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Virological self-sampling to monitor influenza antiviral susceptibility in a community cohort.
J Antimicrob Chemother 2013; 68(10):2324-31JA

Abstract

OBJECTIVE

To perform antiviral susceptibility monitoring of treated individuals in the community during the 2009 influenza A(H1N1) pandemic in England.

PATIENTS AND METHODS

Between 200 and 400 patients were enrolled daily through the National Pandemic Flu Service (NPFS) and issued with a self-sampling kit. Initially, only persons aged 16 and over were eligible, but from 12 November (week 45), self-sampling was extended to include school-age children (5 years and older). All samples received were screened for influenza A(H1N1)pdm09 as well as seasonal influenza [A(H1N1), A(H3N2) and influenza B] by a combination of RT-PCR and virus isolation methods. Influenza A(H1N1)pdm09 RT-PCR-positive samples were screened for the oseltamivir resistance-inducing H275Y substitution, and a subset of samples also underwent phenotypic antiviral susceptibility testing by enzyme inhibition assay.

RESULTS

We were able to detect virus by RT-PCR in self-taken samples and recovered infectious virus enabling further virological characterization. The majority of influenza A(H1N1)pdm09 RT-PCR-positive NPFS samples (n = 1273) were taken after oseltamivir treatment had begun. No reduction in phenotypic susceptibility to neuraminidase inhibitors was detected, but five cases with minority quasi-species of oseltamivir-resistant virus (an H275Y amino acid substitution in neuraminidase) were detected.

CONCLUSIONS

Self-sampling is a useful tool for community surveillance, particularly for the follow-up of drug-treated patients. The virological study of self-taken samples from the NPFS provided a unique opportunity to evaluate the emergence of oseltamivir resistance in treated individuals with mild illness in the community, a target population that may not be captured by traditional sentinel surveillance schemes.

Authors+Show Affiliations

Microbiology Services Colindale, Public Health England, London, UK.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

23759670

Citation

Lackenby, Angie, et al. "Virological Self-sampling to Monitor Influenza Antiviral Susceptibility in a Community Cohort." The Journal of Antimicrobial Chemotherapy, vol. 68, no. 10, 2013, pp. 2324-31.
Lackenby A, Elliot AJ, Powers C, et al. Virological self-sampling to monitor influenza antiviral susceptibility in a community cohort. J Antimicrob Chemother. 2013;68(10):2324-31.
Lackenby, A., Elliot, A. J., Powers, C., Andrews, N., Ellis, J., Bermingham, A., ... Zambon, M. (2013). Virological self-sampling to monitor influenza antiviral susceptibility in a community cohort. The Journal of Antimicrobial Chemotherapy, 68(10), pp. 2324-31. doi:10.1093/jac/dkt203.
Lackenby A, et al. Virological Self-sampling to Monitor Influenza Antiviral Susceptibility in a Community Cohort. J Antimicrob Chemother. 2013;68(10):2324-31. PubMed PMID: 23759670.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Virological self-sampling to monitor influenza antiviral susceptibility in a community cohort. AU - Lackenby,Angie, AU - Elliot,Alex J, AU - Powers,Cassandra, AU - Andrews,Nick, AU - Ellis,Joanna, AU - Bermingham,Alison, AU - Thompson,Catherine, AU - Galiano,Monica, AU - Large,Shirley, AU - Durnall,Hayley, AU - Fleming,Douglas, AU - Smith,Gillian, AU - Zambon,Maria, Y1 - 2013/06/12/ PY - 2013/6/14/entrez PY - 2013/6/14/pubmed PY - 2014/3/13/medline KW - influenza virus KW - oseltamivir KW - pandemic KW - surveillance KW - zanamivir SP - 2324 EP - 31 JF - The Journal of antimicrobial chemotherapy JO - J. Antimicrob. Chemother. VL - 68 IS - 10 N2 - OBJECTIVE: To perform antiviral susceptibility monitoring of treated individuals in the community during the 2009 influenza A(H1N1) pandemic in England. PATIENTS AND METHODS: Between 200 and 400 patients were enrolled daily through the National Pandemic Flu Service (NPFS) and issued with a self-sampling kit. Initially, only persons aged 16 and over were eligible, but from 12 November (week 45), self-sampling was extended to include school-age children (5 years and older). All samples received were screened for influenza A(H1N1)pdm09 as well as seasonal influenza [A(H1N1), A(H3N2) and influenza B] by a combination of RT-PCR and virus isolation methods. Influenza A(H1N1)pdm09 RT-PCR-positive samples were screened for the oseltamivir resistance-inducing H275Y substitution, and a subset of samples also underwent phenotypic antiviral susceptibility testing by enzyme inhibition assay. RESULTS: We were able to detect virus by RT-PCR in self-taken samples and recovered infectious virus enabling further virological characterization. The majority of influenza A(H1N1)pdm09 RT-PCR-positive NPFS samples (n = 1273) were taken after oseltamivir treatment had begun. No reduction in phenotypic susceptibility to neuraminidase inhibitors was detected, but five cases with minority quasi-species of oseltamivir-resistant virus (an H275Y amino acid substitution in neuraminidase) were detected. CONCLUSIONS: Self-sampling is a useful tool for community surveillance, particularly for the follow-up of drug-treated patients. The virological study of self-taken samples from the NPFS provided a unique opportunity to evaluate the emergence of oseltamivir resistance in treated individuals with mild illness in the community, a target population that may not be captured by traditional sentinel surveillance schemes. SN - 1460-2091 UR - https://www.unboundmedicine.com/medline/citation/23759670/Virological_self_sampling_to_monitor_influenza_antiviral_susceptibility_in_a_community_cohort_ L2 - https://academic.oup.com/jac/article-lookup/doi/10.1093/jac/dkt203 DB - PRIME DP - Unbound Medicine ER -