#19,379
For the past 3 years we've been following scattered reports of `reduced susceptibility' of the seasonal H1N1 flu virus to the antiviral drug oseltamivir (aka `Tamiflu') around the globe.
In March 2024 The Lancet Microbe published - Global Emergence of Neuraminidase Inhibitor-Resistant Influenza A(H1N1)pdm09 Viruses with I223V and S247N Mutations - which reported reduced oseltamivir inhibition among samples tested in Hong Kong in 2023.
A concerning trend, but not nearly enough of a reduction to invalidate the use of the drug.
Three months later (June 2024), the EID Journal: Multicountry Spread of Influenza A(H1N1)pdm09 Viruses with Reduced Oseltamivir Inhibition, May 2023–February 2024 reported a ≈ 13-fold reduced inhibition by oseltamivir.
In July of 2025, Virus Research: A 15-year Study of Neuraminidase Mutations and the Increasing of S247N Mutation in Spain, we looked at a study that found a sharp increase in detections of the NA:S247N mutation beginning in 2024, but not combined with I223V.
Last December, in Eurosurveillance: Expansion of influenza A(H1N1)pdm09 NA:S247N Viruses with Reduced Susceptibility to Oseltamivir, Catalonia, Spain, and in Europe, July to October 2025. a Rapid Communications reported on another dramatic surge in H1N1 viruses carrying the NA:S247N mutation in Catalonia Spain, and other parts of Europe.
Some weeks (see above graphic), as many as 100% of viruses tested showed this NA:S247N mutation. The good news, however, was that once again a second synergistic mutation - NA:I223V - was not detected in these recent Catalonia isolates.
As for detections in the United States (see Feb 2026 blog), over the entire 2024-2025 flu season - out of 1697 H1N1 viruses tested - only one carried the NA-I223V and NA-S247N amino acid substitutions.
But shortly after the New Year we began to seen an uptick in reduced inhibition detections in the United States. By late February (FluView week 7) - based on 517 H1N1 isolates tested since October - the CDC reported 10 isolates with reduced inhibition and 4 with highly reduced inhibition (due to NA:H275Y).
In early June we looked at the last full FluView report of the 2025-2026 flu season, which reported a total 20 reduced inhibition results, and 11 highly reduced results:
Nine A(H1N1)pdm09 viruses had NA-H275Y amino acid substitution conferring highly reduced inhibition by oseltamivir and peramivir. Nineteen A(H1N1)pdm09 viruses had amino acid substitutions NA-I223V and NA-S247N and showed reduced inhibition by oseltamivir. One A(H1N1)pdm09 virus had amino acid substitutions NA-I223T and NA-S247N and showed reduced inhibition by oseltamivir. Two A(H3N2) viruses had amino acid substitution NA-E119V conferring highly reduced inhibition by oseltamivir. Three B viruses had amino acid substitution NA-M464T and showed reduced inhibition by peramivir.While the number of S247N+I223V mutations remained relatively low (2.1%), this was more than a 35-fold increase over the previous year. And equally concerning - after an extended absence - the tag team of S247N+I223V was being reported again in a newer (D.3.x) NA-clade H1N1 virus.
With the release last Friday of the first full FluView report since last May, we've our first look at the reported detections of the S247N+I223V amino acid substitution over the summer.
While the overall numbers are low - and the lack of any reported H275Y mutations is reassuring - the percentage of H1N1 viruses that harbor the S247N+I223V mutation was nearly 50% higher (3.1%) than at the end of May (2.1%).
Viruses collected in the U.S. since May 24, 2026, were tested for antiviral susceptibility as follows:
Eight A(H1N1)pdm09 viruses had amino acid substitutions NA-I223V and NA-S247N and showed reduced inhibition by oseltamivir.
By way of comparison, over the summer of 2025 the CDC reported zero detections, and none were reported until early 2026.
It still isn't clear how much of a public health impact these mutations will have - if any - going forward, but this week's FluView report provides a useful benchmark of where things stand as we enter into the 2026-2027 flu season.
Stay tuned. Things could get interesting.











