Pandemic (H1N1) 2009 virus infection: Persistent viral shedding after Oseltamivir treatment

Objectives: To study pandemic (H1N1) 2009 virological outcomes after Oseltamivir treatment in confirmed cases of pandemic (H1N1) 2009 virus infections. A hospital-based cohort study was conducted in south Thailand, between June and September 2009. Methods: Throat/swab specimens were tested by real-time reverse transcriptase polymerase chain reaction (rRT-PCR) for pandemic (H1N1) 2009. All 357 confirmed cases (122 inpatients, 235 outpatients), whose received a 5-day Oseltamivir treatment. Post-treatment virological follow-up was performed in 91 eligible cases. The NA gene was screened for the H275Y mutation responsible for Oseltamivir resistance. Results: Thirty-three of 91 patients (36%) had underlying diseases. The duration from the onset of illness to the detection of virus ranged 1-14 days (median 3 days). The rRT-PCR was positive on day 5 of treatment in 24 of 91 patients (26%). Patients with underlying diseases had a higher proportion of post-treatment positive test than those without underlying diseases (15/33 vs 9/58). The rRT-PCR-confirmed viruses detected in all 125 throat swab specimens did not show evidence suggesting Oseltamivir resistance. Conclusions: Prolonged presence of pandemic (H1N1) 2009 detected by rRT-PCR was found. An extended course of antiviral treatment should be considered in patients with underlying diseases and severe clinical symptoms.