Baloxavir treatment of ferrets infected with influenza A(H1N1)pdm09 virus reduces onward transmission

PLoS Pathog. 2020 Apr 15;16(4):e1008395. doi: 10.1371/journal.ppat.1008395. eCollection 2020 Apr.

Abstract

Influenza viruses cause seasonal outbreaks and pose a continuous pandemic threat. Although vaccines are available for influenza control, their efficacy varies each season and a vaccine for a novel pandemic virus manufactured using current technology will not be available fast enough to mitigate the effect of the first pandemic wave. Antivirals can be effective against many different influenza viruses but have not thus far been used extensively for outbreak control. Baloxavir, a recently licensed antiviral drug that targets the influenza virus endonuclease, has been shown to reduce virus shedding more effectively than oseltamivir, a widely used neuraminidase inhibitor drug. Thus it is possible that treatment with baloxavir might also interrupt onward virus transmission. To test this, we utilized the ferret model, which is the most commonly used animal model to study influenza virus transmission. We established a subcutaneous baloxavir administration method in ferrets which achieved similar pharmacokinetics to the approved human oral dose. Transmission studies were then conducted in two different locations with different experimental setups to compare the onward transmission of A(H1N1)pdm09 virus from infected ferrets treated with baloxavir, oseltamivir or placebo to naïve sentinel ferrets exposed either indirectly in adjacent cages or directly by co-housing. We found that baloxavir treatment reduced infectious viral shedding in the upper respiratory tract of ferrets compared to placebo, and reduced the frequency of transmission amongst sentinels in both experimental setups, even when treatment was delayed until 2 days post-infection. In contrast, oseltamivir treatment did not substantially affect viral shedding or transmission compared to placebo. We did not detect the emergence of baloxavir-resistant variants in treated animals or in untreated sentinels. Our results support the concept that antivirals which decrease viral shedding could also reduce influenza transmission in the community.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Animals
  • Antiviral Agents / pharmacology*
  • Dibenzothiepins
  • Female
  • Ferrets
  • Influenza A Virus, H1N1 Subtype / drug effects*
  • Morpholines
  • Neuraminidase / antagonists & inhibitors*
  • Orthomyxoviridae Infections / drug therapy*
  • Orthomyxoviridae Infections / transmission
  • Orthomyxoviridae Infections / virology
  • Oxazines / pharmacology*
  • Pyridines / pharmacology*
  • Pyridones
  • Thiepins / pharmacology*
  • Triazines / pharmacology*
  • Virus Replication / drug effects*
  • Virus Shedding / drug effects*

Substances

  • Antiviral Agents
  • Dibenzothiepins
  • Morpholines
  • Oxazines
  • Pyridines
  • Pyridones
  • Thiepins
  • Triazines
  • baloxavir
  • Neuraminidase

Grants and funding

The Melbourne WHO Collaborating Centre for Reference and Research on Influenza is supported by the Australian Government Department of Health. This work was funded by F. Hoffmann-La Roche (https://www.roche.com/) and Shionogi & Co. Ltd (https://www.shionogi.com/) who both played a role in the study design, data collection and analysis, decision to publish and preparation of the manuscript.