Oseltamivir-resistant influenza virus A (H1N1), Europe, 2007-08 season - PubMed (original) (raw)

Oseltamivir-resistant influenza virus A (H1N1), Europe, 2007-08 season

Adam Meijer et al. Emerg Infect Dis. 2009 Apr.

Abstract

In Europe, the 2007-08 winter season was dominated by influenza virus A (H1N1) circulation through week 7, followed by influenza B virus from week 8 onward. Oseltamivir-resistant influenza viruses A (H1N1) (ORVs) with H275Y mutation in the neuraminidase emerged independently of drug use. By country, the proportion of ORVs ranged from 0% to 68%, with the highest proportion in Norway. The average weighted prevalence of ORVs across Europe increased gradually over time, from near 0 in week 40 of 2007 to 56% in week 19 of 2008 (mean 20%). Neuraminidase genes of ORVs possessing the H275Y substitution formed a homogeneous subgroup closely related to, but distinguishable from, those of oseltamivir-sensitive influenza viruses A (H1N1). Minor variants of ORVs emerged independently, indicating multiclonal ORVs. Overall, the clinical effect of ORVs in Europe, measured by influenza-like illness or acute respiratory infection, was unremarkable and consistent with normal seasonal activity.

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Figures

Figure 1

Figure 1

Prescription data of oseltamivir treatment courses for Western Europe (in thousands); 12 months of data for each year 2002–2007 and through September for 2008. Data from the United Kingdom, the Netherlands, Switzerland, and Portugal are excluded because of negligible values. Data provided by IMS Health (

www.imshealth.com

), London, UK.

Figure 2

Figure 2

Total number of influenza virus detections, by type and subtype and by week, Europe, winter 2007–08.

Figure 3

Figure 3

Total influenza A viruses subtyped as H1N1 and number of oseltamivir-resistant or oseltamivir-sensitive viruses among the subset of influenza viruses A (H1N1) for which oseltamivir susceptibility was determined, by week, Europe, winter 2007–08.

Figure 4

Figure 4

Modeled average prevalence of oseltamivir-resistant influenza viruses A (H1N1), with 95% confidence intervals (error bars), ranked by country, Europe, winter 2007–08. Text columns on the right list the absolute cumulative number of oseltamivir-resistant influenza viruses A (H1N1) and number of influenza viruses A (H1N1) tested for oseltamivir susceptibility per country.

Figure 5

Figure 5

Weighted average prevalence of oseltamvir-resistant influenza viruses A (H1N1), Europe, winter 2007–08. The light gray region indicates the 95% confidence interval.

Figure 6

Figure 6

Phylogenetic comparisons of the hemagglutinin (A) and neuraminidase (B) genes of influenza viruses A (H1N1). Sequences of oseltamivir-resistant viruses, possessing the H275Y (H274Y in N2 numbering) mutation are in boldface; vaccine strains are in italics. Common amino acid changes that distinguish clades 1 and 2 and subgroups of clade 2 are shown. Scale bars indicate 0.01 nucleotide substitutions per site.

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