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In the Netherlands, a case of pandemic A(H1N1) 2009 developed in an immunocompromised child with reduced susceptibility to zanamivir and oseltamivir due to an amino-acid mutation at position 223 in the neuraminidase. The child with an underlying condition that rendered him susceptible to infection died due to deterioration of pulmonary problems. No onward transmission of this variant was detected.
Previously, amino-acid mutations at the 223 (n1 numbering) or 222 (n2 numbering) position in the neuraminidase have been reported in A(H5N1) and seasonal influenza viruses associated with reduced susceptibility or an enhanced level of resistance in combination with other resistance mutations (e.g. H275Y), for oseltamivir only or for both oseltamivir and zanamivir [Hurt, AC et al. Antimicrobial agents and chemotherapy 2009; 53: 4433-40].
Therefore, inclusion of screening for variation of amino-acids at this position is warranted.
The clinical implications of this A(H1N1) 2009 variant are being assessed and a publication is expected.
