (not suptyped)</TD><TD class=content vAlign=top align=middle>49</TD><TD class=content vAlign=top align=middle>2008</TD><TD class=content vAlign=top align=middle>0</TD><TD class=content vAlign=top align=middle>view</TD></TR><TR><TD class=content vAlign=top>463.</TD><TD class=content vAlign=top width=161>Republic of Korea</TD><TD class=content vAlign=top>A (not suptyped)</TD><TD class=content vAlign=top align=middle>50</TD><TD class=content vAlign=top align=middle>2008</TD><TD class=content vAlign=top align=middle>0</TD><TD class=content vAlign=top align=middle>view</TD></TR><TR><TD class=content vAlign=top>464.</TD><TD class=content vAlign=top width=161>Republic of Korea</TD><TD class=content vAlign=top>A (not suptyped)</TD><TD class=content vAlign=top align=middle>51</TD><TD class=content vAlign=top align=middle>2008</TD><TD class=content vAlign=top align=middle>0</TD><TD class=content vAlign=top align=middle>view</TD></TR><TR><TD class=content vAlign=top>465.</TD><TD class=content vAlign=top width=161>Republic of Korea</TD><TD class=content vAlign=top>A (not suptyped)</TD><TD class=content vAlign=top align=middle>52</TD><TD class=content vAlign=top align=middle>2008</TD><TD class=content vAlign=top align=middle>0</TD><TD class=content vAlign=top align=middle>view</TD></TR></TBODY></TABLE>

**AlaskaDenise** · January 14, 2009, 04:08 PM

Re: H1N1 - Influenza Warning Issued Nationwide (South Korea)

[quote=niman;202028]Commentary

Explosion of H1N1 Tamiflu Resistance in Korea Continues

http://www.recombinomics.com/News/01140901/H274Y_Korea_Explodes_More.html

Recombinomics Commentary

Explosion of H1N1 Tamiflu Resistance in Korea Continues
Recombinomics Commentary 14:05
January 14, 2009

week 49 34/39 2.3%
week 50 82/95 48 3.6%
week 51 296/322 214 8.4%
week 52 767/815 471 15.39%
week 53 1275/1333 508 17.63%

The above data from the Korean CDC demonstrate the continued explosion of H1N1 Tamiflu resistance in Korea, which parallels the dramatic increase in reports of influenza like illness (ILI).

The baseline for the ILI rate is 2.6% and last season the rate peaked below 10% in week 9. This season, after crossing the baseline level in week 50, the rate jumped to 8.4% in week 51, which then jumped to 15.39% for week 52, and the latest report has the rate at 17.63%. The vast majority of influenza isolates have been H1N1. The week over week increase in H1N1 confirmations of 508 for week 52 is higher than the increase of 471 in week 53.

In the report released Friday, 16/17 H1N1 isolates were oseltamivir resistant, indicating that the vast majority of H1N1 reported in the past few weeks also has H274Y, as has been reported for neighboring Japan, as well as North America and Europe.

The explosion of H1N1 cases in Korea, in association with the fixing of H274Y is cause for concern. The sequence data from Japan and the United States identifies three receptor binding domain changes, G189V, A193T, H196R, which is likely associated with the rapid spread as well as the escape from prior immunity. None of these three changes is represented in the current H1N1 vaccine and the increased reservoir of H274Y in seasonal flu raises concerns of recombination between the N1 on H1N1 and the N1 of H5N1 to produce Tamiflu resistant H5N1. Both Korea and Japan had H5N1 in the spring of 2008, and one culler in Korea was H5 PCR confirmed.

The explosion of H1N1 in Korea may lead to similar increases in Japan and the United States. One flu outbreak has been reported at a Texas high school in the United States, where all reported influenza A has been H1N1 with H274Y.

.

**HenryN** · January 15, 2009, 08:19 AM

Re: H1N1 - Influenza Warning Issued Nationwide (South Korea)

Week 1, 2009

http://dis.cdc.go.kr/Influenza/download/200901%20Influenza%20Weekly%20Report.pdf

**tropical** · January 16, 2009, 01:51 AM

Re: H1N1 - Influenza Warning Issued Nationwide (South Korea)

#21 pdf:
Isolated 08/09
A/H1 : A/H3
1,275 : 58

22 times more is the rate of H1 (changed multi-receptors) versus the H3 strain in the isolates.
Vow.

**HenryN** · January 21, 2009, 12:53 PM

Re: H1N1 - Influenza Warning Issued Nationwide (South Korea)

http://dis.cdc.go.kr/Influenza/download/200902%20Influenza%20Weekly%20Report.pdf

1,854 influenza viruses were isolated until the 2

th week in 2008-2009 season.
1,772 viruses were identified as A/H1N1 type and 82 viruses were identified as

A/H3N2 type.

**HenryN** · January 21, 2009, 05:04 PM

Re: H1N1 - Influenza Warning Issued Nationwide (South Korea)

Commentary

High Levels of H1N1 Tamiflu Resistance in Korea Continue

http://www.recombinomics.com/News/01210903/H274Y_Korea_Continues.html

Recombinomics Commentary

**AlaskaDenise** · January 23, 2009, 01:52 AM

Re: H1N1 - Influenza Warning Issued Nationwide (South Korea)

Originally posted by niman View Post

Commentary

http://www.recombinomics.com/News/01...Continues.html

Commentary

High Levels of H1N1 Tamiflu Resistance in Korea Continue
Recombinomics Commentary 21:57
January 21, 2009

1,854 influenza viruses were isolated until the 2nd week in 2008-2009 season.

1,772 viruses were identified as A/H1N1 type and 82 viruses were identified as A/H3N2 type.

The above comments from the week 2 report from Korean CDC reflect high levels of H1N1 oseltamivir resistance and an associated high ILI rate, 11.96%. Although this level was lower than the 17.63% in the prior week, it was still above the high for last season, which was below 10%, and extends the double digit rate to three straight weeks. Moreover, the number of new H1N1 isolates, 497, was similar to the 508 isolates a week earlier and signaled a continuing explosion of oseltamivir resistance in South Korea.

The Japan NIH recently released a phylogenetc tree that included 33 recent isolates from Japan, which were similar to the isolates in the United States this season, all of which had A193T in the receptor binding domain, suggesting this acquisition was the key driver in the emergence of H1N1 with H274Y. Japan has reported a number of school closings which have been linked to H1N1.

More information on impact of this explosion of cases in South Korea would be useful.

.

**HenryN** · January 29, 2009, 08:31 AM

Re: H1N1 - Influenza Warning Issued Nationwide (South Korea)

http://dis.cdc.go.kr/Influenza/download/200903%20Influenza%20Weekly%20Report.pdf

2,340 influenza viruses were isolated until the 3

th week in 2008-2009 season.
2,233 viruses were identified as A/H1N1 type and 107 viruses were identified as

A/H3N2 type.

**HenryN** · January 30, 2009, 01:10 PM

Re: H1N1 - Influenza Warning Issued Nationwide (South Korea)

Commentary

Vaccine and Tamiflu Resistant H1N1 in Korea?

http://www.recombinomics.com/News/01300901/H274Y_Korea_Vaccine.html

Recombinomics Commentary

**AlaskaDenise** · January 30, 2009, 01:34 PM

Re: H1N1 - Influenza Warning Issued Nationwide (South Korea)

Originally posted by niman View Post

Commentary

http://www.recombinomics.com/News/01...a_Vaccine.html

Commentary

Vaccine and Tamiflu Resistant H1N1 in Korea?
Recombinomics Commentary 18:06
January 30, 2009

2,340 influenza viruses were isolated until the 3th week in 2008-2009 season.

2,233 viruses were identified as A/H1N1 type and 107 viruses were identified as A/H3N2 type.

The above comments from the week 3 report from South Korea show an increase of 461 H1N1 isolates over levels reported in week 2, which is similar to the week 2 increase of 497 or the week 1 increase of 508. These levels dwarf H3N2 levels (which increased by 25 in week 3), or influenza B levels (which is rarely detected). Thus, about 95% of the reported influenza in South Korea is H1N1 and the frequency of Tamiflu resistance is near 100%.

Tamiflu resistance is also near 100% in Japan, but the levels of H3N2 and influenza B are markedly higher, so the resistance is in about 1/3 of cases. However, Japan has seen a doubling of reported cases in the past week and has issue a nationwide alert, leading to many school closings. Earlier this season, school closings were linked to H1N1 outbreaks and the H1N1 isolated from those outbreaks was similar to the H1N1 in the United States, which has a number of receptor binding domain changes, including A193T.

This change is also likely in Europe, where H274Y levels in H1N1 also approach 100% and the recent update from Italy indicated three of the first five isolates were from patients who had been vaccinated this season. The data raise concerns that the Tamiflu resistant H1N1 is also resistant to the current H1N1 vaccine, which targets Brisbane/59. Although the Tamiflu resistance is in the Brisbane/59 sub-clade 2B, the vaccine target was isolated in 2007, and the current clade 2B in circulation has a number of NA and HA changes that has led to the fixing of H274Y. To avoid the natural immunity that developed last season, the H1N1 acquired these additional changes, some of which were in clade 2C.

As more cases of flu are reported, the emerging H1N1 with H274Y may become increasingly problematic. Japan had a large number of school closings in late 2008 linked to H1N1, and nationwide alerts have been issued due to the jump in cases. Levels have also been high in Korea, raising concerns that the resistance levels in Asia will increase the likelihood of dual infections involving H5N1 and H1N1 in China, where both serotypes are circulating leading to H5N1 with H274Y.

.

**HenryN** · February 5, 2009, 05:13 PM

Re: H1N1 - Influenza Warning Issued Nationwide (South Korea)

2,546 influenza viruses were isolated until the 4

th week in 2008-2009 season.
2,424 viruses were identified as A/H1N1 type, 121 viruses were identified as

A/H3N2 type and 1 virus was identified as B type.

http://dis.cdc.go.kr/Influenza/download/200904%20Influenza%20Weekly%20Report.pdf