Adamantane Resistance Among Influenza A Viruses Isolated Early During the 2005-2006 I

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[FONT=verdana, arial, helvetica, sans-serif]http://jama.ama-assn.org/cgi/gca?al...s=10&RESULTFORMAT=&gca=jama;295/8/891&allchb=

Adamantane Resistance Among Influenza A Viruses Isolated Early During the 2005-2006 Influenza Season in the United States

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[/FONT] [FONT=verdana, arial, helvetica, sans-serif] <nobr>Rick A. Bright, PhD</nobr>; <nobr>David K. Shay, MD, MPH</nobr>; <nobr>Bo Shu, MD</nobr>; <nobr>Nancy J. Cox, PhD</nobr>; <nobr>Alexander I. Klimov, PhD</nobr> [/FONT]

[FONT=verdana, arial, helvetica, sans-serif] JAMA. 2006;295:891-894. [/FONT]
<!-- ABS --> <!--startindex-->[FONT=verdana, arial, helvetica, sans-serif] Context The adamantanes, amantadine and rimantadine, havebeen used as first-choice antiviral drugs against communityoutbreaks of influenza A viruses for many years. Rates of virusesresistant to these drugs have been increasing globally. Rapidsurveillance for the emergence and spread of resistant viruseshas become critical for appropriate treatment of patients.[/FONT]
[FONT=verdana, arial, helvetica, sans-serif]Objective To investigate the frequency of adamantane-resistantinfluenza A viruses circulating in the United States duringthe initial months of the 2005-2006 influenza season.[/FONT]
[FONT=verdana, arial, helvetica, sans-serif]Design and Setting Influenza isolates collected from 26states from October 1 through December 31, 2005, and submittedto the US Centers for Disease Control and Prevention were testedfor drug resistance as part of ongoing surveillance. Isolateswere submitted from World Health Organization collaboratinglaboratories and National Respiratory and Enteric Virus SurveillanceSystem laboratories.[/FONT]
[FONT=verdana, arial, helvetica, sans-serif]Main Outcome Measures Using pyrosequencing and confirmatoryassays, we identified viruses containing mutations within theM2 gene that are known to confer resistance to both amantadineand rimantadine.[/FONT]
[FONT=verdana, arial, helvetica, sans-serif]Results A total of 209 influenza A(H3N2) viruses isolatedfrom patients in 26 states were screened, of which 193 (92.3%)contained a change at amino acid 31 (serine to asparagine [S31N])in the M2 gene known to be correlated with adamantane resistance.Two of 8 influenza A(H1N1) viruses contained the same mutation.Drug-resistant viruses were distributed across the United States.[/FONT]
[FONT=verdana, arial, helvetica, sans-serif]Conclusions The high proportion of influenza A virusescurrently circulating in the United States demonstrating adamantaneresistance highlights the clinical importance of rapid surveillancefor antiviral resistance. Our results indicate that these drugsshould not be used for the treatment or prophylaxis of influenzain the United States until susceptibility to adamantanes hasbeen reestablished among circulating influenza A isolates.[/FONT]

[FONT=verdana, arial, helvetica, sans-serif] Author Affiliations: Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Influenza Branch, Atlanta, Ga. As of February 1, 2006, Dr Bright is with Novavax, Malvern, Pa. [/FONT]

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