N=46 Oseltamivir‐Resistant Pandemic (H1N1) 2009 Virus in Hong Kong 2009-2014

[Biological]

N=25
All virus strain detected were sensitive to zanamivir (Relenza).

2009 (n=5)
Case 1:

snip
Spokesman for the Department of Health (DH) said the department's Public Health Laboratory Services Branch (PHLSB) today (July 3) detected a strain of human swine influenza (HSI) virus which was resistant to oseltamivir (Tamiflu).The virus was identified during PHLSB's routine sensitivity test of HSI virus to oseltamivir and zanamivir, the spokesman said. "This is the first time Tamiflu resistance in HSI virus found in Hong Kong," he said, adding that similar cases were also reported in Denmark and Japan. "Tests showed that this strain is sensitive to zanamivir (Relenza)," he said.The virus was isolated from the specimen taken from a 16-year-old girl coming from San Francisco. She was intercepted by Port Health Office at the Hong Kong International Airport on June 11 upon arrival. The girl was then admitted to Queen Mary Hospital for isolation. She was tested positive to HSI but opted not to take tamiflu. She had mild symptoms and was eventually discharged upon recovery on June 18. The spokesman noted that PHLSB conducted routine sensitivity tests on specimens taken from confirmed HSI patients. "This is the only Tamiflu-resistant strain so far among some 200 HSI samples tested in Hong Kong. Further tests are underway," he said.Hong Kong has maintained an antiviral stockpile of both Tamiflu and Relenza. The case will be reported to the World Health Organization (WHO), the spokesman said.http://www.info.gov.hk/gia/general/2...0907030213.htm

Other links!

http://wwwnc.cdc.gov/eid/article/15/12/09-1057_article.htm

http://download.thelancet.com/flatcontentassets/H1N1-flu/virology/virology-46.pdf

http://www.who.int/csr/disease/swineflu/notes/h1n1_antiviral_resistance_20090708/en/

Case 2:
Department of Health - Press Release 9 Sep 2009- www.news.gov.hk/en/category/h...814en05006.htm (HTTP 404 error)
Hong Kong reports Tamiflu-resistant swine flu case August 15, 2009

Snip
The Centre for Health Protection (CPH) said Friday that the case involved a 40-year-old female resident of a home for the disabled. CPH controller Dr Thomas Tsang said the woman started taking Tamiflu on July 15 after 21 people at the home fell ill and was later confirmed to be infected with swine flu. Laboratory tests available Friday showed the virus sample from the woman, who has since recovered, was resistant to Tamiflu, the main anti-viral flu drug. Describing the case as an isolated one, Dr Tsang said there was no sign of Tamiflu-resistant flu spreading at the home. Early last month Hong Kong announced it had detected a strain of the H1N1 virus that was resistant to Tamiflu involving a 16-year-old girl who arrived from San Francisco. She was later discharged from hospital. The health department said Friday there had been a total of 6,640 cases of swine flu in the city. When Hong Kong discovered its first swine flu case in early May, health authorities quarantined about 300 guests and staff at a hotel where the carrier, a Mexican national, had briefly stayed. In June, authorities ordered all primary schools in the city to be closed for two weeks after the first cluster of local swine flu cases was found. (c) 2009 AFPhttp://phys.org/news169567877.html#jCp

Case 3:
Department of Health - Press Release 9 Sep 2009
Snip
Detection of human swine influenza virus resistant to Tamiflu
A spokesman for the Department of Health (DH) said the department's Public Health Laboratory Services Branch (PHLSB) today (September 9) detected a strain of human swine influenza (HSI) virus which was resistant to oseltamivir (Tamiflu).
The virus was identified during PHLSB's sensitivity test of HSI virus to oseltamivir and zanamivir, the spokesman said.
"The is the third time Tamiflu resistance in HSI virus found in Hong Kong and this is the second local case.
"Tests showed that this strain is sensitive to zanamivir (Relenza)," he said.
The virus was isolated from the specimen taken from a 38-year-old man who had no history of taking Tamiflu.
The patient developed flu-like symptoms on July 26 and his respiratory specimen taken at a Designated Flu Clinic was tested positive to HSI on July 30.
Investigation revealed that four other family members also suffered from laboratory confirmed HSI including his wife, son, and two younger brothers sequentially at end of July. One of his younger brothers, aged 32, who had onset of flu like symptoms on July 23 had received a full course of Tamiflu treatment.
Except for this patient, all available isolates from other members of the family, including the specimen taken from the younger brother before he received Tamiflu treatment, were tested to be sensitive to Tamiflu.
The patient and all other affected members had mild illnesses and recovered.
The spokesman said that there was no evidence of further transmission of Tamiflu-resistant HSI from the patient.
The spokesman said that PHLSB conducted routine sensitivity tests on specimens taken from confirmed HSI patients.So far more than 3000 HSI samples had been tested for sensitivity in Hong Kong.
The case will be reported to the World Health Organization (WHO), the spokesman said.
He reiterated that Hong Kong had an intensive influenza surveillance system on antiviral resistant influenza viruses.
"We will closely liaise with WHO and overseas health authorities and monitor the global development of antiviral resistant HSI virus," he said.

http://www.dh.gov.hk/english/press/2009/090909-2.html

Case 4:
Department of Health - Press Release 22 Oct 2009
Snip
Detection of human swine influenza virus resistant to Tamiflu
The Department of Health's Public Health Laboratory Services Branch (PHLSB) today (October 22) detected a strain of human swine influenza (HSI) virus which was resistant to oseltamivir (Tamiflu). A department spokesman said the virus was identified during PHLSB's sensitivity test of HSI virus to oseltamivir and zanamivir."The is the fourth time Tamiflu resistance in HSI virus is found in Hong Kong and is the third local case."Tests showed that this strain is sensitive to zanamivir (Relenza)," he said. The virus was isolated from the specimen taken from a 16-year-old girl, who developed flu-like symptoms on September 14 and attended a Designated Flu Clinic on September 16.Her respiratory specimen was tested positive for HSI. Further test results today showed that the virus was resistant to Tamiflu. She had no history of taking tamiflu before the specimen was taken. The girl has already recovered. Investigations revealed that her five family members did not have respiratory symptoms. There was no recent influenza-like-illness outbreak in the school she attended. The spokesman said that PHLSB conducted routine sensitivity tests on specimens taken from confirmed HSI patients.
So far more than 5 000 HSI samples had been tested for anti-viral sensitivity in Hong Kong. The case will be reported to the World Health Organization (WHO), the spokesman said. He reiterated that Hong Kong had an intensive influenza surveillance system on antiviral resistant influenza viruses."We will closely liaise with the WHO and overseas health authorities to monitor the global development of antiviral-resistant HSI virus," he said.

http://www.dh.gov.hk/english/press/2009/091022-2.html

Case 5:
Department of Health - Press Release 5 Nov 2009
Snip
Tamiflu-resistant human swine influenza virus detected
The Department of Health's Public Health Laboratory Services Branch (PHLSB) today (November 5) detected a strain of human swine influenza (HSI) virus which was resistant to oseltamivir (Tamiflu).
A department spokesman said the virus was identified during PHLSB's routine sensitivity tests of HSI virus to oseltamivir and zanamivir.
"This is the fifth time Tamiflu resistance in HSI virus found in Hong Kong and is the fourth local case."
"Tests showed that this strain is sensitive to zanamivir (Relenza)," he said.
The virus was isolated from the specimen taken from a 74-year-old man who developed flu-like symptoms on October 4. He was admitted to United Christian Hospital on October 7 for acute exacerbation of his chronic lung condition. He already recovered and was discharged from hospital on October 13.
His nasopharyngeal aspirate specimen was tested positive for HSI.
Further test results today showed that the virus was resistant to Tamiflu. The man had previous history of taking a full course of Tamiflu in late September during another admission for acute exacerbation of his chronic lung condition. His family member was asymptomatic.
The spokesman said there was no evidence of further transmission of Tamiflu-resistant HSI from the patient. The PHLSB conducted routine sensitivity tests on specimens taken from confirmed HSI patients.
So far more than 5,500 HSI samples had been tested for anti-viral sensitivity in Hong Kong.
The case will be reported to the World Health Organisation (WHO), the spokesman said.
Hong Kong had an intensive surveillance system for antiviral resistant influenza viruses.
"We will closely liaise with the WHO and overseas health authorities to monitor the global development of antiviral-resistant HSI virus," he said.

http://www.dh.gov.hk/english/press/2009/091105.html

2010 (n=1)
Case 6:
Department of Health - Press Release 3 Sep 2010
Snip
Tamiflu-resistant human swine influenza virus detected
The Department of Health's Public Health Laboratory Services Branch (PHLSB) today (September 3) detected a strain of human swine influenza (HSI) virus which was resistant to oseltamivir (Tamiflu).
A department spokesman said the virus was identified during PHLSB's routine sensitivity tests of the HSI virus to oseltamivir and zanamivir."This is the sixth case of Tamiflu resistance to HSI virus detected in Hong Kong."Tests showed that this strain is sensitive to zanamivir (Relenza)," he said.The virus was isolated from the specimen taken from a three-year-old boy who developed flu-like symptoms since August 16. He sought medical advice from a general practitioner on August 16 and 20. The patient was admitted to Queen Mary Hospital on August 20. His clinical diagnosis was pneumonia. He has already recovered and was discharged on August 22.His nasopharyngeal aspirate specimen tested positive for HSI. Further test results today showed that the virus was resistant to Tamiflu. No Tamiflu had been prescribed to the boy by the general practitioner nor during hospitalisation.The spokesman said there was no evidence of further transmission of Tamiflu-resistant HSI from the patient.The PHLSB conducts routine sensitivity tests on specimens taken from confirmed HSI patients."So far more than 6,200 HSI samples have been tested for antiviral sensitivity in Hong Kong," the spokesman said.The case will be reported to the World Health Organisation (WHO), he said.Hong Kong has an intensive surveillance system for antiviral resistant influenza viruses."We will closely liaise with the WHO and overseas health authorities to monitor the global development of antiviral-resistant HSI virus," he said.

http://www.dh.gov.hk/english/press/2010/100903-3.html

2011 (n=10)
Case 7:
Department of Health - Press Release 31 Jan 2011
Snip
Tamiflu-resistant human swine influenza virus detected
The Department of Health's Public Health Laboratory Services Branch (PHLSB) today (January 31) detected a strain of human swine influenza (HSI) virus which was resistant to oseltamivir (Tamiflu).
A department spokesman said the virus was identified during PHLSB's routine sensitivity tests of the HSI virus to oseltamivir and zanamivir.
"This is the seventh case of Tamiflu resistance to HSI virus detected in Hong Kong.
"Tests showed that this strain is sensitive to zanamivir (Relenza)," he said.
The virus was isolated from the specimen taken from a two-year-old boy who developed flu-like symptoms since January 10. He was admitted to Tuen Mun Hospital on the same day and his nasopharyngeal aspirate specimen taken on the day of admission was tested positive for HSI virus. He has been discharged and is now in stable condition..
Test results today showed that the virus isolated from the patient?s nasopharyngeal aspirate on January 19 was resistant to Tamiflu but sensitive to Relenza.
The boy had been prescribed with Tamiflu during hospitalisation and it is likely that Tamiflu resistance emerged during the course of drug treatment.
The spokesman said there was no evidence of further transmission of Tamiflu-resistant HSI from the patient.
The case will be reported to the World Health Organisation.
The spokesman said that Hong Kong has an intensive surveillance system for antiviral resistant influenza viruses. The PHLSB conducts routine sensitivity tests on specimens taken from confirmed HSI patients.
"So far more than 6,500 HSI samples have been tested for antiviral sensitivity in Hong Kong," he said.
"We will closely liaise with the WHO and overseas health authorities to monitor the global development of antiviral-resistant HSI virus."

http://www.dh.gov.hk/english/press/2011/110211-2.html

Case 8:
Department of Health - Press Release 9 Feb 2011
Snip
Tamiflu-resistant human swine influenza virus detected
9 Feb 2011
The Department of Health's Public Health Laboratory Services Branch (PHLSB) today (February 9) detected a strain of human swine influenza (HSI) virus which was resistant to oseltamivir (Tamiflu).A department spokesman said the virus was identified during PHLSB's routine sensitivity tests of the HSI virus to oseltamivir and zanamivir."This is the eighth case of Tamiflu resistance to HSI virus detected in Hong Kong."Tests showed that this strain is sensitive to zanamivir (Relenza)," he said.The virus was isolated from the specimen taken from a 53-year-old woman who has underlying chronic disease and is on long-term immunosuppressive therapy. She developed flu-like symptoms since January 16. She was admitted to United Christian Hospital (UCH) on January 19 and her nasopharyngeal aspirate specimen taken on January 24 tested positive for HSI virus and was sensitive to Tamiflu. She was discharged on January 24 in stable condition.The patient was readmitted to UCH on January 28 for shortness of breath. Test results today showed that the virus isolated from the patient?s nasopharyngeal specimen on January 29 was resistant to Tamiflu but sensitive to Relenza. The woman had been prescribed with Tamiflu during hospitalisation and it is likely that Tamiflu resistance emerged during the course of drug treatment. The spokesman said there was no evidence of further transmission of Tamiflu-resistant HSI from the patient.The case will be reported to the World Health Organisation.The spokesman said that Hong Kong has an intensive surveillance system for antiviral resistant influenza viruses. The PHLSB conducts routine sensitivity tests on specimens taken from confirmed HSI patients."So far more than 6,500 HSI samples have been tested for antiviral sensitivity in Hong Kong," he said."We will closely liaise with the WHO and overseas health authorities to monitor the global development of antiviral-resistant HSI virus."

http://www.dh.gov.hk/english/press/2011/110209-2.html

Case 9:
Department of Health - Press Release 11 Feb 2011
Snip
Tamiflu-resistant human swine influenza virus detected
The Department of Health's Public Health Laboratory Services Branch (PHLSB) today (February 11) detected a strain of human swine influenza (HSI) virus which was resistant to oseltamivir (Tamiflu).
A department spokesman said the virus was identified during PHLSB's routine sensitivity tests of the HSI virus to oseltamivir and zanamivir.
"This is the ninth case of Tamiflu resistance to HSI virus detected in Hong Kong.
"Tests showed that this strain is sensitive to zanamivir (Relenza)," he said.
The virus was isolated from the specimen taken from a seven-year-old girl who enjoyed good past health. She presented with fever, sore throat, cough and runny nose since January 31. The girl was admitted to Pamela Youde Nethersole Eastern Hospital on February 2. She was discharged on the next day in stable condition.
Her nasopharyngeal aspirate specimen taken on February 2 tested positive for HSI virus and was resistant to Tamiflu but sensitive to Relenza.
The girl had not been prescribed with Tamiflu during hospitalisation.
The spokesman said there was no evidence of further transmission of Tamiflu-resistant HSI from the patient.
The case will be reported to the World Health Organisation.
The spokesman said that Hong Kong has an intensive surveillance system for antiviral resistant influenza viruses. The PHLSB conducts routine sensitivity tests on specimens taken from confirmed HSI patients.
"So far more than 6,700 HSI virus samples have been tested for antiviral sensitivity in Hong Kong," he said.
"We will closely liaise with the WHO and overseas health authorities to monitor the global development of antiviral-resistant HSI virus."

http://www.dh.gov.hk/english/press/2011/110211-2.html

Case 10:
Department of Health - Press Release 16 Feb 2011
Snip
Another case of Tamiflu-resistant human swine influenza detected
16 Feb 2011
The Department of Health's Public Health Laboratory Services Branch (PHLSB) today (February 16) detected another case of resistance to oseltamivir (Tamiflu) in a strain of human swine influenza (HSI) virus. A department spokesman said the virus was identified during PHLSB's routine sensitivity tests of the HSI virus to oseltamivir and zanamivir.
"This is the tenth case of Tamiflu resistance to HSI virus detected in Hong Kong.
"Tests showed that this strain is sensitive to zanamivir (Relenza)," he said.
The virus was isolated from the specimen taken from a 33-year-old man with chronic illness. He presented with fever and cough since January 27. He sought medical attention in Queen Mary Hospital (QMH) on the same day and was prescribed with Tamiflu. The man was admitted to QMH for persistent fever on February 1. He was discharged on February 7 in stable condition.
His nasopharyngeal aspirate specimen taken on January 27 was tested positive for influenza A virus subtype H1 (human swine influenza), which did not show resistance to Tamiflu. However, the virus in the specimen taken on February 3 was found to be resistant to Tamiflu but sensitive to Relenza. It is likely that Tamiflu resistance emerged during the course of drug treatment.
The spokesman said there was no evidence of further transmission of Tamiflu-resistant HSI from the patient.
The case will be reported to the World Health Organisation.
The spokesman said that Hong Kong has an intensive surveillance system for antiviral resistant influenza viruses. The PHLSB conducts routine sensitivity tests on specimens taken from confirmed HSI patients.
"So far more than 6,800 HSI virus samples have been tested for antiviral sensitivity in Hong Kong," he said.
"We will closely liaise with the WHO and overseas health authorities to monitor the global development of antiviral-resistant HSI virus.?

http://www.dh.gov.hk/english/press/2011/110216.html

Case 11:
Department of Health - Press Release 17 Feb 2011
Snip
Another case of Tamiflu-resistant human swine influenza detected
The Department of Health's Public Health Laboratory Services Branch (PHLSB) today (February 17) detected another case of resistance to oseltamivir (Tamiflu) in a strain of human swine influenza (HSI) virus. A department spokesman said the virus was identified during PHLSB's routine sensitivity tests of the HSI virus to oseltamivir and zanamivir.
"This is the eleventh case of Tamiflu resistance to HSI virus detected in Hong Kong.
"Tests showed that this strain is sensitive to zanamivir (Relenza)," he said.
The virus was isolated from the specimen taken from a four-year-old girl who enjoyed good past health. She presented with fever and cough since February 4. She sought medical attention in the out-patient department of Canossa Hospital on February 7 and was prescribed with Tamiflu. No hospitalisation was required and the girl is now in stable condition.
One of her home contacts had influenza-like illness symptoms in early February before the girl developed symptoms and other home contacts were asymptomatic.
The virus in her nasopharyngeal aspirate specimen taken on February 7 tested positive for influenza A virus subtype H1N1 (human swine influenza) and was found to be resistant to Tamiflu but sensitive to Relenza.
The spokesman said there was no evidence of further transmission of Tamiflu-resistant HSI from the patient.
The case will be reported to the World Health Organisation.
The spokesman said that Hong Kong has an intensive surveillance system for antiviral resistant influenza viruses. The PHLSB conducts routine sensitivity tests on specimens taken from confirmed HSI patients.
"So far more than 6,800 HSI virus samples have been tested for antiviral sensitivity in Hong Kong," he said.
"We will closely liaise with the WHO and overseas health authorities to monitor the global development of antiviral-resistant HSI virus."

http://www.dh.gov.hk/english/press/2011/110217.html

Case 12:
Department of Health - Press Release 18 Feb 2011
Snip
?Another case of Tamiflu-resistant human swine influenza detected
The Department of Health's Public Health Laboratory Services Branch (PHLSB) today (February 18) detected another case of resistance to oseltamivir (Tamiflu) in a strain of human swine influenza (HSI) virus.
A department spokesman said the virus was identified during PHLSB's routine sensitivity tests of the HSI virus to oseltamivir and zanamivir.
"This is the twelfth case of Tamiflu resistance to HSI virus detected in Hong Kong.
"Tests showed that this strain is sensitive to zanamivir (Relenza)," he said.
The virus was isolated from the specimen taken from a two-year-old girl who enjoyed good past health. The girl presented with fever, cough and runny nose since February 11. She was admitted to Queen Mary Hospital on Feb 12. She has been discharged and is now in stable condition.
The virus in her nasopharyngeal specimen taken on February 13 tested positive for influenza A virus subtype H1N1 (human swine influenza) and was found to be resistant to Tamiflu but sensitive to Relenza.
One of her parents had influenza-like illness symptoms, sought medical attention and is in stable condition.
CHP's investigation continues.
The case will be reported to the World Health Organisation.
The spokesman said that Hong Kong has an intensive surveillance system for antiviral resistant influenza viruses. The PHLSB conducts routine sensitivity tests on specimens taken from confirmed HSI patients.
"So far more than 6,900 HSI virus samples have been tested for antiviral sensitivity in Hong Kong," he said.
"We will closely liaise with the WHO and overseas health authorities to monitor the global development of antiviral-resistant HSI virus."

http://www.dh.gov.hk/english/press/2011/110218-4.html

Case 13
Department of Health - Press Release 2 Mar 2011
Another case of Tamiflu-resistant human swine influenza detected
Snip
?The Department of Health's Public Health Laboratory Services Branch (PHLSB) today (March 2) detected the thirteenth case of resistance to oseltamivir (Tamiflu) in a strain of human swine influenza (HSI) virus in Hong Kong.
A department spokesman said the virus was identified during PHLSB's routine sensitivity tests of the HSI virus to oseltamivir and zanamivir.
"Tests showed that this strain is sensitive to zanamivir (Relenza)," he said.
The virus was isolated from the specimen taken from a 58-year-old lady who developed flu-like symptoms since February 6. She was admitted to Prince of Wales Hospital on the same day and her nasopharyngeal specimens taken on February 6, 8 and 9 tested positive for Influenza A virus subtype H1N1 (i.e. Human Swine Influenza) and were sensitive to Tamiflu.
Further test results today showed that the virus isolated from the patient?s nasopharyngeal aspirate on February 11 was resistant to Tamiflu but sensitive to Relenza. She had been prescribed with Tamiflu during hospitalisation and it is likely that Tamiflu resistance emerged during the course of drug treatment.
The patient has been transferred to Shatin Hospital in stable condition.
There was no evidence of further transmission of Tamiflu-resistant HSI from the patient.
The case will be reported to the World Health Organisation.
The spokesman said that Hong Kong has an intensive surveillance system for antiviral resistant influenza viruses. The PHLSB conducts routine sensitivity tests on specimens taken from confirmed HSI patients.
"So far more than 7,000 HSI virus samples have been tested for antiviral sensitivity in Hong Kong," he said.
"We will closely liaise with the WHO and overseas health authorities to monitor the global development of antiviral-resistant HSI virus."
Snip
?From March 3, cases of tamiflu resistance detected would be reported in the Centre for Health Protection?s weekly report, ?Flu Express? which monitors and summaries the latest local and global influenza activities.?

http://www.dh.gov.hk/english/press/2011/110302-2.html

Case 13, 14 and 15:
Snip
?In week 10, two cases of oseltamivir (Tamiflu) resistant human swine influenza infection involving a 58-year-old woman and a 65-year-old woman were reported. They are now in stable condition. In first 4 days of week 11 (March 6 to 9, 2011), one case of Tamiflu resistant human swine influenza infection involving a 1-year-old girl was detected. The girl is still under treatment for surgical problems in hospital. The virus strains detected in these cases were sensitive to zanamivir (Relenza). They are the thirteenth to fifteenth cases of resistance to Tamiflu in strains of human swine influenza virus detected in Hong Kong since 2009.?

http://chp.gov.hk/files/pdf/flu_express_week10_10_3_2011.pdf

Case 15 and 16:
Snip
?In week 10, two cases of oseltamivir (Tamiflu) resistant human swine influenza infection involving a 58-year-old woman and a 65-year-old woman were reported. They are now in stable condition. In first 4 days of week 11 (March 6 to 9, 2011), one case of Tamiflu resistant human swine influenza infection involving a 1-year-old girl was detected. The girl is still under treatment for surgical problems in hospital. The virus strains detected in these cases were sensitive to zanamivir (Relenza). They are the thirteenth to fifteenth cases of resistance to Tamiflu in strains of human swine influenza virus detected in Hong Kong since 2009.?

http://chp.gov.hk/files/pdf/flu_express_week10_10_3_2011.pdf

Case 16:
Snip
?In week 13, one case of oseltamivir (Tamiflu) resistant human swine influenza infection involving a 53-year-old male was reported. He had been discharged. The virus strain detected in this case was sensitive to zanamivir (Relenza). In first 4 days of week 14 (March 27 to 30, 2011), there was no new report of Tamiflu resistant human swine influenza infection. The man is the sixteenth case of resistance to Tamiflu in strains of human swine influenza virus detected in Hong Kong since 2009.

http://chp.gov.hk/files/pdf/flu_express_week13_31_3_2011.pdf

2012 (n=6)
Case 17:
Snip
?In week 8, one case of oseltamivir (Tamiflu) resistant influenza A(H1N1)2009 virus infection involving a 6-month-old boy was reported. He is now in severe condition. The virus strain detected was sensitive to zanamivir (Relenza). In first 4 days of week 9 (Feb 26 to 29, 2012), there were no new reports of oseltamivir (Tamiflu) resistant influenza A(H1N1)2009 virus infection. There are totally 17 reports of resistance to Tamiflu in strains of influenza A(H1N1)2009 virus detected in Hong Kong since 2009.?

http://www.chp.gov.hk/files/pdf/flu_express_wk8_01032012.pdf

Case 18:
Snip
?In week 11, one case of oseltamivir (Tamiflu) resistant influenza A(H1N1)2009 virus infection involving a 61-year-old man who had developed severe pneumonia was reported. He had been discharged. The virus strain detected was sensitive to zanamivir (Relenza). In the first 4 days of week 12 (Mar 18 to 21, 2012), there were no new reports of oseltamivir (Tamiflu) resistant influenza A(H1N1)2009 virus infection. There are totally 18 reports of resistance to Tamiflu in strains of influenza A(H1N1)2009 virus detected in Hong Kong since 2009.?

http://www.chp.gov.hk/files/pdf/flu_express_week11_22_3_2012.pdf

Case 19:
Snip
?In week 20, one case of oseltamivir (Tamiflu) resistant influenza A(H1N1)2009 virus infection involving a 3-year-old girl who had developed fever was reported. She had recovered. The virus strain detected was sensitive to zanamivir (Relenza). In the first 4 days of week 21 (May 20 to 23, 2012), there were no new reports of oseltamivir (Tamiflu) resistant influenza A(H1N1)2009 virus infection. There are totally 19 reports of resistance to Tamiflu in strains of influenza A(H1N1)2009 virus detected in Hong Kong since 2009.?

http://www.chp.gov.hk/files/pdf/flu_express_week20_24_5_2012.pdf

Case 20:
Snip
?In week 23, one case of oseltamivir (Tamiflu) resistant influenza A(H1N1)2009 virus infection involving a 1-year-old girl who had developed fever was reported. She had been discharged. The virus strain detected was sensitive to zanamivir (Relenza). In the first 4 days of week 24 (Jun 10 to 13, 2012), there were no new reports of oseltamivir (Tamiflu) resistant influenza A(H1N1)2009 virus infection. There are totally 20 reports of Tamiflu resistant influenza A(H1N1)2009 virus detected in Hong Kongsince 2009.?

http://www.chp.gov.hk/files/pdf/flu_express_week23_14_6_2012.pdf

Case 21:
Snip
?In week 30, one case of oseltamivir (Tamiflu) resistant influenza A(H1N1)2009 virus infection involving a 27-year-old female who had developed fever was reported. She had recovered. The virus strain detected was sensitive to zanamivir (Relenza). In the first 4 days of week 31 (Jul 29 to Aug 1, 2012), there were no new reports of oseltamivir (Tamiflu) resistant influenza A(H1N1)2009 virus infection. There are totally 21 reports of Tamiflu resistant influenza A(H1N1)2009 virus detected in Hong Kong since 2009.?

http://www.chp.gov.hk/files/pdf/flu_express_week30_2_8_2012.pdf

Case 22:
Snip
?In week 32, one case of oseltamivir (Tamiflu) resistant influenza A(H1N1)2009 virus infection involving a 85-year-old female who had developed fever was reported. She had been discharged. The virus strain detected was sensitive to zanamivir (Relenza). In the first 4 days of week 33 (Aug 12 to 15, 2012), there were no new reports of oseltamivir (Tamiflu) resistant influenza A(H1N1)2009 virus infection. There are totally 22 reports of Tamiflu resistant influenza A(H1N1)2009 virus detected in Hong Kong since 2009.?

http://www.chp.gov.hk/files/pdf/flu_express_week32_16_8_2012.pdf

2013 (n=3)
Case 23:
Snip
Surveillance of Tamiflu resistant influenza A(H1N1)2009 virus infection

?In week 5, there were no new reports of oseltamivir (Tamiflu) resistant influenza A(H1N1)2009 virus infection. In the first 4 days of week 6 (Feb 3 to 6, 2013), one case of oseltamivir (Tamiflu) resistant influenza A(H1N1)2009 virus infection involving a 4‐year‐old boy was reported. He had been discharged. The virus strain detected was sensitive to zanamivir (Relenza). There are totally 23 reports of Tamiflu resistant influenza A(H1N1)2009 virus detected in Hong Kong since 2009.?

http://www.chp.gov.hk/files/pdf/fluexpress_web_week5_7_2_2013_eng.pdf

Case 24:
Snip
Surveillance of Tamiflu resistant influenza A(H1N1)2009 virus infection

?In week 8, one case of oseltamivir (Tamiflu) resistant influenza A(H1N1)2009 virus infection involving a 62‐year‐old male was reported. He is now in stable condition. The virus strain detected was sensitive to zanamivir (Relenza). In the first 4 days of week 9 (Feb 24 to 27, 2013), there were no new reports of oseltamivir (Tamiflu) resistant influenza A(H1N1)2009 virus infection. There are totally 24 reports of Tamiflu resistant influenza A(H1N1)2009 virus detected in Hong Kong since 2009.?

http://www.chp.gov.hk/files/pdf/fluexpress_web_week8_28_2_2013_eng.pdf

Case 25
Snip
Surveillance of Tamiflu resistant influenza A(H1N1)2009 virus infection
In week 9, there were no new reports of oseltamivir (Tamiflu) resistant influenza A(H1N1)2009 virus infection. In the first 4 days of week 10 (Mar 3 to 6, 2013), one case of oseltamivir (Tamiflu) resistant influenza A(H1N1)2009 virus infection involving a 5‐month‐old boy was reported. He had been discharged. The virus strain detected was sensitive to zanamivir (Relenza). There are totally 25 reports of Tamiflu resistant influenza A(H1N1)2009 virus detected in Hong Kong since 2009.

http://www.chp.gov.hk/files/pdf/fluexpress_web_week9_7_3_2013_eng.pdf

[Biological]

Re: Oseltamivir‐Resistant Pandemic (H1N1) 2009 Virus in Hong Kong 2009-2013 (n=26)

Flu Express (Volume 10, Number 10) (Week 10, 2013) 14 March 2013
Surveillance of Tamiflu resistant influenza A(H1N1)2009 virus infection
Snip
Case 26
In week 10, two cases of oseltamivir (Tamiflu) resistant influenza A(H1N1)2009 virus infection involving a 5‐month‐old boy and a 23‐year‐old male were reported. They had been discharged. The virus strain detected in both cases was sensitive to zanamivir (Relenza). In the first 4 days of week 11 (Mar 10 to 13, 2013), there were no new reports of oseltamivir (Tamiflu) resistant influenza A(H1N1)2009 virus infection. There are totally 26 reports of Tamiflu resistant influenza A(H1N1)2009 virus detected in Hong Kong since 2009.

http://www.chp.gov.hk/files/pdf/fluexpress_week10_14_3_2013_eng.pdf

[Biological]

Re: N=28 Oseltamivir‐Resistant Pandemic (H1N1) 2009 Virus in Hong Kong 2009-2013

Flu Express (Volume 10, Number 11) (Week 11, 2013)
21 March 2013
Snip
Surveillance of Tamiflu resistant influenza A(H1N1)2009 virus infection

In week 11, one case of oseltamivir (Tamiflu) resistant influenza A(H1N1)2009 virus infection involving a 6‐year‐old girl was reported. She had recovered uneventfully. In the first 4 days of week 12 (Mar 17 to 20, 2013), one case of oseltamivir (Tamiflu) resistant influenza A(H1N1)2009 virus infection involving a 47‐year‐old male was reported. He is now in stable condition. The virus strain detected in both cases was sensitive to zanamivir (Relenza). There are totally 28 reports of Tamiflu resistant influenza A(H1N1)2009 virus detected in Hong Kong since 2009.

See further information:

http://www.chp.gov.hk/files/pdf/fluexpress_week11_21_3_2013_eng.pdf

[Biological]

Re: N=38 Oseltamivir‐Resistant Pandemic (H1N1) 2009 Virus in Hong Kong 2009-2013

Honk Kong Tamiflu resistant influenza A(H1N1)2009 (n=38)

Surveillance of Tamiflu resistant influenza A(H1N1)2009 virus infection (n=27)

In week 11, one case of oseltamivir (Tamiflu) resistant influenza A(H1N1)2009 virus infection involving a 6‐year‐old girl was reported. She had recovered uneventfully. In the first 4 days of week 12 (Mar 17 to 20, 2013), one case of oseltamivir (Tamiflu) resistant influenza A(H1N1)2009 virus infection involving a 47‐year‐old male was reported. He is now in stable condition. The virus strain detected in both cases was sensitive to zanamivir (Relenza). There are totally 28( edt. 27) reports of Tamiflu resistant influenza A(H1N1)2009 virus detected in Hong Kong since 2009.

http://www.chp.gov.hk/files/pdf/fluexpress_week11_21_3_2013_eng.pdf

--
Surveillance of Tamiflu resistant influenza A(H1N1)2009 virus infection (n=29) 2 cases
In week 12, two cases of oseltamivir (Tamiflu) resistant influenza A(H1N1)2009 virus infection involving a 47‐year‐old male and a 1‐year‐old boy were reported. Both of them are now in stable condition. The virus strain detected in both cases was sensitive to zanamivir (Relenza). In the first 4 days of week 13 (Mar 24 to 27, 2013), there were no new reports of oseltamivir (Tamiflu) resistant influenza A(H1N1)2009 virus infection. There are totally 29 reports of Tamiflu resistant influenza A(H1N1)2009 virus detected in Hong Kong since 2009.

http://www.chp.gov.hk/files/pdf/fluexpress_week12_28_3_2013_eng.pdf

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Surveillance of Tamiflu resistant influenza A(H1N1)2009 virus infection (n=30)

In week 13, one case of oseltamivir (Tamiflu) resistant influenza A(H1N1)2009 virus infection involving a 52‐year‐old female was reported. Her condition deteriorated and she passed away. The virus strain detected was sensitive to zanamivir (Relenza). In the first 5 days of week 14 (Mar 31 to Apr 4, 2013), there were no new reports of oseltamivir (Tamiflu) resistant influenza A(H1N1)2009 virus infection. There are totally 30 reports of Tamiflu resistant influenza A(H1N1)2009 virus detected in Hong Kong since 2009.

http://www.chp.gov.hk/files/pdf/fluexpress_week13_5_4_2013_eng.pdf

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Surveillance of Tamiflu resistant influenza A(H1N1)2009 virus infection (n=31)

In week 21, one case of oseltamivir (Tamiflu) resistant influenza A(H1N1)2009 virus infection involving a 55‐year‐old lady was reported. She had recovered uneventfully. The virus strain detected in this case was sensitive to zanamivir (Relenza). In first 4 days of week 22 (May 26 to 29, 2013), there were no new reports of oseltamivir (Tamiflu) resistant influenza A(H1N1)2009 virus infection. There are totally 31 reports of Tamiflu resistant influenza A(H1N1)2009 virus detected in Hong Kong since 2009.

http://www.chp.gov.hk/files/pdf/fluexpress_week21_30_5_2013_eng.pdf

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Surveillance of Tamiflu resistant influenza A(H1N1)2009 virus infection (n=32)

In week 27, one case of oseltamivir (Tamiflu) resistant influenza A(H1N1)2009 virus infection involving a 44‐year‐old lady was reported. She had recovered uneventfully. The virus strain detected in this case was sensitive to zanamivir (Relenza). In first 4 days of week 28 (Jul 7 to 10, 2013), there were no new reports of oseltamivir (Tamiflu) resistant influenza A(H1N1)2009 virus infection. There are totally 32 reports of Tamiflu resistant influenza A(H1N1)2009 virus detected in Hong Kong since 2009.

http://www.chp.gov.hk/files/pdf/fluexpress_week27_7_11_2013_eng.pdf

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Surveillance of Tamiflu resistant influenza A(H1N1)2009 virus infection (n=33)

In week 30, one case of oseltamivir (Tamiflu) resistant influenza A(H1N1)2009 virus infection involving a 74‐year‐old female was reported. She is now in stable condition. The virus strain detected in this case was sensitive to zanamivir (Relenza). In the first 4 days of week 31 (Jul 28 to 31, 2013), there were no new reports of oseltamivir (Tamiflu) resistant influenza A(H1N1)2009 virus infection. There are totally 33 reports of Tamiflu resistant influenza A(H1N1)2009 virus detected in Hong Kong since 2009.

http://www.chp.gov.hk/files/pdf/fluexpress_web_week30_1_8_2013_eng.pdf

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Surveillance of Tamiflu resistant influenza A(H1N1)2009 virus infection (n=35)

In week 33, two cases of oseltamivir (Tamiflu) resistant influenza A(H1N1)2009 virus infection involving a 1‐year‐old girl and a 56‐year‐old man were reported. The girl is now in stable condition, and the man has been discharged. The virus strains detected in both cases were sensitive to zanamivir (Relenza). In the first 4 days of week 34 (Aug 18 to 21, 2013), there were no new reports of oseltamivir (Tamiflu) resistant influenza A(H1N1)2009 virus infection. There are totally 35 reports of Tamiflu resistant influenza A(H1N1)2009 virus detected in Hong Kong since 2009.

http://www.chp.gov.hk/files/pdf/fluexpress_web_week33_22_8_2013_eng.pdf

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Surveillance of Tamiflu resistant influenza A(H1N1)2009 virus infection (n=36)

In week 38, one case of oseltamivir (Tamiflu) resistant influenza A(H1N1)pdm09 virus infection involving a 6‐year‐old boy was reported. He had been discharged. The virus strain detected was sensitive to zanamivir (Relenza). In the first 4 days of week 39 (Sep 22 to 25, 2013), there were no new reports of oseltamivir (Tamiflu) resistant influenza A(H1N1)pdm09 virus infection. There are totally 36 reports of Tamiflu resistant influenza A(H1N1)pdm09 virus detected in Hong Kong since 2009.

http://www.chp.gov.hk/files/pdf/fluexpress_web_week38_26_9_2013_eng.pdf

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Surveillance of Tamiflu resistant influenza A(H1N1)2009 virus infection (n=37)

In week 40, one case of oseltamivir (Tamiflu) resistant influenza A(H1N1)pdm09 virus infection involving a 2‐year‐old boy was reported. He had been discharged. The virus strain detected was sensitive to zanamivir (Relenza). In the first 4 days of week 41 (Oct 6 to 9, 2013), there were no new reports of oseltamivir (Tamiflu) resistant influenza A(H1N1)pdm09 virus infection. There are totally 37 reports of Tamiflu resistant influenza A(H1N1)pdm09 virus detected in Hong Kong since 2009.

http://www.chp.gov.hk/files/pdf/fluexpress_web_week40_10_10_2013_eng.pdf

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Honk Kong Tamiflu resistant influenza A(H1N1)2009
New update
Surveillance of Tamiflu resistant influenza A(H1N1)2009 virus infection (n=38)

In week 49, one case of oseltamivir (Tamiflu) resistant influenza A(H1N1)pdm09 virus infection involving a 31‐year‐old male was reported. He had been discharged. The virus strain detected was sensitive to zanamivir (Relenza). In the first 4 days of week 50 (Dec 8 to 11, 2013), there were no new reports of oseltamivir (Tamiflu) resistant influenza A(H1N1)pdm09 virus infection. There are totally 38 reports of Tamiflu resistant influenza A(H1N1)pdm09 virus detected in Hong Kong since 2009.

http://www.chp.gov.hk/files/pdf/fluexpress_web_week49_12_12_2013_eng.pdf

[Biological]

Re: N=39 Oseltamivir‐Resistant Pandemic (H1N1) 2009 Virus in Hong Kong 2009-2013

Surveillance of Tamiflu resistant influenza A(H1N1)2009 virus infection (n=39)

Flu Express (Volume 10, Number 50) (Week 50, 2013)

Surveillance of Tamiflu resistant influenza A(H1N1)pdm09 virus infection

In week 50, one case of oseltamivir (Tamiflu) resistant influenza A(H1N1)pdm09 virus infection involving a 13‐year‐old boy was reported. He had been discharged. The virus strain detected was sensitive to zanamivir (Relenza). In the first 4 days of week 51 (Dec 15 to 18, 2013), there were no new reports of oseltamivir (Tamiflu) resistant influenza A(H1N1)pdm09 virus infection. There are totally 39 reports of Tamiflu resistant influenza A(H1N1)pdm09 virus detected in Hong Kong since 2009.

http://www.chp.gov.hk/files/pdf/fluexpress_web_week50_19_12_2013_eng.pdf

I'm not sure how to bump the title to 39 on Forum page!

[Biological]

Re: N=41 Oseltamivir‐Resistant Pandemic (H1N1) 2009 Virus in Hong Kong 2009-2013

Flu Express (Volume 11, Number 2) (Week 2, 2014)
16 January 2014
Surveillance of Tamiflu resistant influenza A(H1N1)pdm09 virus infection

In week 2, there were no new reports of oseltamivir (Tamiflu) resistant influenza A(H1N1)pdm09 virus infection. In the first 4 days of week 3 (Jan 12 to 15, 2014), there were two new reports of oseltamivir (Tamiflu) resistant influenza A(H1N1)pdm09 virus infection involving a 17‐month‐old boy and a 4‐year old boy were reported. They had been discharged. The virus strains detected were sensitive to zanamivir (Relenza). There are totally 41 reports of Tamiflu resistant influenza A(H1N1)pdm09 virus detected in Hong Kong since 2009.

http://www.chp.gov.hk/files/pdf/fluexpress_web_week2_16_1_2014_eng.pdf

[JJackson]

Re: N=41 Oseltamivir‐Resistant Pandemic (H1N1) 2009 Virus in Hong Kong 2009-2013

Unfortunately they seem to have stopped putting in as much data as they did in the first cases. There are 3 key bits of data missing which are needed to make sense of the case numbers.
Was the patient immunocompromised to some degree?
Was the patient on Tamiflu prior to testing (i.e. possibly induced by treatment)?
Which NA change was associated with the reduced susceptibility?

The first two items were given in the early cases but all three are need in the release template, even if sequence data is not immediately available and has to be added in a later release.
Raw numbers are of limited use without this associated data.

Why?
Immunodeficient patients are a resistance development nightmare as they fail to clear infections even with the aid of drugs. This gives the pathogen time to keep trying different genetic combination until it finds a drug resistant one. At this point it is critical the patient remains isolated from the general population in case they have found a drug resistant form that can compete with the wild types.

Oseltamivir has been know to regularly throw up resistance, in those under treatment, but normally these are associated with a fitness penalty which causes the resultant strain to be out performed once in an untreated host. Without this information we have no way of knowing how many of the resistant strains were acquired at infection (already fit) and how many developed under treatment (more likely to be an evolutionary dead end).

Oseltamivir (Tamiflu) is know to suffer differing levels of resistance conferred by a number of Single Point Mutations (SNPs) on the NA strand. Which of these is causing the resistance is useful data - particularly in conjunction with the 'community acquired'/'developed during treatment' data - so we know which SNP(s) have found a home in the fit wild-type gene pool.

[Biological]

Re: N=41 Oseltamivir‐Resistant Pandemic (H1N1) 2009 Virus in Hong Kong 2009-2013

Flu Express (Volume 11, Number 2) (Week 3-9 2014)


Surveillance of Tamiflu resistant influenza A(H1N1)pdm09 virus infection (2 cases)

In week 3, there were two new reports of oseltamivir (Tamiflu) resistant influenza A(H1N1)pdm09 virus infection involving a 17‐month‐old boy and a 4‐year old boy were reported. They had been discharged. The virus strains detected were sensitive to zanamivir (Relenza). In the first 4 days of week 4 (Jan 19 to 22, 2014), there were no new reports of oseltamivir (Tamiflu) resistant influenza A(H1N1)pdm09 virus infection. There are totally 41 reports of Tamiflu resistant influenza A(H1N1)pdm09 virus detected in Hong Kong since 2009.

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Surveillance of Tamiflu resistant influenza A(H1N1)pdm09 virus infection

In week 4, there were no new reports of oseltamivir (Tamiflu) resistant influenza A(H1N1)pdm09 virus infection. In the first 4 days of week 5 (Jan 26 to 29, 2014), three new reports of oseltamivir (Tamiflu) resistant influenza A(H1N1)pdm09 virus infection involving three males were reported. Their ages ranged from 3 to 84 years. They had been discharged. The virus strains detected were sensitive to zanamivir (Relenza). There are totally 44 reports of Tamiflu resistant influenza A(H1N1)pdm09 virus detected in Hong Kong since 2009.

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Surveillance of Tamiflu resistant influenza A(H1N1)pdm09 virus infection (3 cases)

In week 5, three new reports of oseltamivir (Tamiflu) resistant influenza A(H1N1)pdm09 virus infection involving three males were reported. Their ages ranged from 3 to 84 years. They had been discharged. The virus strains detected were sensitive to zanamivir (Relenza). In the first 4 days of week 6 (Feb 2 to 5, 2014), there were no new reports of oseltamivir (Tamiflu) resistant influenza A(H1N1)pdm09 virus infection. There are totally 44 reports of Tamiflu resistant influenza A(H1N1)pdm09 virus detected in Hong Kong since 2009.

[pending age of one case!]
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Surveillance of Tamiflu resistant influenza A(H1N1)pdm09 virus infection (One case)

In week 6, one new report of oseltamivir (Tamiflu) resistant influenza A(H1N1)pdm09 virus infection involving an 1‐year‐old boy was reported. He had been discharged. The virus strain detected was sensitive to zanamivir (Relenza). In the first 4 days of week 7 (Feb 9 to 12, 2014), there were no new reports of oseltamivir (Tamiflu) resistant influenza A(H1N1)pdm09 virus infection. There are totally 45 reports of Tamiflu resistant influenza A(H1N1)pdm09 virus detected in Hong Kong since 2009.

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Surveillance of Tamiflu resistant influenza A(H1N1)pdm09 virus infection

In week 7 and the first 4 days of week 8 (Feb 16 to 19, 2014), there were no new reports of oseltamivir (Tamiflu) resistant influenza A(H1N1)pdm09 virus infection. There are totally 45 reports of Tamiflu resistant influenza A(H1N1)pdm09 virus detected in Hong Kong since 2009.

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Surveillance of Tamiflu resistant influenza A(H1N1)pdm09 virus infection (one case)

In week 8, one new report of oseltamivir (Tamiflu) resistant influenza A(H1N1)pdm09 virus infection involving an 48‐year‐old man was reported. He is now in serious condition. The virus strain detected was sensitive to zanamivir (Relenza). In the first 4 days of week 9 (Feb 23 to 26, 2014), there were no new reports of oseltamivir (Tamiflu) resistant influenza A(H1N1)pdm09 virus infection. There are totally 46 reports of Tamiflu resistant influenza A(H1N1)pdm09 virus detected in Hong Kong since 2009.

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Surveillance of oseltamivir resistant influenza A(H1N1)pdm09 virus infection

In week 9 and the first 4 days of week 10 (Mar 2 to 5, 2014), there were no new reports of oseltamivir (Tamiflu) resistant influenza A(H1N1)pdm09 virus infection. There are totally 46 reports of oseltamivir resistant influenza A(H1N1)pdm09 virus detected in Hong Kong since 2009.

I'll hyperlink these soon!

[Biological]

Re: N=41 Oseltamivir‐Resistant Pandemic (H1N1) 2009 Virus in Hong Kong 2009-2013

Communicable Disease Watch Feb 16 - Mar 1, 2014 WEEKS 8-9 VOL 11 ISSUE NO 5
Human Infections with Oseltamivir-resistant Influenza A(H1N1)pdm09 Virus in Hong Kong
Reported by Dr Henry YH Mou, Medical and Health Officer, Respiratory Disease Office, Surveillance andEpidemiology Branch, CHP.
Clip:

In Hong Kong, antiviral susceptibility testing for influenza viruses is available at the Public Health Laboratory Services Branch of the Centre for Health Protection (CHP).

Below we summarised the human cases of oseltamivir-resistant influenza A(H1N1) pdm09 virus infection.

From May 2009 to February 2014, more than 2,700 influenza A(H1N1)pdm09 viruses were tested for oseltamivir resistance in Hong Kong. Among them, a total of 46 reports (<2&#37; of tested samples) of oseltamivir-resistant influenza A(H1N1)pdm09 virus were detected.

The cases affected 26 males and 20 females with a male to female ratio of 1.3:1.

Their ages ranged from 5 months to 85 years (median: 16 years).

Most of them (87%) were known to acquire the infection locally.

No epidemiological linkage was identified among the cases.

The annual number of cases detected ranged from 1 to 17 during the period between 2009 and 2013.

The monthly number of cases ranged from 0 to 6.

Fifteen cases (33%) had known exposure to a full course of oseltamivir before the collection of specimens.

Among the 44 cases with information available, 26 cases (59%) enjoyed good past health.

The remaining 18 cases had one or more underlying medical conditions such as hypertension, diabetes, chronic lung diseases, malignant conditions, etc.

There was one fatal case affecting a 52 years old female who had multiple chronic medical conditions including hypertension, diabetes and depression.
It was also noted that five cases were known to have conditions that resulted in immunosuppressed or immunocompromised state.

Acknowledgement- H/T to CHP for summarising exposure and UMC cases!

Please see hyperlink-

http://www.chp.gov.hk/files/pdf/cdw_v11_5.pdf

Please bump to 46 cases and edit date----May 2009-2014!

[JJackson]

Re: N=41 Oseltamivir‐Resistant Pandemic (H1N1) 2009 Virus in Hong Kong 2009-2013

Thank you CHP for adding the additional data on immune status and Oseltamivir treatment. I doubt my Email had anything to do with it but, regardless of the reason, thanks.