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Transmitting D225G Tamiflu Resistant H1N1 In Texas / California
Recombinomics Commentary 19:15
May 18, 2012

The recently released H1N1pdm09 sequences confirm and extend clonal expansion of H274T tamiflu (oseltamivir) resistance in Mexico, Texas, California, and Illinois.  All of these cases are closely related to each other, signaling clonal expansion.  Moreover, the week 19 FluView confirms that 13 of the 16 cases had no exposure to Tamiflu, while two cases were family members of patients being treated with Tamiflu, confirming clustered transmission of H274Y.

In addition to the presence of H274Y in the recently released sequences, two of the cases (60F and 19M) also had D225G (A/California/21/2012 and A/Texas/34/2012, respectively), raising concerns that D225G and H274Y are transmitting.  The genetic background of these cases matches a dominant 2012 H1N1pdm09 genotype that is widespread in the United States, indicating the sub-clade is well adapted for spread and raising concerns that H274Y and D225G are circulating as mixtures, and the true level is markedly higher than the recently reported cases.

More information on the clinical picture of the two D225G cases would be useful, as well as minor signals in sequences that have been presented as wild type for HA position 225 and NA position 274.

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