Please use this identifier to cite or link to this item: http://hdl.handle.net/2381/7577
Title: Neuraminidase Inhibitor Resistance after Oseltamivir Treatment of Acute Influenza A and B in Children
Authors: Stephenson, Iain
Democratis, Jane
Lackenby, Angie
McNally, Teresa
Smith, James
Pareek, Manish
Ellis, Joanna
Bermingham, Alison
Nicholson, Karl
Zambon, Maria
First Published: 15-Feb-2009
Publisher: University of Chicago Press for the Infectious Diseases Society of America
Citation: Clinical Infectious Diseases, 2009, 48 (4), pp. 389–396.
Abstract: Background.Oseltamivir, a specific influenza neuraminidase inhibitor, is an effective treatment for seasonal influenza. Emergence of drug‐resistant influenza viruses after treatment has been reported, particularly in children in Japan, where the dosing schedule is different from that used throughout the rest of the world. We investigated the emergence of drug‐resistant infection in children treated with a tiered weight‐based dosing regimen. Methods.We analyzed sequential clinical nasopharyngeal samples, obtained before and after tiered weight‐based oseltamivir therapy, from children with acute influenza during 2005–2007. We isolated viruses, tested for drug resistance with use of a fluorescence‐based neuraminidase inhibition assay, performed neuraminidase gene sequencing, and determined quantitative viral loads. Results.Sixty‐four children (34 with influenza A subtype H3N2, 11 with influenza A subtype H1N1, and 19 with influenza B virus) aged 1–12 years (median age, 3 years, 1 month) were enrolled. By days 4–7 after initiation of treatment, of 64 samples tested, 47 (73.4%) and 26 (40.6%) had virus detectable by reverse‐transcriptase polymerase chain reaction and culture, respectively. By days 8–12 after initiation of treatment, of 53 samples tested, 18 (33.9%) and 1 (1.8%) had virus detectable by reverse‐transcriptase polymerase chain reaction and culture, respectively. We found no statistically significant differences in the reduction of viral shedding or time to clearance of virus between viral subtypes. Antiviral‐resistant viruses were recovered from 3 (27.3%) of 11 children with influenza A subtype H1N1, 1 (2.9%) of 34 children with influenza A subtype H3N2, and 0 (0%) of 19 children with influenza B virus, all of whom were treated with oseltamivir ( ) There was no evidence of prolonged illness in children infected with drug‐resistant virus. Conclusions.Drug resistance emerges at a higher rate in influenza A subtype H1N1 virus than in influenza A subtype H3N2 or influenza B virus after tiered weight‐based oseltamivir therapy. Virological surveillance for patterns of drug resistance is essential for determination of antiviral treatment strategies and for composition of pandemic preparedness stockpiles.
DOI Link: 10.1086/596311
ISSN: 1058-4838
Links: http://cid.oxfordjournals.org/content/48/4/389
http://hdl.handle.net/2381/7577
Type: Article
Rights: This paper was published as Clinical Infectious Diseases, 2009, 48 (4), pp. 389-396. © 2009 the Infectious Diseases Society of America. It is available from http://www.journals.uchicago.edu/doi/abs/10.1086/596311. Doi: 10.1086/596311
Appears in Collections:Published Articles, Dept. of Infection, Immunity and Inflammation

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