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Resistant Cluster in Wales UK
The above comments describe a large cluster of Tamiflu resistant swine H1N1 in a hospital in Wales. Earlier reports had described resistance in 2 immuno-compromised patients, but the updated report of 5-9 patients leaves little doubt that the virus is transmitting human to human. All prior examples of resistance in swine H1N1 involved H274Y, which is almost certainly the case for this outbreak. Previously there have been multiple reports of clusters of two, including recent outbreak in Edinburgh, and this large outbreak raises concerns that H1N1 with H274Y will become far more common.
Although prior cases were said to be due to "spontaneous mutation, by Roche and agency reports, there was little data to support that conclusion. All resistance involved the same change, H274Y, on multiple H1N1 backgrounds and appearance was too soon to support a spontaneous origin. Instead the rapid appearance supported circulation of H274Y as a minor population which was below detection limit in the absence of Tamiflu selection, but rapidly appeared after treatment. The appearance of 5-9 cases at the same facility indicates the detected H274Y was not due to independent mutations and reinforces concerns that H274Y is widespread and efficiently transmitting..