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Paradigm Shift Intervention Monitoring
Resistance in Mexico
All eight of the NA sequences from Mexico had H274Y. They were collected between Jan 2, 2012 (Puebla, A/Mexico/InDRE327/2012, and Feb 28, 2012 (San Luis Potosi City, A/Mexico/InDRE6023/2012). Locations are throughout Mexico (Hidalgo City, A/Mexico/InDRE5498/2012 and A/Mexico/InDRE1818/2012; Tlaxcala City, A/Mexico/InDRE3354/2012; Veracruz City, A/Mexico/InDRE5726/2012; Guanajuato City, A/Mexico/InDRE2440/2012; and Mexico City, A/Mexico/InDRE2718/2012) and match earlier sequences from Mexico City, as well as US sequences in Texas, California, and Illinois.
Although weekly PAHO reports describe the high levels of H1N1pdm09 in Mexico when these samples were collected, the high levels of H274Y were not described. Recent PAHO and CDC reports have noted increased levels of H274Y in Texas, including 13/16 cases with no Tamiflu exposure. The sequence identities and clonal expansion have not been described.
The familial clusters in the US further confirm the transmission of this sub-clade and the number of cases undoubtedly is many or orders of magnitude higher than the cases represented by the recently released sequences.