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PAHO Silence on H1N1pdm09 Tamiflu Resistance in Mexico
Recombinomics Commentary 20:30
May 25, 2012

In Mexico, from EW 1 through the 24th of February 2012, there were a total of 5,544 cases of influenza, of which 90.9% (n=5,042) were influenza A(H1N1)pdm 09. This number includes 180 influenza deaths, of
which 92.2% (n=166) were influenza A(H1N1)pdm09. According to laboratory data, in EW 07, of the total samples analyzed, the proportion of samples positive for influenza decreased to ~35%. Influenza
A(H1N1)pdm09 was the predominant circulating virus.

The above comments from the week 7 PAHO report on influenza in the Americas describes H1N1pdm09 cases in Mexico in 2012 and is similar to earlier weekly reports.  The increased activity and deaths were widely known and sequences released  from 2011 collections in Mexico and Texas were similar.  However, the PAHO descriptions failed to mention Tamiflu resistance (H274Y) in Mexico, although recent reports have noted the H274Y in Texas.

However, the sequence data clear demonstrates the widespread H274Y in Mexico and the relationship to H274Y in Texas.  In February Biologia Molecular y Validacion de Tecnicas in Santo Tomas, Mexico released (at Genbank) two sets of H1N1pdm09 sequences (A/Mexico/InDRE689/2012 and A/Mexico/InDRE1474/2012) from two Mexico City cases (35F, 2M) collected on January 19 and 26, 2012, respectively. Both NA sequences had H274Y and the sequences were closely related to the earlier sequences from Mexico and Texas.

The US CDC subsequently released 4 sets of sequences from Mexico, including collections from the two cases above, (A/Mexico/689/2012, A/Mexico/1474/2012, A/Mexico/1818/2012, A/Mexico/2440/2012) and all four had H274Y. In addition, five NA sequences from Texas were released (A/Texas/23/2012, A/Texas/24/2012, A/Texas/26/2012, A/Texas/29/2012, A/Texas/30/2012), which also had H274Y. The Texas sequences were collected over a longer time frame (January-March) and all sequences were closely related signaling clonal expansion.

The CDC then released four additional NA sequences from March collections (A/Texas/31/2012, A/Texas/33/2012, A/Texas/34/2012, A/Texas/35/2012) as well as sequences outside of Texas (A/California/21/2012) and A/Illinois/1/2012), which also had H274Y and were also closely related to the above isolates from Texas and Mexico).

Most recently, Biologia Molecular y Validacion de Tecnicas, released 8 more NA sequences from 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, demonstrating that H274Y is widespread and present in all 2012 NA sequences from Mexico.

The absence of comment on the H274Y in Mexico in 2012 raises concerns.

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