Announcement

**Snicklefritz** · July 3, 2009, 05:48 AM

Hong Kong: Detection of human swine influenza virus resistant to Tamiflu (7/3/09)

The virus was isolated from the specimen taken from a 16-year-old girl coming from San Francisco. She was intercepted by Port Health Office at the Hong Kong International Airport on June 11 upon arrival. The girl was then admitted to Queen Mary Hospital for isolation. She was tested positive to HSI but opted not to take tamiflu. She had mild symptoms and was eventually discharged upon recovery on June 18.

Any questions?

**HenryN** · July 3, 2009, 05:56 AM

First Tamiflu-resistant swine flu case found in teenager (Hong Kong ex San Francisco)

<TABLE class=bodyCopy border=0 cellSpacing=1 cellPadding=1 width=500 align=center><TBODY><TR><TD>First Tamiflu-resistant swine flu case found in teenager
(10 mins ago)
A 16-year-old girl was found to be infected with a mutation of the swine flu virus that is resistant to the antiviral Tamiflu soon after arriving from San Francisco, the Department of Health said today.

It is the first such case in Hong Kong. Similar cases have been reported in Denmark and Japan.

The teenager was intercepted at the airport on June 11 and admitted to Queen Mary Hospital.

She opted not to be put on a course of Tamiflu before testing positive for the swine flu strain, which is known to be resistant to the antiviral.

She had mild symptoms and was discharged on June 18.

The case will be reported to the World Health Organization.

Danish health authorities have used Relenza, an alternative anti-flu medication, to successfully treat a female patient with the same strain.

The Japanese said a patient was found to be resistant to Tamiflu after being put on the drug since she was being diagnosed with the H1N1 virus around two weeks ago, Kyodo news agency reported yesterday.

The Osaka prefecture patient was recovering after having been given Relenza.

A spokeswoman for Swiss pharmaceuticals giant Roche, which makes Tamiflu, said the company had been informed of the case and described as ''normal'' such resistance to the drug.

''It is absolutely normal,'' she said, adding that ''0.4 percent of adults develop resistance'' to Tamiflu.

She said such cases do not indicate Tamiflu has become less effective against swine flu.

http://www.thestandard.com.hk/breaki...l.asp?id=15461</TD></TR></TBODY></TABLE>

**HenryN** · July 3, 2009, 06:00 AM

Re: First Tamiflu-resistant swine flu case found in teenager (Hong Kong ex San Francisco)

NO indication that this case was Tamiflu treated.

**Gert van der Hoek** · July 3, 2009, 06:08 AM

Re: Hong Kong: Detection of human swine influenza virus resistant to Tamiflu (7/3/09)

Coming from USA .

**Commonground** · July 3, 2009, 06:12 AM

Re: Hong Kong: Detection of human swine influenza virus resistant to Tamiflu (7/3/09)

discovered during routine testing

The spokesman noted that PHLSB conducted routine sensitivity tests on specimens taken from confirmed HSI patients.

**the doctor** · July 3, 2009, 06:12 AM

Re: Hong Kong: Detection of human swine influenza virus resistant to Tamiflu (7/3/09)

So the 274 was fit as a fiddle and contracted in the good ole USA.

GW

**HenryN** · July 3, 2009, 06:25 AM

Re: Hong Kong: Detection of human swine influenza virus resistant to Tamiflu (7/3/09)

Originally posted by the doctor View Post

So the 274 was fit as a fiddle and contracted in the good ole USA.

GW

Exactly right.

H274Y - NO tamiflu required.

**HenryN** · July 3, 2009, 07:47 AM

Re: Hong Kong: Detection of human swine influenza virus resistant to Tamiflu (7/3/09)

<a rel="nofollow" href="http://www.recombinomics.com/News/07030901/H274Y_HK_SF.html">Commentary</a>

**St Michael** · July 3, 2009, 08:01 AM

Re: Hong Kong: Detection of human swine influenza virus resistant to Tamiflu (7/3/09)

Originally posted by niman View Post

<a rel="nofollow" href="http://www.recombinomics.com/News/07030901/H274Y_HK_SF.html">Commentary</a>

Thanks Dr. Niman:

<a rel="nofollow" href="http://www.recombinomics.com/News/07030901/H274Y_HK_SF.html">Commentary</a>

Recombinomics Commentary 13:36
July 3, 2009

The virus was identified during PHLSB's routine sensitivity test of HSI virus to oseltamivir and zanamivir, the spokesman said.

"This is the first time Tamiflu resistance in HSI virus found in Hong Kong," he said, adding that similar cases were also reported in Denmark and possibly Japan.

"Tests showed that this strain is sensitive to zanamivir (Relenza)," he said.

The virus was isolated from the specimen taken from a 16-year-old girl coming from San Francisco. She was intercepted by Port Health Office at the Hong Kong International Airport on June 11 upon arrival. The girl was then admitted to Queen Mary Hospital for isolation. She was tested positive to HSI but opted not to take tamiflu. She had mild symptoms and was eventually discharged upon recovery on June 18.

The spokesman noted that PHLSB conducted routine sensitivity tests on specimens taken from confirmed HSI patients.

The above comments from the Hong Kong Department of Health press release describe Tamiflu resistance (presumably H274Y, aka H275Y) in a patient arriving from San Francisco. The resistance was discovered during routine surveillance and there is no indication the patient was taking oseltamivir, indicating the pandemic H1N1 was evolutionarily fit.

The two other cases described this were (in Denmark and Japan) were in patients under prophylactic treat of Tamiflu. In both cases the resistance was due to H274Y (and discovered because of the prophylactic treatment).

Evolutionarily fit swine flu with H274Y is cause for concern. Last year seasonal H1N1 with H274Y spread worldwide. It had previous spread from one genetic background to another via genetic hitchhiking and recombination.

It is likely that H274Y in pandemic H1N1 will now follow a similar, but accelerated, pathway due to widespread use of oseltamivir to control the spread of pandemic H1N1.

The export of H274Y from San Francisco, and failure to identify the polymorphism in the United States, raises serious surveillance concerns.

**Snicklefritz** · July 3, 2009, 08:34 AM

Re: Hong Kong: Detection of human swine influenza virus resistant to Tamiflu (7/3/09)

**HenryN** · July 3, 2009, 09:33 AM

Re: Hong Kong: Detection of human swine influenza virus resistant to Tamiflu (7/3/09)

<a rel="nofollow" href="http://www.recombinomics.com/News/07030902/H274Y_Swine_Spread.html">Commentary</a>

**sharon sanders** · July 3, 2009, 09:44 AM

Re: Hong Kong: Detection of human swine influenza virus resistant to Tamiflu (7/3/09)

Tamiflu resistance in Swine flu in Denmark -

Denmark - Dane with novel H1N1 found resistant to Tamiflu - FluTrackers News and Information

http://www.flutrackers.com/forum/showthread.php?t=113101

Tamiflu resistance in Swine flu in Japan

FluTrackers News and Information

http://www.flutrackers.com/forum/showthread.php?t=113750

**HenryN** · July 3, 2009, 10:16 AM

Re: Hong Kong: Detection of human swine influenza virus resistant to Tamiflu in person from USA

Hong Kong finds 1st case of Tamiflu-resistant H1N1

Fri Jul 3, 2009 8:39am EDT

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HONG KONG (Reuters) - Hong Kong's health department said on Friday it had detected a case of human swine influenza virus that was resistant to Tamiflu, the main antiviral flu drug.
The World Health Organization has declared a pandemic is under way from the new H1N1 virus, also known as swine flu.
"This is the first time Tamiflu resistance in HSI virus (was) found in Hong Kong," a spokesman for the health department said in a statement.
Only two other cases of Tamiflu-resistant H1N1 have been found so far, in Denmark and Japan.
According to the statement, the virus was isolated from a specimen taken from a 16-year-old girl coming from San Francisco, who was taken in by the Port Health Office at the Hong Kong International Airport upon arrival on June 11.
The virus was identified during the health department's routine sensitivity test of HSI virus to oseltamivir and zanamivir, the spokesman said.
Tamiflu, a tablet known generically as oseltamivir, is made by Switzerland's Roche AG and Gilead Sciences, while Relenza, an inhaled drug known generically as zanamivir, is made by GlaxoSmithKline under license from Australia's Biota Inc.
The department said that tests showed that the strain was sensitive to zanamivir.
Resistance to Tamiflu has been previously documented in the deadly bird flu virus H5N1 and seasonal H1N1 flu.
"You can always expect a certain number of resistances," said Roche spokeswoman Claudia Schmitt. "It does not necessarily mean that the strain is resistant to Tamiflu."
(Reporting by Michael Flaherty; Additional reporting by Sam Cage; Editing by Alex Richardson)

reuters.com

http://www.reuters.com/article/internal_ReutersNewsRoom_ExclusivesAndWins_MOLT/idUSTRE5622F720090703

**HenryN** · July 3, 2009, 10:20 AM

Re: Hong Kong: Detection of human swine influenza virus resistant to Tamiflu in person from USA

Tamiflu-Resistant Swine Flu Virus Found in Hong Kong (Update2)

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By Nipa Piboontanasawat and Jason Gale
July 3 (Bloomberg) -- Tamiflu-resistant swine flu was found in a teenager who hadn?t taken Roche Holding AG?s best-selling antiviral medicine, Hong Kong?s health department said.
The city?s Public Health Laboratory Services Branch identified the drug-evading variant during routine surveillance of flu specimens, the department said in a statement today.
This marks the first known case of Tamiflu resistance in a swine flu patient not treated with the drug, which has been stockpiled by governments worldwide to fight pandemic influenza. The specimen was collected from a 16-year-old girl who flew from San Francisco and was intercepted by officials at Hong Kong International Airport on June 11, according to the statement.
?Picking it up in a patient who was not treated is a cause for concern,? Malik Peiris, professor of microbiology at Hong Kong University, said in an interview. ?One case doesn?t change the world, but if we are seeing more and more cases in patients who are not treated, then I think it would be more serious.?
The patient, who was admitted to Queen Mary Hospital for isolation, tested positive for the new H1N1 flu strain and opted not to take Tamiflu, Hong Kong?s health department said. She had mild symptoms and was discharged upon recovery on June 18.
Denmark, Japan
Basel, Switzerland-based Roche said on June 29 that a swine flu patient treated with Tamiflu in Denmark showed resistance to the drug for the first time. Japan?s health ministry reported a case of resistance yesterday in a woman from Osaka who had taken a 10-day course.
Studies have shown that Tamiflu-resistant bugs develop in 0.4 percent to 4 percent of adults and children treated for seasonal influenza, Claudia Schmitt, a spokeswoman at Roche, said by phone from Basel today.
It?s likely the few reported cases of drug-resistant swine flu emerged independently, Hong Kong University?s Peiris said.
?The key point is whether the strains will become dominant and then we will have a problem,? he said. ?At this moment, I don?t think there is cause for alarm. There is certainly cause for heightened surveillance.?
The new H1N1 pandemic virus and a seasonal H1N1 variant are more likely to develop resistance to Tamiflu than other common flu strains, Peiris said. About 95 percent of the H1N1 seasonal flu viruses circulating around the world evade the Roche pill, according to a March 21 World Health Organizationreport.
Glaxo?s Relenza
No widespread resistance to GlaxoSmithKline Plc?s flu drug Relenza has been reported in seasonal flu, and there have been no reports of resistance in swine flu.
?Constant, random mutation is the survival mechanism of the microbial world,? WHO Director-General Margaret Chan said in an address to a meeting on the flu pandemic in Cancun, Mexico, yesterday. ?Like all influenza viruses, H1N1 has the advantage of surprise on its side.?
Tamiflu and Relenza, an inhaled powder, reduce the severity and the duration of flu symptoms by 24 to 30 hours if treatment is started within the first two days of illness, according to the companies.
Both drugs work by blocking a protein on the surface of influenza particles called neuraminidase, which allows the virus to spread from infected cells to other cells in the body.
Scientists say mutant H1N1 viruses have evolved to evade Tamiflu through a single mutation in the neuraminidase that prevents the medicine from clinging to the viral protein, enabling the pathogen to spread.
The case in Hong Kong indicates that the mutant virus is capable of being transmitted among people, said Jennifer McKimm- Breschkin, a virologist at the Commonwealth Science and Industrial Research Organization in Melbourne.
?It?s very disturbing that, fresh into the human population, this one appears now to be able to retain fitness despite having the mutation and to be able to spread,? she said in a telephone interview today.
To contact the reporters on this story: Nipa Piboontanasawat in Hong Kong at npiboontanas@bloomberg.net; To contact the reporters on this story: Jason Gale in Singapore at j.gale@bloomberg.net.
Last Updated: July 3, 2009 07:46 EDT

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