Community-acquired Oseltamivir-Resistant Pandemic (H1N1) 2009 in Child, Israel

DOI: 10.3201/eid1606.091875
Suggested citation for this article: Zonis Z, Englehard D, Hindiyeh M, Ram D, Mandelboim M, Mendelson E, et al. Community-acquired oseltamivir-resistant pandemic (H1N1) 2009 in child, Israel [letter]. Emerg Infect Dis. 2010 Jun; [Epub ahead of print]

Community-acquired Oseltamivir-Resistant Pandemic (H1N1) 2009 in Child, Israel

To the Editor: During the spring of 2009, a pandemic influenza A (H1N1) virus
emerged and spread globally. Initial testing of the virus found it susceptible to neuraminidase inhibitors and resistant to adamantanes (1,2). As of March 5, 2010, only 264 cases of oseltamivir-resistant pandemic (H1N1) 2009 infection had been reported to the World Health Organization, but the number of cases has been steadily increasing (2). These viruses were carrying the H275Y mutation, which conferred resistance to oseltamivir (2). Most of the reported cases were in immunocompromised patients who had prolonged viral shedding or in patients who had received oseltamivir prophylaxis or treatment (1–4). We describe an otherwise healthy 2-year-old boy with oseltamivir-resistant pandemic (H1N1) 2009 infection and a traumatic lung contusion, complicated by acute respiratory distress syndrome (ARDS). He had not received prior chemoprophylaxis or treatment with oseltamivir.

In November 2009, a healthy 2-year-old boy was admitted to the pediatric intensive care unit at the Western Galilee Hospital in Nahariya, Israel, after he had been hit by a car. One day before the accident, he had exhibited fever and cough (for which he was treated with acetaminophen). His 4-year-old brother had recovered recently from an influenza-like illness without antiviral treatment. The other household contacts were his parents, who did not have a respiratory illness.

On admission, small, bilateral lung contusions, right pneumothorax, and liver lacerations were shown on computed tomographic scan. The patient was treated with a chest tube for drainage, supplemental oxygen, and oseltamivir from hospital day 1 (30 mg 2 ×/day; child's body weight = 13 kg) and was placed in droplet isolation. Respiratory swab specimens, obtained on hospital day 1, were sent to the Israel Central Virology Laboratory (ICVL) and found to be...

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