ArticleEuro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin2026
Baloxavir susceptibility of seasonal influenza viruses during the first seven seasons of clinical use in Japan, 2017/18 to 2023/24.
Article in Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
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Who cites it
5 citing papers in PubMed.
- Genomic Surveillance of Human Metapneumovirus in the United States, 2010-2025.The Journal of infectious diseases · 2026Article
- Detection and characterization of antiviral-resistant viruses during the influenza season of 2024-25.Microbiology spectrum · 2026Article
- A Cluster of Influenza A(H3N2) Viruses in 2024 From Tasmania, Australia, With Reduced Susceptibility to Baloxavir.Influenza and other respiratory viruses · 2026Article
- A Sequence-Based Update on Amino Acid Substitutions in Influenza Polymerase Acidic Protein in Europe That Alter Baloxavir Susceptibility From 2009 to 2025.Influenza and other respiratory viruses · 2026Article
- Antiviral Resistance in Influenza: Clinical and Public Health Implications.Influenza and other respiratory viruses · 2026Review
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Abstract
backgroundBaloxavir marboxil, a cap-dependent endonuclease inhibitor, was approved in Japan in February 2018 for treatment of influenza A and B infections, making Japan the first country to introduce its clinical use.
aimWe aimed to assess baloxavir susceptibility among seasonal influenza viruses in Japan during the first seven seasons of clinical use, from 2017/18 to 2023/24.
methodsWe conducted nationwide surveillance on 3,671 influenza viruses using phenotypic and genotypic assays to evaluate baloxavir susceptibility and identify amino acid substitutions in the polymerase acidic (PA) protein associated with reduced susceptibility.
resultsOverall, 1.7% of tested viruses exhibited reduced susceptibility to baloxavir. Influenza A(H3N2) viruses showed the highest frequency (3.6%), followed by influenza A(H1N1)pdm09 (0.9%); no influenza B viruses exhibited reduced susceptibility. Key PA substitutions included E23K, Y24C, I38M/N/S/T/V and E199G/K. Viruses with reduced susceptibility were detected in both treated and untreated individuals. Reduced susceptibility was most frequent during the 2018/19 (4.6%) and 2022/23 (3.2%) seasons, both dominated by A(H3N2) viruses. Notably, the 2018/19 season coincided with peak baloxavir supply to medical institutions, while subsequent seasons with lower antiviral use showed a lower proportion of reduced-susceptibility viruses.
conclusionOur findings suggest a possible association between the extent of baloxavir use and the emergence of resistance and highlight how circulating subtypes shape seasonal susceptibility profiles. Although reduced susceptibility to baloxavir remains relatively rare, emergence of transmissible virus variants emphasises the need for continued phenotypic and genotypic surveillance to guide treatment strategies, support public health preparedness, and prevent the spread of resistant viruses.
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