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Commentary
H1N1 Tamiflu
Resistance in UK Jumps Higher
Recombinomics
Commentary 10:15
December 25, 2009
The above comments are from the latest (week 51) influenza update from Scotland. The above numbers represent an increase of 5 from the prior week for the UK and like the US, show that in the past 5 reports, the numbers have jumped darmatically. In the week 46 report, there were 12 cases in the UK (including 3 in Scotland) for the entire pandemic and now there are 30.
The increases add to the evidence that H274Y has passed a tipping point and is visibly transmitting. In earlier isolates, the H274Y was transmitting as a mixture that was largely being detected in patients receiving Tamiflu. Now the detection numbers and rate have jumped worldwide.
Recently released sequences from Japan show that the newly deposited sequences from isolates with H274Y segregate into small number of sub-clades, signaling efficient transmission. This transmission was also support by the recent NEJM report from Vietnam describing transmission of H274Y to previously healthy students who had no exposure to Tamiflu. In one group, at least six of 10 students had lab confirmed H274Y, signaling a fit H1N1 with a high attack rate.
Currently, many countries are experiencing a reduction in the number of H1N1 cases, which will provide an opportunity for the H274Y sub-clades to become much more dominant in the next wave. The increase in H274Y has also produced more linkage to receptor binding domain changes at position 225, including lethal combinations of H274Y with D225G.
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