Tamiflu resistance in pandemic influenza - historical compilation of news
Sunday, Aug. 30, 2009
Pregnant women warned to protect against H1N1
Death rates in Brazil prompt calls for precautions
Kyodo News
Since more than 10 percent of the H1N1 swine flu fatalities in Brazil were pregnant women, doctors in Japan are asking expectant mothers ? who have a higher risk of developing complications if infected ? to wash their hands and take other precautions.
The Japan Society of Obstetrics and Gynecology, an organization of OB-GYN doctors, is calling for pregnant women with suspected swine flu symptoms to get treatment at fever clinics and general hospitals rather than OB-GYN clinics to prevent the H1N1 virus from spreading to other expectant mothers during the epidemic.
JSOG is recommending Tamiflu and Relenza for pregnant women who catch the new flu. A guideline in the United States says the two antiviral drugs have no negative side effects on babies. The organization is also urging the government to give expectant women priority for swine flu vaccines.
The figures announced Wednesday by the Brazilian government sent shock waves around the world. Of the 557 people who died, 58 were pregnant. No such deaths have been reported so far in Japan.
The government is expected to formally place expectant mothers on the vaccine priority list in September.
"Pregnant women comprise only about 1 percent of the population but the number of deaths (among those women) is high," Hisanori Minakami, a professor at Hokkaido University who belongs to JSOG, said during a meeting Thursday to discuss the priority list for new influenza vaccines. "I have a sense of crisis."
Women are also concerned.
"I'm worried about the higher risk of pregnant women but I'm also worried what will happen to my newborn baby," said a 42-year-old woman in Bunkyo Ward, Tokyo, who is close to giving birth.
She wears a mask when she needs to go out and avoids crowds. "But I don't know which department to be treated at when I am infected," she said.
When women are pregnant, their immunity to viruses weakens, putting them at higher risk of complications. Seasonal and new flu viruses can lead to pneumonia and other diseases.
JSOG is urging pregnant women with potential flu symptoms ? fever, runny nose, sore throat and cough ? to call a general hospital and get treated early.
Nationwide, total swine flu deaths grew to seven Saturday when a woman in her 30s in Tatsuno, Hyogo Prefecture, died after contracting the virus, the municipal government of Himeji said the same day.
She was preceded by a female cancer patient, also from Hyogo, in her 60s, the Kagoshima Prefectural Government said.
The woman, from Makurazaki, Hyogo Prefecture, had cancer of the digestive system and a tumor that spread to her lungs after surgery, local government officials said.
She was treated with Tamiflu on Friday after being entering a hospital complaining of a sore throat, coughing and a 38-degree fever she had developed the previous day, officials said. But her condition worsened, and she died early Saturday, becoming the nation's sixth swine flu fatality.
In Shiga Prefecture, a 5-year-old boy infected with swine flu showed signs of resistance toward Tamiflu, the prefecture said Saturday, becoming the fifth Tamiflu-resistant patient in the country.
Prefecture officials said the virus is likely to have mutated in his body.
Although the boy was given Tamiflu, he showed no signs of recovery and was admitted to a hospital, the officials said, adding he has now fully recovered from the virus.
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Tamiflu resistance in pandemic influenza - historical compilation of news
If the new gene recombinant influenza experts worry brewing in Taiwan and the United States disaster
(Central News Agency, Taipei Chen Qingfang 28, Xinhua)
Taiwan, the United States, Chinese experts were today warned that if the new H1N1 avian influenza and the H5N1 flu virus genetic recombination, would be disastrous to create highly infectious and drug-resistant virus; if the new influenza and drug-resistant Seasonal influenza virus mixed, then make Tamiflu failure.
Respiratory disease experts, the Chinese Academy of Engineering, Zhong Nanshan, told Xinhua here today, H1N1 influenza virus currently does not appear a new variation, it has a very infectious, but the lethality is not high, but once mixed with a high lethal H5N1 avian influenza virus, would be very dangerous.
U.S. Department of Health Office of Health Services, director of Southeast Asia, Mali W (Dr.Michael D. Malison) today at the Department of Health Center for Disease Control press conference pointed out that, H5N1 bird flu fatality rate more than 5 into, if the new H5N1 avian influenza and H1N1 influenza in the same person body infection, once the genetic recombination, creating highly lethal flu virus, it will be a disaster.
Mali Sheng pointed out that the World Health Organization (WHO) and Viet Nam, Indonesia, Egypt to cooperate in monitoring, the three countries at the same time both influenza pandemic virus, fearing there mixed virus.
Deputy Director of Health-Chwen Chang to make another worry that 9 percent of seasonal influenza H1N1 viruses are resistant to Tamiflu, if and H1N1 influenza virus genes new hybrid, resulting in a new drug-resistant influenza virus, then the Tamiflu will lapse, Tamiflu is also stored more useless.
The former Health and Director of the Academia Sinica Chen Chien-jen, today suggested that the Department of Health should be widely at the grassroots level to build hospitals and clinics cloth Tamiflu to prevent the patient pushed large hospitals, causing severe infection in hospital patients.
In response, CDC chief Hsu-Sung Kuo believes that the Department of Health will consider part of the publicly-funded Tamiflu shop at the grassroots level, but not a comprehensive distribution in order to avoid misuse promote drug resistance.
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Re: CDC lists 7 cases of Tamiflu resistant viruses
Some more snips from CDC report:
The majority of 2009 influenza A (H1N1) viruses are susceptible to the neuraminidase inhibitor antiviral medication oseltamivir, however rare sporadic cases of oseltamivir resistant 2009 influenza A (H1N1) viruses have been detected worldwide, including seven viruses in the United States. All tested viruses retain their sensitivity to the other neuraminidase inhibitor zanamivir.
Additional information on antiviral recommendations for treatment and chemoprophylaxis of 2009 influenza A (H1N1) infection is available at http://www.cdc.gov/h1n1flu/recommendations.htm
All 2009 influenza A (H1N1) viruses tested to date are resistant to the adamantane antiviral medications, amantadine and rimantadine. Antiviral treatment with either oseltamivir or zanamivir is recommended for all patients with confirmed, probable or suspected cases of 2009 influenza A (H1N1) virus infection who are hospitalized or who are at higher risk for seasonal influenza complications.
Six of the seven patients had documented exposure to oseltamivir through either treatment or chemoprophylaxis, and the remaining patient is currently under investigation to determine exposure to oseltamivir.
Occasssional development of oseltamivir resistance during treatment or prophylaxis is not unexpected. Enhanced surveillance is expected to detect additional cases of oseltamivir resistant 2009 influenza A (H1N1) viruses and such cases will be investigated to assess the spread of resistant strains in the community.
To prevent the spread of antiviral resistant virus strains, CDC reminds clinicians and the public of the need to continue hand and cough hygiene measures for the duration of any symptoms of influenza
(http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5832a3.htm)
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Re: Increase in AH1N1 cases in Honduras- total 8 deaths
Increase to 10 killed by H1N1 in Honduras
To date four pregnant women have been killed by H1N1
27.08.09 - Updated: 28.08.09
TEGUCIGALPA, HONDURAS
The deaths of a child and a woman rose to 10 deaths from H1N1 flu in Honduras, which are recorded at least 381 confirmed cases, today reported a medical source.
"We already have 10 patients who have died and so far we have 381 cases confirmed by lab," he told reporters the head of Health Surveillance, Ministry of Health of Honduras, Marco Antonio Pinel.
Until last Wednesday, the dead were eight confirmed cases 371. The two new victims killed in recent days, but until now it was confirmed that due to influenza A, said.
Pinel said the boy was a year and a half old, was from the town of Macuelizo, western department of Santa Barbara, and died at the Mario Catarino Rivas Hospital in San Pedro Sula (north). The woman was a woman from the southern region, he added, without elaborating.
The first case of influenza A in Honduras was confirmed on 21 May and the first death on June 22, according to medical records.
Pregnant women are most affected
Pregnant women are more likely to go to the hospital to get influenza A/H1N1, explained the specialist Tito Alvarado.
The disease has resulted in the country the death of eight people, four of them pregnant. A cascade of toxins are nested in the influenza A/H1N1 virus.
A biological bomb to reach the airways of victims from respiratory failure to generate severe pneumonia, which causes death.
And is that pregnant women have become a group of the most fragile population against the epidemic, infectious diseases Tito Alvarado explained.
In recent weeks, members of the Center for Disease Control and Prevention, CDC, have developed new recommendations for treatment of victims in case of pregnant women.
"In serious cases can double doses of Tamiflu, which means that we can apply 150 milligrams per dose until the patient has improved," said the specialist.
The standard treatment is two tablets daily of Tamiflu for five days.
For newborns, it is now recommended to apply the medicine in infants three months thereafter, contrary to what was known until a few weeks, as it only applied to children over one year.
"For a mother to give birth when the symptoms present, the newborn must be removed from the mother and be fed breast milk through a bottle," he added.
HIV Patients
Currently, patients with HIV should be considered as priority to receive treatment at the time of presenting symptoms of the disease.
According to the doctor, the doctors before applying the medication for influenza should be sure that the victim before the virus, because otherwise it would generate resistance.
People infected with the virus, since the first hours begin to suffer the attack of the disease and transmit without having developed symptoms.
The positive cases registered in the country add up to 371, most of which are in Tegucigalpa and San Pedro Sula.
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Re: EuroFlu - Weekly Electronic Bulletin - Influenza Surveillance
EuroFlu - EuroFlu - Weekly Electronic Bulletin Week 34 : 17/08/2009-23/08/2009 28 August 2009, Issue N? 320 (edited)
EuroFlu - Weekly Electronic Bulletin Week 34 : 17/08/2009-23/08/2009 28 August 2009, Issue N? 320<cite cite="http://www.euroflu.org/cgi-files/bulletin_v2.cgi">EuroFlu - Bulletin Review</cite>
Low or moderate influenza activity and a continued overall decrease in the number of Pandemic (H1N1) 2009 virus detections
Pandemic (H1N1) 2009 virus detections were first reported in the European Region in week 18/2009 and as of week 24/2009 bulletins present developments involving this strain. As of 19 August 2009, 47 of the 53 countries in the WHO European Region have reported to WHO confirmed cases of pandemic (H1N1) 2009 virus infection, in compliance with their obligations under the International Health Regulations. Ninety fatalities associated with pandemic (H1N1) 2009 virus infection were reported in nine countries. An overview of the global pandemic (H1N1) 2009 situation is available, as of 13 August 2009.
Summary:
In week 34/2009, a total of 697 detections of A(H1N1)v influenza were reported. The number of Pandemic (H1N1) 2009 virus detections in Europe was highest in week 30, and has decreased since week 31. All countries reported low or moderate influenza activity based on normal or slightly increased levels of ILL/ARI consultations. Twenty-one countries reported pandemic A(H1)v as the dominant virus.
Epidemiological situation - week 34/2009:
For the intensity indicator, the national network levels of influenza-like illness (ILI) and/or acute respiratory infection (ARI) were low or moderate in all countries. For the geographical spread indicator, Austria and Israel reported widespread activity, while other countries reported local or no activity. Of 14 countries reporting the impact of the pandemic, Ireland reported a moderate impact and all other countries reported a low impact, i.e. demands on health care services were not above usual levels (click here for definitions).
Cumulative epidemiological situation - weeks 16-34/2009:
Until week 25/2009, detections of pandemic H1N1 influenza had not caused increased levels of ILI or ARI in countries of the European Region. An increase in influenza activity has been observed for England, Luxembourg, Turkey (26/2009), Wales (27/2009), Northern Ireland (29/2009), Malta, Norway, Ireland (30/2009), Israel and Austria (31/2009), and the Netherlands (32/2009). Around week 31 a substantial increase in ILI rates was observed in Norway and this has continued in week 34 (click here). While the ILI rate for Norway has been elevated over the last few weeks, the proportion of ILI cases (i.e. sentinel specimens) with detectable virus remains very low. The rise in ILI is therefore likely to represent increased public concern for influenza and probably does not indicate a substantial rise in the incidence of ILI.
Virological situation - week 34/2009:
The total number of respiratory specimens collected by sentinel physicians in week 34/2009 was 466 of which 67 (14%) were positive for influenza virus: all 67 were type A (65 subtype H1v and 2 not subtyped). In addition, 722 non-sentinel source specimens (e.g. specimens collected for diagnostic purposes in hospitals or as part of enhanced surveillance for pandemic (H1N1) 2009) were reported positive for influenza virus: 718 type A (632 subtype H1v, 34 subtype H1, five subtype H3 and 47 not subtyped) and four type B. Of the total influenza A virus detections that were subtyped in week 34/2009 (N=736), 95% were the pandemic (H1N1) 2009 virus. In general, the number of Pandemic (H1N1) 2009 virus detections in Member States is decreasing or levelling off.
Cumulative virological situation - weeks 16/2009-34/2009:
Of 14752 virus detections (sentinel and non-sentinel) since week 16/2009, 14186 (96%) were type A, 9726 subtype H1v, 354 subtype H3, 330 subtype H1 and 3776 not subtyped) and 566 (4%) were type B.
Based on the antigenic and/or genetic characterisation of 3992 influenza viruses reported from week 40/2008 to week 34/2009, 2187 (55%) were A/Brisbane/10/2007 (H3N2)-like, 108 (3%) A/Brisbane/59/2007 (H1N1)-like, 27 (1%) B/Florida/4/2006-like (B/Yamagata/16/88 lineage) and 996 (25%) as B/Malaysia/2506/2004 or B/Brisbane/60/2008-like (B/Victoria/2/87 lineage) (click here). A total of 674 (17%) were pandemic H1N1, A/California/7/2009-like, the current virus strain recommended by WHO for pandemic vaccine preparation (click here).
Antiviral susceptibility reports from week 40/2008 to 34/2009 have shown all type B influenza viruses to be sensitive to oseltamivir and zanamivir, all A(H3N2) viruses to be susceptible to oseltamivir and zanamivir but resistant to M2 inhibitors, while for seasonal A(H1N1) viruses 98% were resistant to oseltamivir, 100% sensitive to zanamivir and 99% sensitive to M2 inhibitors. All pandemic (H1N1) 2009 viruses have been susceptible to zanamivir and resistant to M2 inhibitors, while only a single case of oseltamivir resistance has been reported in Denmark (click here).
Comment:
In week 34/2009 influenza activity was of low or moderate intensity across the European Region. For the geographical spread indicator, widespread activity was reported for Austria and Israel, with the other countries reporting local or no activity. A peak in Pandemic (H1N1) 2009 virus detections was observed around week 30 for Europe as a whole (click here) and total detections continued to decline in week 34/2009, possibly due in part to some countries switching to virological monitoring rather than testing of all cases. The impact on health care services is currently considered moderate in Ireland and low in other countries.
For more information about the situation in Europe, please go to the dedicated web pages of WHO (click here) and ECDC (click here). EuroFlu provides data for the global situation updates on the WHO headquarters website (click here).
Background:
The EuroFlu Bulletin presents and comments on influenza activity in the 53 countries of the WHO European Region. Of these countries, 14 reported both clinical and virological data, 18 reported virological data only and six reported clinical data only in week 34/2009. The spread of influenza viruses and their epidemiological impact in Europe are being monitored by WHO Regional Office for Europe in Copenhagen (Denmark), in collaboration with the WHO Collaborating Centre for Reference and Research on Influenza in London (UK).
Network comments (where available)
- Italy. The data collected this week been matched by substantial stability in pandemic H1N1v influenza lab-confirmed cases, if compared to the previous week. Starting from 30th week, Italian policy has been changed: a syndromic surveillance has been implemented and only a limited number of samples have been collected from particular FLU cases (i.e. severe hospedalized cases, in-country transmission cases).
- Netherlands. The decrease in the number of virus detections is caused by the change in the notification criteria for Pandemic (H1N1) cases in the Netherlands. Since the 15th of August only hospitalized cases and deaths in whom Influenza A or Pandemic (H1N1) virus has been confirmed are notifiable. The sentinel GP surveillance is now the most import data source to measure the extent of circulation of Pandemic (H1N1) virus in the Netherlands.
(...)
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Tamiflu resistance in pandemic influenza - historical compilation of news
WHO. Preparing for the second wave: lessons from current outbreaks
Preparing for the second wave: lessons from current outbreaks<cite cite="http://www.who.int/csr/disease/swineflu/notes/h1n1_second_wave_20090828/en/index.html">WHO | Preparing for the second wave: lessons from current outbreaks</cite>
Pandemic (H1N1) 2009 briefing note 9
28 AUGUST 2009 | GENEVA
Monitoring of outbreaks from different parts of the world provides sufficient information to make some tentative conclusions about how the influenza pandemic might evolve in the coming months.
WHO is advising countries in the northern hemisphere to prepare for a second wave of pandemic spread. Countries with tropical climates, where the pandemic virus arrived later than elsewhere, also need to prepare for an increasing number of cases.
Countries in temperate parts of the southern hemisphere should remain vigilant. As experience has shown, localized ?hot spots? of increasing transmission can continue to occur even when the pandemic has peaked at the national level.
H1N1 now the dominant virus strain
Evidence from multiple outbreak sites demonstrates that the H1N1 pandemic virus has rapidly established itself and is now the dominant influenza strain in most parts of the world. The pandemic will persist in the coming months as the virus continues to move through susceptible populations.
Close monitoring of viruses by a WHO network of laboratories shows that viruses from all outbreaks remain virtually identical. Studies have detected no signs that the virus has mutated to a more virulent or lethal form.
Likewise, the clinical picture of pandemic influenza is largely consistent across all countries. The overwhelming majority of patients continue to experience mild illness. Although the virus can cause very severe and fatal illness, also in young and healthy people, the number of such cases remains small.
Large populations susceptible to infection
While these trends are encouraging, large numbers of people in all countries remain susceptible to infection. Even if the current pattern of usually mild illness continues, the impact of the pandemic during the second wave could worsen as larger numbers of people become infected.
Larger numbers of severely ill patients requiring intensive care are likely to be the most urgent burden on health services, creating pressures that could overwhelm intensive care units and possibly disrupt the provision of care for other diseases.
Monitoring for drug resistance
At present, only a handful of pandemic viruses resistant to oseltamivir have been detected worldwide, despite the administration of many millions of treatment courses of antiviral drugs. All of these cases have been extensively investigated, and no instances of onward transmission of drug-resistant virus have been documented to date. Intense monitoring continues, also through the WHO network of laboratories.
Not the same as seasonal influenza
Current evidence points to some important differences between patterns of illness reported during the pandemic and those seen during seasonal epidemics of influenza.
The age groups affected by the pandemic are generally younger. This is true for those most frequently infected, and especially so for those experiencing severe or fatal illness.
To date, most severe cases and deaths have occurred in adults under the age of 50 years, with deaths in the elderly comparatively rare. This age distribution is in stark contrast with seasonal influenza, where around 90% of severe and fatal cases occur in people 65 years of age or older.
Severe respiratory failure
Perhaps most significantly, clinicians from around the world are reporting a very severe form of disease, also in young and otherwise healthy people, which is rarely seen during seasonal influenza infections. In these patients, the virus directly infects the lung, causing severe respiratory failure. Saving these lives depends on highly specialized and demanding care in intensive care units, usually with long and costly stays.
During the winter season in the southern hemisphere, several countries have viewed the need for intensive care as the greatest burden on health services. Some cities in these countries report that nearly 15 percent of hospitalized cases have required intensive care.
Preparedness measures need to anticipate this increased demand on intensive care units, which could be overwhelmed by a sudden surge in the number of severe cases.
Vulnerable groups
An increased risk during pregnancy is now consistently well-documented across countries. This risk takes on added significance for a virus, like this one, that preferentially infects younger people.
Data continue to show that certain medical conditions increase the risk of severe and fatal illness. These include respiratory disease, notably asthma, cardiovascular disease, diabetes and immunosuppression.
When anticipating the impact of the pandemic as more people become infected, health officials need to be aware that many of these predisposing conditions have become much more widespread in recent decades, thus increasing the pool of vulnerable people.
Obesity, which is frequently present in severe and fatal cases, is now a global epidemic. WHO estimates that, worldwide, more than 230 million people suffer from asthma, and more than 220 million people have diabetes.
Moreover, conditions such as asthma and diabetes are not usually considered killer diseases, especially in children and young adults. Young deaths from such conditions, precipitated by infection with the H1N1 virus, can be another dimension of the pandemic?s impact.
Higher risk of hospitalization and death
Several early studies show a higher risk of hospitalization and death among certain subgroups, including minority groups and indigenous populations. In some studies, the risk in these groups is four to five times higher than in the general population.
Although the reasons are not fully understood, possible explanations include lower standards of living and poor overall health status, including a high prevalence of conditions such as asthma, diabetes and hypertension.
Implications for the developing world
Such findings are likely to have growing relevance as the pandemic gains ground in the developing world, where many millions of people live under deprived conditions and have multiple health problems, with little access to basic health care.
As much current data about the pandemic come from wealthy and middle-income countries, the situation in developing countries will need to be very closely watched. The same virus that causes manageable disruption in affluent countries could have a devastating impact in many parts of the developing world.
Co-infection with HIV
The 2009 influenza pandemic is the first to occur since the emergence of HIV/AIDS. Early data from two countries suggest that people co-infected with H1N1 and HIV are not at increased risk of severe or fatal illness, provided these patients are receiving antiretroviral therapy. In most of these patients, illness caused by H1N1 has been mild, with full recovery.
If these preliminary findings are confirmed, this will be reassuring news for countries where infection with HIV is prevalent and treatment coverage with antiretroviral drugs is good.
On current estimates, around 33 million people are living with HIV/AIDS worldwide. Of these, WHO estimates that around 4 million were receiving antiretroviral therapy at the end of 2008.
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Tamiflu resistance in pandemic influenza - historical compilation of news
According to incomplete statistics, up to 17 hours on 27 / 8, with 44/63 provinces and cities across the country with people infected with influenza A/H1N1 total 2312 positive cases and 2 deaths.
27 / 8, Vietnam has recorded 86 more cases positive for influenza A/H1N1, which, in the South 69 ca, Region 7 North Central region ca 10 and ca.
Patients had a discharge from the 1267, 1043 cases are to be isolated, treated in hospitals, treatment facilities, community supervision, the health condition is stable.
Between September, in Hanoi, the Ministry of Health will hold a preliminary meeting on prevention of influenza A/H1N1 service in Vietnam since cases first appeared in May so far.
Expected that this conference will have participation of health professionals from various countries, territories, exchange of experience flu A/H1N1 in every aspect.
This is an opportunity for Vietnam to study prevention and service experience of other countries and territories, drawing experience prevention services in the country prepared to deal with influenza A/H1N1 in winter service to -- time is considered peak of the epidemic influenza A/H1N1 in Vietnam.
According to the Ministry of Health, up to date in Vietnam, Tamiflu is promoting good effect in the treatment of influenza A/H1N1 patients.
Experts confirm epidemiological Vietnam has not happened influenza A/H1N1 human cases of Tamiflu resistance can be assured using this medication during treatment.
Previously, the phenomenon of drug Tamiflu resistance has appeared in Japan, Denmark, China, America, Hongkong and Singapore.
Ministry of Health has ordered the drug Zanamivir plan to cope with Tamiflu-resistant cases occurred in Vietnam. /.
http://vovnews.vn/Home/44-tinh-thanh...098/120351.vovLeave a comment:
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Re: WHO. Recommended use of antivirals (August 21, 2009, edited)
I think you have stated my position clearer than I did. I think we all agree that Tamiflu resistance in novel H1N1 will not result from over prescription and use, it will result from the acquistion or changes of H274Y or Pro453Ser.
http://www.flutrackers.com/forum/sho...71&postcount=1The bottom line here is that these two genetic changes -- in NA and Pro453Ser -- are associated and seem to be related to the unexpected fitness of Tamiflu resistant seasonal H1N1.Leave a comment:
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Re: WHO. Recommended use of antivirals (August 21, 2009, edited)
Al - thanks for filling in the blanks that those following this issue for 2-3 years have taken for granted.
Just for clarification.....
I believe ARR_309, myself, & Al are all on the same page, which is:
Is the above a fair statement?Tamiflu usage is being discouraged with the explanation it will lead to resistance, when in fact, the increasing resistance is mostly (but not entirely) due to the fact it picked up the applicable gene (NA/274Y) from old seasonal H1N1.
The unfortunate outcome of this ill-advised policy is avoidable deaths.
And as Al points out - "it won't be very long until Tamiflu is no longer useful in battling the novel H1N1 virus" - probably more due to gene-acquisition, rather than tamiflu-usage.
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Tamiflu resistance in pandemic influenza - historical compilation of news
During this week, the CDPH Viral and Rickettsial Diseases Laboratory detected a specimen with the H275Y resistance mutation (associated with oseltamivir resistance); the result was confirmed by the CDC. This is the first time that this mutation has been detected by the VRDL and provides strong evidence for the importance of enhanced surveillance for antiviral resistance testing. The specimen was obtained from a hospitalized patient in Northern California. To date, 308 specimens have been tested at VRDL for the resistance mutation; all but one have tested negative for the mutation. VRDL and CDC will continue prospective antiviral resistance testing from a sampling of pandemic (H1N1) 2009 influenza viruses through the summer and the 2009-10 influenza season.Leave a comment:
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Re: WHO. Recommended use of antivirals (August 21, 2009, edited)
As I recall, the only country that extensively administered Tamiflu for seasonal flu was Japan. But buried somewhere here, most likely in a Niman post, there was evidence of worldwide resistance of seasonal flu to Tamiflu that was not linked to over prescription in Japan or anywhere else. I leave to the genetics guys to explain it, but it certainly wasn't magic. In any case, as I understand it, certain strains of last year's seasonal flu were almost 100% resistant to Tamiflu and ARR_309 suggests that it won't be very long until Tamiflu is no longer useful in battling the novel H1N1 virus.Originally posted by AlaskaDenise View PostLeave a comment:
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Re: WHO. Recommended use of antivirals (August 21, 2009, edited)
No, that is not the case. Tamiflu resistance in pandemic H1N1 viruses is now a well established FACT. The only uncertainties remain around their frequency, the rate of change in resistance frequency, and geographic distribution of resistant viruses among host populations?Originally posted by ironorehopper View Post
As Niman and others have indicated before, it seems highly likely that current sampling and sequencing strategies are highly biased and thus presently incapable of determining these freuqnecies and rates with any degress of accuracy.
BUT such data are critical if RESPONSIBLE advice is to be provided on antiviral usage. IRRESPONSIBLE advice on antiviral use (ie. in an environment of IGNORANCE) will continue to cost lives.
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Worldwide, most patients infected with the pandemic virus continue to experience typical influenza symptoms and fully recover within a week, even without any form of medical treatment. [B]Healthy patients with uncomplicated illness need not be treated with antivirals.
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At the same time, the presence of underlying medical conditions will not reliably predict all or even most cases of severe illness. Worldwide, around 40% of severe cases are now occurring in previously healthy children and adults, usually under the age of 50 years.
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Some of these patients experience a sudden and very rapid deterioration in their clinical condition, usually on day 5 or 6 following the onset of symptoms.
Studies show that early treatment, preferably within 48 hours after symptom onset, is strongly associated with better clinical outcome.
Does anyone spot a fatal flaw in the WHO advice?
If a clinician cannot reliability predict whether an otherwise healthy infected patient might develop a rapid, life-threatening condition up to 5 or 6 days after the onset of symptoms, and knowing that in order to be of much use, antivirals need to be administered within 48 hours of symptoms, how does this add up?
It doesn't. The entire purpose of administering antivirals post infection is to reduce the risk of a severe outcome. Advising clinicians against treating people with no underlying health conditions is extremely FOOLISH. Pandemic H1N1 IS the only underlying health condition for 20-50% of deaths that have occurred!!
I don't know about you but I get a strong sense that the WHO is very keen to push Tamiflu. You would be forgiven for thinking that the ONLY remaining effective antiviral, Relenza, was very poor second choice.
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Where oseltamivir is unavailable or cannot be used for any reason, zanamivir may be given.
This recommendation applies to all patient groups, including pregnant women, and all age groups, including young children and infants.
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Clinicians, patients, and those providing home-based care need to be alert to warning signals that indicate progression to a more severe form of illness, and take urgent action, which should include treatment with oseltamivir.
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In cases of severe or deteriorating illness, clinicians may consider using higher doses of oseltamivir, and for a longer duration, than is normally prescribed.
After reading this rubbish, one would be forgiven for being more confused than ever. Not only does this advice ignore the clinical evidence that itself presents but if it were followed it is clear that many needless fatalities will occur that would otherwise not occur.
Government Purchasers should note that Tamiflu now has a VERY limited life-span that cannot be extended simply by using it less frequently. This is the lesson the WHO should have learned from the rapid, silent, ubuiquitous spread of the H274Y resistance polymorphism in seasonal H1N1 populations in 2007/08...IN THE ABSENCE OF TAMIFLU USE.
Governments wishing otherwwise are living in a fools paradise and will thoroughly deserve the contempt of its population.Leave a comment:
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Re: Why are some people getting H1N1 so severely and others very mildly?
So far, no one has been able to identify a more virulent strain - just Tamiflu resistance. With seasonal flu, one can generally tell who is going to have a more stormy course because of age and underlying conditions. With H1N1, there is presently no way to predict who, among the young healthy group, is going to have serious problems. Scary.Leave a comment:
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Tamiflu resistance in pandemic influenza - historical compilation of news
August 27, 2009
Disclose the test location for winter
Deputy Head, deals in Vietnam is not touching the top. "Although some cases are still increasing each day but powerful new spread in the community in some localities," said Deputy Head.
To prepare for winter, Deputy Head directed the concerned unit should immediately place a list of capable and qualified test influenza A/H1N1, publicly available to all local and all people know.
"Demand is actively testing of people is legitimate. They can find to these addresses, if negative test will be charged as other diseases, "Mr. Head said.
Previous status reflects a lack of local funding for prevention services, leading to many difficulties such as lack of equipment, ... Deputy Manager asked: "The ministries, ministerial agencies must be accountable the specific report tr? budget deal of their own progress. This was announced long and is one of the contents of the plan prevention services, need to do because winter is fast approaching.
According to Nguyen Huy Nga, Director of Department of Preventive Health and Environment (Ministry of Health), the plan for monitoring disease have been adjusted to fit the new situation, especially in winter.
Accordingly, in the local epidemic strong community monitor large cluster cases many patients and subjects at high risk.
At the local service penetration scattered, ca monitoring of infection and where no progress, it should strengthen monitoring suspected.
Fear flu virus transgenic
The mission of the Ministry of Health has trip Beijing (China) to attend conference on influenza A/H1N1. Accordingly, highlights worrying than drawn from this conference is the ability to genetically modified influenza viruses.
Mr. Trinh Quan Huan that "The world was Japan, America, Hong Kong, Chinese mainland, and some other patients infected with influenza, to use other drugs tamiflu treatment and are cured .
According to Mr. Head, this show has made some changes in the virus group of genes, causing drug resistance. "So, the Left groups can also transform or rearrange the order and create a new virus strains are more pathogenic," Mr. Head said.
Currently, no research results or specific cases demonstrate that the drug-resistant flu virus strain has spread from person to person, from one place to another.
"If the phenomenon has occurred, the treatment tamiflu will become very complicated," said Head worry.
According to the direct prevention of pandemic influenza A/H1N1 Lao Cai, Lai Chau, now sending samples of local products from this remote to make Hanoi a major inadequacies, has caused cost poor has increased waiting time, pressure for both patients and health facilities.
In addition, the current backup of tamiflu second province expire use (March 11/2009). Therefore, the two provinces have proposed the transfer of health tamiflu where this is required to use immediately to avoid waste and also provide long-term tamiflu to backup.
Proposal was Vice Trinh Quan Huan noted. In the new conditions, in places where the need for tamiflu no or not high, the amount will be transferred to the reserve areas are the hot spots.
The past week, more than 5,000 members tamiflu was transferred from the Department of Health and Hanoi to Ho Chi Minh City Institute of Infectious Diseases and Tropical Countries.
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Tamiflu resistance in pandemic influenza - historical compilation of news
Information Center: Egypt does not appear, the cases of resistance to Tamiflu
August 26th, 2009أكد مركز المعلومات ودعم اتخاذ القرار التابع لمجلس الوزراء أن عقار التاميفلو مازال يمثل عقارا فاعلا ومؤثرا فى التخفيف من حدة فيروس أنفلونزا الخنازير والمضاعفات الناتجة عنه، إذا استخدم العقار بالطريقة الموصى بها، وتم إعطاؤه خلال 48 ساعة من بدء ظهور الأعراض على المريض، موضحا أن مصر لم يظهر بها حتى الآن أية حالات مقاومة للتاميفلو.
Center confirmed the information and decision support of the Council of Ministers that the Tamiflu drug is still active and influential in the alleviation of swine influenza virus and the complications resulting from it, if used in the manner recommended by the drug was given within 48 hours of onset of symptoms the patient, pointing out that Egypt does not appear, so far no cases of resistance to Tamiflu.
وأشار المركز - فى بيان أصدره اليوم الأربعاء - إلى أنه لم يظهر حتى الآن سوى 17 حالة فقط مقاومة للتاميفلو على مستوى دول العالم، ومن ثم فهذه الحالات لا تعدو كونها سوى مجرد حالات فردية ومحدودة، ولم يثبت حتى الآن علميا فقدان عقار التاميفلو لفاعليته.
The Center - in a statement issued on Wednesday - that does not appear, so far only 17 cases of Tamiflu resistance only at the level of the world, then this case is nothing but merely individual cases and limited, not so far proved scientifically loss of Tamiflu to be effective.
وأوضح أن إجمالى عدد الحالات التى تم اكتشاف إصابتها بأنفلونزا أيه (إتش 1 إن 1) فى مصر بلغت 649 حالة حتى مساء أمس الثلاثاء، بحسب نتائج الفحص المعملى وبيانات وزارة الصحة.
The total number of cases of avian bird flu in A (H 1, that 1) in Egypt amounted to 649 cases as Tuesday evening, according to laboratory test results and data from the Ministry of Health.وأضاف أن جميع الحالات الثمانى عشر المكتشفة أمس، مصرية الجنسية (14 حالة مقيمة فى مصر، وحالة واحدة قادمة السعودية، وحالة واحدة قادمة من قطر، وحالة واحدة قادمة من لبنان، وحالة واحدة قادمة من لندن ... 11 حالة لذكور، و7 حالات لإناث)، وتتمتع جميع الحالات بوضع وحالة صحية مستقرة.
He added that all the eight cases detected ten yesterday, Egyptian nationality (14 cases resident in Egypt, and one arriving in Saudi Arabia, and one coming from Qatar, and one from Lebanon, and one from London ... 11 cases of males and 7 cases of female ), and enjoy all the cases developed and stable condition.
ووفق البيان، فقد تم فحص 130 عينة اشتباه بأنفلونزا الخنازير جاءت النتائج المعملية جميعها سلبية، كما فحص 13 حالة اشتباه لمرض أنفلونزا الطيور (إتش 5 إن 1)، وجاءت نتائجهم المعملية جميعها سلبية أيضا.
According to the statement, has been examined 130 samples of swine flu suspected laboratory results were all negative, also examined 13 cases of suspected bird flu (HP 5, 1), and laboratory findings were all negative as well.Leave a comment:
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