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Influenza virus strains show increasing drug resistance and ability to spread
Date:12/7/2010

cessary in the future."

A second study, conducted by Catherine Moore and colleagues in the United Kingdom, examined an outbreak of oseltamivir resistant (OR) pandemic H1N1 infection in a hematology unit in the UK. The study is the first to confirm person-to-person transmission of this dually resistant strain through molecular epidemiologic methods. The 2009 pandemic H1N1 virus was inherently resistant to adamantine, but was susceptible to and treated with oseltamivir. However, by October 2009, emergence of OR H1N1 had been documented in rare patients on oseltamivir therapy.

In the hematology unit that Moore and colleagues studied, eight of the 11 pandemic H1N1 virus infections were resistant to oseltamivir, with half of those cases resulting from direct transmission of the resistant virus. Immunocompromised patients were more susceptible to the emergence of OR H1N1 virus on treatment and also transmitted the virus to others, despite often having no influenza symptoms or having completed antiviral therapy. As a result, the screening of patients for OR H1N1 viruses became particularly important, and treatment guidelines were altered to include treatment with zanamivir, to which the viruses remained susceptible.

"These findings suggest that oseltamivir may not be the frontline drug of choice in hematology patients, and zanamivir may prove to be more beneficial," the study authors wrote. "Guidelines may need to be changed to include active screening for the [OR] mutation in hematology patients diagnosed with H1N1 and other patients who are immunocompromised when oseltamivir is used." If high risk groups are more actively monitored, early diagnosis will help prevent the spread of H1N1 viruses, and proper screening for infection and resistance will aid in making proper therapeutic decisions.

In an accompanying editorial, Frederick G. Hayden, MD, of the University of Virginia School of Medicine, and Menno D. de Jong, MD, of the Unive
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Contact: John Heys
jheys@idsociety.org
703-299-0412
Infectious Diseases Society of America
Source:Eurekalert

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