Hurt Aeron C, Barr Ian G
WHO Collaborating Centre for Reference and Research on Influenza, Parkville, Victoria.
Commun Dis Intell Q Rep. 2008 Mar;32(1):57-62. doi: 10.33321/cdi.2008.32.7.
The neuraminidase inhibitors are a class of antiviral drugs used for both the prophylaxis and treatment of influenza infections. Clinical trials of these inhibitors detected a low level of resistant viruses from treated individuals, although a higher frequency was detected in children (5%-6%) compared to adults (1%-4%). In addition, there have been some previous reports of NA inhibitor resistant viruses being isolated from untreated individuals. Here we report on the NA inhibitor sensitivity of over 1,000 influenza isolates collected through the World Health Organization (WHO) global influenza surveillance program. Of the total number of viruses analysed, only 2 (0.2%) strains (an A(H1N1) strain and an influenza B strain) were considered to have a significant reduction in sensitivity to at least one of the neuraminidase inhibitor drugs. Interestingly, both of these strains were isolated from untreated patients in the youngest age cohort (less than 2 years). Although the influenza B strain is unlikely to be clinically resistant, the A(H1N1) virus contained the same His274Tyr neuraminidase mutation that has been observed in resistant mutants following oseltamivir treatment. Given these results it may be important to enhance neuraminidase inhibitor susceptibility testing of viruses from patients in the less than two years cohort.
神经氨酸酶抑制剂是一类用于预防和治疗流感感染的抗病毒药物。这些抑制剂的临床试验检测到治疗个体中存在低水平的耐药病毒，不过与成人（1%-4%）相比，儿童中检测到的耐药病毒频率更高（5%-6%）。此外，此前有一些报告称从未经治疗的个体中分离出了对神经氨酸酶抑制剂耐药的病毒。在此，我们报告了通过世界卫生组织（WHO）全球流感监测计划收集的1000多株流感病毒分离株对神经氨酸酶抑制剂的敏感性。在分析的病毒总数中，仅有2株（0.2%）毒株（1株甲型（H1N1）毒株和1株乙型流感毒株）被认为对至少一种神经氨酸酶抑制剂药物的敏感性显著降低。有趣的是，这两株毒株均从未经治疗的最年幼年龄组（小于2岁）患者中分离得到。尽管乙型流感毒株临床耐药的可能性不大，但甲型（H1N1）病毒携带了与在接受奥司他韦治疗后出现的耐药突变体中观察到的相同的His274Tyr神经氨酸酶突变。鉴于这些结果，加强对两岁以下年龄组患者病毒的神经氨酸酶抑制剂敏感性检测可能很重要。
