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Paradigm Shift Intervention Monitoring
Delaware’s Division of Public Health
(DPH) is following up on an antiviral-resistant influenza case
identified March 2 in a child from Kent County. The child was not
hospitalized and has fully recovered.
The specimen – part of a random sample submitted for routine anti-viral resistance testing – was reported as oseltamivir-resistant the first week of March.
Delaware’s Division of Public Health (DPH) is following-up on three additional antiviral-resistant influenza cases. Lab results provided March 21 found that a 1 month-old girl and a 33 year-old woman from Kent County were infected with influenza strains found to be resistant to oseltamivir
A 3 year-old Sussex County boy was also identified as having had antiviral resistant influenza.
The above comments describe a cluster of four cases of H274Y in recent H1N1 cases in Delaware, strongly suggesting the resistance is transmitting. The releases do not suggest the samples were collected after Tamiflu treatment. Instead the samples were part of routine surveillance and the index case was not hospitalized, which also argues against treatment.
The finding of three cases in the same week in the small state of Delaware is in marked contrast to the three cases reported for the entire United States for the entire flu season, as indicated in the CDC week 10 report.
This cluster signals transmission of Tamiflu resistant H1N1 that is evolutionarily fit in patients who appear to have been previously healthy and not treated with oseltamivir prior to sample collection. The cluster in previously healthy patients is in contrast to the previously reported Duke Medical center cluster.