Sunday, December 07, 2025

The Gift of Preparedness 2025

CDC Infographic

#18,976

Just over 18 years ago, in a blog called Hickory Farms Will Hate Me For This, I began promoting the idea that - instead of gifting cheese platters, fruitcakes and ugly sweaters to friends and family - we should be giving preparedness items for holidays, birthdays, and anniversaries.
Most disasters boil down to unscheduled camping - for days, or sometimes weeks - in your home, in a community shelter, or possibly even in your backyard. Preparedness can not only make that process possible, it can make it less miserable as well.
So, in what has become a holiday tradition at AFD, for the 19th year running I present my updated list of preparedness items - ranging from stocking stuffers to some big ticket items - that I've either recently bought or built for myself, or have given as gifts (sometimes both).

Living in hurricane country, my biggest concerns revolve around prolonged power outages, which also can impact other utilities (including water, sewer, and internet). 

Following last year's one-two punch from Hurricanes Helene & Milton, I got my power back after only 4 days (although internet took a week). Before that, I went nearly a week without power following Irma in 2017but many people had it far  worse (most of Puerto Rico was without power for months after hurricane Maria in 2017). 

Not quite five years ago, in February of 2021, 3 successive winter storms swept across Texas, Louisiana, and Oklahoma, causing the worst collapse of the Texas energy grid on record (see Texas: The Latest - But Not The Last - Grid Down Crisis), resulting in hundreds of deaths (see City of Austin & Travis County 2021 WINTER STORM URI AFTER-ACTION REVIEW).

And just last July, the U.S. Department of Energy published a 73-page report that warns that if current schedules for retirement of reliable power generation (especially baseload) continue, without enough firm replacement, the risk of blackouts in 2030 could increase by 100× over current levels.

While those with tens of thousands of dollars to spend can have a whole-house solar system or generator - one capable of running freezers, refrigerators, and air conditioners - even a small system can make life a little more bearable.

My primary goal is to have enough sustainable power for lights, radio, phone charging, and fans. Trying to run appliances, HVAC, or other high-draw devices is simply beyond my budget (but if you have enough money . . . . it can be done ).

The following is an example of how you can put together a plug-and-play mini solar power system for under $100; one that will keep your phones, lanterns, and charged, along with some mini-fans.

While I'm not recommending specific brands or suppliers, these are all typical of items I've purchased and used myself. 

The `core' ingredients are 1 (or more) USB battery banks, preferably 20,000 milliamps each ($20 each), and at least one solar panel. I went with a single 30 watt 5 volt panel ($35) since two of my battery banks have (very) small integral solar panels.
The accessories: . . . in my case, they include mini-fans, rechargeable lanterns, cell phones, my iPAD, and a USB powered battery charger. This allows me to recharge my supply of Ni-CD or Ni-MH batteries that power my walkie-talkies, battery operated lanterns, radios, and other devices.

Many people are now opting for  `solar generators' being sold by a number of companies. These are not true `generators', but rather large batteries with a variety of output options to power devices. Most will only run a large appliance (like a refrigerator) for a few hours, without recharging.

While more expensive, solar generators are a plug-and-play solution that can be set up by just about anyone, and that have a good deal more capacity than the USB system described above. 

But if something breaks, you have to send it back to the factory for repairs. That turnaround time might be weeks. No matter how good the warranty, it's of limited comfort when the power is already out.

A year ago, I detailed my home build of (3) USB power banks (see Post-Milton Improvements To My Power Preps). By building my own, I saved some money, and if one breaks, I have a decent chance of being able to repair it (I have spare parts for major components).


Weighing in at less than 15 lbs, this 50 amp/hr (600 watt/hour) setup is self contained, with storage for cables, a wall charger, and a small 110v inverter. All you need to add is a solar panel (100 watts or better).

Whether home built, or store bought, these `solar generators' can greatly expand what you can do during a prolonged blackout. 
For Christmas presents two years ago I purchased some very nice 4-packs of LED lanterns, and some USB battery powered water pumps that attach as a faucet to large water jugs. Just three days after they arrived I endured a 3-day water outage at home, and found the faucets actually worked pretty well.

Sometimes I make the gifts myself, as when several years back I cobbled together some first aid kits, and distributed them to a number of friends and relatives. You can either put one together yourself, or purchase one already assembled.


Believe me, there is no substitute for having a well stocked first aid kit when you really need one. Having a kit isn't enough. Knowing what to do in an emergency is equally important. Luckily there are a number of good first aid books available, including:

High on the list of things to have is a way to make water potable.

Although (unscented) bleach will work, it requires measuring, and imparts a taste to the water many dislike. An option that has gotten a lot less expensive in recent years are personal filtration systems, like the LifeStraw ®.


At just 2 ounces, this personal water filter will reportedly filter 1000 liters down to .2 microns. Not bad for around $20. I've recently added the Sawyer Mini-Filter to my preps, again about $20.

Speaking of water, having a way to store enough water for three days (1 gal/person/day) is essential. A family of 4 will need at least 12 gallons for 72 hours. Personally, I keep enough on hand for a couple of weeks.

While there are plenty of `free options’ – like rinsed and recycled 2-liter plastic soda bottles or other food-safe plastic jugs – you can also buy collapsible 5 gallon containers.

A couple of years ago I bought several 5 gal. buckets (with lids) from a home improvement store, along with mylar bags and oxygen absorbers from Amazon, and put together some long-term food storage buckets for friends.

Cost per bucket? About $40. But enough food (rice, beans, tinned meat, etc.) to keep two people going for ten days or more in an emergency. I keep a couple on hand (one for me, one for the cat), myself.

With a propane or butane camp stove or even a single burner Propane burner (see below) and a couple of 1 pound gas cylinders (about $5 each) and you can cook for a week or longer. Typically, a 1lb cylinder proves 1.5 to 2.0 hours of cooking.

Indoors, even a `Sterno Stove' can be used for basic `heat and eat' cooking. 


Something as simple, and as utilitarian, as a multi-function `Swiss’ army knife, a flashlight, or a USB charger for the car make great stocking stuffers. 


Every home should have a battery operated radio (with NWS weather band), yet many do not. Some are available with crank or solar charging. In any event, you'll want something which can pick up the NOAA NWS Emergency Broadcaster in you region.


While my primary concern in Florida is staying cool during a summer power outage, in colder climes, staying warm can be a major concern. Even here in Florida it can drop below freezing. Sleeping bagspop-up tents (that can be used indoors or out), and propane or kerosene heaters can be lifesaving.

This year - with a mutated seasonal H3N2 virus steadily rising, COVID still hanging on, and the specter of bird flu in the wings - safety goggles, a box of vinyl or nitrile gloves, or a box of facemasks (or N95 masks) should be in everyone’s emergency kit as well.

And while not necessarily lifesaving, having a way to occupy your mind (or your kids) during an extended grid down situation can help maintain your sanity. 

Books, board games, and having good old-fashioned conversations are undoubtedly the best, but when they run dry having a low-drain-battery-powered MP3 player, or a battery run DVD player, can seem like a lifesaver.


As an aside - I've collected (public domain) OTR (Old Time Radio) shows since the early 1990s, and have literally thousands of hours stored on CDs in MP3 format. The Internet Archive has a huge repository where you can download them for free, along with thousands of audio books.

I keep a couple of MP3 players filled with these shows and with audio books in my bug-out bag. When the power and internet were down, they provided me with hours of entertainment.  

Over the years I've bought several cheap MP3 players ($20-$30) and filled them with thousands of hours of these shows (mostly from the 1940s and 1950s), giving them as gifts.  And the nice thing is, you don't have to wait for an emergency to enjoy them. 

Admittedly, some of the items listed above are useful more for comfort and convenience, than for survival.

But the physical and psychological impacts stemming from the hardships following a disaster are quite real (see Post-Disaster Sequelae), and a modicum of creature comforts can go a long ways towards mitigating their effects.

FEMAReady.gov and a myriad of other state and national entities know the risks we face, and would like to see Americans adopt and embrace a culture of preparedness.

And we can do that for ourselves, our families, and our friends.

One gift at a time.

Saturday, December 06, 2025

WHO DON: Broader Transmission of Mpox Due to clade Ib MPXV – Global situation

 

#18,975

Although the 2nd declaration of a public health emergency of international concern (PHEIC) for mpox was lifted 3 months ago, since then we've seen a small, but growing number of `community cases' from around the globe (see chart above). 

Overnight the World Health Organization published a lengthy DON (Disease Outbreak Report) on these recent cases. Due to its length, I'll just provide a link for you to follow, and a couple of brief excerpts.  

I'll have a bit more after the break.  

Broader transmission of mpox due to clade Ib MPXV – Global situation
5 December 2025

Description of the situation

Since the lifting of the second PHEIC for mpox on 5 September 2025, and as of 24 November 2025, 43 new confirmed cases of clade Ib MPXV have been reported across six WHO regions outside areas where sustained community transmission of this virus strain has been occurring. In four of these regions (Region of the Americas, South-East Asia Region, European Region and the Western Pacific Region), 24 cases had reported no recent international travel, suggesting local transmission.
Based on this, Italy, Malaysia, the Netherlands, Portugal, Spain, and the United States of America are now considered to be experiencing community transmission of clade Ib MPXV. In addition, travel-related cases continue to be reported in many countries.

Among the 43 cases, half (22) were documented among men who have sex with men, while other cases were linked to travel to countries with known community transmission of clade Ib, or secondary to travel-related cases (household contacts and/or sexual partners).

This report provides an overview of these recent cases of mpox confirmed to be due to clade Ib MPXV, by WHO region and country, summarizing key available epidemiological information, followed by WHO’s rapid risk assessment and public health advice.
        (SNIP)
WHO risk assessment

In light of the epidemiological developments presented above and confirmation of community transmission of clade Ib MPXV in all WHO regions, WHO assesses the public health risk posed by clade Ib MPXV as moderate for men who have sex with men with new and/or multiple partners, and the risk to the general population as low.

       (Continue . . . )

While the number of community cases reported outside of the endemic regions of Africa remain limited, they do appear to be increasing.  In recent months we've looked at a number of reports, including:




Like all viruses, Monkeypox continues to evolve and diversify, a topic that was addressed in the 2014 EID Journal article Genomic Variability of Monkeypox Virus among Humans, Democratic Republic of the Congo, where the authors cautioned:

Small genetic changes could favor adaptation to a human host, and this potential is greatest for pathogens with moderate transmission rates (such as MPXV) (40). The ability to spread rapidly and efficiently from human to human could enhance spread by travelers to new regions.

In the decade since, 2 new clades (Ib and IIb) have emerged, and have spread outside of Africa. 

While clade Ib continues to struggle to establish a foothold outside of Africa, our collective immunity from the smallpox vaccine - which was discontinued in the late 1970s - continues to wane.

Which only increases the chances that it - or another emerging pox virus - will someday find a way to make a comeback.

ECDC Epidemiological Update: 2 Imported MERS-CoV Cases In France

 
Credit WHO 


#18,974


Details on the two imported MERS-CoV cases reported by France earlier this week remain scant, with no additional press releases from the French MOH, although a brief report yesterday in the BMJ identified the two patients as being men in their 70s, who are both reportedly in stable condition. 

Their itinerary, onset dates, number of close contacts, and likely route of exposure have not been released. 

Yesterday the ECDC released two reports on this incident: 1) a brief synopsis in their Communicable disease threats report (Week 49), and 2) an Epidemiological Update, neither of which shed light on the above mentioned questions.

Both, however, stress that while the risk to the EU is currently low, `.  .  sporadic MERS cases in travellers returning to the EU/EEA can be expected'. Therefore:

European public health authorities should remain vigilant, continue surveillance of acute respiratory infections and maintain preparedness for travel-related MERS-CoV cases entering the EU/EEA. 

I've reproduced the Epidemiological Update below.  I'll return with a brief postscript after the break. 

Two cases of Middle East respiratory syndrome (MERS) in travellers returning to France from the Arabian Peninsula
Epidemiological update
5 Dec 2025
 
On 3 December 2025, the French Ministry of Health reported two imported human Middle East respiratory syndrome (MERS) cases with travel history to the Arabian Peninsula. The two affected individuals participated in the same group trip. No secondary cases have been identified so far.

French authorities are implementing response measures and monitoring the situation. (More information from the French Ministry of Health)

European public health authorities should continue surveillance of acute respiratory infections and maintain preparedness for potential travel-related MERS cases entering the EU/EEA. Information about the recent cases, case definitions and diagnostic approaches should be shared with clinicians to maintain increased awareness for early identification, isolation and diagnosis of possible MERS cases. Adherence to strict infection control protocols during contact with patients that may have a Middle East respiratory syndrome coronavirus (MERS-CoV) infection – including hand hygiene and respiratory measures – is critical to prevent further spread of the virus in healthcare settings.

Countries should also advise travellers returning from areas where MERS-CoV may be circulating to seek medical attention if they develop a respiratory illness with fever and cough or diarrhoea during the two weeks following their return and to disclose their recent travel history to their healthcare provider. Travellers to the Arabian Peninsula are also advised to avoid contact with dromedary camels and consumption of camel products. When visiting markets or places where dromedary camels are present, strict hygiene measures should be followed. These include hand hygiene before and after touching animals and avoiding any contact with sick animals. Further information can be found in the World Health Organization’s MERS-CoV factsheet.

Although sporadic MERS cases in travellers returning to the EU/EEA can be expected, the probability of sustained human-to-human transmission among the general population in Europe remains very low and the impact of the disease in the general population is considered low. The current MERS situation poses a low risk to the EU/EEA, and recommendations from the Rapid Risk Assessment published by ECDC on 29 August 2018 still apply.

ECDC published a technical report, ‘Health emergency preparedness for imported cases of high-consequence infectious diseases’, in October 2019 that is still useful for EU/EEA countries wishing to assess their level of preparedness for a disease such as MERS. ECDC also published ‘Risk assessment guidelines for infectious diseases transmitted on aircraft (RAGIDA) – Middle East respiratory syndrome coronavirus (MERS-CoV)’ on 22 January 2020.

MERS-CoV is a zoonotic virus transmitted mostly from infected dromedary camels and via consumption of raw or undercooked camel products, including milk. Human-to-human transmission is possible, with documented events occurring mostly in hospital settings. Since April 2012, and as of 1 December 2025, a total of 2 640 cases of MERS, including 958 deaths, have been reported by health authorities worldwide. The majority of these have been reported in the Middle East. Excluding these two recent cases, the latest imported case in Europe occurred in 2018.

While the number of reported MERS-CoV cases from the Middle East has plummeted in recent years, so too have surveillance and reporting. A decade ago - flawed as it sometimes was - Saudi Arabia provided daily MERS-CoV updates.

Several times, however, their MOH went dark for months at a time on the subject (see 2018's The Saudi MOH Breaks Their Silence On MERS-CoV).

Regular MERS reporting ended in 2020 with the arrival of COVID, but starting in 2022, KSA announced they would report MERS-CoV cases on a bi-annual basis.  

To be fair, we don't hear much from other nations on the Arabian peninsula, where MERS-CoV has also been been detected in both camels and humans. And it seems likely that cases are being missed in North and Central Africa as well (see EID Journal: Geographic Distribution of MERS-CoV among Dromedary Camels, Africa).


Over the past decade we've looked at many of the challenges of MERS-CoV surveillance, including:

And in 2018 - in Evaluation of a Visual Triage for the Screening of MERS-CoV Patients - we looked at a highly critical review of the screening methods used by the Saudis for selecting patients for MERS testing. As a result, the official total of 2,640 cases is highly suspect.

Last August, in IJID Editorial: Al-Tawfiq on Global Epidemiology and Public Health Challenges of Middle East Respiratory Syndrome Coronavirus (MERS-CoV), we looked at what may be the most challenging aspect of MERS detection; asymptomatic or mildly symptomatic cases. 

Also last June, in JEGH: Epidemiological Characteristics of MERS-CoV Human Cases, 2012- 2025, we looked at the changing epidemiology of MERS-CoV cases since 2012, as well as substantial gaps in our current understanding of the disease.

Prior to the emergence of COVID in late 2019, MERS-CoV was viewed as being the top coronavirus pandemic threat (see 2017's A Pandemic Risk Assessment Of MERS-CoV In Saudi Arabia), with its R0 (basic reproduction number) briefly flirting with 1.0.

Whether MERS-CoV will re-emerge as a global health threat remains unknown, but it continues to circulate - and evolve - on both the Arabian Peninsula and in Africa.  

We ignore its potential at considerable risk. 

Friday, December 05, 2025

Eurosurveillance: Expansion of influenza A(H1N1)pdm09 NA:S247N Viruses with Reduced Susceptibility to Oseltamivir, Catalonia, Spain, and in Europe, July to October 2025


Abrupt rise in resistance in Catalonia, Spain - fall 2025

#18,973

For the past couple of years we've been seeing sporadic reports of `reduced susceptibility' of the seasonal H1N1 flu virus to the antiviral drug oseltamivir (aka `Tamiflu') around the globe (see EID Journal: Multicountry Spread of Influenza A(H1N1)pdm09 Viruses with Reduced Oseltamivir Inhibition, May 2023–February 2024).

While concerning, these reports indicated reduced inhibition - not complete resistance - and its incidence was modest; typically in the low single digits. 

Five months ago, in 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 S247N mutation beginning in 2024. 

Highlights

• In a landscape of a very narrow arsenal of influenza antivirals, resistance mutations are a significant threat.

• Resistance mutations were present in 0.5-5% in A and B influenza viruses during the last 15 years.

• However, S247N resistance mutation in the NA gene sharply increased during 2023-2024 season.

• While this mutation does not confer strong resistance by itself, their fixation could increase the risk of resistance in the future if other resistance mutations appears or get fixed together with it

Two months ago, Taiwan's CDC reported that 6.5% of the H1N1 viruses they have characterized in 2025 have shown signs of oseltamivir resistance, and just yesterday we looked at a similar report out of China: National Influenza Center Reporting Increased Oseltamivir Resistance in Seasonal H1N1.

The good news, at least short-term, is that this does not affect the H3N2 virus, only H1N1.

Yesterday the ECDC Journal Eurosurveillance published a Rapid Communications which reports - over the past 3 months - a dramatic surge in H1N1 viruses carrying the NA:S247N mutation in Catalonia Spain, and parts of Europe. 

While most pronounced in Spain; France, Norway, Belgium, Denmark, and the Netherlands are also reporting increased detections (see heat map below)


So far, the CDC hasn't reported similar surges in the United States (see FluView Week 47 Report), but fewer than 100 H1N1 viruses have been characterized this fall. 

The reported 4-to-6 fold reduction in inhibition with this S247N mutation isn't usually enough to render oseltamivir clinically useless, but it may modestly reduce its effectiveness. 

Another encouraging note is that the I223V substitution - which further decreases oseltamivir susceptibility when combined with S274N - was not detected in these recent Catalonia isolates.  
The concern is that I223V - or other permissive amino acid changes - could emerge over time (see Viruses: Increase of Synergistic Secondary Antiviral Mutations in the Evolution of A(H1N1)pdm09 Influenza Virus Neuraminidases).

Prior to the 2008 collapse of the effectiveness of oseltamivir against the old (pre-2009) H1N1 virus, the assumption was that the changes that created resistance exacted a `fitness penalty' on the virus, limiting its ability to transmit from human-to-human.

That `fitness penalty' evaporated unexpectedly in 2008, and seasonal H1N1 - carrying the H275Y mutation - spread globally in a matter of months. 

Since then, we've only seen limited transmission of H1N1 viruses with resistance markers. That is, until recently.  The authors state:

Importantly, it has been demonstrated that the S247N strains do not show reduced transmissibility in comparison with strains not carrying this mutation

Due to its length, I've only posted the link and some excerpts below.  I'll have a postscript after the break.

During the sentinel surveillance of respiratory viruses in Catalonia, Spain, an increase in the percentage of influenza A(H1N1)pdm09 sequences harbouring the NA:S247N substitution was detected from summer 2025 when compared with previous years [1-5]. This substitution is related to lower oseltamivir susceptibility, and not resistance [6,7]. Here, we present the results obtained from surveillance in Catalonia, together with phenotypic test results of susceptibility to oseltamivir. We compare our results with the presence of the NA:S47N substitution in other European countries, using sequences downloaded from GISAID.

Presence of NA:S247N in Catalonia

Through the respiratory virus sentinel surveillance network in Catalonia (SIVIC; https://sivic.salut.gencat.cat), influenza viruses — submitted from 37 sentinel primary care centres and 7 hospitals (Hospital Universitari de Bellvitge; Hospital Universitari Germans Trias i Pujol; Hospital Universitari Doctor Trueta; Hospital Universitari Joan XXIII,; Hospital Universitari Verge de la Cinta; Hospital Arnau de Vilanova; Hospital Universitari Vall d’Hebron) distributed across Catalonia — are genetically characterised by whole genome sequencing using the Illumina platform. An in-house bioinformatic application, mitMutFinder [8], detects the amino acid substitutions responsible for resistance to antivirals (according to the list provided by the World Health Organization) [9].

An analysis from week 36/2024 to week 41/2025 showed that the prevalence of influenza A(H1N1)pdm09 strains (genetic clades 6B.1A.5a.2a.1 and 6B.1A.5a.2a) carrying the NA:S247N amino acid substitution had increased notably in the last 12 weeks of this period. During the whole period of study, the S247N mutation was detected in 11.8% (63/532) of A(H1N1)pdm09 strains in Catalonia.

However, most of the S247N sequences were detected between weeks 30/2025 and 41/2025 (56 S247N/117 A(H1N1)pdm09), with proportions ranging from 20 to 100% (Figure 1A). No I223V substitution, a synergistic substitution that decreases oseltamivir susceptibility when combined to S274N [3], was detected in the sequences from Catalonia.
        (SNIP)
Notably, the World Health Organization, only reported sporadic strains harbouring the S247N mutation in the most recent documents recommending the vaccine composition for the northern and southern hemispheres, respectively [1,19]. Importantly, it has been demonstrated that the S247N strains do not show reduced transmissibility in comparison with strains not carrying this mutation [20].
In our series, the proportion of strains carrying the S247N mutation was much higher, i.e. 20–100% on a weekly basis, with an annual average of 11.8%. Similar results were observed in other Spanish regions and several European countries based on GISAID sequence data. It is important to note that no I223V substitution was detected in the sequences from Catalonia, which, combined with S247N, would further decrease drug susceptibility [21].
Conclusion
In Europe, the 2025/26 influenza season has started 3–4 weeks early, dominated by A(H3N2) viruses. However, the fact that the proportion of A(H1N1) NA:S247N sequences observed from July to October 2025 was very high in some countries even approaching 100% in some weeks, together with evidence that this mutation does not reduce virus infectivity, warrants strengthening surveillance on the evolution of these A(H1N1) strains.
        (Continue . . . .)


Although there are alternatives to oseltamivir for the treatment of influenza A (e.g. Baloxavir) - with the exception of Japan - oseltamivir remains the most widely available (and affordable) antiviral stockpiled today. 
And as we've seen (see EID Journal: Influenza A(H1N1)pdm09 Virus with Reduced Susceptibility to Baloxavir, Japan, 2024), Baloxavir is susceptible to its own set of resistance mutations (e.g. PA I38T ).
While oseltamivir continues to be effective against the vast majority of seasonal flu viruses currently in circulation, we are seeing some early warning signs.
Which suggests that public health authorities may need to start thinking about stockpiling alternatives (e.g., zanamivir, baloxavir) should these trends continue.
As we are so frequently reminded - evolution never stops - and while our modern armamentarium against bacterial, fungal, and viral infections have been nothing short of miraculous - history has shown these pharmacological victories often prove fleeting. 

Thursday, December 04, 2025

China: National Influenza Center Reporting Increased Oseltamivir Resistance in Seasonal H1N1

Credit NIAID


18,972


Although our primary seasonal influenza concern right now revolves around the newly emerging subclade (K) of H3N2, we continue to see sporadic reports of low - but increasing - resistance to the antiviral drug oseltamivir among H1N1 viruses.  

While spontaneous `resistance' to oseltamivir (aka `Tamiflu') develops in roughly 1%-2% of treated patients, for the past 20 months we've been watching a slow rise in the number of antiviral resistant H1N1 viruses around the world.

In 2008 - before the arrival of a new, and still susceptible swine-origin H1N1 pandemic virus in 2009 - the old H1N1 virus had rapidly grown nearly 100% resistant to oseltamivir in less than a year (see CIDRAP article With H1N1 resistance, CDC changes advice on flu drugs).

Although that crisis was averted, since then we've been closely watching for signs of increased antiviral resistance in seasonal flu - and while a few isolated pockets have occurred - none have managed to established a foothold. 

But in March of 2024 we saw a worrisome report in The Lancet - Global Emergence of Neuraminidase Inhibitor-Resistant Influenza A(H1N1)pdm09 Viruses with I223V and S247N Mutations - which reported a much higher incidence of oseltamivir resistance among samples tested in Hong Kong in 2023.
Unlike the near total collapse of oseltamivir effectiveness in 2008 - which was due to a an H275Y mutation in the NA - this was due to I223V and S247N, and was not as profound of a loss in effectiveness.
Since then we've seen a number of studies (see Viruses: Increase of Synergistic Secondary Antiviral Mutations in the Evolution of A(H1N1)pdm09 Influenza Virus Neuraminidases and Virus Research: A 15-year Study of Neuraminidase Mutations and the Increasing of S247N Mutation in Spain) from around the world finding similar patterns. 

While most of these increases have been modest, just over 2 months ago Taiwan's CDC reported that 6.5% of the H1N1 viruses they have characterized in 2025 have shown signs of oseltamivir resistance. 

In recent days the Chinese press has been warning about an increase in oseltamivir resistant viruses, and the most recent influenza report (Dec 3rd) from China's National Influenza Center cites a 3.9% resistance rate in H1N1 since March 31st, 2025. 

(Translation)

Overview of the Influenza Epidemic Situation in China (as of November 30, 2025 )

Monitoring data shows that influenza activity has increased in both southern and northern provinces this week. A total of 1,541 outbreaks of influenza-like illness have been reported nationwide .

The National Influenza Center conducted antigenic analysis on a subset of influenza virus strains collected between March 31, 2025 and November 30 , 2025 ( based on experimental dates) . The results showed that 98.0% ( 1054/1076 ) of the A(H1N1)pdm09 subtype influenza virus strains were similar to strain A/Victoria/4897/2022 ; 49.9% (415/832) of the A(H3N2) subtype influenza virus strains were similar to strain A/Croatia/10136RV/2023 ( chicken embryo strain), and 82.8% ( 689/832 ) were similar to strain A/District of Columbia/27/2023 (cell strain); and 97.5 % ( 313/321 ) of the B(Victoria) lineage influenza virus strains were similar to strain A /District of Columbia/27/2023 (cell strain) . () is a similar strain to B/Austria/1359417/2021 .


The National Influenza Center conducted drug resistance analysis on some influenza virus strains collected since March 31 , 2025. The results showed that
3.9% ( 31/792 ) of the A(H1N1)pdm09 subtype influenza virus strains had reduced or highly reduced sensitivity to neuraminidase inhibitors, while the remaining A(H1N1)pdm09 subtype influenza virus strains were sensitive to neuraminidase inhibitors; all A(H3N2) and type B influenza virus strains were sensitive to neuraminidase inhibitors; and all A(H1N1)pdm09 , A(H3N2) , and type B influenza virus strains were sensitive to polymerase inhibitors .

While not horrendous, this is roughly double the expected rate, making it a trend very much worth watching.  

So far - based on 302+ H1N1 viruses tested since May - we aren't seeing signs of  increased detections reported by the U.S. CDC (see FluView Week 47 Report below), but > 2/3rds of those tests (n=219) were conducted before the start of this fall's flu season 


One A(H1N1)pdm09 virus had amino acid substitutions NA-I223V and NA-S247N and showed reduced inhibition by oseltamivir. One A(H1N1)pdm09 virus had PA-K34R amino acid substitution associated with reduced susceptibility to baloxavir.
High levels of resistance to the adamantanes (amantadine and rimantadine) persist among influenza A(H1N1)pdm09 and influenza A(H3N2) viruses (the adamantanes are not effective against influenza B viruses). Therefore, use of these antivirals for treatment and prevention of influenza A virus infection is not recommended and data from adamantane resistance testing are not presented.
While oseltamivir continues to be effective against the vast majority of seasonal flu viruses currently in circulation - and we don't appear to be anywhere near a repeat of the 2008 collapse - we are seeing some cracks in the veneer.

A reminder that evolution never stops, making our pharmacological victories over viruses, bacteria, and fungal pathogens often temporary. 

Stay tuned. 

ECDC Pre-pandemic Guidance: Strategies to Fight Avian and Swine flu in Humans


#18,871

Today the ECDC has released an impressive 71-page operations framework for European countries to use when dealing with outbreaks of novel swine or avian influenza. This comes just 8 months after releasing ECDC Guidance: Recommendations for Preparedness Planning for Public Health Threats

This operations support guide includes 14 scenarios (see chart below) that are `. . . based on specific epidemiological and virological factors, including animal origin, characteristics of human cases (number and exposure context), severity signals, that are then further defined based on the presence of virus mammalian adaptation, antiviral resistance and mismatch with available pre-pandemic vaccines and/or candidate vaccine viruses.'














They describe this framework as being for ` . . . EU/EEA national public health authorities, in particular those involved in preparedness plan updating, risk assessors and managers, and policy-makers in EU/EEA countries. It is also relevant to clinical and laboratory stakeholders involved in zoonotic influenza surveillance, risk communication, and outbreak response.'

Due to its length and complexity, I'll simply post the press release and a link and a few excerpts from the framework.  This is a remarkably detailed framework, and you'll definitely want to download and review at length. 

ECDC defines strategies to fight avian and swine flu in humans
Press release
4 Dec 2025
 
Unprecedented outbreaks in birds highlight the need for early detection and preparedness.

This autumn, Europe has seen a sharp increase in avian influenza A(H5N1) cases in wild birds and poultry. Its wide circulation among birds increases the risk of human exposure to infected animals and the virus subsequently spilling over to humans.

The European Centre for Disease Prevention and Control (ECDC) has today released a guide and tools to help European countries detect and respond to possible animal-related influenza threats, including pandemics.
Although the current risk for the European people is low, avian influenza is still a serious public health threat due to widespread outbreaks among animals across Europe.’ says Edoardo Colzani, ECDC Head of Respiratory Viruses. ‘We need to make sure that early warning signs don’t go unnoticed and that public health actions are timely, coordinated, and effective. This document provides countries with a clear and adaptable framework to prepare for and respond to animal-to-human influenza transmission.’
This new guide sets out practical response scenarios ranging from the current situation - where no human cases have been reported in the European Union (EU)/European Economic Area (EEA) but avian influenza viruses are circulating widely in animals - to more serious scenarios involving human infections and even potential transmission human-to-human that could lead to a pandemic.

The framework is designed to help countries act quickly and proportionately as risks evolve. It includes a range of public health response measures, from enhancing surveillance and laboratory testing to ensuring protective equipment is available and communicating clearly with the public. It also highlights the importance of genomic surveillance, laboratory capacity building, and real-time data sharing.

Crucially, the guidance embraces a ‘One Health’ approach, recognising that human health is closely connected to the health of animals and the environment. Close collaboration between veterinary services, agriculture, and public health, is essential to detect and contain threats early and protect people across Europe.

The guide was developed in close collaboration with the European Food Safety Authority (EFSA), the European Medicines Agency (EMA), the European Agency for Safety and Health at Work (EU-OSHA), the European Reference Laboratory for avian influenza and national experts. These materials are designed to help countries integrate the recommendations into their national preparedness plans.
Access the guide

 


You'll find two additional supporting documents at:
Scenarios for pre-pandemic zoonotic influenza preparedness and response
Operational support
4 Dec 2025

The aim of this framework is to guide a scalable public health response to influenza of zoonotic origin in EU/EEA countries and provide options for preparing and responding to different possible pre-pandemic scenarios. The European Food Safety Authority (EFSA) reported unprecedented levels of HPAI A(H5N1) circulation in wild birds across Europe during the 2025 autumn migration, highlighting the need for strengthened preparedness and coordinated public health action.




While we continue to see calls for enhanced surveillance and reporting, this is the most ambitious and detailed pre-pandemic planning guide I've seen in years.
As with our own CDC - these are not mandates, only recommendations - and it is up to each individual public health entity to decide what to incorporate in their planning.

Hopefully nations - in Europe, and around the globe - are taking notice.  Because while the threat from HPAI to the general public may be deemed `low' today, that could change in a heartbeat.