2009年-2012年上海地区儿童甲型H3N2流感病毒的耐药性监测

Drug resistance surveillance of influenza A(H3N2) virus in children in Shanghai,2009-2012

目的了解2009年-2012年上海地区儿童流行的甲型H3N2流感病毒对金刚烷胺和奥司他韦(达菲)的耐药情况。方法收集2009年6月-2012年5月期间复旦大学儿科医院、31家上海市流感哨点医院门诊类流感患儿的鼻咽拭子标本,所有的标本抽提核酸后采用荧光RT-PCR检测甲型H3N2流感病毒。选取部分检测阳性标本行普通RTPCR进一步扩增H3N2流感病毒基质蛋白2(Matrix protein,M2)和神经氨酸酶(Neuraminidase,NA)的部分基因片段并测序,通过相关耐药位点的分子标志来评价抗病毒耐药。结果在17 312份标本中,1 148份(6.63%)检测为H3N2亚型流感病毒阳性。测序的76株甲型H3N2病毒均携带介导对金刚烷胺耐药的S31N突变标志,未发现甲型H3N2病毒株携带对奥司他韦耐药的分子标志。结论目前上海地区儿童中流行的甲型H3N2流感病毒对金刚烷胺普遍耐药,金刚烷胺不应该推荐治疗儿童流感。奥司他韦是防治甲型H3N2流感病毒敏感的药物。

Objective To investigate the drug resistance of influenza A（H3N2） virus to amantadine and oseltamivir among children in Shanghai during 2009-2011.Methods Nasopharyngeal or throat swabs were collected from the outpatient children with influenza-like illness from June 2009 to May 2012 in Children＇s Hospital of Fudan University and 31 influenza sentinel hospitals in Shanghai.All the specimens were tested for influenza A（H3N2） virus using real-time RT-PCR.One-step RT-PCR reaction was performed for amplification of partial M2 and NA genes of some samples.The antiviral resistance of influenza A（H3N2） virus was determined using the drug-resistant molecular markers of the M2 and NA genes.Results In 17 312samples,influenza A（H3N2） virus was detected in 1 148 samples（6.63%）.Seventy-six strains of influenza A（H3N2） virus were sequenced,and all the strains were found S31N mutation in the M2 gene indicating amantadine resistance,but no amino acid mutation associated with oseltamivir resistance was found.Conclusion Given that amantadine-resistant influenza A（H3N2） virus were widely circulated among Shanghainese children in recent years,amantadine should not be recommended for the treatment of influenza in children.Oseltamivir remains a sensitive antiviral drug for the treatment and prophylaxis of influenza.