Oseltamivir-resistant pandemic (H1N1)2009 in Yemen - case report.
BACKGROUND
During the influenza season of 2007-08, oseltamivir-resistant influenza A (H1N1) viruses emerged in several countries in Europe, North America, and Asia. Despite substantial prevalence of oseltamivir-resistant viruses, few data are available on the clinical profile of subjects infected with these viruses.


OBJECTIVE
to describe the first oseltamivir-resistant (H1N1) influenza virus pandemic 2009 from the Eastern Mediterranean Region including Yemen and to determine the evidence by clinical presentation of children infected with these oseltamivir - resistant viruses.


METHODS
History, physical examination and laboratory investigations including Complete Blood Count, chest x-ray, blood cultures, CSF examination, LFTs, RFTs, blood for sugar, H1N1 test and oseltamivir resistance test.


RESULTS
Nasal swabs indicated positivity on both H1N1 test and the RNP gene (Human R Nase P gene that serves as internal positive control for Human RNA. Both clinical specimens presented the mutation S31N in the M2 gene associated with resistance to adamantanes and H274Y in NA gene associated with resistance to oseltamivir. This was the first diagnosed case of resistance to oseltamivir in Yemen and also it is the first reported case of oseltamivir resistance virus in the Eastern Mediterranean Region.


CONCLUSIONS
The pattern of resistance found in the oseltamivir resistant isolate collected from Yemen is the same as has been reported elsewhere in other WHO regions. Clinical description and outcomes are not different from what is described elsewhere.
Thabet
Ahmed A K
AA
Community Medicine Department (Communicable Diseases Epidemiology), Faculty of Medicine and Health Sciences, Thamar University, Sana'a road, Dhamar, Republic of Yemen. Thabet64@live.com
Al-Bahlooli
Saeed H
SH
Al-Kohlani
Abdulhakeem
A
Shoja'a
Ahmed
A
D019943:Amino Acid Substitution; D000818:Animals; D000998:Antiviral Agents / Q000494:pharmacology*; D002675:Child, Preschool; D024882:Drug Resistance, Viral; D005260:Female; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype / Q000187:drug effects* / Q000302:isolation & purification; D007251:Influenza, Human / Q000473:pathology* / Q000821:virology*; D020125:Mutation, Missense; D009297:Nasal Mucosa / Q000821:virology; D009439:Neuraminidase / Q000235:genetics; D053139:Oseltamivir / Q000494:pharmacology*; D014763:Viral Matrix Proteins / Q000235:genetics; D014764:Viral Proteins / Q000235:genetics; D015006:Yemen; D000086082:Viroporin Proteins
D000998:Antiviral Agents; D009439:Neuraminidase; D053139:Oseltamivir; D014763:Viral Matrix Proteins; D014764:Viral Proteins; C488937:M2 protein, Influenza A virus; D000086082:Viroporin Proteins; C487630:NA protein, influenza A virus
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