Tamiflu Resistance Driving Severe California pH1N1 Cases?

Sunday, January 5, 2014
By Paul Martin

January 5, 2014

If patients continue to do poorly on oral oseltamivir, investigational intravenous zanamivir is available under an emergency investigational new drug (EIND) request to the Food and Drug Administration (FDA). To request an EIND, contact: (8:00AM – 4:30PM EST): 301-796-1500

The California Department of Public Health (CDPH) issued a pH1N1 health advisory earlier this week. Like advisories from Texas and the CDC, the CDPH advisory warned of severe and fatal pH1N1 cases in previously health young and middle aged adults, as well as the lack of sensitivity in rapid tests, and the utility of starting antiviral treatment based on clinical presentation rather than test results from rapid tests or PCR re-testing. Although the CDPH report is considerably longer that the advisories from Texas and the CDC the above comments and detail on the use of IV Relenza via an EIND raises concerns that Tamiflu resistance is creating problems.

Boots on the ground reports have suggested that cases in Texas (see map) and northern California have not been responding to Tamiflu treatment, and a blast FAX was sent to physicians in northern California. Earlier sequences released by the CDC included those with H274Y which had clonally expanded in Louisiana (see map), and were also identified in Mississippi as well as Utah. Similarly, NIID in Japan had released sequencing supporting H274Y clonal expansion of another sub-clade in Sapporo.

This week media reports have described ICU and fatal H1N1 cases in California, which a heavy concentration in the Bay Area (see map). More detail from California (and Texas) on antiviral testing would be useful.

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