Departments of Infectious Diseases, Tan Tock Seng Hospital, Singapore.
Clin Infect Dis. 2010 Apr 1;50(7):963-9. doi: 10.1086/651083.
Pandemic influenza (H1N1) 2009 is susceptible to oseltamivir. There are few reports on its clinical and virologic response to oseltamivir.
During the pandemic containment response in Singapore, all patients with positive polymerase chain reaction (PCR) results for pandemic influenza (H1N1) 2009 were hospitalized, given oseltamivir for 5 days, and discharged when daily PCR results for combined nasal and throat swab samples became negative. Six patients had concurrent positive viral culture and PCR results.
The median age of the first 70 consecutive patients was 26 years (interquartile range, 21-38 years); 60% were men, and 29% had comorbidity. The mean time (+/-SD) from illness onset to hospital admission was 3+/-2 days. Influenza-like illness was noted in 63% of patients. Fever occurred in 91%, cough in 88%, sore throat in 66%, and rhinorrhea in 53% of patients. The mean duration (+/-SD) of viral shedding from illness onset was day 6+/-2 days. Viral shedding persisted beyond 7 days in 37% of patients. Clinical features and viral shedding were similar between those with and without comorbidity, except the former had more cough and lower oxygen saturation. Patients receiving oseltamivir on days 1 to 3 of illness had significantly shorter viral shedding duration, compared with those treated from day 4 onwards (P < .05). The mean durations (+/-SD) of positive PCR and viral culture results were 5+/-8 and 4+/-18 days, respectively, for 6 patients with concurrent positive viral culture and PCR results.
Prolonged viral shedding was noted in young immunocompetent adults with mild pandemic influenza (H1N1) 2009 despite receipt of oseltamivir. When prescribed during the first 3 days of illness, oseltamivir shortened the duration of viral shedding.
大流行性流感（H1N1）2009 对奥司他韦敏感。有关其对奥司他韦的临床和病毒学反应的报道很少。
在新加坡的大流行遏制反应期间，所有聚合酶链反应（PCR）结果呈大流行性流感（H1N1）2009 阳性的患者均住院治疗，给予奥司他韦 5 天，当每日鼻咽拭子联合 PCR 结果为阴性时出院。6 例患者同时具有病毒培养和 PCR 阳性结果。
前 70 例连续患者的中位年龄为 26 岁（四分位间距，21-38 岁）；60％为男性，29％有合并症。从发病到住院的平均时间（+/-SD）为 3+/-2 天。63％的患者出现流感样疾病。91％的患者发热，88％的患者咳嗽，66％的患者咽痛，53％的患者流鼻涕。从发病到病毒脱落的平均持续时间（+/-SD）为 6+/-2 天。37％的患者病毒脱落持续超过 7 天。有合并症的患者与无合并症的患者的临床特征和病毒脱落相似，除前者咳嗽更多和氧饱和度更低外。与从第 4 天开始治疗的患者相比，在发病第 1 至 3 天接受奥司他韦治疗的患者病毒脱落持续时间明显缩短（P <.05）。6 例同时具有病毒培养和 PCR 阳性结果的患者的阳性 PCR 和病毒培养结果的平均持续时间（+/-SD）分别为 5+/-8 天和 4+/-18 天。
尽管接受了奥司他韦治疗，免疫功能正常的年轻轻症大流行性流感（H1N1）2009 患者仍存在病毒持续脱落。在发病的前 3 天内使用奥司他韦可缩短病毒脱落时间。
