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Korean Tamiflu Resistant H1N1 Outbreak Grows
Recombinomics Commentary 17:34
January 13, 2009

symptoms in patients were 17.6 of the 1000 people

The above translation indicates influenza like illness in South Korea continues to increase.  The baseline is 2.6 and in the last three weekly reports, the frequency increased to 3.6 to 8.4 to 15.4 for weeks 50, 51, 52, respectively.  Last season the frequency formed two peaks.  The first peak at week 52 was approximately 7, while the peak for the season was just below 10 in week 9.  Thus, the current rise is almost double the highest level last season.

Moreover, most of these cases are likely to be H1N1 and Tamiflu resistant.  Today’s ProMED report confirmed last week's KCDC report of 16/17 tested H1N1 isolates having H274Y.  Moreover, the week 52 report indicated 767/815 sub-typed isolates were H1N1.  The numbers were dramatically higher than the week 51 report, where 296/322 sub-typed isolates to date were H1N1.

The high level of Tamiflu resistance is not a surprise.  The WHO reported that 13/14 H1N1 isolates from Japan had H274Y, and levels are approaching, or have reached, 100% in the United States, Canada, and multiple countries in Europe.

The sequences at an outbreak at 10 elementary schools in Sendai, Japan, matched the dominant sub-clade reported to date in the United States (HI, TX, PA) this season. In addition to the HA change, A193T, driving the fixing of H274Y in H1N1 worldwide, the sequences have two flanking acquisitions, G189V and H196R.  Moreover, an outbreak of ILI has been reported at a Taylor High School in Williamson County in central Texas.  All influenza sub-typed to date in Texas has been H1N1.

None of these changes are in the current H1N1 Brisbane/59 vaccine.

The dramatic increase in ILI in Korea, coupled with a dominant Tamiflu resistant H1N1 reported throughout the country, raises concerns of significant complications for at risk patients in Asia and North America.

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