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Clonal Expansion of H274Y pH1N1 Tamiflu Resistance In PA
Recombinomics Commentary 23:43
March 28, 2014

Today the CDC released two sets of 2014 pH1N1 sequences from patients in Pennsylvania (A/Pennsylvania/04/2014 and A/Pennsylvania/05/2014) which were collected more than 2 weeks apart (18F on January 28 and 20F on February 15, respectively).  The CDC typically releases sequences from H1, N1, and MP, but for these two cases PB1, NP, and NS sequences were released because both had H274Y, signaling Tamiflu resistance.  The H1, N1, and MP sequences were virtually identical to sequences released earlier this week from two other Pennsylvania cases (A/Pennsylvania/02/2014 and A/Pennsylvania/03/2014) which were collected on January 22 (18M and 21F) respectively.
The CDC had released a full set of sequences from the two earlier cases which also had H274Y and the full set of sequences were virtually identical to each other as well as the more recent sequences, signaling  clonal expansion of Tamiflu resistant pH1N1 in Pennsylvania in 2014.

In today’s week 12 FluView the CDC also cited 11 new cases of H274Y Tamiflu resistance, which is the most such pH1N1 cases in the this season's CDC’s FluView.  Moreover, these new sequences represented more than 5% of the new sequences tested, which is also an all time high frequency in newly reported pH1N1 sequences of 5 or more in a weekly FluView summary this season.

In spite of these record numbers, the CDC made no comments other than boiler-plate comments on spontaneous H274Y cases (even though the latest sequences support clonal expansion) in the week 12 FluView, and a note that there were 11 new cases in the CDC summary of the week 12 report.

The spike in cases and the clonal expansion raise serious concerns.

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