Presence of oseltamivir-resistant pandemic A/H1N1 minor variants before drug therapy with subsequent selection and transmission

J Infect Dis. 2012 Nov 15;206(10):1504-11. doi: 10.1093/infdis/jis571. Epub 2012 Sep 10.

Abstract

A small proportion (1%-1.5%) of 2009 pandemic influenza A/H1N1 virus strains (A[H1N1]pdm09) are oseltamivir resistant, almost exclusively because of a H275Y mutation in the neuraminidase protein. However, many individuals infected with resistant strains had not received antivirals. Whether drug-resistant viruses are initially present as minor variants in untreated individuals before they emerge as the dominant strain in a virus population is of great importance for predicting the speed at which resistance will arise. To address this issue, we used ultra-deep sequencing of viral populations from serial nasopharyngeal specimens from an immunocompromised child and from 2 individuals in a household outbreak. We observed that the Y275 mutation was present as a minor variant in infected hosts before the onset of therapy. We also found evidence for the transmission of this drug-resistant variant with drug-susceptible viruses. These observations provide important information on the relative fitness of the Y275 mutation in the absence of oseltamivir treatment.

Publication types

  • Case Reports
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Antiviral Agents / pharmacology
  • Antiviral Agents / therapeutic use*
  • Child, Preschool
  • Drug Resistance, Viral / genetics
  • Humans
  • Influenza A Virus, H1N1 Subtype / drug effects*
  • Influenza A Virus, H1N1 Subtype / genetics*
  • Influenza, Human / drug therapy*
  • Influenza, Human / transmission
  • Influenza, Human / virology*
  • Male
  • Middle Aged
  • Neuraminidase / genetics
  • Oseltamivir / pharmacology
  • Oseltamivir / therapeutic use*
  • RNA, Viral / chemistry
  • Real-Time Polymerase Chain Reaction
  • Reverse Transcriptase Polymerase Chain Reaction
  • Zanamivir / therapeutic use

Substances

  • Antiviral Agents
  • RNA, Viral
  • Oseltamivir
  • Neuraminidase
  • Zanamivir