Increased symptom severity but unchanged neuraminidase inhibitor effectiveness for A(H1N1)pdm09 in the 2010-2011 season: comparison with the previous season and with seasonal A(H3N2) and B.
BACKGROUND
No studies of the clinical symptoms before starting therapy or of the effectiveness of neuraminidase inhibitors (NAIs) have been carried out of the 2009-2010 and 2010-2011 seasons that compare A(H1N1)pdm09 or the three circulating types of influenza virus.


METHODS
The clinical symptoms and duration of fever (body temperature ≥37·5°C) after the first dose of an NAI (oseltamivir, zanamivir, laninamivir) were analyzed. PCR was carried out for 365 patients with A(H1N1)pdm09 in the 2009-2010 season and for 388 patients with one of the three types of influenza circulating in the 2010-2011 season. IC50 for the three NAIs was also analyzed in 51 patients in the 2010-2011 season.


RESULTS
The peak body temperature was significantly higher in 2010-2011 than in 2009-2010 for patients under 20 years with A(H1N1)pdm09, and in the 2010-2011 season for children 15 years or younger with A(H1N1)pdm09 than for those with other virus types. The percentage of A(H1N1)pdm09 patients with loss of appetite or fatigue was significantly higher in 2010-2011 than in the previous season. The duration of fever was not affected by the kind of NAI or by age in multiple regression analysis. The percentage of patients afebrile at 48 hours after the first dose of NAI was significantly higher for A(H1N1)pdm09 than for A(H3N2) (laninamivir) or B (oseltamivir and laninamivir).


CONCLUSIONS
Although the clinical symptoms of A(H1N1)pdm09 were slightly more severe in the 2010-2011 season, the effectiveness of the NAIs remained high in comparison with 2009-2010 and with other types of seasonal influenza.
Japan Physicians Association, Tokyo Medical Association Building 3F, Tokyo, Japan. nkawai@city.gifu.med.or.jp
Naoki
N
Kawai
Hideyuki
H
Ikematsu
Takashi
T
Kawashima
Tetsunari
T
Maeda
Hiroshi
H
Ukai
Nobuo
N
Hirotsu
Norio
N
Iwaki
Seizaburo
S
Kashiwagi
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000998:Antiviral Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004791:Enzyme Inhibitors / Q000627:therapeutic use*; D005260:Female; D005334:Fever / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000821:virology; D006801:Humans; D007223:Infant; D053118:Influenza A Virus, H1N1 Subtype / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification / Q000502:physiology; D053122:Influenza A Virus, H3N2 Subtype / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification / Q000502:physiology; D007251:Influenza, Human / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology* / Q000821:virology; D020128:Inhibitory Concentration 50; D008297:Male; D008875:Middle Aged; D009439:Neuraminidase / Q000037:antagonists & inhibitors*; D053139:Oseltamivir / Q000627:therapeutic use; D012621:Seasons; D012720:Severity of Illness Index; D016896:Treatment Outcome; D055815:Young Adult; D053243:Zanamivir / Q000627:therapeutic use
D000998:Antiviral Agents; D004791:Enzyme Inhibitors; D053139:Oseltamivir; D009439:Neuraminidase; D053243:Zanamivir