{
  "abstract": "Influenza antivirals (IAs) have been detected in aquatic environments inhabited by dabbling ducks, the natural reservoir of influenza A virus (IAV), raising concerns about the development of antiviral resistance. Because novel human IAV strains often contain genetic material of avian origin, this may contribute to resistance in viruses with pandemic potential. This study aimed to assess the environmental risk posed by four IAs—oseltamivir carboxylate (OC), zanamivir (ZA), peramivir (PE), and amantadine (AM)—based on their potential for environmental release, environmental stability, and induction of antiviral resistance. The assessment combined data from new experiments on (1) environmental release and (2) environmental stability of PE, AM, OC, and ZA, with results from previously published in vivo experiments in a mallard model examining (3) resistance development to OC, PE, and ZA in IAV. The risk of environmental release was assessed as high for OC, AM, and PE, and very high for ZA. Environmental stability ranged from very high to low, in the order PE > AM > OC > ZA. The potential to induce resistance in IAV was similar for PE and OC, and lower for ZA. Overall, the environmental risk ranking was PE > OC > ZA, with PE and OC posing the highest risks. Prudent use of IAs requires balancing the risk of resistance development against clinical benefit. In cases of complicated influenza or in high-risk patient groups, the clinical benefits are substantial and justify IA use. However, in uncomplicated influenza among otherwise healthy individuals, the clinical benefit is limited, and the risk of resistance development should be carefully considered. Among the evaluated antivirals, ZA showed the lowest environmental risk and should be preferred when feasible.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Epidemiology and Global health, Umeå University, Umeå, Sweden",
    "Department of Natural Science, Design and Sustainable Development, Mid Sweden University, Östersund, Sweden",
    "Department of Chemistry, Umeå University, Umeå, Sweden",
    "Department of Medical Sciences, Uppsala University, Uppsala, Sweden"
  ],
  "article_type": "Research Article",
  "arxiv": null,
  "author_total": 5,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Hanna Söderström Lindström"
    },
    {
      "affs": [
        1
      ],
      "name": "Sara H. Norström"
    },
    {
      "affs": [
        2
      ],
      "name": "Chaojun Tang"
    },
    {
      "affs": [
        3
      ],
      "name": "Richard H. Lindberg"
    },
    {
      "name": "Josef D. Järhult"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/9mzf73xmmrmt6.bib",
  "cited_by": 0,
  "doi": "10.1371/journal.pone.0358447",
  "fulltext_url": null,
  "id": "9mzf73xmmrmt6",
  "issns": [
    "1932-6203"
  ],
  "landing_url": "https://doi.org/10.1371/journal.pone.0358447",
  "language": null,
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "journal",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2310|Pharmaceutical and Antibiotic Environmental Impacts"
    ],
    [
      "plos",
      "/Biology and life sciences/Microbiology/Medical microbiology/Microbial pathogens/Viral pathogens/Orthomyxoviruses/Influenza viruses/Influenza A virus"
    ],
    [
      "plos",
      "/Biology and life sciences/Microbiology/Microbial control/Antimicrobials/Antivirals"
    ],
    [
      "plos",
      "/Biology and life sciences/Microbiology/Virology/Antivirals"
    ],
    [
      "plos",
      "/Biology and life sciences/Organisms/Viruses/RNA viruses/Orthomyxoviruses/Influenza viruses/Influenza A virus"
    ],
    [
      "plos",
      "/Biology and life sciences/Organisms/Viruses/Viral pathogens/Orthomyxoviruses/Influenza viruses/Influenza A virus"
    ],
    [
      "plos",
      "/Earth sciences/Geology/Petrology/Sediment"
    ],
    [
      "plos",
      "/Earth sciences/Geology/Sedimentary geology/Sediment"
    ],
    [
      "plos",
      "/Earth sciences/Hydrology/Surface water"
    ],
    [
      "plos",
      "/Earth sciences/Marine and aquatic sciences/Aquatic environments/Freshwater environments/Rivers"
    ],
    [
      "plos",
      "/Earth sciences/Marine and aquatic sciences/Bodies of water/Rivers"
    ],
    [
      "plos",
      "/Ecology and environmental sciences/Aquatic environments/Freshwater environments/Rivers"
    ],
    [
      "plos",
      "/Ecology and environmental sciences/Environmental impacts"
    ],
    [
      "plos",
      "/Medicine and health sciences/Epidemiology/Medical risk factors"
    ],
    [
      "plos",
      "/Medicine and health sciences/Epidemiology/Pandemics"
    ],
    [
      "plos",
      "/Medicine and health sciences/Pathology and laboratory medicine/Pathogens/Microbial pathogens/Viral pathogens/Orthomyxoviruses/Influenza viruses/Influenza A virus"
    ],
    [
      "plos",
      "/Medicine and health sciences/Pharmacology/Drugs/Antimicrobials/Antivirals"
    ]
  ],
  "openalex": "W7213900374",
  "pdf_url": "https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0358447&type=printable",
  "pmcid": null,
  "pmid": null,
  "published": "2026-09-21",
  "publisher": "Public Library of Science",
  "ris": "https://research.draconitic.com/paper/9mzf73xmmrmt6.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:17:43Z",
      "native_id": "10.1371/journal.pone.0358447",
      "source": "plos",
      "url": "https://doi.org/10.1371/journal.pone.0358447"
    }
  ],
  "subjects": [
    {
      "field": "biology",
      "origin": "plos:microbiology",
      "subfield": "microbiology"
    },
    {
      "field": "earth",
      "origin": "plos:geology",
      "subfield": "geology-geochemistry"
    },
    {
      "field": "medicine",
      "origin": "plos:epidemiology",
      "subfield": "epidemiology-public-health"
    }
  ],
  "title": "Occurrence of influenza antivirals and resistance development in influenza A viruses in aquatic environments: A risk assessment",
  "title_text": "Occurrence of influenza antivirals and resistance development in influenza A viruses in aquatic environments: A risk assessment",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:17:43Z",
  "url": "https://research.draconitic.com/paper/9mzf73xmmrmt6",
  "venue": "PLOS One",
  "versions": []
}