Dharan Nila J, Gubareva Larisa V, Meyer John J, Okomo-Adhiambo Margaret, McClinton Reginald C, Marshall Steven A, St George Kirsten, Epperson Scott, Brammer Lynnette, Klimov Alexander I, Bresee Joseph S, Fry Alicia M
Epidemic Intelligence Service, Office of Workforce and Career Development Assigned to Influenza Division, Centers for Disease Control and Prevention, 1600 Clifton Rd, MS A-32, Atlanta, GA 30333, USA.
JAMA. 2009 Mar 11;301(10):1034-41. doi: 10.1001/jama.2009.294. Epub 2009 Mar 2.
During the 2007-2008 influenza season, oseltamivir resistance among influenza A(H1N1) viruses increased significantly for the first time worldwide. Early surveillance data suggest that the prevalence of oseltamivir resistance among A(H1N1) viruses will most likely be higher during the 2008-2009 season.
To describe patients infected with oseltamivir-resistant influenza A(H1N1) virus and to determine whether there were any differences between these patients and patients infected with oseltamivir-susceptible A(H1N1) virus in demographic or epidemiological characteristics, clinical symptoms, severity of illness, or clinical outcomes.
DESIGN, SETTING, AND PATIENTS: Influenza A(H1N1) viruses that were identified and submitted to the Centers for Disease Control and Prevention by US public health laboratories between September 30, 2007, and May 17, 2008, and between September 28, 2008, and February 19, 2009, were tested as part of ongoing surveillance. Oseltamivir resistance was determined by neuraminidase inhibition assay and pyrosequencing analysis. Information was collected using a standardized case form from patients with oseltamivir-resistant A(H1N1) infections and a comparison group of patients with oseltamivir-susceptible A(H1N1) infections during 2007-2008.
Demographic and epidemiological information as well as clinical information, including symptoms, severity of illness, and clinical outcomes.
During the 2007-2008 season, influenza A(H1N1) accounted for an estimated 19% of circulating influenza viruses in the United States. Among 1155 influenza A(H1N1) viruses tested from 45 states, 142 (12.3%) from 24 states were resistant to oseltamivir. Data were available for 99 oseltamivir-resistant cases and 182 oseltamivir-susceptible cases from this period. Among resistant cases, median age was 19 years (range, 1 month to 62 years), 5 patients (5%) were hospitalized, and 4 patients (4%) died. None reported oseltamivir exposure before influenza diagnostic sample collection. No significant differences were found between cases of oseltamivir-resistant and oseltamivir-susceptible influenza in demographic characteristics, underlying medical illness, or clinical symptoms. Preliminary data from the 2008-2009 influenza season identified resistance to oseltamivir among 264 of 268 influenza A(H1N1) viruses (98.5%) tested.
Oseltamivir-resistant A(H1N1) viruses circulated widely in the United States during the 2007-2008 influenza season, appeared to be unrelated to oseltamivir use, and appeared to cause illness similar to oseltamivir-susceptible A(H1N1) viruses. Circulation of oseltamivir-resistant A(H1N1) viruses will continue, with a higher prevalence of resistance, during the 2008-2009 season.
在2007 - 2008年流感季节，甲型H1N1流感病毒对奥司他韦的耐药性在全球范围内首次显著增加。早期监测数据表明，在2008 - 2009年季节，甲型H1N1流感病毒中奥司他韦耐药性的流行率很可能更高。
描述感染对奥司他韦耐药的甲型H1N1流感病毒的患者，并确定这些患者与感染对奥司他韦敏感的甲型H1N1流感病毒的患者在人口统计学或流行病学特征、临床症状、疾病严重程度或临床结局方面是否存在差异。
设计、地点和患者：作为正在进行的监测的一部分，对2007年9月30日至2008年5月17日以及2008年9月28日至2009年2月19日期间美国公共卫生实验室鉴定并提交给疾病控制和预防中心的甲型H1N1流感病毒进行了检测。通过神经氨酸酶抑制试验和焦磷酸测序分析确定奥司他韦耐药性。在2007 - 2008年期间，使用标准化病例表格从感染对奥司他韦耐药甲型H1N1流感病毒的患者以及对奥司他韦敏感甲型H1N1流感病毒感染的患者对照组中收集信息。
人口统计学和流行病学信息以及临床信息，包括症状、疾病严重程度和临床结局。
在2007 - 2008年季节，甲型H1N1流感病毒估计占美国流行流感病毒的19%。在从45个州检测的1155株甲型H1N1流感病毒中，来自24个州的142株（12.3%）对奥司他韦耐药。这段时期有99例奥司他韦耐药病例和182例奥司他韦敏感病例的数据。在耐药病例中，中位年龄为19岁（范围为1个月至62岁），5例患者（5%）住院，4例患者（4%）死亡。在流感诊断样本采集前，无人报告有奥司他韦接触史。在人口统计学特征、基础疾病或临床症状方面，奥司他韦耐药流感病例和奥司他韦敏感流感病例之间未发现显著差异。2008 - 2009年流感季节的初步数据显示，在检测的268株甲型H1N1流感病毒中有264株（98.5%）对奥司他韦耐药。
在2007 - 2008年流感季节，对奥司他韦耐药的甲型H1N1流感病毒在美国广泛传播，似乎与奥司他韦的使用无关，并且似乎引起与对奥司他韦敏感的甲型H1N1流感病毒相似的疾病。在2008 - 2009年季节，对奥司他韦耐药的甲型H1N1流感病毒将继续传播，耐药性流行率更高。
