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Paradigm Shift Intervention Monitoring
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Tamiflu Resistance in
Ukraine Sub-clade in Spain and US Georgia
The detection of H274Y in two isolates that matched the sub-clade in western Ukraine is cause for concern. Although D225G was not in the published sequence, its absence may have been linked to the tissue source of the viruses. The CDC isolate was collected on 9/11/2009 from a patient (7F) in Georgia. The tissue source was not listed, nor was the patient's current status. The virus in Spain was isolated from a nasopharyngeal swab collected on 11/26/2009, which may explain why D225G was not detected. In Ukraine, five nasopharyngeal washes had the matching sub-clade, but D225G was not in the published sequence. Similarly, it is likely that many if not most of CDDC isolates are also from nasopharyngial swabs, so the associate of H274Y with D225G is unclear, although a recent case in France was said to have D225G and H274Y.
The spread of this combination would be cause for concern. Reported samples with H274Y has spiked in the past two weeks, adding to concerns that H274Y is transmitting and prior silent spread is becoming more visible
Sequence data of samples from the lower respiratory tract would be useful in general, and most useful for samples from patients with D225G.