Tamiflu Resistant Cluster in Maryland / Virginia USA
Recombinomics Commentary 22:45
December 2, 2009

Two swine flu patients in Maryland and one in Virginia were hospitalized with a form of the virus resistant to a commonly used medicine, prompting infectious disease specialists to call for renewed caution

The above comments describe a Tamiflu resistant cluster in the Washington, DC area.  This cluster follows recent clusters at Duke, Wales and Edinburgh signaling efficient transmission of H274Y.  Silent spread of H274Y has been suggested by the short time period between the start of Tamiflu and symptoms.  In the spring these examples were relatively rare, which was likely due to the relatively low level of H274Y.  In most cases the host immune system would control H274Y positive virus, so most selection was sub-clinical.  However, there have been dramatic jumps in reported cases in the past several weeks, suggesting the viral load or circulating levels of H274Y have increased.  These increased levels has led to more efficient transmission; leading to more cases and clusters.

In addition to the indirect evidence for mixtures, an upcoming report on the first reported case of resistance in the absence of Tamiflu treatment indicated that the patient was infected with equal levels of wild type and H274Y positive virus.  In most cases however, the ratio of H274Y to wild type was lower, allowing H274Y to silently spread.



•  Mikalai Shaulau: We have faced completely inexplicable illness. WHO’s aid is needed urgently (Link)

•  Hong Kong reports new death from influenza A/H1N1 (Link)

•  Egypt announces the death of case No. 23 swine flu to a pregnant woman from Aswan (translated) (Link)

•  Pune; toll mounts to 118 (Link)

•  New H1N1 death toll figure (translated) (Link)

•  Netherlands reports mutant swine flu death (Link)

North Korea
•  Swine flu hits North Korea border area (Link)

•  Two more deaths due to A(H1N1) virus (Link)

United Kingdom
•  HPA Weekly Update 3rd December 2009 (Link)
•  Pandemic 2009 England (Link)

United States
•  Novartis opens first US plant (Link) (Link)
•  CA: Third inmate dies of swine flu (Link)
•  FL: Flu almost kills girl despite negative tests (Link)
•  OR: only up 11 hospitalizations, but 4 more deaths in three days (Link)
•  PA: 3rd swine flu death in Montco (Link)
•  PA: (2) New Deaths on PA DOH Website for 12.03.09 (Link)

•  H1N1 & H5N1 could form deadly cocktail: health official (Link)

•  Environmental Stresses Increase Risk of H5N1 Outbreak (Link)
•  Tamiflu-resistant flu not spreading more widely – WHO (Link)
•  H1N1 malware epidemic is more contagious than real deal (Link)

•  CIDRAP: Resistant flu clusters warrant greater vigilance, treatment tweaks (Link)
•  Recombinomics: 446 Dead in Ukraine – D225G and Deaths Spread (Link)