Infections With Oseltamivir-Resistant Influenza A(H1N1) Virus in the United States
Infections With Oseltamivir-Resistant Influenza A(H1N1) Virus in the United States
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DOI：
10.1001/jama.2009.294
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发表时间：
2009-03-11
影响因子：
120.7
通讯作者：
Fry, Alicia M.
中科院分区：
文献类型：
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作者：
Dharan, Nila J.;Gubareva, Larisa V.;Fry, Alicia M.
背景2007-2008年流感季节期间，全球甲型H1N1流感病毒对奥司他韦的耐药性首次显著增加。目的描述在2007年9月30日至2008年5月17日和2008年9月28日期间由美国公共卫生实验室鉴定并提交给疾病控制和预防中心的甲型H1N1流感病毒感染患者，并确定这些患者与感染奥司他韦敏感甲型H1N1病毒的患者在人口学或流行病学特征、临床症状、病情严重程度或临床结果方面是否存在差异。和2009年2月19日，作为持续监测的一部分进行了检测。神经氨酸酶抑制试验和焦磷酸测序分析检测奥司他韦的耐药性。使用标准化病例表收集2007-2008年间耐奥司他韦的甲型H1N1流感病毒感染患者和对奥司他韦敏感的甲型H1N1流感病毒感染的对照组患者的信息。主要结果衡量人口统计学和流行病学信息以及临床信息，包括症状、疾病严重程度和临床结果。在45个州检测的1155株甲型H1N1流感病毒中，有24个州的142株(12.3%)对奥司他韦具有抗药性。这一时期有99例奥司他韦耐药病例和182例对奥司他韦敏感病例的数据。在耐药病例中，中位年龄为19岁(1个月至62岁)，5例(5%)住院，4例(4%)死亡。在收集流感诊断样本之前，没有报告接触过奥司他韦。在对奥司他韦耐药的流感病例和对奥司他韦敏感的流感病例之间，在人口学特征、潜在的内科疾病或临床症状方面没有发现显著差异。2008-2009年流感季节的初步数据显示，在268株甲型H1N1流感病毒中，有264株(98.5%)对奥司他韦产生了耐药性。结论在2007-2008年流感季节，耐奥司他韦的甲型H1N1流感病毒在美国广泛流行，似乎与奥司他韦的使用无关，似乎引起的疾病类似于对奥司他韦敏感的甲型H1N1病毒。在2008-2009年期间，耐奥司他韦的甲型H1N1流感病毒将继续传播，耐药性的流行率会更高。
Context During the 2007-2008 influenza season, oseltamivir resistance among influenza A(H1N1) viruses increased significantly for the first time worldwide. Early surveillance data suggest that the prevalence of oseltamivir resistance among A( H1N1) viruses will most likely be higher during the 2008-2009 season.Objectives To describe patients infected with oseltamivir-resistant influenza A( H1N1) virus and to determine whether there were any differences between these patients and patients infected with oseltamivir-susceptible A(H1N1) virus in demographic or epidemiological characteristics, clinical symptoms, severity of illness, or clinical outcomes.Design, Setting, and Patients Influenza A(H1N1) viruses that were identified and submitted to the Centers for Disease Control and Prevention by US public health laboratories between September 30, 2007, and May 17, 2008, and between September 28, 2008, and February 19, 2009, were tested as part of ongoing surveillance. Oseltamivir resistance was determined by neuraminidase inhibition assay and pyrosequencing analysis. Information was collected using a standardized case form from patients with oseltamivir-resistant A(H1N1) infections and a comparison group of patients with oseltamivir-susceptible A(H1N1) infections during 2007-2008.Main Outcome Measures Demographic and epidemiological information as well as clinical information, including symptoms, severity of illness, and clinical outcomes.Results During the 2007-2008 season, influenza A(H1N1) accounted for an estimated 19% of circulating influenza viruses in the United States. Among 1155 influenza A(H1N1) viruses tested from 45 states, 142 (12.3%) from 24 states were resistant to oseltamivir. Data were available for 99 oseltamivir-resistant cases and 182 oseltamivir-susceptible cases from this period. Among resistant cases, median age was 19 years (range, 1 month to 62 years), 5 patients (5%) were hospitalized, and 4 patients (4%) died. None reported oseltamivir exposure before influenza diagnostic sample collection. No significant differences were found between cases of oseltamivir-resistant and oseltamivir-susceptible influenza in demographic characteristics, underlying medical illness, or clinical symptoms. Preliminary data from the 2008- 2009 influenza season identified resistance to oseltamivir among 264 of 268 influenza A(H1N1) viruses (98.5%) tested.Conclusions Oseltamivir-resistant A(H1N1) viruses circulated widely in the United States during the 2007-2008 influenza season, appeared to be unrelated to oseltamivir use, and appeared to cause illness similar to oseltamivir-susceptible A(H1N1) viruses. Circulation of oseltamivir-resistant A(H1N1) viruses will continue, with a higher prevalence of resistance, during the 2008-2009 season.