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U.S. - First Tamiflu-resistant swine flu (Singapore ex-Hawaii)

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  • #16
    Re: U.S. - First Tamiflu-resistant swine flu (Singapore ex-Hawaii)

    Well, it can be a silent spread, or it can be a well monitored noisy spread, but after all is said and done, it will continue to spread nonetheless.

    Comment


    • #17
      Re: U.S. - First Tamiflu-resistant swine flu (Singapore ex-Hawaii)

      Originally posted by Mamabird View Post
      Well, it can be a silent spread, or it can be a well monitored noisy spread, but after all is said and done, it will continue to spread nonetheless.
      Yes, it will continue, but most have no clue.

      Comment


      • #18
        Re: U.S. - First Tamiflu-resistant swine flu (Singapore ex-Hawaii)

        Originally posted by Mamabird View Post
        Well, it can be a silent spread, or it can be a well monitored noisy spread, but after all is said and done, it will continue to spread nonetheless.
        While it will continue to spread, a media myth has been created so MD's believe resistance is rare. As a result, patients in trouble are treated with Tamiflu, leading to more problems. So the key question is whether the media myth on Tamiflu resistance is driving the increasing death toll.

        Comment


        • #19
          Re: U.S. - First Tamiflu-resistant swine flu (Singapore ex-Hawaii)

          Originally posted by niman View Post
          While it will continue to spread, a media myth has been created so MD's believe resistance is rare. As a result, patients in trouble are treated with Tamiflu, leading to more problems. So the key question is whether the media myth on Tamiflu resistance is driving the increasing death toll.
          The physicians with which I work have long been concerned with the inappropriate use of Tamiflu, and CDC guidance on the use of antivirals also attempts to keep all on track.

          However, it's probably a bit late to attempt to turn things completely around. We will likely continue to see increased resistance, basically in the same manner as Seasonal H1N1. It's just a matter of time.

          Comment


          • #20
            Re: U.S. - First Tamiflu-resistant swine flu (Singapore ex-Hawaii)

            Originally posted by Mamabird View Post
            The physicians with which I work have long been concerned with the inappropriate use of Tamiflu, and CDC guidance on the use of antivirals also attempts to keep all on track.

            However, it's probably a bit late to attempt to turn things completely around. We will likely continue to see increased resistance, basically in the same manner as Seasonal H1N1. It's just a matter of time.
            I agree that the spread will continue, but I think patients are needlessly dying because Tamiflu remains the first treatment choice for SERIOUS cases (which are the patients who are dying or getting hospitaltized).

            Comment


            • #21
              Re: U.S. - First Tamiflu-resistant swine flu (Singapore ex-Hawaii)

              Updated H274Y travel log

              gb|GQ463202.1| Influenza A virus (A/Hunan/SWL3/2009(H1N1)) se... 34.2 2.9
              gb|CY043352.1| Influenza A virus (A/Denmark/528/2009(H1N1)) s... 34.2 2.9
              gb|GQ397279.1| Influenza A virus (A/Yamaguchi/22/2009(H1N1)) ... 34.2 2.9
              gb|GQ365445.1| Influenza A virus (A/Osaka/180/2009(H1N1)) seg... 34.2 2.9
              gb|GQ351316.1| Influenza A virus (A/Hong Kong/2369/2009(H1N1)... 34.2 2.9
              gb|EU567011.1| Influenza A virus (A/Indiana/01/2008(H1N1)) se... 34.2 2.9
              gb|DQ493078.1| Influenza A virus (A/Vietnam/CL2009/2005(H5N1)... 34.2 2.9
              gb|DQ250165.1| Influenza A virus (A/Vietnam/CL2009/2005(H5N1)... 34.2 2.9

              Comment


              • #22
                Re: U.S. - First Tamiflu-resistant swine flu (Singapore ex-Hawaii)

                Originally posted by niman View Post
                I agree that the spread will continue, but I think patients are needlessly dying because Tamiflu remains the first treatment choice for SERIOUS cases (which are the patients who are dying or getting hospitaltized).
                I assume you are referring to the fact that by the time they are seriously ill or hospitalized it is too later for Tamiflu to be effective.
                http://novel-infectious-diseases.blogspot.com/

                Comment


                • #23
                  Re: U.S. - First Tamiflu-resistant swine flu (Singapore ex-Hawaii)

                  Originally posted by Laidback Al View Post
                  I assume you are referring to the fact that by the time they are seriously ill or hospitalized it is too later for Tamiflu to be effective.
                  No. What I am saying is that physicians assume that resistance may very well happen in the future, but think that currently, there is little, so they treat at risk patients with Tamiflu (patients with underlying conditions that place then at risk for complications). These patients don't respond (or briefly respond) and then become too ill for any antiviral to be effective.

                  Comment


                  • #24
                    Re: U.S. - First Tamiflu-resistant swine flu (Singapore ex-Hawaii)

                    <TABLE class=lan18 border=0 cellSpacing=0 cellPadding=0 width="97%" align=center><TBODY><TR><TD class=hei22 height=25 vAlign=bottom>Singapore confirms first Tamiflu-resistant A/H1N1 case
                    </TD></TR><TR><TD bgColor=#ffffff height=4></TD></TR></TBODY></TABLE><TABLE border=0 cellSpacing=0 cellPadding=0 width="50%" align=center><TBODY><TR><TD height=8></TD></TR></TBODY></TABLE><TABLE border=0 cellSpacing=0 cellPadding=0 width="97%" align=center><TBODY><TR><TD width="48%">www.chinaview.cn 2009-08-15 07:43:41</TD><TD class=hui12 width="26%" align=middle> </TD><TD class=hui12 width="12%" align=middle> Print</TD></TR></TBODY></TABLE><TABLE border=0 cellSpacing=0 cellPadding=0 width="80%"><TBODY><TR><TD height=20></TD></TR></TBODY></TABLE><TABLE class=lt14 border=0 cellSpacing=0 cellPadding=0 width="97%" align=center><TBODY><TR><TD class=lt14>


                    SINGAPORE, Aug. 14 (Xinhua) -- Singapore's Ministry of Health on Friday confirmed that the country has found its first Tamiflu-resistant A/H1N1 case.

                    A Health Ministry spokesperson said that the isolated case involved a patient who fell sick towards the end of May and was admitted to hospital for isolation and treatment.
                    The patient was infected by a Tamiflu-susceptible strain of the virus and treated with Tamiflu. The resistant strain emerged during treatment and was detected through laboratory testing but by then the patient had already improved clinically.
                    "Patients can recover from their illness even if they are infected with a Tamiflu-resistant influenza strain because the immune system plays an important part in clearing the body of the virus," the spokesperson said.
                    The spokesperson did not reveal the age and gender of the patient. "So far, we have not detected any other cases of antiviral resistance. We will continue to conduct surveillance for antiviral resistance," the spokesperson said. Singapore reported its first confirmed case of flu A/H1N1 on May 27. The country's first A/H1N1 related death case was reportedon July 18. The country has reported 11 A/H1N1 related death cases so far.

                    http://news.xinhuanet.com/english/20...t_11884727.htm

                    </TD></TR></TBODY></TABLE>

                    Comment


                    • #25
                      Re: U.S. - First Tamiflu-resistant swine flu (Singapore ex-Hawaii)

                      GGTTGATGATGGTTT
                      gb|CY044080.1| Influenza A virus (A/New York/3715/2009(H1N1))... 28.3 1.2
                      gb|CY044072.1| Influenza A virus (A/New York/3702/2009(H1N1))... 28.3 1.2
                      gb|CY042320.1| Influenza A virus (A/swine/Illinois/Sg-00445/2... 28.3 1.2
                      gb|CY042316.1| Influenza A virus (A/swine/Illinois/Sg-00444/2... 28.3 1.2
                      gb|CY042312.1| Influenza A virus (A/swine/Illinois/Sg-00443/2... 28.3 1.2
                      gb|GQ414768.1| Influenza A virus (A/Sao Paulo/43812/2009(H1N1... 28.3 1.2
                      gb|GQ377095.1| Influenza A virus (A/California/24/2009(H1N1))... 28.3 1.2
                      gb|GQ359765.1| Influenza A virus (A/Stockholm/31/2009(H1N1)) ... 28.3 1.2
                      gb|GQ292961.1| Influenza A virus (A/Mexico City/22/2009(H1N1)... 28.3 1.2
                      gb|GQ229365.1| Influenza A virus (A/swine/Hong Kong/NS623/200... 28.3 1.2
                      gb|GQ229357.1| Influenza A virus (A/swine/Hong Kong/9656/2001... 28.3 1.2
                      gb|GQ229348.1| Influenza A virus (A/swine/Hong Kong/NS857/200... 28.3 1.2
                      gb|GQ229333.1| Influenza A virus (A/swine/Hong Kong/1562/2005... 28.3 1.2
                      gb|GQ229293.1| Influenza A virus (A/swine/Hong Kong/NS1659/20... 28.3 1.2
                      gb|GQ229269.1| Influenza A virus (A/swine/Hong Kong/915/2004(... 28.3 1.2
                      gb|GQ229261.1| Influenza A virus (A/swine/Hong Kong/NS837/200... 28.3 1.2
                      gb|GQ232085.1| Influenza A virus (A/Guangdong/02/2009(H1N1)) ... 28.3 1.2
                      gb|GQ223435.1| Influenza A virus (A/Guangdong/05/2009(H1N1)) ... 28.3 1.2
                      gb|GQ161163.1| Influenza A virus (A/swine/Granstedt/IDT3475/2... 28.3 1.2
                      gb|GQ161145.1| Influenza A virus (A/swine/Kitzen/IDT6142/2007... 28.3 1.2
                      gb|GQ161143.1| Influenza A virus (A/swine/Groitzsch/IDT6016-2... 28.3 1.2
                      gb|GQ161141.1| Influenza A virus (A/swine/Groitzsch/IDT6016-1... 28.3 1.2
                      gb|GQ161104.1| Influenza A virus (A/swine/Bakum/1832/2000(H1N... 28.3 1.2
                      gb|CY040604.1| Influenza A virus (A/swine/North Carolina/9675... 28.3 1.2
                      gb|CY040603.1| Influenza A virus (A/swine/North Carolina/4871... 28.3 1.2
                      gb|CY040602.1| Influenza A virus (A/swine/North Carolina/4775... 28.3 1.2
                      gb|CY040601.1| Influenza A virus (A/swine/North Carolina/4509... 28.3 1.2
                      gb|CY040600.1| Influenza A virus (A/swine/North Carolina/4488... 28.3 1.2
                      gb|CY040599.1| Influenza A virus (A/swine/North Carolina/4427... 28.3 1.2
                      gb|CY040598.1| Influenza A virus (A/swine/North Carolina/3668... 28.3 1.2
                      gb|CY040597.1| Influenza A virus (A/swine/North Carolina/2969... 28.3 1.2
                      gb|CY040596.1| Influenza A virus (A/swine/North Carolina/2676... 28.3 1.2
                      gb|CY040595.1| Influenza A virus (A/swine/North Carolina/9856... 28.3 1.2
                      gb|CY040594.1| Influenza A virus (A/swine/North Carolina/4511... 28.3 1.2
                      gb|CY040593.1| Influenza A virus (A/swine/North Carolina/4488... 28.3 1.2
                      gb|CY040592.1| Influenza A virus (A/swine/North Carolina/4452... 28.3 1.2
                      gb|CY040591.1| Influenza A virus (A/swine/North Carolina/4350... 28.3 1.2
                      gb|CY040590.1| Influenza A virus (A/swine/North Carolina/4162... 28.3 1.2
                      gb|CY040589.1| Influenza A virus (A/swine/North Carolina/3789... 28.3 1.2
                      gb|CY040588.1| Influenza A virus (A/swine/North Carolina/3527... 28.3 1.2
                      gb|CY040587.1| Influenza A virus (A/swine/North Carolina/2948... 28.3 1.2
                      gb|CY040586.1| Influenza A virus (A/swine/North Carolina/1286... 28.3 1.2
                      gb|CY040578.1| Influenza A virus (A/swine/North Carolina/4257... 28.3 1.2
                      gb|CY040576.1| Influenza A virus (A/swine/North Carolina/3876... 28.3 1.2
                      gb|CY040573.1| Influenza A virus (A/swine/North Carolina/2629... 28.3 1.2
                      gb|CY040571.1| Influenza A virus (A/swine/North Carolina/1286... 28.3 1.2
                      gb|CY040569.1| Influenza A virus (A/swine/North Carolina/3456... 28.3 1.2
                      gb|CY040567.1| Influenza A virus (A/swine/North Carolina/901/... 28.3 1.2
                      gb|CY040565.1| Influenza A virus (A/swine/North Carolina/4613... 28.3 1.2
                      gb|CY040563.1| Influenza A virus (A/swine/North Carolina/4390... 28.3 1.2
                      gb|CY040561.1| Influenza A virus (A/swine/North Carolina/2812... 28.3 1.2
                      gb|CY040559.1| Influenza A virus (A/swine/North Carolina/9647... 28.3 1.2
                      gb|CY040557.1| Influenza A virus (A/swine/North Carolina/4743... 28.3 1.2
                      gb|CY040555.1| Influenza A virus (A/swine/North Carolina/4685... 28.3 1.2
                      gb|CY040553.1| Influenza A virus (A/swine/North Carolina/4620... 28.3 1.2
                      gb|CY040551.1| Influenza A virus (A/swine/North Carolina/4401... 28.3 1.2
                      gb|CY040549.1| Influenza A virus (A/swine/North Carolina/4395... 28.3 1.2
                      gb|CY040547.1| Influenza A virus (A/swine/North Carolina/4311... 28.3 1.2
                      gb|CY040545.1| Influenza A virus (A/swine/North Carolina/7571... 28.3 1.2
                      gb|CY040543.1| Influenza A virus (A/swine/North Carolina/7386... 28.3 1.2
                      gb|CY040541.1| Influenza A virus (A/swine/Texas/36440-2/2005(... 28.3 1.2
                      gb|CY039991.1| Influenza A Virus (A/New Jersey/8/1976(H1N1)) ... 28.3 1.2
                      gb|GQ132144.1| Influenza A virus (A/Canada-ON/RV1529/2009(H1N... 28.3 1.2
                      gb|CY039925.1| Influenza A Virus (A/swine/Indiana/1726/1988(H... 28.3 1.2
                      gb|CY039917.1| Influenza A Virus (A/swine/Wisconsin/1915/1988... 28.3 1.2
                      gb|CY039909.1| Influenza A Virus (A/Maryland/12/1991(H1N1)) s... 28.3 1.2
                      gb|FJ986621.1| Influenza A virus (A/Ohio/02/2007(H1N1)) segme... 28.3 1.2
                      gb|FJ986620.1| Influenza A virus (A/Ohio/01/2007(H1N1)) segme... 28.3 1.2
                      gb|FJ986619.1| Influenza A virus (A/Wisconsin/87/2005(H1N1)) ... 28.3 1.2
                      gb|AY377936.2| Influenza A virus (A/swine/Pingtung/92-2/2003(... 28.3 1.2
                      gb|EU604689.1| Influenza A virus (A/swine/OH/511445/2007(H1N1... 28.3 1.2
                      gb|CY036863.1| Influenza A virus (A/swine/Tennessee/107/1977(... 28.3 1.2
                      gb|CY036799.1| Influenza A virus (A/swine/Wisconsin/30954/197... 28.3 1.2
                      dbj|AB434416.1| Influenza A virus (A/swine/Saitama/1996(H1N2)... 28.3 1.2
                      dbj|AB434408.1| Influenza A virus (A/swine/Ehime/1/1980(H1N2)... 28.3 1.2
                      dbj|AB434400.1| Influenza A virus (A/swine/Niigata/1/1977(H1N... 28.3 1.2
                      dbj|AB434392.1| Influenza A virus (A/swine/Hokkaido/2/1981(H1... 28.3 1.2
                      gb|FJ357104.1| Influenza A virus (A/turkey/NC/17026/1988(H1N1... 28.3 1.2
                      gb|CY035070.1| Influenza A virus (A/swine/Memphis/1/1990(H1N1... 28.3 1.2
                      gb|CY035030.1| Influenza A virus (A/X-53A(Puerto Rico/8/1934-... 28.3 1.2
                      gb|EU798784.1| Influenza A virus (A/swine/Korea/Asan04/2006(H... 28.3 1.2
                      gb|EU798783.1| Influenza A virus (A/swine/Korea/JL04/2005(H1N... 28.3 1.2
                      gb|EU798781.1| Influenza A virus (A/swine/Korea/JL01/2005(H1N... 28.3 1.2
                      gb|EU798780.1| Influenza A virus (A/swine/Korea/Hongsong2/200... 28.3 1.2
                      gb|EU798779.1| Influenza A virus (A/swine/Korea/CAS08/2005(H1... 28.3 1.2
                      gb|EU743159.1| Influenza A virus (A/turkey/IA/21089-3/1992(H1... 28.3 1.2
                      gb|EU743175.1| Influenza A virus (A/chicken/NY/21665-73/1998(... 28.3 1.2
                      gb|CY032929.1| Influenza A virus (A/swine/Tennessee/109/1977(... 28.3 1.2
                      dbj|AB434384.1| Influenza A virus (A/swine/Kyoto/3/1979(H1N1)... 28.3 1.2
                      gb|EU735786.1| Influenza A virus (A/turkey/NC/19762/1988(H1N1... 28.3 1.2
                      gb|EU735794.1| Influenza A virus (A/chicken/PA/35154/1991(H1N... 28.3 1.2
                      gb|EU742636.1| Influenza A virus (A/turkey/KS/4880/1980(H1N1)... 28.3 1.2
                      gb|EU409960.1| Influenza A virus (A/swine/Ohio/C62006/06(H1N1... 28.3 1.2
                      gb|EU409948.1| Influenza A virus (A/swine/Ohio/24366/07(H1N1)... 28.3 1.2
                      gb|CY030735.1| Influenza A virus (A/swine/Tennessee/9/1978(H1... 28.3 1.2
                      gb|CY028780.1| Influenza A virus (A/swine/California/T9001707... 28.3 1.2
                      gb|CY028788.1| Influenza A virus (A/swine/Iowa/1/1986(H1N1)) ... 28.3 1.2
                      gb|CY028435.1| Influenza A virus (A/swine/Tennessee/7/1978(H1... 28.3 1.2
                      gb|CY028427.1| Influenza A virus (A/swine/Tennessee/4/1978(H1... 28.3 1.2

                      Comment


                      • #26
                        Re: U.S. - First Tamiflu-resistant swine flu (Singapore ex-Hawaii)

                        HA travel log of A/Singaore/57/2009

                        gb|CY044080.1| Influenza A virus (A/New York/3715/2009(H1N1))... 28.3 1.2
                        gb|CY044072.1| Influenza A virus (A/New York/3702/2009(H1N1))... 28.3 1.2
                        gb|CY042320.1| Influenza A virus (A/swine/Illinois/Sg-00445/2... 28.3 1.2
                        gb|CY042316.1| Influenza A virus (A/swine/Illinois/Sg-00444/2... 28.3 1.2
                        gb|CY042312.1| Influenza A virus (A/swine/Illinois/Sg-00443/2... 28.3 1.2
                        gb|GQ414768.1| Influenza A virus (A/Sao Paulo/43812/2009(H1N1... 28.3 1.2
                        gb|GQ377095.1| Influenza A virus (A/California/24/2009(H1N1))... 28.3 1.2
                        gb|GQ359765.1| Influenza A virus (A/Stockholm/31/2009(H1N1)) ... 28.3 1.2
                        gb|GQ292961.1| Influenza A virus (A/Mexico City/22/2009(H1N1)... 28.3 1.2

                        gb|GQ229365.1| Influenza A virus (A/swine/Hong Kong/NS623/200... 28.3 1.2
                        gb|GQ229357.1| Influenza A virus (A/swine/Hong Kong/9656/2001... 28.3 1.2
                        gb|GQ229348.1| Influenza A virus (A/swine/Hong Kong/NS857/200... 28.3 1.2
                        gb|GQ229333.1| Influenza A virus (A/swine/Hong Kong/1562/2005... 28.3 1.2
                        gb|GQ229293.1| Influenza A virus (A/swine/Hong Kong/NS1659/20... 28.3 1.2
                        gb|GQ229269.1| Influenza A virus (A/swine/Hong Kong/915/2004(... 28.3 1.2
                        gb|GQ229261.1| Influenza A virus (A/swine/Hong Kong/NS837/200... 28.3 1.2
                        gb|GQ232085.1| Influenza A virus (A/Guangdong/02/2009(H1N1)) ... 28.3 1.2
                        gb|GQ223435.1| Influenza A virus (A/Guangdong/05/2009(H1N1)) ... 28.3 1.2

                        gb|GQ161163.1| Influenza A virus (A/swine/Granstedt/IDT3475/2... 28.3 1.2
                        gb|GQ161145.1| Influenza A virus (A/swine/Kitzen/IDT6142/2007... 28.3 1.2
                        gb|GQ161143.1| Influenza A virus (A/swine/Groitzsch/IDT6016-2... 28.3 1.2
                        gb|GQ161141.1| Influenza A virus (A/swine/Groitzsch/IDT6016-1... 28.3 1.2
                        gb|GQ161104.1| Influenza A virus (A/swine/Bakum/1832/2000(H1N... 28.3 1.2
                        gb|CY040604.1| Influenza A virus (A/swine/North Carolina/9675... 28.3 1.2
                        gb|CY040603.1| Influenza A virus (A/swine/North Carolina/4871... 28.3 1.2
                        gb|CY040602.1| Influenza A virus (A/swine/North Carolina/4775... 28.3 1.2
                        gb|CY040601.1| Influenza A virus (A/swine/North Carolina/4509... 28.3 1.2
                        gb|CY040600.1| Influenza A virus (A/swine/North Carolina/4488... 28.3 1.2
                        gb|CY040599.1| Influenza A virus (A/swine/North Carolina/4427... 28.3 1.2
                        gb|CY040598.1| Influenza A virus (A/swine/North Carolina/3668... 28.3 1.2
                        gb|CY040597.1| Influenza A virus (A/swine/North Carolina/2969... 28.3 1.2
                        gb|CY040596.1| Influenza A virus (A/swine/North Carolina/2676... 28.3 1.2
                        gb|CY040595.1| Influenza A virus (A/swine/North Carolina/9856... 28.3 1.2
                        gb|CY040594.1| Influenza A virus (A/swine/North Carolina/4511... 28.3 1.2
                        gb|CY040593.1| Influenza A virus (A/swine/North Carolina/4488... 28.3 1.2
                        gb|CY040592.1| Influenza A virus (A/swine/North Carolina/4452... 28.3 1.2
                        gb|CY040591.1| Influenza A virus (A/swine/North Carolina/4350... 28.3 1.2
                        gb|CY040590.1| Influenza A virus (A/swine/North Carolina/4162... 28.3 1.2
                        gb|CY040589.1| Influenza A virus (A/swine/North Carolina/3789... 28.3 1.2
                        gb|CY040588.1| Influenza A virus (A/swine/North Carolina/3527... 28.3 1.2
                        gb|CY040587.1| Influenza A virus (A/swine/North Carolina/2948... 28.3 1.2
                        gb|CY040586.1| Influenza A virus (A/swine/North Carolina/1286... 28.3 1.2
                        gb|CY040578.1| Influenza A virus (A/swine/North Carolina/4257... 28.3 1.2
                        gb|CY040576.1| Influenza A virus (A/swine/North Carolina/3876... 28.3 1.2
                        gb|CY040573.1| Influenza A virus (A/swine/North Carolina/2629... 28.3 1.2
                        gb|CY040571.1| Influenza A virus (A/swine/North Carolina/1286... 28.3 1.2
                        gb|CY040569.1| Influenza A virus (A/swine/North Carolina/3456... 28.3 1.2
                        gb|CY040567.1| Influenza A virus (A/swine/North Carolina/901/... 28.3 1.2
                        gb|CY040565.1| Influenza A virus (A/swine/North Carolina/4613... 28.3 1.2
                        gb|CY040563.1| Influenza A virus (A/swine/North Carolina/4390... 28.3 1.2
                        gb|CY040561.1| Influenza A virus (A/swine/North Carolina/2812... 28.3 1.2
                        gb|CY040559.1| Influenza A virus (A/swine/North Carolina/9647... 28.3 1.2
                        gb|CY040557.1| Influenza A virus (A/swine/North Carolina/4743... 28.3 1.2
                        gb|CY040555.1| Influenza A virus (A/swine/North Carolina/4685... 28.3 1.2
                        gb|CY040553.1| Influenza A virus (A/swine/North Carolina/4620... 28.3 1.2
                        gb|CY040551.1| Influenza A virus (A/swine/North Carolina/4401... 28.3 1.2
                        gb|CY040549.1| Influenza A virus (A/swine/North Carolina/4395... 28.3 1.2
                        gb|CY040547.1| Influenza A virus (A/swine/North Carolina/4311... 28.3 1.2
                        gb|CY040545.1| Influenza A virus (A/swine/North Carolina/7571... 28.3 1.2
                        gb|CY040543.1| Influenza A virus (A/swine/North Carolina/7386... 28.3 1.2
                        gb|CY040541.1| Influenza A virus (A/swine/Texas/36440-2/2005(... 28.3 1.2
                        gb|CY039991.1| Influenza A Virus (A/New Jersey/8/1976(H1N1)) ... 28.3 1.2
                        gb|GQ132144.1| Influenza A virus (A/Canada-ON/RV1529/2009(H1N... 28.3 1.2
                        gb|CY039925.1| Influenza A Virus (A/swine/Indiana/1726/1988(H... 28.3 1.2
                        gb|CY039917.1| Influenza A Virus (A/swine/Wisconsin/1915/1988... 28.3 1.2
                        gb|CY039909.1| Influenza A Virus (A/Maryland/12/1991(H1N1)) s... 28.3 1.2
                        gb|FJ986621.1| Influenza A virus (A/Ohio/02/2007(H1N1)) segme... 28.3 1.2
                        gb|FJ986620.1| Influenza A virus (A/Ohio/01/2007(H1N1)) segme... 28.3 1.2
                        gb|FJ986619.1| Influenza A virus (A/Wisconsin/87/2005(H1N1)) ... 28.3 1.2
                        gb|AY377936.2| Influenza A virus (A/swine/Pingtung/92-2/2003(... 28.3 1.2
                        gb|EU604689.1| Influenza A virus (A/swine/OH/511445/2007(H1N1... 28.3 1.2
                        gb|CY036863.1| Influenza A virus (A/swine/Tennessee/107/1977(... 28.3 1.2
                        gb|CY036799.1| Influenza A virus (A/swine/Wisconsin/30954/197... 28.3 1.2
                        dbj|AB434416.1| Influenza A virus (A/swine/Saitama/1996(H1N2)... 28.3 1.2
                        dbj|AB434408.1| Influenza A virus (A/swine/Ehime/1/1980(H1N2)... 28.3 1.2
                        dbj|AB434400.1| Influenza A virus (A/swine/Niigata/1/1977(H1N... 28.3 1.2
                        dbj|AB434392.1| Influenza A virus (A/swine/Hokkaido/2/1981(H1... 28.3 1.2
                        gb|FJ357104.1| Influenza A virus (A/turkey/NC/17026/1988(H1N1... 28.3 1.2
                        gb|CY035070.1| Influenza A virus (A/swine/Memphis/1/1990(H1N1... 28.3 1.2
                        gb|CY035030.1| Influenza A virus (A/X-53A(Puerto Rico/8/1934-... 28.3 1.2
                        gb|EU798784.1| Influenza A virus (A/swine/Korea/Asan04/2006(H... 28.3 1.2
                        gb|EU798783.1| Influenza A virus (A/swine/Korea/JL04/2005(H1N... 28.3 1.2
                        gb|EU798781.1| Influenza A virus (A/swine/Korea/JL01/2005(H1N... 28.3 1.2
                        gb|EU798780.1| Influenza A virus (A/swine/Korea/Hongsong2/200... 28.3 1.2
                        gb|EU798779.1| Influenza A virus (A/swine/Korea/CAS08/2005(H1... 28.3 1.2
                        gb|EU743159.1| Influenza A virus (A/turkey/IA/21089-3/1992(H1... 28.3 1.2
                        gb|EU743175.1| Influenza A virus (A/chicken/NY/21665-73/1998(... 28.3 1.2
                        gb|CY032929.1| Influenza A virus (A/swine/Tennessee/109/1977(... 28.3 1.2
                        dbj|AB434384.1| Influenza A virus (A/swine/Kyoto/3/1979(H1N1)... 28.3 1.2
                        gb|EU735786.1| Influenza A virus (A/turkey/NC/19762/1988(H1N1... 28.3 1.2
                        gb|EU735794.1| Influenza A virus (A/chicken/PA/35154/1991(H1N... 28.3 1.2
                        gb|EU742636.1| Influenza A virus (A/turkey/KS/4880/1980(H1N1)... 28.3 1.2
                        gb|EU409960.1| Influenza A virus (A/swine/Ohio/C62006/06(H1N1... 28.3 1.2
                        gb|EU409948.1| Influenza A virus (A/swine/Ohio/24366/07(H1N1)... 28.3 1.2
                        gb|CY030735.1| Influenza A virus (A/swine/Tennessee/9/1978(H1... 28.3 1.2
                        gb|CY028780.1| Influenza A virus (A/swine/California/T9001707... 28.3 1.2
                        gb|CY028788.1| Influenza A virus (A/swine/Iowa/1/1986(H1N1)) ... 28.3 1.2
                        gb|CY028435.1| Influenza A virus (A/swine/Tennessee/7/1978(H1... 28.3 1.2
                        gb|CY028427.1| Influenza A virus (A/swine/Tennessee/4/1978(H1... 28.3 1.2

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                        • #27
                          Re: U.S. - First Tamiflu-resistant swine flu (Singapore ex-Hawaii)

                          <a rel="nofollow" href="http://www.recombinomics.com/News/08150902/H274Y_SS_Confirmed.html">Commentary</a>

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                          • #28
                            Re: U.S. - First Tamiflu-resistant swine flu (Singapore ex-Hawaii)

                            Originally posted by niman View Post
                            <a rel="nofollow" href="http://www.recombinomics.com/News/08150902/H274Y_SS_Confirmed.html">Commentary</a>
                            Commentary

                            Silent Spread of Tamiflu Resistant Pandemic H1N1 Confirmed

                            Recombinomics Commentary 14:26
                            August 15, 2009

                            A Health Ministry spokesperson said that the isolated case involved a patient who fell sick towards the end of May and was admitted to hospital for isolation and treatment.

                            The patient was infected by a Tamiflu-susceptible strain of the virus and treated with Tamiflu. The resistant strain emerged during treatment and was detected through laboratory testing but by then the patient had already improved clinically.

                            The above comments provide additional detail on the first confirmed case of Tamiflu resistance in a swine pandemic H1N1 case. The H274Y was identified in an <a rel="nofollow" href="http://www.recombinomics.com/News/08090903/H274Y_Singapore_Hawaii.html">NA sequence</a>, A/Singapore/57/2009, which was recently deposited by the CDC, along with the HA and MP sequences. All three were clearly from the swine H1N1 pandemic strain, but the presence of H274Y in NA signaled oseltamivir resistance. The sample was from a 28F and was collected May 30, consistent with the description of the above Health Ministry spokesperson.

                            The MOH website provided a great deal of detail on the initial confirmed cases and contacts. The first confirmed case was May 27, and the third confirmed case matched the description associated with Singapore/57. The only 28F confirned patient ib Singapore in late May / early June was an American who was working in Singapore, She arrived from Honolulu via Tokyo on a flight that arrive just before midnight (23:53) on the night of May 26. Although she did not feel well during the flight, she was not detected by the fever scanners at the airport. However, the next she was transported by ambulance and arrive at the hospital in the afternoon of the 27th, and tested H1N1 positive on the afternoon (16:10) of the 28th.

                            The NA sequence from the 28th has not been made public, but the comments above indicate the sample was Tamiflu sensitive, It is not clear if treatment began the 27th (upon admission to the hospital), or the 28th, following confirmation of H1N1, because the MOH website does not mention Tamiflu treatment. The patient was described as having a mild case, and was discharged May 31st.

                            However, the sample collected on May 30th had H274Y, which was 3 days after admission or 2 days after confirmation, indicating the H274Y was silently spreading since it was not detected in the May 28th sample. Detection in the May 30th sample indicates that the H274Y was already present in May 28, but not detected, based on the comments by the spokesperson above, supporting silent spread which is detected in samples collected after Tamiflu treatment.

                            Although the May 28th sample was Tamiflu sensitive, the May 30th sample had H274Y in the NA sequence, as well as a polymorphism in the HA sequence that was subsequently detected in California and New York in the US, as well as Guangdong Province in China, Mexico City, Stockholm, and the first fatal case in Sao Paulo, Brazil (see list here), raising concerns of silent spread of H274Y worldwide.

                            The presence of H274Y in a minor species would explain the failure to find H274Y in the above locations, but its presence just below the detection level in untreated patient may explain the recent increases in fatalities. Agencies have repeatedly cited the lack of H274Y detection, leading to the widespread use of Tamiflu in H1N1 in positive cases, including the two <a rel="nofollow" href="http://www.recombinomics.com/News/08150901/H274Y_WA.html">imuno-suppressed</a> in the state of Washington, where H274Y was detected for the first time in the United States. In those two patients H274Y was not detected until the patients either had a reoccurrence of symptoms or a failure to respond to treatment. The resistance was found in August, even though both patients developed resistance weeks or months earlier. These detection delays and recent reports of patients, who were resistant in May and June, raise concern that the number of samples with H274Y is significantly higher that the 11 confirmed cases thus far. Media reports have described in at least one patient in <a rel="nofollow" href="http://www.recombinomics.com/News/08090901/H274Y_Thailand.html">Thailand</a>, and earlier media reports described multiple cases in <a rel="nofollow" href="http://www.recombinomics.com/News/08040902/H274Y_TX_Spread.html">Texas</a> along the <a rel="nofollow" href="http://www.recombinomics.com/News/08040901/H274Y_TX_Cases.html">Mexican border</a>.

                            However, the detection of H274Y in the sample collected a few days after the start of treatment in the patient in Singapore suggests the actual incidence is much higher than the reported or <a rel="nofollow" href="http://www.recombinomics.com/News/08120901/H274Y_More.html">withheld cases described by the WHO</a>, and a more intense screening program is critical, especially of samples collected after the start of osletamivir treatment and the increasingly common <a rel="nofollow" href="http://www.recombinomics.com/News/08091001/H274Y_Toll.html">fatal cases</a>.

                            .
                            "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

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                            • #29
                              Re: U.S. - First Tamiflu-resistant swine flu (Singapore ex-Hawaii)

                              http://www.themalaysianinsider.com/i...d-in-singapore

                              SINGAPORE, Aug 22 — Resistance to Tamiflu has been detected in a patient in Singapore who was down with the pandemic Influenza A (H1N1) bug. Similar cases have also emerged in Hong Kong, China, Japan, Canada, the United States and Denmark.
                              When the novel strain first appeared in April, the antiviral worked well against it. The World Health Organisation (WHO) feels that these instances of it not working are isolated cases of resistance that have developed because Tamiflu had been used at lower, prophylactic doses in people who might have been exposed to the bug.
                              Because these so-called contacts were, in fact, already infected, the lower doses turned out to be suboptimal, which allowed resistance to emerge. There is no proof that resistance is circulating in the community at large, the WHO asserts.
                              Yet there is at least one documented case of a 16-year-old girl who fell ill while travelling from San Francisco to Hong Kong on June 11. Though she declined Tamiflu, an isolate from her was found to carry the H274Y mutation, which signals Tamiflu-resistance.
                              She was, however, not the world’s first case of such resistance, an honour belonging to a woman seen in Denmark in late June. When she got home from Britain, she was given Tamiflu prophylaxis. Yet she still fell ill on the fifth day of taking Tamiflu. H274Y was detected in her isolate.
                              Could she have been infected in Britain by someone carrying mainly Tamiflu-sensitive bugs but also a small population of resistant bugs? In that case, suboptimal Tamiflu dosage might have suppressed enough of the sensitive bugs to prevent any clinical symptoms. Over the five days, however, the resistant bugs could have replicated enough to predominate and thus cause clinical illness.
                              But if this is so, then the mutation must already have been circulating in Britain — which, however, has not reported any cases of Tamiflu resistance yet. Alternatively, she might have caught the resistant bug in Denmark itself, during the five days when she was well and ambulant.
                              One reason for suspecting community circulation of the resistant bug is that 98 per cent of all seasonal H1N1 bugs now carry H274Y. If patients are infected with both strains, that mutation could jump from seasonal flu to pandemic flu. But the WHO insists there is no evidence this has occurred, so all resistant cases must have emerged because of suboptimal Tamiflu dosages.
                              There are signs of community circulation in the US, at least. First, the genomics of the Hong Kong isolate where no Tamiflu was used suggests that the infection originated in the US.
                              Second, it was revealed only this month that a May 30 isolate taken from a young American woman returning to Singapore from Honolulu carried H274Y.
                              Flying on May 26, she fell ill on board the plane, was hospitalised here on May 27, was confirmed to be a H1N1 case on May 28, but was discharged on May 31 feeling well.
                              Although her May 28 sample was Tamiflu-sensitive, her May 30 sample had H274Y. Two days is probably too short an interval for resistance to develop from any suboptimal dosages of Tamiflu. At any rate, as a confirmed case, she would have been given the full dosage.
                              Thus it is entirely possible that she was infected in the US with both the sensitive and resistant strains, which her immune defences could have cleared quickly, so she was discharged fairly quickly.
                              Third, on Aug 15, the US authorities sent out an urgent report to physicians that two intensive care patients in Washington state who had been infected last month and treated aggressively with Tamiflu were found to have bugs with H274Y.
                              These four cases suggest that H274Y may already be circulating in the US. It is possible we are seeing relatively few of these isolates for a technical reason: All published genomes are consensus sequences of DNA. That is, the base that is considered to occupy a specific position on the genome is the one that occurs most frequently. But it needs do so 100 per cent of the time.
                              If a base occurs in only 10 per cent of viral particles, it isn’t likely to show up in the published sequence. It is only when a base occurs in, say, half the cases that it might appear in the consensus sequence.
                              If H274Y were found in, say, 10 per cent of viral particles, it won’t appear in the consensus sequence of samples taken from a patient prior to Tamiflu being used. Once Tamiflu is employed, the population of sensitive bugs would be drastically reduced. However, those with H274Y would flourish.
                              Thus, although it was already around prior to Tamiflu being used, the resistant bug would not be detected. After the drug is employed, however, the resistant bugs can grow to greater numbers than the sensitive ones, rendering them detectable.
                              Of course, if more samples are taken before Tamiflu is used, H274Y might be detected more often. Such comprehensive surveillance, however, would consume too much resources.
                              History suggests it was limited testing that enabled Tamiflu-resistance in seasonal Influenza A (H1N1) to creep up on the world unawares. The first instance of that was detected in Norway in spring last year.
                              By the 2008/2009 season, however, it was found in 98 per cent of bugs worldwide. Yet a re-testing of old samples showed that H274Y was already widespread by the autumn of 2007. This means it was circulating in the community before it was first detected in Norway last year.
                              Is history repeating itself? If so, Singapore should be stocking up on Relenza, the other antiviral that still works. — Straits Times

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