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

First Tamiflu-resistant H1N1 case in Utah detected

<!--subtitle-->Rare strain ? Only 29 cases -- excluding Utah man -- have been reported nationally.
<!--byline-->
By Lisa Rosetta
The Salt Lake Tribune

<!--date-->Updated: 12/18/2009 06:20:02 AM MST

Public health officials announced Thursday they have detected the first case of Tamiflu-resistant H1N1 flu in Utah this season.

A Salt Lake County man over the age of 65, with chronic health conditions, was hospitalized earlier this fall with H1N1 and has since been released, said Utah Department of Health spokesman Tom Hudachko.

It wasn't until Thursday morning that the Centers for Disease Control and Prevention (CDC) notified the state that the man's strain is resistant to Tamiflu, a commonly prescribed antiviral drug.

So far the Tamiflu-resistant strain doesn't seem to be circulating in the community, said state epidemiologist Robert Rolfs. Even if it were, those who have been vaccinated for H1N1 flu have protection against it. This particular mutation hasn't changed the virus enough to allow it to resist vaccine-induced antibodies.

Rolfs said getting a high rate of the general population vaccinated is important because it reduces the transmission of the virus and its opportunities to mutate. The health department, however, estimates only 13 percent to 15 percent of Utahns have been innoculated.

"We'd like that number to be closer to 30 or 40 percent to get the type of immunity in the population we'd really need to slow down or prevent a third wave from occurring," Hudachko said.

Tom Skinner, a spokesman for the CDC, said since April there have been only 29 documented cases -- excluding the Utah man -- ofTamiflu-resistant H1N1 in the U.S. Of those, 19 people took Tamiflu to prevent or treat the flu; two did not; and the rest were still being investigated.

The occasional development of resistance to Tamiflu during treatment is not unexpected, he said.

While detecting Tamiflu-resistant strains is important, the CDC would only be concerned if it saw "sustained transmission from person to person going on in multiple places around the country -- that's the kind of clustering we're looking for and we just haven't seen that," Skinner said.

People infected with a Tamiflu-resistant strain can be treated with another antiviral drug, Relenza, though some are too sick to inhale it, he said. Another option is Peramivir, though it has been approved by the Food and Drug Administration only for emergency use. Since the outbreak began, the CDC has received about 1,000 requests to use the drug, which is given intravenously. Its effectiveness is still being studied.

Flu-like activity in Utah has decreased for the seventh consecutive week, but it is still above the statewide epidemic threshold of 1.1 percent of clinic visits, according to the health department's latest report.

There have been a total of 25 H1N1-related deaths this season, including a woman between the ages of 50 and 64 who died last week, the Southwest Utah Health District reported. Hospitalizations due to both H1N1 and the seasonal flu have hit 857, which is 16 more than last week.

The state has now received approximately half of all the H1N1 vaccine it is scheduled to get; as of Dec. 9, an estimated 371,532 doses had been given out. All but two local health departments -- Bear River and Southeast -- are offering the vaccine to the general public.

http://www.flutrackers.com/forum/sho...123#post330123

Note that this is a different case than the 28 year old woman with a "mutated" strain from earlier this summer in Utah.

http://www.deseretnews.com/article/705350460/Utah-woman-had-mutated-version-of-swine-flu-virus.html

See this thread: http://www.flutrackers.com/forum/sho...d.php?p=326852

[german-docter]

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

Germany: First two cases of Tamiflu resistant strains of pandemic H1N1 influenza found at the University hospital M?nster (UKM)

The first two cases of Oseltamivir (Tamiflu?) resistant strains of the pandemic influenza virus H1N1 in Germany have been detected at the University hospital of M?nster (North Rhine-Westphalia). It?s a 10 year old girl and a 31 year old man, the latter being on ventilator at the ICU. Both patients do have underlying medical conditions and are immunocompromised. They are treated with Zanamivir (Relenza?) now, Prof. Georg Peters chief of the department of microbiology said on Friday. The finding of Tamiflu-resistant strains was confirmed by the Robert Koch-Institute.


sources:

http://www.halternerzeitung.de/nachr...;art321,765993

http://www.rki.de/cln_151/nn_200120/...Situation.html

http://www.klinikum.uni-muenster.de/...ikel&tx_ttnews[tt_news]=298&tx_ttnews[backPid]=30&cHash=27d815d8fc


related thread:

http://www.flutrackers.com/forum/showthread.php?t=137067

[mixin]

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

Dec. 18 Update WHO:

Worldwide, more than 15,000 clinical specimens (samples and isolates) of the pandemic H1N1 virus have been tested and found to be sensitive to oseltamivir.

136 cases of oseltamivir resistant pandemic H1N1 have been reported by GISN so far.

http://www.who.int/csr/disease/swineflu/laboratory18_12_2009/en/index.html

[Treyfish]

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

(Star Island) December 22, 2009 Tuesday 05:30
(Roundup)

(Sing Tao Daily reported) at any time reached the second wave of human swine influenza in Hong Kong, Hong Kong University-virus expert Yuen Kwok-yung authoritative new study released yesterday found that Tamiflu is only for minor cases and fever within 48 hours of effective, a number of serious cases of swine influenza virus is not attacks the lungs, but also cause severe inflammation of the heart, acute myocarditis, pleural effusion, vascular infarction and other malignant diseases; the other bone marrow of patients also found that individual macrophages, even double Tamiflu prescriptions is also invalid. The results will be published early next year, "Clinical Infectious Diseases journal."

Reporter: Yang, Yuzhu

University of Hong Kong and Queen Mary Hospital and 12 hospital doctors co-operation analysis includes 11 public hospital and a private hospital in cases of severe and mild cases than the 37 cases.

Severe cases, 23 people have severe respiratory failure secondary to intubation or ventilator, most of the time more than 14 to the hospital on the 30th, in which 13 people were killed and two were described as non-risk factors in healthy individuals.

Yuen Kwok-yung, the study found cause of death in patients with critical or important reason is that inflammatory response. Now, with the effectiveness of antiviral drugs for treatment of swine influenza is not ideal, Tamiflu is only for minor cases, and only valid for 48 hours in patients with fever, but many serious cases have onset of the disease five to seven days after admission, Tamiflu has no effect.

University of Hong Kong Yuen Kwok-yung, Head of the Department of Microbiology, according to Australia, Canada, outbreaks and laboratory, we estimate that there will be a second wave of 2-300 people have died of swine influenza, of which about two free of risk factors, and therefore urged the public vaccinated, Yuan said: "Prevention is better than cure, they do not die, we are the best idea is to use vaccine to prevent it happen!"

The study also found that the seventh day after the onset of mild cases, the virus volume has dropped drastically, Yuen Kwok-yung said: "The serious cases, go to the 11th days there are many viruses, it is not been found before, whether to the double Tamiflu or Relenza, the virus is still very slow rate of decline, inflammation response factor is still rising. "

Yesterday by a dead one in critical condition

Analysis of three serious cases, including the United Christian Hospital a death is a serious lung water bubbles, combined with a lot of alveolar walls caused by inflammation of the white blood cells, died under the patient could not breathe. Another death from the Princess Margaret Hospital, part of the cardiac anatomy was found dead there are many white blood cells, indicating myocardial cells have died, finally died due to acute myocarditis.

Yuen Kwok-yung, said: "Recently, a number of cases is a very young age, died of acute myocarditis when the heart suddenly bounce, no way to pump the patient a good easy to die."

Another individual was found in patients with bone marrow macrophages, eat a lot of red blood cells, white blood cells, Yuen Kwok-yung said: "The blood of the induced inflammatory response factor was so high that it is discouraging eating of unhygienic things, the situation in the H5N1 (bird flu) infection can see. In severe swine influenza patients, because of the virus to stimulate the inflammatory response caused by very serious happened 『proliferation of mononuclear phagocytes and macrophage hyperlipidemia』 phenomenon, leading to acute myocarditis. "

In addition, our last new one death and one swine influenza critical cases, the deceased was a risk of heart disease, hypertension and high cholesterol 57-year-old male patient, critical case that is a good track record of the thirty-year-old healthy woman. http://hk.news.yahoo.com/article/091221/3/fri2.html

[sharon sanders]

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

hat tip lili -


Admin.ch: Avian H1N1: two cases of Tamiflu resistance identified in Switzerland

Les premiers agents pathog?nes de la grippe pand?mique H1N1 r?sistants ? l'oseltamivir (Tamiflu?) sont apparus en Suisse.

The first pathogen of pandemic influenza H1N1 resistant to oseltamivir (Tamiflu ?) have emerged in Switzerland.

Le m?dicament antiviral s'est, en effet, av?r? d'une efficacit? moindre chez deux patients hospitalis?s et dont le syst?me immunitaire ?tait fortement affaibli.

The antiviral drug has indeed proved a less effective in two hospitalized patients whose immune system was severely weakened.

D'autres cas isol?s de r?sistance au Tamiflu ont d?j? ?t? observ?s ? l'?tranger.

Other isolated cases of resistance to Tamiflu have already been seen abroad.

Les experts ne sont gu?re surpris de ces d?couvertes.

Experts are not surprised by these findings.

Pour lire cette news dans son int?gralit?, veuillez cliquer ici .

To read this news in its entirety, please click here.

[estacion]

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

The infections by influenza A fall to its lowest level in the Basque Country
Health studies extend the vaccine to more groups at risk from those initially recommended. 710 people have been hospitalized with the virus so far

23.12.09 - 03:02 -- LIDE AGUIRRE | SAN SEBASTI?N.

DATA
Hospitalized: 713 since April. Currently remain 13 in facility. In addition, 72 were admitted to the ICU, of which two remain in this unit. The average stay is 5.8 days admission to hospital and 7.2 in the ICU.
Profile of the hospitalized: 56% were men and 44% female, mean age 38 years and previous pathologies.
Deaths: Seven, two in Gipuzkoa.
Medical personnel vaccinated: Only 3,000 professionals have been vaccinated for 43,425.


The number of infections by influenza A has fallen below the epidemic threshold. Euskadi (Basqe Country) recorded since the virus first infected with N1H1 on 25 April, the flu has been spread from person to person, reaching peaks of transmission of infection to 534 per hundred thousand in the last week of October. However, since early November, the disease has been weakening rapidly until last week only managed to infect 37 people in a hundred thousand, the lowest figure since the virus began to expand.

Still, since the institutions are advised not to lower our guard, and actions against influenza A are active-hygiene and medical surveillance network, among others, taking into account that according to the World Health Organization (WHO), a second round of infection could wait around January. In addition, there are no precedents for this type of influenza that enable file and calculate pull its behavior in the coming weeks.

So, with medical advice also remains operational the vaccination campaign. Hospitals and clinics still have 373,570 Basques ready for inoculation dose, since five weeks since the start of the immunization campaign called risk groups (from personal health and social services to the chronically ill), only 94,614 people have been vaccinated for the planned 468,184, ie one fifth.
Among the most have turned to his appointment with the doctor are diabetics, of whom 29,827 were vaccinated, followed by heart disease. In contrast, highlights the poor response of pregnant women. Of the 26,055 who were recommended to be vaccinated, only 1791 have done so, according to data presented yesterday by the Minister of Health Basque, Rafael Bengoa, in the Basque Parliament.

More vaccinated

Despite the low response of the population, Bengoa said yesterday that the vaccine does not rule extend to other groups than those originally envisaged by the remaining doses, but did not specify what people would come in or whether we should vary the type of vaccine, if the virus mutate and become resistant to oseltamivir, Tamiflu, as happened last month. Then a girl younger than two years and risk factors entered the nursing unit of the Hospital Donostia with influenza A resistant to oseltamivir, but after remaining in the Intensive Care Unit "was recovered and was transferred to guard."

In total, since April 25 have been hospitalized 718 individuals, which in eight months shows a balance of 90 inmates per week. Currently, 13 remain in hospital, although, if met with statistics drawn so far should not stay more than six days in the hospital. In addition, 72 people had to be admitted to the ICU after his condition complicated, in most cases by previous pathologies, although currently only two are cared for in that section of hospitals. In addition, seven people died.

Influenza A has no gender distinction and has affected nearly as many women as men, younger than 50 years. Still, the increased incidence has occurred among children 5 to 14 years, followed by children aged five years.

Source: Diario Vasco

http://translate.google.es/translate?js=y&prev=_t&hl=es&ie=UTF-8&layout=1&eotf=1&u=http%3A%2F%2Fwww.diariovasco.com%2F20091223%2Fal-dia-sociedad%2Fcontagios-gripe-caen-nivel-20091223.html&sl=es&tl=en

[Pathfinder]

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

December 23, 2009

FLU BULLETIN #18

Manitoba Health is reporting a case of oseltamivir (antiviral) resistance in a child under the age of 18 who was being treated for lab-confirmed H1N1. The child has an underlying medical condition and was not hospitalized.

A public health investigation continues, but it appears this is an isolated case with no evidence to date that a resistant strain of H1N1 flu has been transmitted to others.

At this time, Manitoba Health is not recommending any changes to its clinical care guidelines on the appropriate use of antivirals for H1N1 flu. Information about antiviral use and this case is being sent to health-care providers. In addition, Manitoba Health continues to recommend that Manitobans take the same basic precautions to prevent infection, including getting the H1N1 flu shot, and follow previous advice on when to seek care for their symptoms.

This case was found as part of routine testing of influenza specimens for antiviral resistance at the Public Health Agency of Canada?s National Microbiology Lab in Winnipeg.

Oseltamivir (Tamiflu) is an antiviral drug commonly used to treat people infected with influenza. This is the first case of antiviral resistance related to H1N1 flu reported in Manitoba and the eighth in Canada. Other cases are being reported around the world and have also been noted in some clinical drug trials. These antiviral resistant cases appear to be isolated as there have been no reports showing evidence of transmission to others. This is being monitored by the World Health Organization.

Antiviral resistance has previously been found with some strains of seasonal flu. It occurs when there is a shift or mutation of the flu virus into a resistant strain. It can be difficult to pinpoint the cause in a single case, but generally antiviral resistance can result when:
? people don?t finish the antivirals prescribed to them to treat an illness or don?t follow the directions for their use;
? antivirals are prescribed to prevent rather than treat illness;
? prolonged treatment with antivirals is prescribed, particularly for people with weakened immune systems; or
? the virus imperfectly replicates itself, creating genetic changes that make antivirals less effective.

http://news.gov.mb.ca/news/index.html?archive=2009-12-01&item=7395

[estacion]

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

Detectados m?s de 40 casos de mutaciones del virus en Espa?a

MADRID, 23 Dic. (EUROPA PRESS) -


El Centro Nacional de Vigilancia Epidemiol?gica del Instituto de Salud Carlos III informa de que ya se han registrado en Espa?a m?s de 40 casos de mutaciones del virus H1N1 causante de la gripe A, entre las cuales estar?an dos por resistencia al antiviral 'Tamiflu', cinco similares a la mutaci?n registrada por primera vez en Noruega y una variante de la misma, que ya se ha detectado en m?s de 30 pacientes.

El pasado 4 de diciembre, el director general de Salud P?blica y Sanidad Exterior, Ildefonso Hern?ndez, inform? de los tres primeros casos de mutaciones del virus de la gripe A en Espa?a, uno en un paciente de 66 a?os de Catalu?a que present? resistencias a oseltamivir --el antiviral que Roche comercializa como 'Tamiflu'-- y los otros dos en pacientes, tambi?n en Catalu?a, con una misma mutaci?n del virus registrada poco antes en Noruega, la 'D222G', que provoc? el fallecimiento de uno de ellos.

Sin embargo, el ?ltimo informe del Sistema de Vigilancia de la Gripe en Espa?a, relativo a la semana del 13 al 19 de diciembre, informa de nuevos casos de mutaciones ya que, en cuanto a las asociadas con resistencia a oseltamivir, informa de una registrada en una ni?a de 14 meses del Pa?s Vasco que presentaba factores de riesgo.

Ambos casos, seg?n dicho informe, fueron ingresados en la UCI y tratados con oseltamivir durante cinco d?as y posteriormente, y tras la recuperaci?n, recibieron el alta.

En cuanto a las mutaciones 'D222G', el Centro Nacional de Vigilancia Epidemiol?gica informa de una en Andaluc?a en un hombre de 31 a?os sin antecedentes m?dicos que despu?s de varias complicaciones fallece con fallo multiorg?nico; una en Castilla La Mancha en una mujer de 28 a?os y otra en Galicia en un hombre de 27 a?os, de las que se desconoce si presentaban factores de riesgo y su posterior evoluci?n . A estas tres habr?a que a?adir las dos ya conocidas en Catalu?a.

Seg?n explica el informe, "aunque la significaci?n de esta mutaci?n no est? del todo definida, la posici?n 222 est? situada en la zona de uni?n al receptor celular y por tanto, el cambio de D a G podr?a influir en la especificidad haciendo que el virus tuviera m?s facilidad para infectar zonas m?s inferiores del tracto respiratorio".

Por otro lado, este centro dependiente del Carlos III informa de la mutaci?n D222E, de la que el Centro Nacional de Microbiolog?a (CNM) ha encontrado su presencia en 34 pacientes procedentes de Castilla-La Mancha, Ceuta, Galicia, Madrid, Melilla y Navarra. Adem?s, Andaluc?a y Asturias lo han identificado en 6 y 1 casos respectivamente.

Dicha mutaci?n del ARN afecta a la cubierta del virus en un lugar pr?ximo al punto de uni?n del receptor a la c?lula del epitelio bronquial y, aunque "la significaci?n de este cambio en el sitio de uni?n al receptor es muy dudosa", explican los autores del informe, "los datos de los pacientes que la presentan pueden ser de gran ayuda para tratar de interpretar si tiene alguna funcionalidad".

Seg?n explic? el profesor Jos? L?pez Aldeguer, miembro de la Sociedad Espa?ola de Enfermedades Infecciosas (SEIMC), este comportamiento "no es inusual" ya que "las mutaciones del virus de la gripe son esperables, como tambi?n sucede anualmente con el de la estacional".

En cualquier caso, este experto declar? a Europa Press que "no parece especialmente grave" ya que seg?n las previsiones la temporada gripal va a seguir con la misma intensidad que hasta el momento est? demostrando en Espa?a.

CANARIAS, ASTURIAS Y CATALU?A, LAS CCAA M?S CASTIGADAS

En lo que respecta a la incidencia gripal en la ?ltima semana, el Centro Nacional de Vigilancia Epidemiol?gica informa de que la mayor tasa de contagios en la semana del 13 al 19 de diciembre se ha registrado en Canarias, con 145,08 casos por 100.000 habitantes; a la que siguen Asturias (122,18), Catalu?a (107,3), Castilla y Le?n (95,87), Arag?n (86,09), Andaluc?a (85,12), Extremadura (83,87), Castilla-La Mancha (82,75) y Melilla (82,28).

Ya por debajo de la media, que en esta semana est? en 78,55 casos por 100.000 habitantes, se sit?an la Comunidad Valenciana (70,19), Navarra (68,48), Pa?s Vasco (66,02), Cantabria (52,7), Ceuta (50,44), La Rioja (49,33), Baleares (48,69) y Comunidad de Madrid (48,24). De Galicia y Murcia no se especifican datos en el citado informe.

Con respecto a la semana anterior, la actividad gripal se estabiliza en Espa?a ya que la mayor?a de las comunidades (hasta 10) se?alan una estabilizaci?n de la incidencia de gripe mientras que en las seis restantes (Andaluc?a, Baleares, Castilla La Mancha, Comunidad Valenciana, Extremadura y Melilla) se observa una disminuci?n de la misma.

En Baleares, Cantabria, Navarra y La Rioja se registran por segunda semana consecutiva valores de incidencia gripal propios del periodo pre-epid?mico y en otras seis redes del sistema la incidencia gripal se sit?a muy cercana al umbral basal. Por otro lado, el nivel de intensidad gripal es medio en la mayor?a del territorio sujeto a vigilancia y bajo en la Comunidad Valenciana, Ceuta y cuatro redes en el norte del pa?s. La difusi?n geogr?fica de la enfermedad tan s?lo es epid?mica en Murcia, local en diez redes y espor?dica o nula en el resto.

Fuente: europa press

http://www.europapress.es/salud/noticia-detectados-mas-40-casos-mutaciones-virus-espana-20091223212121.html

Identified over 40 cases of mutations of the virus in Spain

MADRID, 23 Dec. (EUROPA PRESS) --


The National Epidemiological Surveillance Center of the Health Institute Carlos III reports that have already been registered in Spain more than 40 cases of mutations of the H1N1 virus causing the influenza A, including two for resistance would antiviral Tamiflu, five Similar to the first mutation found in Norway and a variant thereof, that has already been detected in 30 patients.

On 4 December, the director general of Health and Foreign Health, Ildefonso Hernandez, the first three reported cases of mutation in influenza A virus in Spain, one in a patient 66 years of Catalonia presented resistance to oseltamivir - the antiviral drug that Roche sells as' Tamiflu' - and the other two patients, also in Catalonia, with the same mutation of the virus recorded earlier in Norway, 'D222G', which caused the death of one of them.

However, the recent report of the System Influenza Surveillance in Spain on the week of 13 to 19 December, reports of new cases of mutations because, as those associated with oseltamivir resistance to reports of a registered in a girl of 14 months of the Basque Country that presented risk factors.

Both cases, he reported, were admitted to the ICU and treated with oseltamivir for five days and then, after recovery, were discharged.

As for the mutations 'D222G', the National Epidemiological Surveillance Center reports a man in Andalusia in 31 years with no history of medical complications after several died with multiorgan failure, one in Castilla La Mancha in a woman 28 years and one in Galicia in a man aged 27, from which it is unknown if had risk factors and their subsequent evolution . To these three should be added the two already known in Catalonia.

According to the report explains, "although the significance of this mutation is not fully defined, the position 222 is located in the area of cellular receptor binding and therefore the change from D to G may influence the specific virus causing the ease had more areas to infect lower respiratory tract.

Furthermore, this center under the Carlos III reports the D222E mutation, which the National Microbiology Center (NMC) has found its presence in 34 patients from Castilla-La Mancha, Ceuta, Galicia, Madrid, Melilla and Navarra . In addition, Andalusia and Asturias have identified in 6 and 1 cases respectively.

The mutation of RNA affects the viral envelope in a place near the junction of the receiver to the bronchial epithelial cell, although "the significance of this change in the receptor-binding site is highly questionable," the authors explain the report, "data from patients who have can be very helpful in trying to interpret if you have any functionality."

As explained by Professor Jose Lopez Aldeguer, member of the Spanish Society for Infectious Diseases (SEIMC), this behavior is "not unusual" and that "mutations of flu viruses are to be expected, as does each year with the seasonal" .

In any case, this expert told Europa Press that "does not seem particularly serious" as predicted by the flu season will continue unabated so far is showing in Spain.

Canary Islands, Asturias and Catalonia, the Regions More punishment

As regards the impact on the flu last week, the National Epidemiological Surveillance Center reports that the highest rate of infection in the week of 13 to 19 December, has been registered in the Canaries, with 145.08 cases per 100,000 population ; to the following Asturias (122.18), Catalonia (107.3), Castilla y Leon (95.87), Aragon (86.09), Andalusia (85.12), Extremadura (83.87), Castilla La Mancha (82.75) and Melilla (82.28).

Already below the average, which this week is 78.55 per 100,000 inhabitants, is situated the Comunidad Valenciana (70.19), Navarra (68.48), Basque Country (66.02), Cantabria (52 , 7), Ceuta (50.44), La Rioja (49.33), Baleares (48.69) and Madrid (48.24). In Galicia and Murcia are not specified in that report data.

With respect to the previous week, influenza activity stabilizes in Spain as most of the communities (to 10) indicate a stabilization of the incidence of influenza while in the remaining six (Andalucia, Baleares, Castilla La Mancha, Comunidad Valenciana , and Melilla Extremadura) shows a decrease of the same.

In the Balearic Islands, Cantabria, Navarra and La Rioja are recorded for the second straight week own flu incidence values from the pre-epidemic and six other system networks influenza incidence is situated very close to the baseline threshold. Furthermore, the level of influenza intensity is half in most of the territory under surveillance and under in Valencia, Ceuta and four networks in the north. The geographical spread of the disease is epidemic only in Murcia, in ten local networks and sporadic or none in others.

Source: europa press

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[Hogweed]

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

Five new Tamiflu resistant cases reported in the UK since last week. Two of them in Scotland. That's 22% of Scottish samples tested since last week with H274Y (H275Y).

http://www.documents.hps.scot.nhs.uk/respiratory/swine-influenza/situation-reports/weekly-influenza-sitrep-2009-12-24.pdf

A total of 789 (780 last week) Scottish samples have been analysed for genotype and of these 15 were fully phenotyped. A total of seven (5 last week) viruses (included in the UK total of 30 (25 last week)) have been found to carry the H275Y mutation. These have been phenotypically confrmed to be resistant to oseltamivir whilst retaining sensitivity to zanamivir.

[Commonground]

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

from the pdf Post #309:

Virological surveillance: genetic changes and antiviral resistance (UK)
Antiviral susceptibility (as at 23/12/2009): Testing for antiviral susceptibility is carried out at the
Respiratory Virus Unit, Centre for Infections, Colindale. Since the beginning of the pandemic
a total of 4464 pandemic influenza viruses have been analysed for the marker commonly
associated with resistance to oseltamivir in seasonal influenza (H275Y); a total of 30 samples
have been found to carry this mutation in the UK. Of these 4464 viruses, 293 have been fully
tested for susceptibility; 3 of the 30 viruses carrying the H275Y mutation have been confirmed to
be phenotypically resistant to oseltamivir whilst retaining sensitivity to zanamivir. Information on
medical history was available for 17 cases, all of whom had an underlying medical condition: 14
were immunosuppressed and three had chronic respiratory or neurological illnesses. Probable
person to person transmission has occurred in an outbreak in a hospital ward.
A total of 789 Scottish samples have been analysed for genotype and of these 15 were fully
phenotyped. A total of seven viruses (included in the UK total of 30) have been found to carry
the H275Y mutation. These have been phenotypically confirmed to be resistant to oseltamivir
whilst retaining sensitivity to zanamivir.

[Commonground]

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

Vietnam
December 29, 2009

Patient mortality after 13 days treatment Tamiflu

(AFP) - A male patients (aged 64) in the Mexican Department, Van Giang, **** Yen [Mễ Sở, Văn Giang, Hưng Y?n] died after 13 days continuous treatment Tamiflu and antibiotics. This is the first 53 deaths across the country related to influenza A/H1N1.

Am December 29, Nguyen Huy Nga, Director of Department of Preventive Health and Environment (Ministry of Health) said, patients onset disease with symptoms of fever on June 12, 2009 [12/6] hot, thorny malaria, cough white sputum. Patient self-treatment at 3 days but does not help, then visit and enter the hospital with 108 TU army [TƯ Qu?n đội 108] diagnosed severe pneumonia.
Here, patients are antibiotic treatment and PCR test results positive for influenza A/H1N1 virus. Patients treated antiviral drug (Tamiflu) 6 on the condition should not support as of December 18, 2009, the patient be forwarded to the tropical disease hospital TU [Bệnh viện Bệnh nhiệt đới TƯ]
Here, patients continued treatment Tamiflu and antibiotics immediately after admission. However, severe disease continued progress, the situation did not improve and pneumonia patients die today December 25, 2009, after 13 consecutive days were treated with Tamiflu. Patients also have a history of high blood pressure 8 years now.

http://www.flutrackers.com/forum/showthread.php?p=332136#post332136

[Shiloh]

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

Source: http://www.cbc.ca/canada/new-brunswi...flu-death.html


N.B. records 8th H1N1 death
Young Quispamsis man fought flu for a month
Last Updated: Tuesday, December 29, 2009 | 8:52 PM AT
CBC News

New Brunswick public health officials are reporting the province's first death related to a drug-resistant H1N1 strain.

A 27-year-old Quispamsis man died in hospital on Monday after nearly a month in intensive care, public health officials said. Doctors tried treating him with the anti-viral drug Tamiflu but those efforts failed.

The man was the eighth person in New Brunswick to die with the H1N1 virus.

?He was suffering from a number of underlying conditions that predisposed him to having a very severe case of the disease,? said Dr. Paul Van Buynder, the province's deputy chief medical health officer.

According to Van Buynder, the H1N1 strain the man contracted was resistant to drugs such as Tamiflu that are used to fight the virus.

Vaccine available

Van Buynder said it's unlikely the victim had received an H1N1 shot. Had he been vaccinated, the man would have been safe from the virus ? even the drug-resistant strain, Van Buynder said.

Health officials said they have not found a second case linked to the most recent H1N1 flu victim.

About two-thirds of New Brunswick residents have received the H1N1 shot.

Van Buynder encouraged those who haven't been vaccinated to get a shot as possible.

Although mass vaccinations have ended, shots are still available in VON (Victorian Order of Nurses) clinics, public health clinics and from certain family doctors.

[Giuseppe]

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

From January, 1st 2009 EuroFlu Weekly Bulletin:

(...)
Virological update: week 52/2009

Sentinel physicians collected 942 respiratory specimens this week, of which 312 (33%) were positive for influenza virus.

Of these virus detections, 312 (100%) were type A (300 pandemic A(H1), 12 not subtyped).

Of the 13 countries testing 20 or more sentinel specimens this week, influenza-positive rates ranged from 0% (Hungary) to 72% (Greece), with a median of 36% and a mean of 34%.

Based on the antigenic characterization of 799 influenza viruses reported from week 40/2009 to week 52/2009, 792 were pandemic A(H1N1), A/California/7/2009-like, 3 were A/Perth/16/2009 (H3N2)-like, 2 were A(H3) A/Brisbane/10/2007 (H3N2)-like, 1 was A/Brisbane/59/2007 (H1N1)-like, and 1 was B/Brisbane/60/2008-like.

Genetic characterizations were available for 252 isolates; all belonged to the A/California/7/2009 A(H1N1) pandemic influenza lineage.

Ten countries have tested isolates of pandemic (H1N1) 2009 virus for oseltamivir resistance.

Of the 1312 cases tested, 26 were resistant to oseltamivir. All viruses tested for resistance to zanamivir (346/346) have been found to be zanamivir-sensitive and all viruses tested for resistance to adamantanes (64/64) have been found to be resistant.

This week the Netherlands reported that one additional patient was retrospectively diagnosed with a monopopulation of H275Y oseltamivir resistant virus. This patient did not receive oseltamivir therapy and the epidemiological investigation is ongoing.

(...)

Source: EuroFlu http://www.euroflu.org/cgi-files/bulletin_v2.cgi
On FT: http://www.flutrackers.com/forum/sho...99&postcount=1

[sharon sanders]

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

2010-01-01

HA syn413K and NA syn407V Cross Segment Linkage Increases Range and Penetration

Cross-Linked Silent HA and NA Polymorphisms Correlated with Fatal 225G Cases in the Ukraine and Russia

• HA:syn413K encoded from A1281G, AAa->AAg
• NA:syn407V encoded from T1221C, GTt->GTc

PF11 Sequences Demonstrating Cross Segment Linkage

• Ukraine Kyiv377 with mixture of 225D, 225G, 225N, 225S, 225T and 225A
• Ukraine Lviv673
• Ukraine Lviv682
• Ukraine Cherkasy332 *
• Ukraine Cherkasy333 *
• Ukraine Cherkasy346 *
• Ukraine Dnipropetrovsk260 *
• Ukraine Dnipropetrovsk267 *
• Ukraine Dnipropetrovsk268 *
• Ukraine Dnipropetrovsk272 *
• Ukraine Dnipropetrovsk273 with mixture of wt 225D and 225G *
• Ukraine Dnipropetrovsk274 *
• Ukraine Dnipropetrovsk1124 *
• Ukraine Dnipropetrovsk1171 *
• Ukraine LvivN2
• Ukraine LvivN6
• Ukraine TernopilN10
• Ukraine TernopilN11
• MoldovaG120 *
• MoldovaG140 *
• MoldovaG181 *
• MoldovaG182 *
• MoldovaG191 *
• HA and NA Norway2924 with mixture of wt 225D and 225G
• HA and NA Norway3364-2
• HA and NA CatNS7362 TamiFlu Resistant
• HA and NA CatS1096
• HA and NA CatS1162
• HA and NA CatS1179
• HA and NA CatS1181
• HA and NA CatS1267
• HA and NA CatS1268
• HA and NA CatS1402
• HA and NA CatS1501
• HA and NA CatS1687
• HA and NA CatS1748
• HA and NA CatS1751
• HA and NA CatS1761
• HA and NA CatS1827
• HA and NA CatS1935 *
• HA and NA Guangdong02
• HA and NA Guangdong05
• HA and NA SingaporeON1156
• HA and NA Stockholm31
• HA and NA Russia14
• HA and NA Russia19
• HA and NA Russia74
• HA and NA Russia165
• HA and NA Russia178
• HA and NA Russia190
• HA and NA Russia191
• HA and NA Omsk02
• HA and NA Tver2969 with 225G, Fatal outcome *
• HA and NA Salekhard01 with 225G, presumptive Fatal outcome
• HA and NA Orenburg2974 with 225N, potential Fatal outcome
• HA and NA NY3702
• HA and NA NY3715
• HA and NA NY3828
• HA and NA RhodeIsland08
• HA and NA Texas42102708
• HA and NA Texas45072128
• HA and NA Texas45122886
• US Private Sequence TamiFlu Resistant

63 sequences have encircled the globe as of 2010-01-13 * with high fidelity carrying a cross-segment paired set of background markers matching and potentially contributing to the Ukraine fatal cases. Kyiv377 from early November in the Ukraine demonstrates a level of hyper-morphic behaviour at amino acid 225 that is previously undocumented in ΣPF11, but is the natural progression of the genetic acquisition trend line on this pandemic reservoir. Two sequences now additionally demonstrate the TamiFlu Resistant 275Y on NA, one from Spain in late November 2009 and one from the US with details stored in a private database.

Moldova, a neighbor of the Ukraine, demonstrates extensive NA syn407V, but is missing the HA area for the syn413K on most sequences. 5 of 7 from Moldova with complete HA sequences display the cross segment linkage.

Expect to see many sequences from the Ukraine on this particular background when HA and NA are deposited for review as most of the recent published Hemagglutinins do carry the syn413K and the published Neuraminidase match the syn407V. Chernihiv452 from the Ukraine with a mixture of 225D, 225G, 225N and 225S carries the syn413K, but has no NA published. A more comprehensive deposit of these two antigenic gene segments (HA and NA) from the Ukraine would allow a definitive conclusion.

Areas covered include Texas (3), the Northeastern United States (4), China (2), Singapore, the Ukraine (18), Moldova (5), Russia (11), Norway (2), Sweden and extensive penetration in Spain (15 sequences). This particular background pattern may precurse 225G and mixtures of 225D / 225G. If LvivN6 is officially confirmed as a vaccine escape event, these cross-segment pairs may be surveilled as potential future effectors of vaccine efficacy failure.

Publication of the remaining Neuraminidase segments for the 33 Norwegian and Japanese specimens bearing HA syn413K would allow a more precise review. Although 9 of the recent sequences from Norway carry syn413K, none of the 225E strains from Norway have the syn413K. The patterns are highly suggestive that all of the Norse 225G strains do. The 2009-12-29 release of the NA for Norway2924 confirmed that previous suggestion.

The Orenburg2974 sequence from Russia also carries 225N on this background. Bryansk2971, also from Russia with presumably fatal 225G from the lung, demonstrates the syn413K but has no entry for the Neuraminidase to confirm this cross segment linkage.

If RBS revisions at amino acid 225 are, in fact, instructive of high pathogenicity, then Russia is in the FlightPath for a more virulent winter and the Ukraine has presently built a fog of miasma that appears to be capable of spreading across the globe.

[sharon sanders]

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

edited by NS1 via email -

Added Ukraine from today, 100% of sequences with HA and NA are on the cross-segment linkage background. 18 HA have syn413K and 11 NA have syn407V.

Added Tver from Russia, 225G and fatal.