Rhiza Labs FluTracker Forum

Mar 23, 2011 posted by: Mari Lou-WGMD News

3 more anti-viral resistant flu cases found in DE

State Public Health officials have found 3 more cases of anti-viral resistant flu in Delaware. A 1-month old girl and a 33 year old woman in Kent County and a 3 year old Sussex County boy have all been infected with an influenza A/H1N1 that is resistant to Tamiflu – the most used treatment. While these cases are rare, this makes a total of 4 anti-viral resistant flu cases found this year. Other treatments for the flu are available.

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NEWS RELEASE: THREE ADDITIONAL ANTI-VIRAL RESISTANT FLU CASES IDENTIFIED

Delaware’s Division of Public Health (DPH) is following-up on three additional antiviral-resistant influenza cases. Lab results provided March 21 found that a 1 month-old girl and a 33 year-old woman from Kent County were infected with influenza strains found to be resistant to oseltamivir, an antiviral medication used to treat influenza. A 3 year-old Sussex County boy was also identified as having had antiviral resistant influenza. This brings Delaware’s number of influenza cases resistant to oseltamivir (brand name Tamiflu) treatment to four for the 2010-2011 flu season.

“DPH routinely sends randomly-selected flu specimens for advanced testing to determine antiviral resistance,” explained Dr. Karyl Rattay, DPH director. Of 82 Delaware samples tested for resistance from late November to mid March, only these four cases were found resistant.

All four of Delaware’s resistant flu cases tested positive for influenza A / H1N1. Oseltamivir is the preferred treatment for confirmed cases of influenza. Resistance to oseltamivir is very rare, occurring in just 0.5 percent of cases studied during the 2009-2010 flu season. There is no reason to change treatment approaches at this time.

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Mar 9, 2011 posted by: Mari Lou-WGMD News

First antiviral-resistant flu case found in Delaware
A child in Kent County has been diagnosed with an anti-viral-resistant influenza – the first in Delaware that has been found to be resistant to Tamiflu. State Health officials say the child tested positive for influenza A-H1N1 last month and was found to be Tamiflu resistant last week. Officials say less than one percent of flu cases are confirmed anti-viral resistant.

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NEWS RELEASE: ANTI-VIRAL RESISTANT FLU CASE IDENTIFIED

Delaware’s Division of Public Health (DPH) is following up on an antiviral-resistant influenza case identified March 2 in a child from Kent County. The child was not hospitalized and has fully recovered. This is Delaware’s first known case of influenza resistant to oseltamivir (brand name Tamiflu) treatment for the 2010-2011 flu season.

The case under investigation tested positive for influenza A / H1N1 in mid-February. The specimen – part of a random sample submitted for routine anti-viral resistance testing – was reported as oseltamivir-resistant the first week of March. Oseltamivir is the preferred treatment for confirmed cases of influenza. Resistance to oseltamivir is very rare, occurring in just 0.5 percent of cases studied during the 2009-2010 flu season. There is no reason to change treatment approaches at this time.

http://www.wgmd.com/?p=20464

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Virus
Samples
tested (n) Resistant
Viruses,
Number (%)
Oseltamivir Virus
Samples
tested (n) Resistant
Viruses,
Number (%)
Zanamivir
Seasonal Influenza A (H1N1) 0 0 (0.0) 0 0 (0.0)
Influenza A (H3N2) 454 0 (0.0) 447 0 (0.0)
Influenza B 418 0 (0.0) 418 0 (0.0)
2009 Influenza A (H1N1) 533 3 (0.6) 165 0 (0.0)

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Deleware has four cases of H274Y compared to 3 reported for the entire country.

http://www.cdc.gov/flu/weekly/

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Commentary

http://www.recombinomics.com/News/03241 ... 4Y_DE.html

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Could finally be the start of what we expected last year.

Would love to know how many were tested in the last few weeks. They have tested 82 since November 2010. You would think 4 would be a very large ratio compared to recently tested. Very large indeed.

It is worth noting that release of H1N1 by the CDC at GISAID appears to be lagging. The CDC typically releases three batches of sequences (H1N1, H3N2, influenza B) collected in the same time frame. This week they released H3N2 and influenza B sequences which were largely sequences collected in late December, 2010 or 2011. However, the corresponding batch of H1N1 sequences has not been released. The last H1N1 release was Febraury 2, and was larely composed of sequences from late 2010.

It is likley that at least one of the H274Y positive sequences from Delaware would be in the next released. The clustering of the 4 cases in time and space suggest that most or all will be closely related to each other. The next batch of h1N1 sequences should be interesting, espacially if they include collections from Febraury/March.

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Delaare has 4 of the 5 cases reported for the entire country

Neuraminidase Inhibitor Resistance Testing Results on Samples Collected Since October 1, 2010 Virus
Samples
tested (n) Resistant
Viruses,
Number (%)
Oseltamivir Virus
Samples
tested (n) Resistant
Viruses,
Number (%)
Zanamivir
Seasonal Influenza A (H1N1) 0 0 (0.0) 0 0 (0.0)
Influenza A (H3N2) 473 0 (0.0) 471 0 (0.0)
Influenza B 461 0 (0.0) 461 0 (0.0)
2009 Influenza A (H1N1) 670 5 (0.7) 191 0 (0.0)

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Four NA sequences with H274Y from DE were released today by the CDC. 3 associated HA sequences were released. All three had S188T and two also had A189T.

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HA sequences of MD/06/2011 and DE/08/2011 are identical and NA sequences from both have H274Y, indicating Tamiflu resistance is transmitting in DE and MD. Similarly, DE/04/2011 and DE/07/2011 HA sequences are identical (and have S188T and A189T) and both have H274Y, indicating Tamiflu resistance in this sub-clade is also transmitting.

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