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Tamiflu ineffective against influenza strain spreading in Japan
A strain of influenza that spread across Japan this winter is proving resistant to the influenza medicine Tamiflu, a survey by the Ministry of Health, Labor and Welfare has found.
About one in three influenza patients in Japan are infected with the strain, referred to as Soviet-A. Last winter 2.6 percent of cases were resistant to Tamiflu.
The reason for the sudden increase in Tamiflu-resistant cases is unclear, but it is possible that a strain from overseas was carried to Japan. The ministry has set up a research team to investigate the strain and compile guidelines for treatment.
In the survey, local public health institute data was compiled by the National Institute of Infectious Diseases, which operates under the ministry. Data showed that 303 of the 671 influenza patients had the Hong Kong-A strain, and 243, or about 36 percent, had the Soviet-A strain. The other 125 had B-type influenza.
The Institute separately examined samples of the Soviet-A strain taken from 35 patients in 11 prefectures, and found that Tamiflu was ineffective for 34 of the patients, or 97 percent. Researchers did not find Tamiflu-resistance among patients with Hong Kong-A and B-type influenza.
The Tamiflu-resistant Soviet-A virus spread last winter, mainly in Europe. This winter it has spread worldwide, and has been detected in over 90 percent of areas in Britain and the United States. The U.S. Centers for Disease Control and Prevention announced emergency treatment guidelines last month, permitting the use of the inhalant drug Relenza.
Japan has enough Tamiflu to treat 28 million patients. The drug will also be used to treat a new type of influenza.
"Drug resistance is limited to the Soviet-A strain, and there is no need to review our response to the new type of influenza," a Health, Labor and Welfare Ministry representative said. "Vaccines are thought to be effective against drug-resistant viruses. There is no need to be overly anxious. We want people to take care to carry out preventive measures such as washing their hands and gargling."
I believe that the above Soviet strain is H1N1 clade 2B (Brisbane/59), while the Hong Kong strain is H3N2 (Brisbane/10). Thus, the above increases resistance from 13/14 in the WHO report, to 34/35 in the above report for H1N1 with H274Y.
A virus of the Soviet A-type influenza now sweeping the country has developed resistance to the medicine Tamiflu.
The health ministry inspected the viruses of 35 Soviet A-type flu patients living in 11 prefectures and found that 34 patients, or 97 percent, were resistant to Tamiflu,resulting not responding well .
Last winter, the ratio of Tamiflu-resistant virus of the Soviet A-type flu was only 2.6 percent.
Soviet A-type is one of 3 types of flu detected in Japan this winter, accounting for 36% of total cases.
The hospitals are instructed to use an alternative remedy called Relenza when Tamiflu fails.
Recently,the Japanese have prepared stocks of Tamiflu for 28 million patients in case of an outbreak of new types of influenza, such as a bird-flu mutation.
With the flu season starting to gear up, North Texas public health officials are concerned that fewer people have been vaccinated against the virus.
The Garland Health Department has even slashed its vaccine price to $5 ? down from $20 ? in an effort to get more people to protect themselves before the season peaks in February.
?We?re concerned that we may not have enough people immunized to prevent the spread of the flu once it really hits here,? said Richard Briley, Garland?s managing director of health.
Dallas County health officials say their vaccination numbers are down about 50 percent compared with last year, while Garland, which has its own health department, says its numbers are down by 35 percent. Collin and Tarrant counties also reported drops.
Officials said there may be a variety of factors for the drop, including the fact that the flu season so far has been relatively mild nationwide. There are also reports that last year?s vaccine did not target the strains that appeared, meaning lots of people who were vaccinated still got sick. Plus there may be possible confusion over news that the leading flu treatment appears to be ineffective against one of this year?s most common strains.
Briley and others said early reports indicate that the most prevalent flu strain appears to be resistant to Tamiflu, a leading flu treatment. But this year?s flu vaccine, unlike other years, appears to be very effective against the strains that are in circulation, he said.
Peggy Wittie, chief epidemiologist in Collin County, said it was a ?sad possibility? that people may be confused about the difference between the flu vaccine and Tamiflu.
Jacqueline Bell, a spokeswoman for Dallas County Health and Human Services, said the department still has about 2,900 adult and 440 children vaccines available ? a high number at this point in the flu season.
?It?s very concerning to us since it appears there is resistance to Tamiflu? that means people who contract the flu may have a more difficult course,? Bell said.
Officials note that other medications can treat the flu, but Tamiflu has been the leading drug. It must be prescribed by a doctor within 48 hours of the flu?s onset.
?People can get protection with the vaccine, and there is an ample supply this year, but people are just not taking advantage of that,? Bell said.
Bell noted that in addition to public health facilities such as Dallas County?s, vaccines also are available at a variety of places such as smaller clinics, private doctors offices and even pharmacies.
Vanassa Joseph, a spokeswoman for Tarrant County Public Health, said her agency also has seen a drop in the number of people getting the vaccine, but the reasons are uncertain.
?Each season is different,? Joseph said. ?We don?t know what to factor into it. Maybe some people just have not gotten around to it this year. There?s a myriad of reasons for why they may not have gotten the flu shot.
?But what we do know is that the flu vaccine is the best prevention measure,? she said.
Wittie, from Collin County, said statistics indicate the flu cases are only now showing an upswing in North Texas. About 6 percent of samples in Dallas County are being confirmed as flu, while in Collin County it has been about 10 percent.
Wittie noted that flu spreads especially quickly among school-age children.
?We have vaccines for children 3 and up and for adults,? Wittie said. ?We really encourage people to take advantage of that.?
At a glance
Flu shots
?The Dallas County Health and Human Services Immunization Clinic is open from 8 a.m. to 4 p.m. Monday through Friday at the health services building, 2377 N. Stemmons Freeway. For more information, call 214-819-2163.
?Collin County Health Care Services offers flu vaccines from 8 to 11 a.m. and 1 to 4 p.m. Monday through Friday. For more information, call 972-548-5500.
?The Garland Health Department offers flu shots from 8 to 11 a.m. Monday, Tuesday and Thursday. For more information, call 972-205-3370.
?Tarrant County Public Health offers flu vaccines Monday through Friday at several locations. For more information, call 817-238-4448. Is it the flu? Flu: Symptoms, sometimes severe, include fever, sore throat, body aches, headache, extreme tiredness, dry cough and runny or stuffy nose. Diarrhea and vomiting may also occur, but are more common among children than adults. Cold: Symptoms, including a sore throat, cough and runny or stuffy nose, are usually milder than the flu.
◆ 2008/09 flu season
52 weeks a year until 2008 in the AH1 subtype 157 cases from 19 prefectures, AH3 subtype are 207 cases from 24 prefectures,
B-11 from the 84 prefectures have been detected in the separation.
The last four weeks (48-51 weeks) is a subtype AH1 Hokkaido 43, 27, Tokyo, Osaka 11, Miyagi
10, 6, Kanagawa, Okayama 5, 4, Nagano, Niigata, Shizuoka, Nara Prefecture, Hiroshima Prefecture, and three each, total
128 cases, AH3 Osaka subtype the 26 cases, 19 cases, Nara, 11, Shimane Prefecture, Mie 9, 8, Tokyo, Kanagawa,
Hyogo Prefecture, Yamaguchi Prefecture and 7, 6 Hokkaido, Aichi 5, 4, Hiroshima Prefecture, Akita Prefecture, Shizuoka, and three each, a total of 118
Cases, B-11, Hyogo Prefecture, 7, Kanagawa Prefecture, Yamagata Prefecture, Osaka and Nara 6, Akita Prefecture, Chiba Prefecture, Niigata
1 each prefecture, a total of 39 cases (26 cases Victoria line, Yamagata strains 8, PCR 5 cases) are reported in separate detection
.
In Sendai 10 cases were isolated from outbreaks in primary schools in late A/H1N1 virus subtype NA genes
An indicator of a child H275Y oseltamivir resistance has been reported that the recognition of amino acid substitution
(15 pages this issue, "news").
Influenza virus is detected early separation please refer http://idsc.nih.go.jp/iasr/influ.html
H1N1 Tamiflu Resistance Spreads Across Japan Recombinomics Commentary 12:30
January 17, 2009
In the survey, local public health institute data was compiled by the National Institute of Infectious Diseases, which operates under the ministry. Data showed that 303 of the 671 influenza patients had the Hong Kong-A strain, and 243, or about 36 percent, had the Soviet-A strain. The other 125 had B-type influenza.
The Institute separately examined samples of the Soviet-A strain taken from 35 patients in 11 prefectures, and found that Tamiflu was ineffective for 34 of the patients, or 97 percent.
The above comments provide an update on oseltamivir resistance in Japan. The ?Soviet-A? strain is H1N1 clade 2B Brisbane/59, which was phylogenetically described for three isolates from an elementary school outbreak in Sendai. Those sequences matched sequences in the United States from HI, TX, PA. An earlier WHO report indicated 13/14 H1N1 isolates had H274Y. the above report extends the resistance to 34/35 isolates collected from 11 prefectures, indicating the resistance is widespread.
The results from Japan match those of Korea. Where H1N1 cases have exploded and 16/17 H1N1 isolates had H274Y. Similar results have been described for the United States and Canada in North America, as well as England and many countries in Europe.
Since the H1N1 with H274Y in Japan is called the ?Soviet ?A? strain, it is likely that resistance levels in Russia and China are similar to Europe, North America, and Korea/Japan.
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"The next major advancement in the health of American people will be determined by what the individual is willing to do for himself"-- John Knowles, Former President of the Rockefeller Foundation
~30% of cases in 2008 were H1N1, yet only 1/20=5% of genomes are H1N1.
And that where we are facing unexplained Tamiflu-resistance in H1N1 and
tracking the evolution of H1N1 is particularily important.
The number of genomes in total did also decrease a lot, this is not just
some project. Also these projects don't make much sense when they are
restricted to one year - with what do you want to compare the data ?
~30% of cases in 2008 were H1N1, yet only 1/20=5% of genomes are H1N1.
And that where we are facing unexplained Tamiflu-resistance in H1N1 and
tracking the evolution of H1N1 is particularily important.
The number of genomes in total did also decrease a lot, this is not just
some project. Also these projects don't make much sense when they are
restricted to one year - with what do you want to compare the data ?
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