Department of Maternal and Pediatric Sciences, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
Virol J. 2010 Aug 26;7:202. doi: 10.1186/1743-422X-7-202.
A resistance of A/H1N1 influenza viruses to oseltamivir has recently emerged in a number of countries. However, the clinical and socioeconomic importance of this resistance has not been precisely defined. As children have the highest incidence of influenza infection and are at high risk of severe disease, the aim of this study was to evaluate the clinical importance and the impact on the households of oseltamivir-resistant seasonal A/H1N1 influenza virus in an otherwise healthy pediatric population. A total of 4,726 healthy children younger than 15 years with influenza-like illness were tested for influenza viruses by real-time polymerase chain reaction in the winters of 2007-2008 and 2008-2009 in Italy. The influenza A virus-positive samples underwent neuraminidase gene analysis using pyrosequencing to identify mutations H275Y and N294 S in A/H1N1, and E119V, R292K, and N294 S in A/H3N2. Among the A/H1N1 subtypes, the H275Y mutation was found in 2/126 samples taken in 2007-2008 (1.6%) and in all 17 samples (100%; p < 0.0001) taken in 2008-2009. No other mutation was identified in any of the A/H1N1 or A/H3N2 influenza viruses. No significant differences were found in terms of clinical importance or impact on the households between the children with oseltamivir-resistant seasonal A/H1N1 influenza virus and those with the wild-type. The spread of H275Y-mutated A/H1N1 seasonal influenza virus is a common phenomenon and the clinical importance and impact on the households of the mutated virus is similar to that of the wild-type in an otherwise healthy pediatric population.
最近，在许多国家出现了对奥司他韦有耐药性的 A/H1N1 流感病毒。然而，这种耐药性的临床和社会经济学重要性尚未得到准确界定。由于儿童流感感染发病率最高，且患重病的风险较高，因此本研究旨在评估在其他健康的儿科人群中，季节性 A/H1N1 流感病毒对奥司他韦耐药性的临床重要性及其对家庭的影响。2007-2008 年和 2008-2009 年冬季，意大利对 4726 名年龄小于 15 岁、有流感样症状的健康儿童进行了实时聚合酶链反应检测流感病毒。对甲型流感病毒阳性样本进行神经氨酸酶基因分析，使用焦磷酸测序法鉴定 A/H1N1 中的 H275Y 和 N294 S 突变，以及 A/H3N2 中的 E119V、R292K 和 N294 S 突变。在 A/H1N1 亚型中，2007-2008 年期间检测到 126 份样本中的 2 份（1.6%）和 2008-2009 年期间检测到的所有 17 份样本（100%）均存在 H275Y 突变（p<0.0001）。在任何 A/H1N1 或 A/H3N2 流感病毒中均未发现其他突变。在奥司他韦耐药季节性 A/H1N1 流感病毒与野生型病毒的儿童中，未发现临床重要性或对家庭影响方面的显著差异。H275Y 突变的季节性 A/H1N1 流感病毒的传播是一种常见现象，在其他健康的儿科人群中，突变病毒的临床重要性和对家庭的影响与野生型相似。
