Oseltamivir (Tamiflu) Resistance in Seasonal Influenza A (H1N1) Viruses

Scully, Mary-Louise
February 2009
Travel Medicine Advisor;Feb2009, Vol. 19 Issue 2, p5
INFLUENZA ACTIVITY HAS BEEN RELATIVELY LOW THUS FAR IN THE 2008-2009 season in the United States. However, of the influenza viruses isolated and tested to date there is significant resistance among the influenza A (H1N1) viruses to the antiviral oseltamivir. As of mid-December 2008, 50 influenza A (H1N1) viruses from 12 states were tested. Ninety-eight percent were resistant to oseltamivir, but all were susceptible to zanamivir, amantadine, and rimantidine. Influenza A (H3N2) and B viruses remain susceptible to oseltamivir. In light of this information, on December 19, 2008, the CDC issued interim guidelines for antiviral treatment or prophylaxis in suspected cases of influenza. The use of influenza tests that can distinguish influenza A from influenza B is encouraged. If a patient has a positive test for influenza A and treatment is indicated, the use of zanamivir should be considered. Alternatively, the combination of oseltamivir plus rimantidine could be used. If the patient has a positive test for influenza B, oseltamivir or zanamivir (no preference) may be given. The same recommendations hold for persons who are candidates for chemoprophylaxis as well. Ideally, local or state surveillance data should be used to determine which types (A or B) and subtypes (H1N1 or H3N2) are currently circulating in a given area, but this information may not be available at the time clinical decisions need to be made. Based on preliminary information, it does not appear that oseltamivir-resistant influenza A (H1N1) viruses cause more severe symptoms compared to oseltamivir-sensitive influenza A (H1N1) viruses. In addition, since oseltamivir-resistant influenza A (H1N1) viruses are antigenically similar to the (H1N1) virus included in the 2008-2009 influenza vaccine (A/Brisbane/59/2007), ongoing influenza vaccination remains an effective strategy to prevent influenza.


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