Anti-viral resistance in 2009 A/H1N1 flu - historical compilation of news

[Laidback Al]

Re: Tamiflu resistance in A/H1N1 flu - historical compilation of news

Hong Kong press release from November 5, 2009 refers to fifth individual first noted in post #262 above.


Tamiflu-resistant human swine influenza virus detected
************************************************** ****

The Department of Health's Public Health Laboratory Services Branch (PHLSB) today (November 5) detected a strain of human swine influenza (HSI) virus which was resistant to oseltamivir (Tamiflu).

A department spokesman said the virus was identified during PHLSB's routine sensitivity tests of the HSI virus to oseltamivir and zanamivir.

"This is the fifth time Tamiflu resistance in HSI virus has been found in Hong Kong and is the fourth local case.

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

The virus was isolated from the specimen taken from a 74-year-old man who developed flu-like symptoms on October 4. He was admitted to United Christian Hospital on October 7 for acute exacerbation of his chronic lung condition. He has already recovered and was discharged from hospital on October 13.

His nasopharyngeal aspirate specimen tested positive for HSI.

Further test results today showed that the virus was resistant to Tamiflu. The man had a previous history of taking a full course of Tamiflu in late September during another admission for acute exacerbation of his chronic lung condition. His family member was asymptomatic.

The spokesman said there was no evidence of further transmission of Tamiflu-resistant HSI from the patient.

The PHLSB conducts routine sensitivity tests on specimens taken from confirmed HSI patients.

So far more than 5,500 HSI samples have been tested for antiviral sensitivity in Hong Kong.

The case will be reported to the World Health Organisation (WHO), the spokesman said.

Hong Kong has an intensive surveillance system for antiviral resistant influenza viruses.

"We will closely liaise with the WHO and overseas health authorities to monitor the global development of antiviral-resistant HSI virus," he said.

Ends/Thursday, November 5, 2009
Issued at HKT 19:46

http://www.info.gov.hk/gia/general/200911/05/P200911050238.htm

[Commonground]

Re: Tamiflu resistance in A/H1N1 flu - historical compilation of news

Wales
Nov 20 2009 by Gregory Tindle, Western Mail

Excerpt:

And it emerged last night that two patients being treated in hospital have developed resistance to the antiviral Tamiflu, which has been used to treat the H1N1 virus.
Both received an alternative drug and one has recovered. The other patient, who has not been named, is being closely monitored.

http://www.walesonline.co.uk/news/health-news/2009/11/20/young-children-to-get-swine-flu-jab-as-number-of-deaths-increase-91466-25211302/

[sharon sanders]

Re: Tamiflu resistance in A/H1N1 flu - historical compilation of news

hat tip Lisa Schnirring
News: Person to person spread of swine flu resistant to Tamiflu

20 November 2009, National Public Health Service for Wales (NPHS)

The National Public Health Service for Wales (NPHS) has found person-to-person spread of a strain of swine flu resistant to Tamiflu within a South Wales hospital.

Five patients on a unit treating patients with severe underlying health conditions at the University Hospital of Wales, Cardiff, have been diagnosed with swine flu resistant to Oseltamivir (Tamiflu).

Three appear to have acquired the infection in hospital.

Dr Roland Salmon, Director of the NPHS Communicable Disease Surveillance Centre, said: ?The emergence of influenza A viruses that are resistant to Tamiflu is not unexpected in patients with serious underlying conditions and suppressed immune systems, who still test positive for the virus despite treatment.

?In this case, the resistant strain of swine flu does not appear to be any more severe than the swine flu virus that has been circulating since April.

?For the vast majority of people, Tamiflu has proved effective in reducing the severity of illness. Vaccination remains the most effective tool we have in preventing swine flu so I urge people identified as being at risk to look out for their invitation to be vaccinated by their GP surgery.?

Chief Medical Officer, Dr Tony Jewell, said: ?We know that people with suppressed immune systems are more susceptible to the swine flu virus, which is why they are a priority group under the first phase of the vaccination programme in Wales which is progressing at pace.

?We have stringent processes in place for monitoring for antiviral resistance in the UK so that we can spot resistance early and the causes can be investigated and the cases managed. Identifying these cases shows that our systems are working so patients should be reassured.

?Treatment with Tamiflu is still appropriate for swine flu and people should continue to take Tamiflu when they are prescribed it.

?It?s also important that good hygiene practices are followed to further prevent the spread of the virus.?

All patients diagnosed with Tamiflu-resistant swine flu on the unit have been treated with an alternative antiviral.

All other patients on the unit have been tested for swine flu.

Patients have been isolated or are being cared for in a designated area for influenza cases and Cardiff and Vale University Health Board has ensured that all appropriate infection control measures are in place on the unit.

Patients and staff at the unit have been offered swine flu vaccination. Patients due to come into the unit for treatment are being advised to have the vaccination from their GP in advance of coming to the hospital.

Household contacts of the patients with swine flu are being followed up to ensure early and appropriate treatment is offered should symptoms of influenza develop.

Two patients with Tamiflu-resistant swine flu have recovered and have been discharged from hospital. One patient remains in critical care and two others continue to be treated on the ward.

http://www.wales.nhs.uk/newsitem.cfm?contentid=13713

[Commonground]

Re: Tamiflu resistance in A/H1N1 flu - historical compilation of news

USA: North Carolina

Drug resistant swine flu found in N.C. hospital

Posted <script type="text/javascript">document.write(niceDate('11/20/2009 3:05 PM'));</script>29m ago
By Steve Sternberg, USA TODAY
Epidemic experts have launched an investigation of four Tamiflu-resistant swine flu cases at Duke University Medical Center to see whether the resistant virus has begun spreading person-to-person at the Durham, N.C. hospital and beyond.


If so, the cluster appears to be the first instance in which Tamiflu-resistant virus has been transmitted from person to person.



"The four patients involved in this situation had the same resistance pattern," says Daniel Sexton, the hospital epidemiologist leading the investigation, adding that the Centers for Disease Control and Prevention are now testing virus samples to see whether they're identical.



"The resistance pattern suggests that might be the case," he says.
All of the patients were located in a ward for people with cancer or severe blood disorders. All were severely ill and were highly susceptible to infections, Sexton says.


The patients became ill with flu in October. When they didn't respond to Tamiflu, the hospital sent specimens of their virus to see whether the virus might be resistant to antiviral treatment. The results didn't come back until two weeks ago, prompting Duke to launch an investigation.

Sexton says three epidemiologists from the CDC as well as experts from the state health department are now at Duke assisting in the investigation. The investigation has now been extended outside Duke to determine whether Tamiflu-resistant flu is circulating elsewhere in North Carolina.
CDC spokesman Dave Daige says the agency did confirm the cases and has sent three Epidemic Intelligence Service "disease detectives" to assist in the investigation.


Three of the four Duke patients have died; the fourth is extremely ill but is being treated with another antiviral called Relenza and appears to be recovering.

-snip-

http://www.flutrackers.com/forum/showthread.php?t=133970

[sharon sanders]

Tamiflu resistance in A/H1N1 flu - historical compilation of news

November 20, 2009, 1 submitted by Fondazione IRCCS Policlinico San Matteo, Italy:
<table border="0" cellpadding="2"> <thead> <tr> <td>
</td> <th>PB2</th> <th>PB1</th> <th>PA</th> <th>HA</th> <th>NP</th> <th>NA</th> <th>MP</th> <th>NS</th> </tr> </thead> <tbody><tr valign="top"> <th align="left">Influenza A virus
(A/Pavia/21/2009(H1N1))</th> <td>
</td> <td>
</td> <td>
</td> <td>
</td> <td>
</td> <td>GU216651*</td> <td>
</td> <td>
</td> </tr> </tbody><tbody> </tbody></table> * This sequence has the H274Y mutation that confers resistance to Oseltamivir.

http://www.ncbi.nlm.nih.gov/genomes/FLU/SwineFlu.html

[sharon sanders]

Re: Tamiflu resistance in A/H1N1 flu - historical compilation of news

2009-11-22

TamiFlu Resistance #13 from Italy: Novel with Swine Inclusion plus 4 Rare PF11 Amendments

The thirteenth TamiFlu Resistant specimen with a publicly available sequence, A/Pavia/21, was deposited Friday at GenBank with only Segment 6 (NA). The sample is contemporary and was taken 2009-11-16 on a nasal swab from a host with no gender or age identification in Pavia, a city of 71,000 in the Lombardy region of north central Italy. This Neuraminidase is remarkable due to the number and range of polymorphisms though the sequence is truncated 35 bases from the end.

The NA of Pavia21 is novel at the protein and the nucleotide level with no peer within ΣPF11, nor in the TamiFlu Resistant subset. The 5 polymorphisms on this sequence, if acquired via recombination, require a wide set of donors or more likely coincident recombination and adaptation events. Inclusions are noted that previously appear on Swine H1N1 (recent and 1931), Avian H1N1, Seasonal H1N1, Avian H5N1, Avian H6N1, Avian H10N1, Avian H11N1 and on very small and diverse sets of European PF11 sequences.

Three of the polymorphisms are silent. No combination of any 2 of the 5 signals seems to appear on documented public sequences. None of the signals other than 275Y appear on any previous PF11 TamiFlu-Resistant sequence.

NA Protein Codings to 1 Novel Polymorphism and 4 Rare Signals

• syn70S
• 275Y
• 332K
• syn360G
• syn398E

syn70S
encoded from C210T, AGc->AGt
A/Catalonia/NS675 (2009-06-08) is the singular ΣPF11 peer.

332K
Novel to ΣPF11.
Progenitors may include:
H5N1 Avian Asia 2005, 2006, 2007, 2008
H6N1 Avian Europe 2005
H1N1 Swine 1977, 2002
H1N1 Seasonal 2007 (230I)
NCsw36883 (212E)
HKswNS1659
Iowa human swine worker 2005 H1N1 (IA/CEID23/2005)

syn360G
encoded from G1080A, GGg->GGa
Rare to ΣPF11 with 4 French instances in early pandemic.
Paris2590
Paris2591 (HA:225E)
Paris2592
Paris2604
Progenitors may include:
H1N1 Human North America 2007, Middle East 2006, 2007
H1N1 Avian North America 2006, 2007, 2008
H1N1 Avian Asia 2006
H1N1 Swine North America 1931, 2003, 2004, 2005, 2006
H1N1 Swine US 1931
H1N1 Swine Asia 1993, 2001, Europe 2001
H5N1 Avian North America 2005
H6N1 Avian North America 2007, Asia 2006
H10N1 Avian North America 2007
H11N1 Avian North America 2002

syn398E
encoded from G1194A, GAg->GAa
Rare to ΣPF11 with 7 instances.
Italy160 (July from Veneto)
Spain with 5 sequences as recently as 2009-10-28
Canada (May)
Progenitors unknown; however, a 12 residue span in this area, including protein 398, revises for WSN33 and H5N1 Human.

On Pavia21 TamiFlu Resistance is indicated in typical PF11 fashion via a Single Nucleotide Polymorphism coding for 275Y on the Neuraminidase. The sequence displays the following NA Quadruple Combination:

106I, 248D, 275Y, 286S

The following permutations are now represented on the thirteen PF11 anti-viral resistant sequences:

106V, 248N, 275Y, 286S = WA28, WA29, TX47
106I, 248N, 275Y, 286S = Osaka180
106I, 248D, 275Y, 286S = HK2369, Yamaguchi22, Denmark528, Hunan SWL3, Singapore57, Tokushima2, Iwate3, Quebec147365, Pavia21

Until the 2009-08-21 deposit of the two Washington sequences, all 275Y TamiFlu-Resistant specimens on PF11 backgrounds were paired with 106I. We continue to see only 3 of the 13 with 106V. The addition of Pavia21 heavily leverages position 248 toward Aspartate (D) with 9 specimens versus 4 with Asparagine (N). No TamiFlu Resistant specimen on file displays 286G as yet.

Pavia21 is the most hypermorphic TamiFlu-Resistant PF11 strain seen since the oddities from the immuno-compromised patients in Washington. Four changes other than H275Y is unusual in a single sequence.

We are quite impressed with the Influenza reservoir's ability to recycle data between serotypes without reassortment. Unless this sample were exposed to low level radiation during incubation, a series of accumulative recombinations have occurred over a very short time period or a triple co-infection enlisted all variants to build Pavia21 within a single host using an adaptation event to smooth the topping.

The most probable explanation is an accumulation of recombinations across the hypermorphic Catalonia region then exporting data to Italy via wild birds with a single co-incident adaptation event within the eventual host. Additionally, our team would not be at all surprised to find 225E on the HA of this patient's virus if the data is eventually published.

At any measure, another new background is now carrying TamiFlu Resistance in a central flyway for Influenza's primary transportation vector, wild birds.

[sharon sanders]

Re: Tamiflu resistance in A/H1N1 flu - historical compilation of news

2009-11-22

TamiFlu Resistant Cluster of 4 at Duke Medical Center, North Carolina, US

As the thirteenth TamiFlu Resistant sequence was released publicly by Italy demonstrating a hypermorphic progression to another novel strain, the Duke University Medical Center contemporaneously described a group of patients acquiring PF11 Influenza in an isolated ward of their hospital. Four of the patients from this isolated ward were found to be infected with a TamiFlu Resistant strain. Transmission is suspected and may be verified by publication of all sequences from that ward over a time period covering two weeks prior, during and two weeks after the event. Three of the four patients had fatal outcomes (75%).

Antiviral resistance has now been documented in 50 instances, when investigated, including North America, Europe and widely across Asian countries. The 13 sequences that are available are, for the most part, incomplete for research into cross-segment linking of Hemagglutinin (HA) polymorphisms correlative to the antiviral-resistance conferring H275Y Neuraminidase (NA). Investigators are left at bare benches staring into empty beakers waiting for catalyst.

The resistance marker is now found on numerous backgrounds potentially demonstrating an ability to travel as a silent sub-species. Up to this current stage of the pandemic virus progression, this resistance trait, in several cases, appears to arise in an individual as the prominent super-infection (co-infecting silent H275Y PF11 strain) based on some unidentified characteristic of the individual's host-pathogen meshing, including immune dysregulation or other existing Cytokinic Dysregulation morbidities.

Publication of the remaining 37 sequences, including the Duke University Medical Center clinicals from this prestigious research institution, may benefit worldwide understanding of the efficacy and longevity of currently promulgated mediation measures for PF11.

For additional background on the clinical and epidemiological observational facts concerning Pandemic Influenza H1N1, please refer to the Table of Contents for PF11 Trends & Issues, Mid-Term.

[Commonground]

Re: Tamiflu resistance in A/H1N1 flu - historical compilation of news

S.Korea reports first Tamiflu-resistant flu case

SEOUL ? Health authorities Monday reported South Korea's first case of swine flu that was resistant to the anti-viral drug Tamiflu, and called for extra precautions against any future cases.


The health ministry said in a statement that it found a Tamiflu-resistant strain of the (A)H1N1 virus in a five-year-old boy, who needed repeated and doubled doses of Tamiflu to recover.


Another anti-viral drug, Relenza, proved effective in specimens taken from the child but he was too young to take the drug, it added.


The ministry urged people to report immediately to hospitals or health authorities if Tamiflu had no effect five straight days after the first dose.
It said the World Health Organization has reported 75 Tamiflu-resistant cases globally since the first such case in North America in April.
South Korea's swine flu death toll has reached 104 but the spread of the disease is waning, according to the ministry.

http://www.google.com/hostednews/afp/article/ALeqM5jt6Hkp1giK9B-AiGiXzpgFsROPMg

[Tonka]

Re: Tamiflu resistance in A/H1N1 flu - historical compilation of news

http://www.laverdad.es/murcia/20091129/region/esta-haciendo-virus-resistente-20091129.html

Spanish to English translation

What is being done about the virus resistant to Tamiflu?

29.11.09 - 03:23 - J. P. PARRA | MURCIA

A possible mutation of H1N1 has been from the outset a major concern of the World Health Organization (WHO). When in summer the epidemic began attacking South America, and demonstrated that the virus was particularly virulent, some voices warned that it was too early to declare victory. They recalled the case of Spanish flu, which appeared as a mild disease and ended up causing pneumonia in the fall of 1918 extreme virulence and thus, thousands of deaths.
Fortunately this has not happened, and many scientists have denounced the excessive alarmism with which health authorities themselves have been addressed from the outset this pandemic. However, that does not mean that vigilance has relaxed. Virology Unit The Arrixaca analyzed hundreds of samples for any alteration. "Many viruses are capable of spontaneous mutations," recalls Antonio Moreno, head of this unit.
The A H1N1, are no exception. Indeed, Norway, Denmark and France have in recent days detected an altered virus that makes it much more aggressive in at least five patients who died completed. Also in Pavia in Italy, has discovered a mutation that could be resistant to osetalmivir (active ingredient of the antiviral Tamiflu, used in severe cases of influenza A). "It happens also with the bacteria, which try to adapt to antibiotics, "explains Dr. Moreno.
In any case, French authorities made it clear yesterday that "there are elements that do not fear the spread of a mutant strain" and insisted that the cases detected are still isolated. Neither the region nor in the rest of Spain has now detected alteration.
What they have made it clear the analysis of over 500 samples analyzed in the Arrixaca in the last week is that the seasonal flu has been wiped off the map. 99% of the cases have tested positive for the new H1N1 virus. The rest, an insignificant amount corresponded to strains that have circulated in previous years.

[sharon sanders]

Re: Tamiflu resistance in A/H1N1 flu - historical compilation of news

In GISAID database -

A/Tennessee/17/2009

1 year old, female

submitted by the CDC on November 25, 2009


oseltamivir resistant

[Celvin11]

Tamiflu resistance in A/H1N1 flu - historical compilation of news

Tamiflu-resistant patients in Maryland and Virginia

By Michael Laris
Washington Post Staff Writer
Wednesday, December 2, 2009; 3:55 PM

Two swine flu patients in Maryland and one in Virginia were hospitalized with a form of the virus resistant to a commonly used medicine, prompting infectious disease specialists to call for renewed caution even as the intensity of the pandemic nationwide has declined.

http://www.washingtonpost.com/wp-dyn/content/article/2009/12/02/AR2009120202759.html

[Giuseppe]

Tamiflu resistance in A/H1N1 flu - historical compilation of news

Emergence of Oseltamivir-Resistant Pandemic H1N1 Virus during Prophylaxis (N Engl J Med., edited)

Emergence of Oseltamivir-Resistant Pandemic H1N1 Virus during Prophylaxis
<!-- PLUGH $RESOURCE.EXT_DOI is 10.1056/NEJMc0910060 -->
<!-- end of outer content box1 --> <!-- end of outer content box2 --> <!-- TEXT --> <!-- <CENTER> Emergence of Oseltamivir-Resistant Pandemic H1N1 Virus during Prophylaxis

</CENTER> -->
To the Editor:

Neuraminidase inhibitors (oseltamivir and zanamivir)are recommended for treatment of severe illness caused by the2009 pandemic influenza A (H1N1) virus, and their use has alsobeen advocated for postexposure prophylaxis in high-risk persons.¹ We report the emergence of an oseltamivir-resistant virusin a familial cluster of infections with the 2009 H1N1 virus.

In a 13-year-old boy with asthma, infection with the 2009 H1N1virus developed and was confirmed by reverse-transcriptase polymerase-chain-reaction(RT-PCR) testing of a nasopharyngeal aspirate. Administrationof oseltamivir (60 mg twice a day for 5 days for this boy whoweighed 32 kg) was begun, and the patient was discharged homethe same day. Simultaneous with treatment of the index patient,postexposure prophylaxis with oseltamivir (75 mg once a dayfor 10 days) was prescribed to all household contacts (the boy's59-year-old father, who had chronic obstructive pulmonary diseaseand was taking prednisone at a dose of 5 mg daily; 50-year-oldmother; and 15-year-old and 18-year-old sisters). Approximately24 hours after oseltamivir prophylaxis was begun, influenza-likesymptoms developed in the father (...). On day 8 of oseltamivirprophylaxis, the father consulted his general practitioner becauseof persistent cough. A nasopharyngeal aspirate collected atthat time was positive for the 2009 H1N1 virus, according toRT-PCR testing and culture. The father had an uneventful clinicalcourse, and a nasopharyngeal aspirate sampled at the end ofhis illness was negative for the 2009 H1N1 virus. Influenza-likesymptoms did not develop in any other household contacts.

The 2009 H1N1 viral isolate collected from the index patientbefore oseltamivir therapy was susceptible to oseltamivir (50&#37;inhibitory concentration, 0.27 nM) and zanamivir (50% inhibitoryconcentration, 0.18 nM), whereas the father's 2009 H1N1 viralisolate was resistant to oseltamivir (50% inhibitory concentration,>400 nM) but susceptible to zanamivir (50% inhibitory concentration,0.12 nM). Complete 2009 H1N1 virus genomes of the father's virus(GenBank accession number, FN434454<!-- HIGHWIRE EXLINK_ID="361:23:2296:1" VALUE="FN434454" TYPEGUESS="GEN" --> [GenBank] <!-- /HIGHWIRE -->) differed from the indexpatient's virus (GenBank accession number, FN434445<!-- HIGHWIRE EXLINK_ID="361:23:2296:2" VALUE="FN434445" TYPEGUESS="GEN" --> [GenBank] <!-- /HIGHWIRE -->) by onlyone substitution (H275Y) in the neuraminidase protein. The roleof the H275Y substitution was assessed by generating recombinantneuraminidase proteins.² The mutant neuraminidase protein wasmore resistant to oseltamivir than was the wild-type proteinby a factor of more than 400, confirming the phenotypic results.

Our results indicate that the same neuraminidase mutation (H275Y)is associated with oseltamivir resistance not only in seasonalH1N1³ and avian H5N1⁴ viruses but now also in 2009 pandemicH1N1 strains. We hypothesize that the presence of subtherapeuticlevels of oseltamivir at a time when viral replication had alreadybegun was an important factor that led to the emergence of theresistant virus in the father of our index patient. Other oseltamivir-resistantstrains of 2009 H1N1 virus detected during postexposure prophylaxishave been reported to the World Health Organization.⁵

These observations support the need for limiting the indicationsfor postexposure prophylaxis. It also seems reasonable to rapidlyconvert prophylactic (once daily) regimens to therapeutic (twicedaily) regimens as soon as influenza-like symptoms develop ina patient receiving prophylactic treatment. Monitoring for theH275Y mutation during outbreaks of 2009 H1N1 virus is importantin order to rapidly identify transmission events that couldlead to large-scale dissemination of an oseltamivir-resistant2009 H1N1 virus, similar to what occurred with recent H1N1 virusseasonal strains.³


Mariana Baz, M.Sc.
Yacine Abed, Ph.D. 
Jesse Papenburg, M.D. 
Xavier Bouhy, B.Sc. 
Marie-&#200;ve Hamelin, Ph.D.
Guy Boivin,M.D. 
Centre Hospitalier Universitaire de Qu&#233;bec
Quebec, QC, Canada
guy.boivin@crchul.ulaval.ca<script type="text/javascript"><!-- var u = "guy.boivin", d = "crchul.ulaval.ca"; document.getElementById("em0").innerHTML = '<a href="mailto:' + u + '@' + d + '">' + u + '@' + d + '<\/a>'//--></script>
Financial and other disclosures provided by the authors areavailable with the full text of this letter at NEJM.org.
This letter (10.1056/NEJMc0910060) was published on November11, 2009, at NEJM.org.

References

1. Updated interim recommendations for the use of antiviral medications in the treatment and prevention of influenza for the 2009-2010 season. Atlanta: Centers for Disease Control and Prevention. (Accessed November 9, 2009, at http://www.cdc.gov/h1n1flu/recommendations.htm.)<!-- HIGHWIRE ID="361:23:2296:1" --> <!-- /HIGHWIRE --><!-- null -->
2. Abed Y, Goyette N, Boivin G. A reverse genetics study of resistance to neuraminidase inhibitors in an influenza A/H1N1 virus. Antivir Ther 2004;9:577-581.<!-- HIGHWIRE ID="361:23:2296:2" --> [Web of Science][Medline]<!-- /HIGHWIRE --><!-- null -->
3. Dharan NJ, Gubareva LV, Meyer JJ, et al. Infections with oseltamivir-resistant influenza A(H1N1) virus in the United States. JAMA 2009;301:1034-1041.<!-- HIGHWIRE ID="361:23:2296:3" --> <nobr>[Free Full Text]</nobr><!-- /HIGHWIRE --><!-- null -->
4. de Jong MD, Tran TT, Truong HK, et al. Oseltamivir resistance during treatment of influenza A (H5N1) infection. N Engl J Med 2005;353:2667-2672.<!-- HIGHWIRE ID="361:23:2296:4" --> <nobr>[Free Full Text]</nobr><!-- /HIGHWIRE --><!-- null -->
5. Antiviral use and the risk of drug resistance: pandemic (H1N1) 2009 briefing note 12. Geneva: World Health Organization, September 25, 2009. (Accessed November 9, 2009, at http://www.who.int/csr/disease/swine.../en/index.html.).

-
------

[estacion]

Re: Tamiflu resistance in A/H1N1 flu - historical compilation of news

Catalunya recorded its first case of resistance to antiviral
December 2, 2009.

Catalunya has recorded its first case of a patient with influenza A resistant to an antiviral, but has been discharged and is being studied, according to Europa Press sources have confirmed to the Regional Ministry of Health.



BARCELONA, 2 (EUROPA PRESS)


Catalunya has recorded its first case of a patient with influenza A resistant to an antiviral, but has been discharged and is being studied, according to Europa Press sources have confirmed to the Regional Ministry of Health.


The same sources explained that all cases of new viruses that are serious, undergoing some study to detect whether there is resistance to antivirals.


The Conselleria stated that this is an isolated case and that the patient has been discharged from hospital.


(EUROPA PRESS CATALUNYA)

Source: Qu?

http://translate.google.es/translate?js=y&prev=_t&hl=es&ie=UTF-8&layout=1&eotf=1&u=http%3A%2F%2Fwww.que.es%2Fbarcelona%2F200912022034-catalunya-registra-primer-caso-resistencia.html&sl=es&tl=en

[Celvin11]

Re: Netherlands: Man dies of Tamiflu resistant swine flu

Netherlands reports mutant swine flu death

http://www.physorg.com/news179059662.html

Netherlands reports mutant swine flu death
December 3, 2009 Dutch authorities said Thursday a patient infected by a mutant strain of the swine flu virus had died.


Harald Wychgel, spokesman for the Dutch Institute for Health and the Environment, told AFP that there had been a "minor change in the virus to make it resistant to Tamiflu," a key treatment for influenza.

"The patient was already seriously ill and being treated for that. He was infected by the Mexican flu and developed a resistance to Tamiflu," Wychgel told AFP.

The Dutch ANP news agency said the man had died in hospital in the northern city of Groningen, adding that two more patients in the Netherlands had shown resistance to Tamiflu.

It is the fifth fatal case of mutated A(H1N1) flu in Europe, after two in France and two in Norway.

The World Health Organisation said last month that a similar mutation had been observed in Brazil, China, Japan, Mexico, where the swine flu pandemic began, Ukraine, and the United States, as early as April.

Italy also reported a non-fatal case on Monday.

"The mutations appear to occur sporadically and spontaneously. To date, no links between the small number of patients infected with the mutated virus have been found and the mutation does not appear to spread," a WHO statement said on November 20.

The WHO also underlined that there was no evidence of more infections or more deaths as a result, while the mutated virus remained sensitive to antiviral drugs used to treat severe flu, oseltamivir (Tamiflu) and zanamivir (Relenza).

Scientists fear that mutations in flu viruses could cause more virulent and deadly pandemic flu. The global health watchdog reiterated a call for close monitoring.

"Although further investigation is under way, no evidence currently suggests that these mutations are leading to an unusual increase in the number of H1N1 infections or a greater number of severe or fatal cases," it added.

(c) 2009 AFP

[Tonka]

Re: Tamiflu resistance in A/H1N1 flu - historical compilation of news

http://oncetv-ipn.net/noticias/index.php?modulo=despliegue&dt_fecha=2009-12-03&numnota=39

Increased cases of H1N1 resistant to antiviral: WHO
Date: December 3, 2009
Reporter: News Writing Eleven
Source: Eleven News


The World Health Organization (WHO) recognized that cases of influenza A virus to the antiviral Oseltamivir-resistant H1N1 has increased from 57 to 96 in the last two weeks.

The international body ruled that these effects could pose a danger to public health.

He said a third of these cases were in patients with weakened immune systems for blood disorders by treatment with cancer chemotherapy or after receiving a transplant