Announcement

**HenryN** · January 10, 2009, 03:56 PM

Re: Influenza Warning Issued Nationwide (South Korea)

The overall proportion of patients, who visited sentinel physicians for influenzalike
illness (ILI) was 2.3‰ for week 49 This permillage is below the national

baseline of 2.6‰.

39 influenza viruses were isolated until the 49th week in 2008-2009 season.

34 viruses were identified as A/H1 type and 5 viruses were identified as A/H3

type.

http://dis.cdc.go.kr/Influenza/download/200849%20Influenza%20Weekly%20Report.pdf

**HenryN** · January 10, 2009, 03:59 PM

Re: Influenza Warning Issued Nationwide (South Korea)

The overall proportion of patients, who visited sentinel physicians for influenza like
illness (ILI) was 3.6‰ for week 50 This permillage is below the national baseline of 2.6‰.

95 influenza viruses were isolated until the 50th week in 2008-2009 season.

82 viruses were identified as A/H1 type and 13 viruses were identified as A/H3

type.

http://dis.cdc.go.kr/Influenza/download/200850%20Influenza%20Weekly%20Report.pdf

**HenryN** · January 10, 2009, 04:01 PM

Re: Influenza Warning Issued Nationwide (South Korea)

The overall proportion of patients, who visited sentinel physicians for influenza like
illness (ILI) was 8.4‰ for week 51 This permillage is above the national

baseline of 2.6‰.

322 influenza viruses were isolated until the 51th week in 2008-2009 season.

296 viruses were identified as A/H1 type and 26 viruses were identified as A/H3

type.

http://dis.cdc.go.kr/Influenza/download/200851%20Influenza%20Weekly%20Report.pdf

**HenryN** · January 10, 2009, 04:03 PM

Re: Influenza Warning Issued Nationwide (South Korea)

The overall proportion of patients, who visited sentinel physicians for influenza like
illness (ILI) was 15.39? for week 52 This permillage is above the national

baseline of 2.6?.

815 influenza viruses were isolated until the 52

th week in 2008-2009 season.
767 viruses were identified as A/H1 type, 46 viruses were identified as A/H3

type and 2 viruses were identified as B type.

http://dis.cdc.go.kr/Influenza/download/200852%20Influenza%20Weekly%20Report.pdf

**HenryN** · January 10, 2009, 04:17 PM

Re: Influenza Warning Issued Nationwide (South Korea)

2008년 1월 노르웨이에서 Oseltamivir에 내성을 가진 인플루엔자 A/H1형 바이러스 발생이 보고된 이후, 전 세계에서 이러한 내성주 발생이 계속 증가되는 추세를 보이고 있으며, 2008-2009 절기 들어 미국은 A/H1N1형 인플루엔자 바이러스에서의 Oseltamivir에 대한 내성 증가 양상을 보고한 바 있다(ProMed, 2008.12.20). 우리나라도 이러한 상황의 중요성을 인식하고 2007-2008 절기 동안 유행했던 인플루엔자 바이러스 A/H1, A/H3, B형의 NA 억제제에 대한 내성 양상을 조사하였으며 모두 Oseltamivir에 대해 감수성이 있는 것으로 실험되었다.
그러나 2008-2009 절기 들어 2008년 37주(2008.9.7-9.13)부터 50주(2008.12.7-12.13)까지 국내에서 분리된 A형 인플루엔자 바이러스 중 27주(A/H1N1 17주, A/H3N2 10주)를 대상으로 인플루엔자 치료제인 Neuraminidase (NA) 억제제(Oseltamivir 및 Zanamivir)에 대해 유전형 및 표현형을 분석한 결과, 내성주의 국내 유행이 확인되었다. 유전형 분석을 위해 분리주의 NA 전체 유전자에 대한 염기서열 분석에서는, A/H1N1형 인플루엔자 바이러스 17주 중 16주(94.1&#37

에서 내성주가 확인되었고 반면, A/H3N2형 인플루엔자 바이러스 10주는 모두 감수성주로 나타났다. 또한 A형 인플루엔자 바이러스 27주를 대상으로 NA 억제제(Zanamivir 및 Oseltamivir)에 대해 표현형 분석 방법인 fluorometric NA inhibition assay를 이용하여 50% 억제농도(50% Inhibitory Concentration, IC50)를 조사하였다. 그 결과 국내 인플루엔자 바이러스 A/H1N1형 분리주는 Oseltamivir에 대한 IC50 값이 내성주 범위에 속했으며, Zanamivir에 대해서는 감수성주 범위에 포함되었다. A/H3N2의 경우 Oseltamivir 및 Zanamivir에 대해 모두 감수성주 범위에 속해, 실험 대상주는 NA 억제제에 모두 감수성인 것으로 나타났다. 그리고 또 다른 항바이러스제인 M2 단백 억제제(Amantadine)에 대한 내성 조사를 위하여 M2 유전자에 대한 염기서열 분석 결과, A/H1N1 17주 중 1주(5.9%)와 A/H3N2 10주 중 10주 모두(100%)에서 내성주로 분석되었다.
2008-2009 절기 동안 현재까지 수행된 국내 인플루엔자 바이러스 분리주의 항바이러스제에 대한 내성 양상은 표 1과 같다. 향후 2008-2009 절기 동안 분리되는 인플루엔자 바이러스에 대한 항바이러스제 내성 분석을 지속적으로 수행할 예정이며, 관련 자료를 국내외에 제공함으로써 효과적인 인플루엔자 치료제 사용 및 관리에 활용하고자 한다.

질병보건통합관리시스템

http://translate.google.com/translate?prev=&hl=en&u=http%3A%2F%2Fwww.cdc.go.kr%2Fkcdchome.portal&sl=ko&tl=en

**HenryN** · January 10, 2009, 04:21 PM

Re: Influenza Warning Issued Nationwide (South Korea)

The antiviral resistance was based on the first 17 isolates tested. 16/17 had H274Y (Tamiflu resistant), while 1/17 had S31N in M2 (Adamantane resistant).

**HenryN** · January 10, 2009, 05:10 PM

Re: Influenza Warning Issued Nationwide (South Korea)

Commentary

H1N1 Tamiflu Resistance In Korea Raises Pandemic Concerns

http://www.recombinomics.com/News/01100902/H274Y_Korea_Pandemic.html

Recombinomics Commentary

**HenryN** · January 10, 2009, 06:35 PM

Re: Influenza Warning Issued Nationwide (South Korea)

Last season Korea reported H274Y in 0/98 H1N1 isolates.

**AlaskaDenise** · January 10, 2009, 06:52 PM

Re: Influenza Warning Issued Nationwide (South Korea)

Originally posted by niman View Post

Commentary

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

Commentary

H1N1 Tamiflu Resistance In Korea Raises Pandemic Concerns

Recombinomics Commentary 22:01
January 10, 2009

A/H1N1 17 16 (94.1%) Oseltamivir
A/H1N1 17 1 (5.9%) Amantadine

The above translation is from the Korean CDC report on antiviral resistance in Korea this season. 16/17 H1N1 isolates were resistance to oseltamivir, while 1/17 was resistant to amantadine. These data indicate the H274Y levels in H1N1 were approaching 100%, as was seen in Japan.

In Japan, the H1N1 was sequenced and H274Y was identified in NA, while G189V, A193T, and H186R were identified in HA from three identical H1N1 isolates from Sendai, Japan. Those isolates were associated with the closing of 10 elementary schools and match H1N1 isolates from the United States (in HI, TX, PA). In the United States the level of H274Y was also approaching 100% (86/88).

These data indicate H274Y has become fixed throughout most if not all of the northern hemisphere. Resistance levels in Canada and Europe are also at or near 100%.

South Korea has issued an alert as ILI physician visits crossed baseline line levels in week 50. H1N1 levels exploded in weeks 51 and 52, suggesting that oseltamivir resistance was associated with an aggressive virus.

This dramatic increase in South Korea raises concerns of transfer of H274Y from H1N1 to H5N1. Two years ago there was a significant H5N1 outbreak in Korea at the end of 2006. That was followed by a larger outbreak in the spring of 2008. In the 2008 outbreak, one culler developed bird flu symptoms and was PCR H5 confirmed. This H5N1 history raises concerns of co-infections involving H5N1 and H1N1.

This concern extends to Japan, which has also had H5N1 outbreaks that coincided with outbreaks in South Korea. Japan is planning an aggressive H5N1 vaccine program for first responders which may be significantly expanded into the general population.

The high levels of H274Y in virtually all aggressive H1N1 in at least two countries in Asia with a history of H5N1 infections are causes for concern. Moreover, the H274Y levels in Korea and Japan suggest other countries in Asia, including China, have similar levels of H274Y, since last season Japan and South Korea had significant levels of clade 2C, which was adamantine resistant but oseltamivir sensitive.

The fixing of H274Y in H1N1 in Asia significantly increases pandemic concerns.

.

**HenryN** · January 13, 2009, 11:00 AM

Re: Influenza Warning Issued Nationwide (South Korea)

INFLUENZA A(H1N1) VIRUS, OSELTAMIVIR RESISTANCE: KOREA
************************************************** ****
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Mon 12 Jan 2008
From: Jang-Hoon Choi <nimbus@cdc.go.kr>

The Korean Centre for Disease Control (CDC) reported on Friday [9 Jan 2009]
that oseltamivir-resistant A/H1N1 strains have been found through the
Korean Influenza Surveillance Scheme (KISS) during the period 7 Sep to 13
Dec 2008. This is the 1st case of oseltamivir-resistant A/H1N1 in Korea.

The Korean CDC performed both genetic and phenotypic analysis of the
neuraminidase gene of Korean isolates during the 2008-2009 season for the
monitoring of drug resistance. From 7 Sep to 13 Dec 2008, a total of 244
influenza viruses (220 A/H1N1 and 24 A/H3N2) were isolated, and 17 A/H1N1
(7.7 per cent, 17/220) and 10 A/H3N2 (41.7 per cent, 10/24) were tested for
oseltamivir and zanamivir resistance. We found 16 oseltamivir-resistant
A/H1N1 (94.1 per cent, 16/17) and could not find any oseltamivir-resistant
A/H3N2 strains. There were no isolates resistant to zanamivir among 27
viruses (0.0 per cent, 0/27).

We also tested amantadine-resistance for these isolates (17 A/H1N1 and 10
A/H3N2). The rate of resistance against amantadine of A/H1N1 and A/H3N2 was
5.9 per cent (1/17) and 100 per cent (10/10), respectively.

--
Jang-Hoon Choi
<nimbus@cdc.go.kr>

[Seasonal influenza A viruses, including 2 subtypes (H1N1 and H3N2), and
influenza B viruses currently circulate worldwide, but the prevalence of
each can vary among communities and within a single community over the
course of an influenza season. In the United States, 4 antiviral
medications (oseltamivir and zanamivir [neuraminidase inhibitors],
amantadine and rimantadine [M2 protein inhibitors]) are approved for
treatment and chemoprophylaxis of influenza.

Since January 2006, the neuraminidase inhibitors (oseltamivir, zanamivir)
have been the only recommended influenza antiviral drugs because of
widespread resistance to the adamantanes (amantadine, rimantadine) among
influenza A (H3N2) virus strains. The neuraminidase inhibitors have
activity against influenza A and B viruses, while the adamantanes have
activity only against influenza A viruses. In 2007-08, a significant
increase in the prevalence of oseltamivir resistance was reported among
influenza A (H1N1) viruses worldwide. During the 2007-08 influenza season,
10.9 per cent of H1N1 viruses tested in the US were resistant to oseltamivir.

In Europe, 3 countries (Norway, Sweden, and the UK) have reported
sequence-based antiviral testing with the majority of those viruses
analysed from the UK also being assessed phenotypically for neuraminidase
inhibitor susceptibility. 58 A(H3N2) viruses have been tested for antiviral
susceptibility so far this season (2008-2009); all those tested were
sensitive to neuraminidase inhibitors (58 for oseltamivir, 56 for
zanamivir) and resistant to the M2 inhibitors (56). Of 30 A(H1N1) viruses
analysed, all were sensitive to zanamivir, and 29 were resistant to
oseltamivir, whilst all of the 19 tested were M2 inhibitor sensitive. Both
B viruses tested were sensitive to neuraminidase inhibitors (one was tested
against both zanamivir and oseltamivir and one against oseltamivir only).
The 1st oseltamivir-resistant H1N1 virus appeared in Norway, a couintry
where the drug had not been in common use. Since H3N2 viruses are currently
the predominant type of influenza virus in Europe, H1N1
oseltamivir-resistant virus is not at the present time considered to be an
immediate hazard.

Further information on the Korean situation would be welcomed. - Mod.CP]

[see also:
2008
---
Influenza A (H1N1) virus, oseltamivir resistance (10): CDC 20081224.4054
Influenza A (H1N1) virus, oseltamivir resistance (09): USA 20081220.4013
Influenza A (H1N1) virus, oseltamivir resistance (08): Europe 20081025.3375
Influenza A (H1N1) virus, oseltamivir resistance (07): Europe 20080906.2783
Influenza A (H1N1) virus, oseltamivir resistance (06): S. Hemisphere
20080825.2648
Influenza virus, oseltamivir resistance (06): Japan 20080228.0812
Influenza A (H1N1) virus, oseltamivir resistance (05): China (HK)
20080203.0438
Influenza A (H1N1) virus, oseltamivir resistance (03): corr. 20080203.0430
Influenza A (H1N1) virus, oseltamivir resistance (04): CA, USA 20080202.0428
Influenza A (H1N1) virus, oseltamivir resistance (03): Europe 20080201.0399
Influenza A (H1N1) virus, oseltamivir resistance (02): Europe 20080129.0371
Influenza A (H1N1) virus, oseltamivir resistance - Norway 20080128.0361
2006
---
Avian influenza, human (162): oseltamivir resistance 20061010.2907]

...................cp/msp/sh

**HenryN** · January 13, 2009, 11:30 AM

Re: Influenza Warning Issued Nationwide (South Korea)

Originally posted by niman View Post

The overall proportion of patients, who visited sentinel physicians for influenza like

illness (ILI) was 15.39? for week 52 This permillage is above the national

baseline of 2.6?.

815 influenza viruses were isolated until the 52

th week in 2008-2009 season.

767 viruses were identified as A/H1 type, 46 viruses were identified as A/H3

type and 2 viruses were identified as B type.

http://dis.cdc.go.kr/Influenza/downl...y%20Report.pdf

cold 1,000 patients at 18 out gamyeombyeong Center for Disease Control statistics, the influenza virus that was the last team in the first week, lawmakers found a bottle of cold symptoms in patients were 17.6 of the 1000 people infected with the influenza virus have the potential to hwanjail said.

이는 지난해 같은 기간 10명 미만이었던 것에 비해서도 크게 높고, 유행 판단 기준인 1000명당 2.6명을 훨씬 넘어선 수치이다.

Less than 10 people to the same period last year was significantly higher than, 2.6 per 1000 in the standard fashion that is far beyond the numbers.

게다가 적은 비율이기는 하지만 일부 인플루엔자 바이러스는 치료약에도 내성을 보여, 치료제를 써도 효과가 없는 것으로 나타나고 있다.

And a small percentage, but some flu virus resistant to the medicine show, the drug use are not working.

질병관리본부는 ?인플루엔자 바이러스의 감염 예방을 위해서는 개인위생 수칙은 물론 예방접종에 더욱 주의를 기울여야 한다?고 밝혔다.

Disease control headquarters "to prevent the infection of influenza virus, as well as personal hygiene rules will be paid more attention to vaccination," he said.

유행성 독감 급증 “지금이라도 예방접종을”

http://translate.google.com/translate?hl=en&sl=ko&u=http://www.hani.co.kr/arti/specialsection/life20/332818.html&sa=X&oi=translate&resnum=2&ct=result&prev=/search%3Fq%3D%25EC%259D%25B8%25ED%2594%258C%25EB%25A3%25A8%25EC%2597%2594%25EC%259E%2590%26hl%3Den%26lr%3D%26rlz%3D1T4TSHA_enUS307%26as_qdr%3Dd

최근 ‘유행성 독감’ 즉 인플루엔자 바이러스에 감염된 것으로 의심되는 환자의 비율이 크게 늘고 있다. 지난달 초에 유행 판단 기준을 넘긴 뒤 올해 첫 주에도 감염 의심 환자가 계속 늘어가고 있다. 유행성 독감은 인플루엔자 바이러스가 원인으로 감기와 비슷하게 기침, 열,

**HenryN** · January 13, 2009, 12:43 PM

Re: Influenza Warning Issued Nationwide (South Korea)

Commentary

Korean Tamiflu Resistant H1N1 Outbreak Grows

http://www.recombinomics.com/News/01130901/H274Y_Korea_Rises.html

Recombinomics Commentary

**AlaskaDenise** · January 13, 2009, 05:41 PM

Re: Influenza Warning Issued Nationwide (South Korea)

Originally posted by niman View Post

Commentary

http://www.recombinomics.com/News/01130901/H274Y_Korea_Rises.html

Korean Tamiflu Resistant H1N1 Outbreak Grows
Recombinomics Commentary 17:34
January 13, 2009

symptoms in patients were 17.6 of the 1000 people

The above translation indicates influenza like illness in South Korea continues to increase. The baseline is 2.6 and in the last three weekly reports, the frequency increased to 3.6 to 8.4 to 15.4 for weeks 50, 51, 52, respectively. Last season the frequency formed two peaks. The first peak at week 52 was approximately 7, while the peak for the season was just below 10 in week 9. Thus, the current rise is almost double the highest level last season.

Moreover, most of these cases are likely to be H1N1 and Tamiflu resistant. Today?s ProMED report confirmed last week's KCDC report of 16/17 tested H1N1 isolates having H274Y. Moreover, the week 52 report indicated 767/815 sub-typed isolates were H1N1. The numbers were dramatically higher than the week 51 report, where 296/322 sub-typed isolates to date were H1N1.

The high level of Tamiflu resistance is not a surprise. The WHO reported that 13/14 H1N1 isolates from Japan had H274Y, and levels are approaching, or have reached, 100% in the United States, Canada, and multiple countries in Europe.

The sequences at an outbreak at 10 elementary schools in Sendai, Japan, matched the dominant sub-clade reported to date in the United States (HI, TX, PA) this season. In addition to the HA change, A193T, driving the fixing of H274Y in H1N1 worldwide, the sequences have two flanking acquisitions, G189V and H196R. Moreover, an outbreak of ILI has been reported at a Taylor High School in Williamson County in central Texas. All influenza sub-typed to date in Texas has been H1N1.

None of these changes are in the current H1N1 Brisbane/59 vaccine.

The dramatic increase in ILI in Korea, coupled with a dominant Tamiflu resistant H1N1 reported throughout the country, raises concerns of significant complications for at risk patients in Asia and North America.

**HenryN** · January 14, 2009, 08:15 AM

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

My title in 2009 raised 1 weeks flu hits 9
Author jeonyeombyeonggamsitim Date 2009-01-14
Newsletter 11 weeks influenza surveillance samples file attachments. Pdf
Abstract Ⅰ. Flu, the doctor-patient balsaengbunyul
1 weeks of the 2009 flu, the doctor-patient balsaengbunyul of 17.63
Higher than last winter fashion standards (2.6/1000 people) chogwaham

※ 2008-2009 season (August 31, 2008 ~ August 29, 2009): 2008 36-2009 weeks 35 weeks

Ⅱ. My virus separation
For the 2008-2009 season total of 1333 shares (A/H1N1 type 1275 shares, A/H3N2 brother 58 weeks) of the
Influenza virus by delimiters

※ 2008-2009 influenza season to 120 in the laboratory surveillance system
In medical institutions and

http://dis.cdc.go.kr/influenza/board/notice_view.asp