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Tamiflu Resistant Pandemic H1N1 Cases in Texas
Recombinomics Commentary 03:14
August 4, 2009

"We have found resistance to Tamiflu on the border. We have observed some cases, few to be sure, in El Paso and close to McAllen, Texas," said Maria Teresa Cerqueira, head of the local PAHO office.

Cerquiera said one patient diagnosed with a Tamiflu-resistant strain had been treated with Zanamivir -- an anti-viral made by GlaxoSmithKline -- and another was given no alternative medication. Both survived.

The above comments describe at least two oseltamivir resistant patients along the Texas / Mexico border.  The cases are at opposite ends of the border (see map) and raise concerns that the resistance developed in the absence of Tamiflu treatment.  One patient had "diagnosed" resistance and was treated with Zanamivir, while the other wasn't treated with Zanamivir, leaving open the possibility that neither were treated with oseltamivir.  Moreover, the wording left open the possibility that there were more than two patients, suggesting fit swine H1N1 with H274Y was circulating over a wide area.

The emergence of fit swine H1N1 with H274Y is not a surprise.  A case has already been reported in Hong Kong in a traveler from San Francisco.  The precursor for this strain has been reported worldwide, although the only case reported in the US was in April in New Jersey, raising concerns that the fit strain was circulating silently, in part because the cases were mild and not being tested.  The patient in Hong Kong, like one of the patients recovered without treatment with Relenza, indicating the cases were relatively mild.

The fact that these cases were reported simultaneously also raises concerns that a fit H274Y is circulating in the area.

Details on the number of cases, and release of sequences, would be useful.

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