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Paradigm Shift Intervention Monitoring
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Transmission of Fit
Tamiflu Resistant H1N1 in Maryland
The above description of the Tamiflu resistant cluster in the Maryland/Virginia area suggests that the first admission was of a patient who had not yet started anti-viral treatment, raising concerns that the H1N1 was evolutionarily fit and is transmitting in the area. The cluster of three confirmed cases in the area also supports this conclusion.
The WHO just issued an update on the spike (57 rising to 96 H274Y cases) in confirmed cases in the past two weeks, and although the report said evidence of a change was lacking, it would appear that most investigations were ongoing, and initial evidence strongly supported a change.
Although 1/3 of the cases were linked to immune-compromised patients, the clustering once again indicated that the virus with H274Y was transmitting. The number of confirmed cases in Wales has now grown to 8, and 3 of the 4 patients in North Carolina have died, demonstrating both transmissibility and lethality for H1N1 carrying H274Y.
The immuno-compromised patients merely offer a window on the emergence of an evolutionarily fit virus. The transmission has also been noted in healthy persons. At least one of the cabin mates in North Carolina was infected by a fit H1N1, which was also true of a familial cluster in Hong Kong. Moreover, new sequences with H274Y are not linked to Tamiflu use, and multiple isolates from the same sub-clade have been seen in Hong Kong ex-San Francisco, Tennessee, Georgia, and Spain. Similarly, the burst of H274Y positive cases described in recent CDC weekly reports have not been linked to prior Tamiflu usage.
Thus, the explosion in cases and clusters in the absence of Tamiflu use strongly suggest that the fixing of H274Y in pandemic H1N1 will soon follow the fixing of H274Y in seasonal flu.