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Fluorescence-based Neuraminidase Inhibition Assay to Assess the Susceptibility of Influenza Viruses to The Neuraminidase Inhibitor Class of Antivirals
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Oseltamivir Resistance in Human Influenza A(H5N1) and A(H7N9) Infections: A Mini Review

Yacine Abed1, Guy Boivin1

  • 1Research Center in Infectious Diseases of the Centre Hospitalo-Universitaire de Québec (CHUQ), Pavillon CHUL and Laval University, Québec City, Québec, Canada.

Open Forum Infectious Diseases
|July 23, 2026
PubMed

Insights

Avian influenza viruses (AIVs) can infect humans, causing severe illness and death. Oseltamivir resistance mutations in A(H5N1) and A(H7N9) viruses limit treatment effectiveness, necessitating improved antiviral strategies.

Area of Science:

  • Virology
  • Infectious Diseases
  • Public Health

Background:

  • Human infections with avian influenza viruses (AIVs) arise from avian-to-human transmission.
  • A(H5N1) and A(H7N9) subtypes cause the majority of human AIV cases, often leading to severe disease and high mortality.
  • Oseltamivir is a key antiviral for controlling AIV infections, but resistance can emerge.

Purpose of the Study:

  • To review human cases of A(H5N1) and A(H7N9) infections associated with oseltamivir resistance mutations.
  • To analyze the specific neuraminidase mutations conferring resistance in different AIV subtypes.
  • To assess the clinical outcomes and mortality in patients treated with oseltamivir despite resistance.

Main Methods:

  • Literature review of published human AIV cases.
  • Analysis of detected neuraminidase gene mutations associated with oseltamivir resistance.
  • Correlation of specific mutations with clinical outcomes and mortality.

Main Results:

  • Neuraminidase mutations conferring oseltamivir resistance emerged in a subtype-specific manner.
  • Predominant mutations included H274Y and N294S in A(H5N1) and R292K in A(H7N9).
  • Most patients with A(H5N1) and A(H7N9) infections and detected resistance mutations experienced severe outcomes and mortality, even with oseltamivir treatment.

Conclusions:

  • Oseltamivir resistance mutations in AIVs pose a significant threat to antiviral therapy efficacy.
  • Specific neuraminidase mutations confer resistance in a subtype-dependent manner.
  • Improved antiviral strategies are crucial for managing severe AIV infections, particularly those with resistance.
Keywords:
H5N1H7N9influenzaoseltamivirresistancetreatment

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