Commentary
Early
Dominance of H1N1
in the United States
Recombinomics Commentary
19:53
November 18, 2008
The above comments from the week 45 CDC report on influenza in the US are curious. The updated report indicates over 80% of the isolates are influenza A (154/191) and over 80% of the sub-typed influenza A is H1 (49/60). Although only one H1N1 sample has been reportedly tested for oseltamivir resistance, early data from the UK, Canada, and Norway indicates that H274Y in the Brisbane strain of H1N1 will be at or near 100% (and the resistant case in Norway had traveled to the US). Thus, the use of adamantines is discouraged because resistance is near 100% for H3N2, yet H3N2 is currently only a minor population in the reported flu cases in the US. The level of H1 is five fold higher, yet the US is withholding changes in recommendations for oseltamivir usage.
Worldwide data from last season demonstrated that many northern countries had high levels of H274Y in H1N1. Over the summer, these levels approached or reached 100% in multiple countries in the southern hemisphere.
These data put surveillance systems on high alert for resistance in the current season, and initial results have indicated the concerns were justified. Moreover, the highest number of reported H1 cases is in the US, yet resistance results have been released for only one of the 49 isolates that have been sub-typed as H1.
Release of resistance results and associated sequences would be useful.
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