Increased circulation of #influenza #H1N1pdm09 viruses with reduced susceptibility to #oseltamivir, #Germany 2024–2026

 

Highlights

    • The National Influenza Center for Germany (Germany NIC) detected an increase in the prevalence of A(H1N1)pdm09 viruses carrying the neuraminidase substitution NA-S247N, rising from 1.16% circulating in the 2024/25 influenza season to 56.8% in the 2025/26 season.

    • The NA-S247N substitution reduced oseltamivir susceptibility slightly; combined NA-S247N/NA-I223V/T substitutions showed reduced inhibition according WHO criteria.

    • Continuous molecular and phenotypic surveillance is essential for public health and the early detection of viruses with reduced susceptibility to antiviral drugs.

    • Rapid pyrosequencing supports the routine surveillance of neuraminidase substitutions associated with reduced susceptibility to antivirals.

    • The findings illustrate the Germany NIC's 30-year contribution to antiviral susceptibility monitoring.

Abstract

Background

Oseltamivir is still considered to be the first-line antiviral treatment for severe seasonal influenza. However, resistance to neuraminidase (NA) inhibitors poses significant challenges to influenza management. Since the 2023/24 season, A(H1N1)pdm09 viruses carrying neuraminidase substitutions (NA-I223V and/or NA-S247N) have emerged in Germany, other EU/EEA countries, and some of the World Health Organization (WHO) regions. These viruses have been linked to reduced oseltamivir susceptibility.

Methods

A rapid RT-PCR/pyrosequencing assay was developed and validated to detect NA-I223X and NA-S247X substitutions. Subsequently, a total of 765 A(H1N1)pdm09 viruses detected in Germany during the 2024/25 and 2025/26 influenza seasons were characterized phenotypically using fluorometric NA inhibition testing and/or genotypically using next-generation sequencing and pyrosequencing.

Results

The prevalence of A(H1N1)pdm09 viruses bearing the NA-S247N substitution increased from 1.2% in the 2024/25 season to 56.8% in the 2025/26 season, accounting for up to 80% of analyzed viruses by March 2026. Viruses carrying NA-S247N exhibited higher oseltamivir IC50 values than wild-type viruses. Combinations of NA-S247N with substitutions at position 223 demonstrated an additional increase. In viruses carrying the combined NA-S247N and NA-I223V/T substitutions oseltamivir showed reduced inhibition with increased IC50 values of up to 17-fold compared to wild type viruses.

Conclusions

The accumulation of NA substitutions in A(H1N1)pdm09 influenza viruses, particularly NA-S247N in combination with NA-I223V/T, substantially reduces susceptibility to oseltamivir. The marked increase in NA-S247N prevalence suggests that this substitution is becoming persistent rather than transient. Targeted pyrosequencing is a practical tool for the early detection of emerging resistance-associated substitutions.

Source: 

Link: https://doi.org/10.1016/j.ijmm.2026.151745

____

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#Maternal #vaccination against #COVID19, #influenza, #pertussis, and #RSV: a scoping review

 

Abstract

Pregnancy and early infancy are periods of heightened vulnerability, with SARS-CoV-2 and influenza infections potentially linked to adverse pregnancy outcomes, including preterm birth and stillbirth. Maternal vaccination provides direct protection to mothers by active immunisation
and to infants by passive immunisation. This scoping review mapped and described published literature on maternal vaccination against COVID-19, influenza, pertussis, and respiratory syncytial virus (RSV). It includes information on the outcome domains studied and if timing of vaccination was examined, with the aim of identifying evidence gaps and supporting decision-makers in choosing priority areas for subsequent systematic review topics. A comprehensive literature search across multiple databases of studies published from January 2000 to October 2025 identified 635 publications (540 publications of primary studies, 95 evidence syntheses). Studies on COVID-19 (260 publications of studies, 45 reviews), influenza (161 publications of studies, 29 reviews), pertussis (113 publications of studies, 20 reviews), and RSV (20 publications of studies, 11 reviews) were analysed. Available evidence on COVID-19, influenza, and pertussis vaccination on efficacy, effectiveness, safety and immunogenicity outcomes is considerable. RSV vaccination evidence is limited. Updated systematic reviews would be helpful to clarify the optimal timing of COVID-19 and influenza vaccination and the effectiveness and safety of the coadministration of influenza and pertussis vaccines.

Source: 

Link: https://www.nature.com/articles/s41541-026-01545-2

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#Taiwan, Seasonal #Influenza and #COVID19 #Epidemics Weekly #Report (CDC, Sept. 29 '26): #H1N1pdm09 flu virus and #SARS-CoV-2 PQ.16.1.1 variant predominated

 

{Excerpts}

(...)

    According to data from the Taiwan Centers for Disease Control (CDC), the influenza epidemic in Taiwan remains stable and is still in its prevalent period. 

    In week 38 (September 20-26), there were 138,654 outpatient and emergency room visits for influenza-like illnesses, a slight decrease of 3.2% compared to the previous week, mainly due to outpatient closures during the long weekend. 

    Additionally, last week (September 22-28), there were 87 new severe cases of influenza (80 H1N1, 1 H3N2, and 6 untyped A cases) and 30 deaths (all H1N1). 

    Laboratory surveillance data shows that the influenza virus currently circulating in the community is predominantly type A, with type A H1N1 accounting for 87.7%. 

    This flu season (2015-2016) saw a cumulative total of 1,673 severe cases (1,041 H1N1, 510 H3N2, 32 unclassified H1N1, and 90 H1N1) and 334 deaths (206 H1N1, 106 H3N2, 10 unclassified H1N1, and 12 H1N1). 

    The majority of severe cases were among those aged 65 and above (65.9%) and those with a history of chronic illnesses (83.4%). 67.7% of patients had not received the flu vaccine this season. 

    Regarding the COVID-19 pandemic, while the number of cases in Taiwan has decreased, it remains in an epidemic period. 

    In week 38 (September 20-26), there were 10,502 outpatient and emergency room visits related to COVID-19, a 28.4% decrease compared to the previous week (September 13-19). 

    Last week (September 22-28), there were 33 new severe cases and 14 new deaths. 

    Since October 2025, there have been a total of 756 cases of COVID-19 complicated by severe illness, of which 147 have died. 

    The majority of severe cases are among the elderly aged 65 and above (73.7%) and those with a history of chronic diseases (82.9%). 83.6% of these cases have not received the COVID-19 vaccine this season. 

    In the past four weeks, the most prevalent local case variants have been PQ.16.1.1 and NB.1.8.1.

(...)

Source: 

Link: https://www.cdc.gov.tw/Bulletin/Detail/PkxM8mKEAbKUXcS81xFuxQ?typeid=9

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#Recommendations announced for #influenza #vaccine composition for the 2027 southern hemisphere influenza season (WHO, extract)

 

{Excerpts}

(...)

    From February to August 2026, influenza A(H1N1)pdm09, A(H3N2) and influenza B viruses circulated in varying proportions across all regions of the world, causing disease. 

    Influenza A viruses were the most common in most regions, except Northern and Western Africa, North America and Eastern Asia, where influenza B viruses dominated.

    WHO recommends that vaccines for use in the 2027 southern hemisphere influenza season contain the following:

Egg-based vaccines

    ° an A/Missouri/11/2025 (H1N1)pdm09-like virus;

    ° an A/Darwin/1454/2025 (H3N2)-like virus; and

    ° a B/Tokyo/EIS13-175/2025 (B/Victoria lineage)-like virus.

Cell culture-, recombinant protein- or nucleic acid-based vaccines

    ° an A/Missouri/11/2025 (H1N1)pdm09-like virus;

    ° an A/Darwin/1415/2025 (H3N2)-like virus; and

    ° a B/Pennsylvania/14/2025 (B/Victoria lineage)-like virus.

    As part of the review, experts also looked at influenza viruses circulating in animals, particularly those that have caused infections in humans. These animal or zoonotic influenza viruses remain a significant concern because of their potential to cause pandemics.

(...)

Source: 

Link: https://www.who.int/news/item/25-09-2026-recommendations-announced-for-influenza-vaccine-composition-for-the-2027-southern-hemisphere-influenza-season

____

Occurrence of #influenza #antivirals and #resistance development in #influenza A viruses in aquatic #environments: A risk assessment

 

Abstract

Influenza antivirals (IAs) have been detected in aquatic environments inhabited by dabbling ducks, the natural reservoir of influenza A virus (IAV), raising concerns about the development of antiviral resistance. Because novel human IAV strains often contain genetic material of avian origin, this may contribute to resistance in viruses with pandemic potential. This study aimed to assess the environmental risk posed by four IAs—oseltamivir carboxylate (OC), zanamivir (ZA), peramivir (PE), and amantadine (AM)—based on their potential for environmental release, environmental stability, and induction of antiviral resistance. The assessment combined data from new experiments on (1) environmental release and (2) environmental stability of PE, AM, OC, and ZA, with results from previously published in vivo experiments in a mallard model examining (3) resistance development to OC, PE, and ZA in IAV. The risk of environmental release was assessed as high for OC, AM, and PE, and very high for ZA. Environmental stability ranged from very high to low, in the order PE > AM > OC > ZA. The potential to induce resistance in IAV was similar for PE and OC, and lower for ZA. Overall, the environmental risk ranking was PE > OC > ZA, with PE and OC posing the highest risks. Prudent use of IAs requires balancing the risk of resistance development against clinical benefit. In cases of complicated influenza or in high-risk patient groups, the clinical benefits are substantial and justify IA use. However, in uncomplicated influenza among otherwise healthy individuals, the clinical benefit is limited, and the risk of resistance development should be carefully considered. Among the evaluated antivirals, ZA showed the lowest environmental risk and should be preferred when feasible.

Source: 

Link: https://doi.org/10.1371/journal.pone.0358447

____

#Taiwan, Seasonal #Influenza and #COVID19 Epidemics Weekly Report (CDC, Sept. 22 '26): #H1N1pdm09 & #SARS-CoV-2 PQ.16.1.1 viruses predominated

 

{Excerpt}

(...)

    The CDC noted that the influenza epidemic in Taiwan is slightly rising and in its epidemic season. 

    In week 37 (September 13-19), there were 141,375 outpatient and emergency room visits for influenza-like illnesses, a slight increase of 1.4% compared to the previous week. 

    Additionally, last week (September 15-21), there were 165 new cases of severe influenza complications (151 H1N1, 6 H3N2, and 8 untyped A cases) and 30 deaths (27 H1N1, 2 H3N2, and 1 untyped A case). 

    Laboratory monitoring data shows that the influenza virus currently circulating in the community is mainly type A, with type A H1N1 accounting for 84.9% of the cases. 

    This influenza season (2025-2026) saw a cumulative total of 1,586 severe cases (958 H1N1, 509 H3N2, 29 untyped type A, 90 type B) and 304 deaths (176 H1N1, 106 H3N2, 10 untyped type A, 12 type B). 

    Severe cases were predominantly among those aged 65 and above (65.8%) and those with a history of chronic diseases (83.2%). 67.8% of patients had not received the influenza vaccine this season.

    According to data from the Taiwan Centers for Disease Control (CDC), the COVID-19 epidemic in Taiwan is declining, but it is still in its epidemic period. 

    In the 37th week (September 13-19), there were 14,462 outpatient and emergency room visits related to COVID-19, a 20.6% decrease compared to the previous week (September 6-12). 

    Last week (September 15-21), there were 48 new severe cases and 9 new deaths. 

    Since October 2025, there have been a cumulative total of 723 cases of COVID-19 complicated by severe illness, of which 133 have died. 

    The majority of severe cases are among those aged 65 and above (73.3%) and those with a history of chronic diseases (82.6%). 83.8% of these cases have not received the COVID-19 vaccine this season. 

    In the past four weeks, the most prevalent local variants in cases have been NB.1.8.1 and PQ.16.1.1.

(...)

Source: 

Link: https://www.cdc.gov.tw/Bulletin/Detail/Tj9G4dJj3yMmEE0URl49CA?typeid=9

____

Limited added #benefit of seasonal #influenza #vaccination before #H5 vaccination in mice and #ferrets challenged with #H5N1

 

ABSTRACT

Limited A(H5)-specific vaccine supply is expected early in a potential A(H5N1) pandemic, raising the question of whether licensed seasonal influenza vaccines could enhance protection when administered before A(H5) vaccination. We evaluated this strategy in mouse and ferret models using clade 2.3.4.4b A(H5N1) viruses. Seasonal influenza vaccination induced antibodies to seasonal haemagglutinins but did not induce detectable antibodies against A(H5) and did not consistently enhance A(H5)-directed antibody responses after A(H5) vaccination. In lethal challenge studies, seasonal vaccine priming before A(H5) vaccination was associated with improved outcomes compared with A(H5) vaccination alone in one of three mouse experiments, but this effect was not observed in the other two mouse experiments or in ferrets. These findings suggest that seasonal influenza vaccine priming provides limited added benefit to A(H5) vaccine-mediated protection against A(H5N1) under the conditions tested.

Source: 

Link: https://doi.org/10.1080/22221751.2026.2731495

____

#Influenza and Other Respiratory Viruses Research #References (AMEDEO, September 19 '26)

 

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Near real-time data on the #human neutralizing #antibody #landscape to #influenza virus in summer of 2026 shows antigenic advance of #H3N2 subclade K region D mutants and #H1N1 D.3.1.1 Sa mutants

 

Abstract

Human seasonal influenza evolves rapidly, necessitating twice yearly decisions about whether to update the strains in the vaccine. To help inform this decision, we have been using high-throughput sequencing-based neutralization assays to make twice yearly measurements of how recent human sera neutralize current human H3N2 and H1N1 strains. Here we provide the third installment in this series of measurements by reporting 47,851 titers representing neutralization of 148 viral strains by 325 human sera collected between April and August of 2026. Our measurements show that new H3N2 subclade K strains with mutations in antigenic region D and new H1N1 subclade D.3.1.1 strains with mutations in antigenic region Sa (such as G155E) have reduced neutralization by human sera, with notable heterogeneity in the impact of some of these mutations across sera from different individuals. This paper is accompanied by an interactive summary (https://jbloomlab.github.io/flu-seqneut-2026/summary.html) that enables detailed exploration of the results, and all titer data are publicly available for further analysis to aid vaccine antigen selection and studies of viral evolution.

Competing Interest Statement

JDB consults for Pfizer, GSK, Apriori Bio, and Merck. JDB has received stock options in the Vaccine Company. JDB is an inventor on Fred Hutch licensed patents related to techniques to characterize the antigenic effects of viral variation. SEH is a co-inventor on patents that describe the use of nucleoside-modified mRNA as a vaccine platform. SEH reports receiving consulting fees from Sanofi, Pfizer, Lumen, Novavax, and Merck. ALG reports contract testing to UW from Abbott, Cepheid, Novavax, Pfizer, Janssen, Assembly Biosciences, Aicuris, Innovative Molecules, and Hologic, research support from Gilead, personal consulting fees from Arisan Therapeutics, outside of the described work. JAE reports support to her institution from GSK, Pfizer, Moderna, and is a consultant for GSK, Pfizer, Merck, Meissa vaccines, Moderna, and Shionogi. ST reports research funding from Pfizer for a separate study.

Funder Information Declared

National Institute of Allergy and Infectious Diseases, R01AI165821, F30AI186284, 75N93021C00015

Howard Hughes Medical Institute, https://ror.org/006w34k90

Source: 

Link: https://doi.org/10.64898/2026.09.15.751855

____

#Taiwan, Seasonal #Influenza and #COVID19 #Epidemics Weekly #Update (CDC, September 15 '26): #H1N1pdm09 flu virus & #SARS-CoV-2 PQ.16.1.1 predominated

 

{Excerpts}

(...)

    The CDC pointed out that the domestic influenza epidemic is rising and in its epidemic season. 

    In the 36th week (September 6th-12th), there were 136,796 outpatient and emergency room visits for influenza-like illnesses, an increase of 16.5% compared to the previous week. 

    Additionally, last week (September 8th-14th), there were 92 new cases of severe influenza complications (79 H1N1, 5 H3N2, and 8 untyped A cases) and 21 deaths (18 H1N1, 2 H3N2, and 1 untyped A case). 

    Laboratory monitoring data shows that the influenza virus currently circulating in the community is mainly type A, with type A H1N1 accounting for 82.2%. 

    This flu season has seen a cumulative total of 1,421 severe cases (800 H1N1, 503 H3N2, 28 untyped type A, and 90 type B) and 274 deaths (149 H1N1, 104 H3N2, 9 untyped type A, and 12 type B). 

    The majority of severe cases are among those aged 65 and above (65.0%) and those with a history of chronic diseases (82.7%). 68.3% of those affected have not received the flu vaccine this season.

    According to data from the Taiwan Centers for Disease Control (CDC), the COVID-19 epidemic in Taiwan is declining, but it is still in its epidemic period. 

    In week 36 (September 6-12), there were 17,847 outpatient and emergency room visits related to COVID-19, a 13.3% decrease compared to the previous week (August 30-September 5). 

    Last week (September 8-14), there were 53 new severe cases and 18 local deaths. 

    Since October 2025, there have been a cumulative total of 675 locally transmitted cases of COVID-19 complicated by severe illness, of which 124 have died. 

    Severe cases are predominantly among those aged 65 and above (73.3%) and those with a history of chronic diseases (82.8%). 83.6% of these cases have not received the COVID-19 vaccine this season. 

    In the past four weeks, the most prevalent local variants have been NB.1.8.1 and PQ.16.1.1.

(...)

Source: 

Link: https://www.cdc.gov.tw/Bulletin/Detail/CqW5UAMFqpDkwJWfWG-WGw?typeid=9

____

#Influenza and Other Respiratory Viruses Research #References (AMEDEO, September 13 '26)

 

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    Virology

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    Virus Res

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