Clinical importance and impact on the households of oseltamivir-resistant seasonal A/H1N1 influenza virus in healthy children in Italy

Susanna Esposito*, Claudio Giuseppe Molteni, Cristina Daleno, Antonia Valzano, Emilio Fossali, Liviana Da Dalt, Valerio Cecinati, Eugenia Bruzzese, Raffaella Giacchino, Carlo Giaquinto, Carlotta Galeone, Angie Lackenby, Nicola Principi

*Corresponding author for this work

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    Abstract

    A resistance of A/H1N1 influenza viruses to oseltamivir has recently emerged in a number of countries. However, the clinical and socioeconomic importance of this resistance has not been precisely defined. As children have the highest incidence of influenza infection and are at high risk of severe disease, the aim of this study was to evaluate the clinical importance and the impact on the households of oseltamivir-resistant seasonal A/H1N1 influenza virus in an otherwise healthy pediatric population. A total of 4,726 healthy children younger than 15 years with influenza-like illness were tested for influenza viruses by real-time polymerase chain reaction in the winters of 2007-2008 and 2008-2009 in Italy. The influenza A virus-positive samples underwent neuraminidase gene analysis using pyrosequencing to identify mutations H275Y and N294 S in A/H1N1, and E119V, R292K, and N294 S in A/H3N2. Among the A/H1N1 subtypes, the H275Y mutation was found in 2/126 samples taken in 2007-2008 (1.6%) and in all 17 samples (100%; p < 0.0001) taken in 2008-2009. No other mutation was identified in any of the A/H1N1 or A/H3N2 influenza viruses. No significant differences were found in terms of clinical importance or impact on the households between the children with oseltamivir-resistant seasonal A/H1N1 influenza virus and those with the wild-type. The spread of H275Y-mutated A/H1N1 seasonal influenza virus is a common phenomenon and the clinical importance and impact on the households of the mutated virus is similar to that of the wild-type in an otherwise healthy pediatric population.

    Original languageEnglish
    Article number202
    JournalVirology Journal
    Volume7
    DOIs
    Publication statusPublished - 2010

    Bibliographical note

    Funding Information:
    This study was supported in part by MedImmune, and in part by the Italian Ministry of Health (Bando Giovani Ricercatori 2007). We would like to thank Laura Cesati, Laura Gualtieri and Emanuela Laicini (Milan, Italy); Andrea Papaleo and Luigi Cantarutti (Padua, Italy); Domenico De Mattia (Bari); Paolo Siani (Napoli); Ilaria Sala and Maria Cristina Diana (Genova) for their contribution to study enrolment, and Shahjahan Miah for his technical assistance.

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