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

[Shiloh]

Tamiflu resistance in pandemic influenza - historical compilation of news

Tamiflu resistance in pandemic influenza - historical compilation of news

Source: http://www.google.com/hostednews/afp/article/ALeqM5gZLouahbIkDtadGE3KnYOs5DuTtA

Tamiflu-resistant swine flu found on US-Mexico border

(AFP) ? 1 hour ago

LA JOLLA, California ? A strain of swine flu that is resistant to treatment with the drug Tamiflu has been discovered near the US-Mexican border, the Pan-American Health Organization (PAHO) said on Monday.

"We have found resistance to Tamiflu on the border. We have observed some cases, few to be sure, in El Paso and close to McAllen, Texas," said Maria Teresa Cerqueira, head of the local PAHO office.

Cases of A(H1N1) that were resistant to the anti-viral medicine have now been found in the United States, Canada, Denmark, Hong Kong and Japan.

Experts gathered in La Jolla, California on Monday to discuss the response to the outbreak, said the resistance was likely due to overuse of antivirals like Tamiflu.

"In the United States Tamiflu is sold with a prescription, but in Mexico and Canada it is sold freely and taken at the first sneeze. Then, when it is really needed, it doesn't work," said Cerqueira.

Roche, the manufacturer of Tamiflu, has said it expects a 0.5 percent rate of case resistance based on clinical trials.

Cerquiera said one patient diagnosed with a Tamiflu-resistant strain had been treated with Zanamivir -- an anti-viral made by GlaxoSmithKline -- and another was given no alternative medication. Both survived.

Since the swine flu outbreak emerged earlier this year it has killed 353 people in the United States and 146 in Mexico, according to authorities from each country.

A large proportion of nearly 1,000 recorded deaths around the world since the virus was first identified in Mexico in April have involved people with underlying medical conditions.

World Health Organization chief Margaret Chan has urged countries to boost their drug stockpiles amid warnings of the virus's continued spread.

"Manufacturing capacity for influenza vaccines is finite and woefully inadequate for a world of 6.8 billion people, nearly all of whom are susceptible to infection by this entirely new and highly contagious virus," Chan said on July 14.

A vaccine against the disease is currently being tested for safety and effectiveness, and is expected to be ready in the next two to four months, although the precise date is unclear.

US officials have recommended that children and pregnant women be among the groups first in line for swine flu shots, but said they were unlikely to have enough vaccine for everyone once the drug is ready to be rolled out.

Greece has announced it will vaccinate all its 11-million-strong population, the first country to introduce such a broad measure amid the current pandemic.

With such pledges emerging, developing nations have expressed concerns they will be left out, as richer nations race to build stock piles.

UN Secretary General Ban Ki-moon has said developing countries could need about one billion dollars by the end of the year to fund measures against the swine flu pandemic, especially vaccines.

 

[HenryN]

Re: Tamiflu-resistant swine flu found on US-Mexico border

Re: Tamiflu-resistant swine flu found on US-Mexico border

Source: http://www.google.com/hostednews/afp/article/ALeqM5gZLouahbIkDtadGE3KnYOs5DuTtA

Tamiflu-resistant swine flu found on US-Mexico border

"We have found resistance to Tamiflu on the border. We have observed some cases, few to be sure, in El Paso and close to McAllen, Texas," said Maria Teresa Cerqueira, head of the local PAHO office.

These two locations are at opposite ends of the Texas border with Mexico. It is unclear if these patients had been treated with Tamiflu. I strongly suspect that the one that recovered without "alternative" (instead of "additional") treatment was NOT treated with Tamiflu.

 

[HenryN]

Re: Tamiflu-resistant swine flu found on US-Mexico border

Re: Tamiflu-resistant swine flu found on US-Mexico border

Check the wording again. They said "few cases" not two cases. Perhaps I am reading the text too closely, but the way it was written implies it may be more than 2. Also:



Again, I may be reading plain English too literally, but they said "another", not "the other." People speaking in an official capacity really ought to be more careful with their wording.

It also says the other patient had "diagnosed" Tamiflu resistance and was treated with Relenza. It doesn't say that the patient developed Tamiflu resistance. I suspect that testing is up because FIT Tamiflu resistance has been found.

 

[Jeremy]

Re: Tamiflu-resistant swine flu found on US-Mexico border

Re: Tamiflu-resistant swine flu found on US-Mexico border

Roche, the manufacturer of Tamiflu, has said it expects a 0.5 percent rate of case resistance based on clinical trials.

Niman,

Correct me if I am wrong but didn't the previous strain of H1N1 from last year have close to 100% Tamiflu Resistance?

If that is the case, this statement can't really be true can it?

 

[wotan]

Re: Tamiflu-resistant swine flu found on US-Mexico border

Re: Tamiflu-resistant swine flu found on US-Mexico border

Niman,

Correct me if I am wrong but didn't the previous strain of H1N1 from last year have close to 100% Tamiflu Resistance?

If that is the case, this statement can't really be true can it?

I think that refers to de novo development.

 

[HenryN]

Re: Tamiflu-resistant swine flu found on US-Mexico border

Re: Tamiflu-resistant swine flu found on US-Mexico border

Niman,

Correct me if I am wrong but didn't the previous strain of H1N1 from last year have close to 100% Tamiflu Resistance?

If that is the case, this statement can't really be true can it?

The seasonal flu was at 100% resistant (had H274Y) but NOT linked to Tamifu use (which I suspect is the case in these patients).

 

[AlaskaDenise]

Re: Tamiflu-resistant swine flu found on US-Mexico border

Re: Tamiflu-resistant swine flu found on US-Mexico border

Commentary

http://www.recombinomics.com/News/08040901/H274Y_TX_Cases.html

Commentary

Tamiflu Resistant Pandemic H1N1 Cases in Texas

Recombinomics Commentary 03:14
August 4, 2009

"We have found resistance to Tamiflu on the border. We have observed some cases, few to be sure, in El Paso and close to McAllen, Texas," said Maria Teresa Cerqueira, head of the local PAHO office.

Cerquiera said one patient diagnosed with a Tamiflu-resistant strain had been treated with Zanamivir -- an anti-viral made by GlaxoSmithKline -- and another was given no alternative medication. Both survived.

The above comments describe at least two oseltamivir resistant patients along the Texas / Mexico border. The cases are at opposite ends of the border (see map) and raise concerns that the resistance developed in the absence of Tamiflu treatment. One patient had "diagnosed" resistance and was treated with Zanamivir, while the other wasn't treated with Zanamivir, leaving open the possibility that neither were treated with oseltamivir. Moreover, the wording left open the possibility that there were more than two patients, suggesting fit swine H1N1 with H274Y was circulating over a wide area.

The emergence of fit swine H1N1 with H274Y is not a surprise. A case has already been reported in Hong Kong in a traveler from San Francisco. The precursor for this strain has been reported worldwide, although the only case reported in the US was in April in New Jersey, raising concerns that the fit strain was circulating silently, in part because the cases were mild and not being tested. The patient in Hong Kong, like one of the patients recovered without treatment with Relenza, indicating the cases were relatively mild.

The fact that these cases were reported simultaneously also raises concerns that a fit H274Y is circulating in the area.

Details on the number of cases, and release of sequences, would be useful.

.

 

[vinny]

Re: Resistant flu virus mutation to Relenza found in lab

Re: Resistant flu virus mutation to Relenza found in lab

Health officials said they had found cases of Tamiflu-resistant swine flu along the US border with Mexico, as India and South Africa announced their first deaths from the A(H1N1) virus.



"We have found resistance to Tamiflu on the border. We have observed some cases, few to be sure, in El Paso and close to McAllen, Texas," said Maria Teresa Cerqueira, head of the Pan-American Health Organization office in La Jolla, California.

Cases of A(H1N1) that were resistant to the anti-viral medicine have now been found in the United States, Canada, Denmark, Hong Kong and Japan.

Experts had gathered in La Jolla on Monday to discuss the response to the outbreak, and warned that resistant strains were likely emerging because of overuse of antivirals like Tamiflu.

"In the United States Tamiflu is sold with a prescription, but in Mexico and Canada it is sold freely and taken at the first sneeze. Then, when it is really needed, it doesn't work," said Cerqueira.

The Tamiflu-resistant cases were reported as South Africa and India both announced their first fatalities from the A(H1N1) virus, which emerged in Mexico in April and has since spread worldwide, gaining pandemic status.

In South Africa, health authorities said Ruan Muller, a 22-year-old student at Stellenbosch University near Cape Town, had died after contracting the virus.

"He died on the 28th (of July), but there had to be some testing done to ensure the cause of death. It was the A(H1N1) influenza," said Fidel Hadebe, spokesman for South Africa's Department of Health.

With the world's highest number of HIV/AIDS-affected people -- nearly 19 percent of a 49-million-person population -- South Africa is considered particularly at risk because people with compromised immunity are more likely to fall prey to the disease.

South Africa's swine flu caseload has increased fourfold since the country's first case was reported on June 14. The government has said its stockpile of Tamiflu will only be used for the seriously ill, but that schools may also be closed on a case-by-case basis.

In India, authorities said a 14-year-old girl in the western city of Pune became the country's first fatality from the virus.

The teenager first felt unwell on July 21, complaining of a sore throat, runny nose and headaches. She returned to school the following day after the general symptoms improved, the Ministry of Health and Family Welfare said.

She then developed a fever again on July 25 and two days later was admitted to a private clinic for treatment. She was put on a ventilator in an intensive care unit and was treated with Oseltamivir, a generic brand of Tamiflu.

"Her condition deteriorated again with multi-system involvement and (she) expired on the evening of 03.08.09," the ministry said in a statement.

Meanwhile, the Russian state health agency warned the country's football fans to stay away from the national team's World Cup qualifying tie with Wales in Cardiff on September 9.

"This would be an extremely unnecessary and inappropriate undertaking at a time of a flu epidemic," the head of Russia's state health agency Gennady Onishchenko said, according to local news agencies.

Onishchenko expressed fear that "the expressions of emotion on the part of football fans involving intense shouting" could lead to the airborne transmission of the flu virus.

Russia has to-date been relatively spared by the swine flu pandemic, with just 55 confirmed cases in the country.

Experts remain puzzled as to why different countries have not always been affected to the same degree, with England and Scotland both heavily hit proportionately, yet neighboring France's tally appearing light by comparison.

Some have argued that gargantuan sums being spent by rich economies on a disease that is no more lethal than seasonal flu are grotesquely disproportionate when thousands die each day of diseases which receive less media coverage.


http://uk.news.yahoo.com/18/20090804/thl-treatment-resistant-swine-flu-detect-5effa79.html

 

[HenryN]

Re: Tamiflu-resistant swine flu found on US-Mexico border

Re: Tamiflu-resistant swine flu found on US-Mexico border

(Google translation)

Several patients were found to be resistant to antiviral near the border. "This is not a surprise, there was no worry," says Roche, which estimated that 0.5% rate of resistance.


Boxes of Tamiflu (Sipa)
Cases of resistance to Tamiflu, the main antiviral drug used against influenza A (H1N1), were found near the border between the United States and Mexico, said Monday 3 August the Pan American Health Organization (PAHO). "We found cases of Tamiflu resistance to the border. We have seen some cases, few of which we are confident, El Paso and around McAllen, Texas," said Dr. Maria Teresa Cerqueira, responsible local office of PAHO, at a conference on influenza A. The persons concerned cross the border regularly and were automédicamentées, says the doctor.


Cases "isolated"
"In the U.S., Tamiflu is a prescription but it is widely available in Mexico and Canada and took the first sneeze. And when it is really useful, it does not work anymore", said Maria Teresa Cerqueira. She explained that a patient with a strain of influenza A (H1N1) viruses resistant to Tamiflu has been treated positively to Zanamivir, another antiviral drug, and another patient received no other treatment. Both patients survived, she argued.
In July, a case of resistance to Tamiflu had been found in Canada. It was the first case in North America, according to Dr. Guy Boivin, Center hospitalier de l'Université Laval (CHUL) in Quebec, who had discovered this resistant strain. Cases of resistance to antiviral therapy were also recorded in Denmark, Japan and Hong Kong.
The World Health Organization (WHO) has estimated that these cases are "isolated" and that it maintains its recommendation for Tamiflu and Relenza.


"There is no worry for the moment"
The laboratory Roche, Tamiflu seller, said he expected at 0.5% of its antiviral resistance from the results of clinical trials.
"This is not a surprise," says the director of the pharmaceutical division of Roche, William Burns: "in the case of the flu season, about 0.4% of the organisms may be resistant. There not worried at the moment. " "We do not increase in these cases of resistance," adds the CEO of Roche Severin Schwan.
"It is not excluded that in a community where people are treated with Tamiflu, there are few cases of viruses that develop resistance and spread," explains Dr. Thierry Buclin, a medical assistant in the office clinical pharmacology and toxicology at the CHUV of Lausanne. "The real question is: who should take Tamiflu?" Dr. Buclin nuance. "What you win to deal with Tamiflu, if one can be cured with paracetamol?" Hits there.

http://tempsreel.nouvelobs.com/actu...stance_au_tamiflu_a_la_frontiere_america.html

 

[HenryN]

Re: Tamiflu-resistant swine flu found on US-Mexico border

Re: Tamiflu-resistant swine flu found on US-Mexico border

(Google translation)

"We found cases of Tamiflu resistance to the border. We have seen some cases, few of which we are confident, El Paso and around McAllen, Texas," said Dr. Maria Teresa Cerqueira, responsible local office of PAHO, at a conference on influenza A. The persons concerned cross the border regularly and were autom?dicament?es, says the doctor.




http://tempsreel.nouvelobs.com/actu...stance_au_tamiflu_a_la_frontiere_america.html

This version of the AFP story suggest that resistance might have been linked to self-prescribed tamiflu. However, it doesn't state that it was, and also does state that the resistance was discovered because the patients received Tamiflu treatment from a doctor. Thus, the number of patients and details surrounding the "diagnosis" remain murky.

 

[sharon sanders]

Tamiflu resistance in pandemic influenza - historical compilation of news

Tamiflu resistance in pandemic influenza - historical compilation of news

Tamiflu resistance puzzle

Category: Antivirals ? Influenza treatment ? Swine flu
Posted on: July 23, 2009 7:00 AM, by revere


There have been three reported oseltamivir (Tamiflu) resistant isolates of H1N1 swine flu (added: and now a fourth in Canada) but with those exceptions all others have been sensitive to this oral antiviral. This is in marked contrast to the other H1N1 strain, the seasonal variety which is almost entirely resistant. The spread of Tamiflu resistance in the seasonal strain happened with dramatic suddenness in the winter of 2007 - 2008 and came as an unhappy surprise. People assume that a rapidly mutating virus would inevitably become resistant, but based on several laboratory studies there were reasons to believe the mutation or mutations conferring resistance also made the virus less fit to replicate, infect host cells or cause disease. Moreover the resistance developed and spread very rapidly in areas where the virus was under little antiviral pressure. But the resultant H1N1 seasonal viruses transmitted readily and caused a typical influenza illness. It was a public health problem, but also in interesting scientific one. Now a clue may be emerging in findings just published in a Letter in Emerging Infectious Diseases from scientists in Luxembourg.


Several mutations in the neuraminidase (NA) gene can cause Tamiflu to lose its effectiveness at blocking the virus's ability to detach its replicated progeny after infecting a host cell (and thus preventing further infection of other cells), but by far the most common is one designated H274Y. The 274 part is the amino acid location along the protein, while the H and Y say that Y has been substituted for H at that location. H is an abbreviation for the amino acid histidine, while Y is the abbreviation for tyrosine. In other words, in a resistant H1N1 virus, there is a change at a single place along the long string of amino acid beads that make up the N1 protein and it occurs 274 places down the line, substituting a tyrosine from a histidine building block. That's a pretty small change but it's enough to interfere with the docking of the Tamiflu to the neuriminidase enzyme on the virus's surface and allow it to perform its detaching function. But is this change all that's involved? Apparently not.


NA is not the only protein made by the virus. Also on its surface is hemagglutinin (HA, one version of which, H1, gives H1N1 part of its name), which is involved in viral attachment to the host cell (and other functions) and 6 other gene segments, most internal to the virus and involved in replication and other functions. Could it be that the virus with mutant NA had other less visible mutations that somehow "mde up for" or corrected the lack of fitness found in resistant viruses with only H274Y? The scientists in Luxembourg compared sequences in all 8 gene segments in Tamiflu resistant versus sensitive H1N1s to see if there was another consistent change. They looked at 140 different isolates collected by Luxembourg's National Influenza Sentinel Surveillance System over the period when resistance emerged (December 2007 - March 2008). About a quarter of these isolates were Tamiflu resistant. They then searched for another genetic marker that accompanied H274Y but wasn't in H274 (the sensitive virus). No difference in most of the other genes -- PB1, polymerase A, hemagglutinin, nucleoprotein, matrix, nonstructural (NS) -- seemed to differentiate resistant from non-resistant. The exception was the PB2 gene, where a serine for proline change at position 453 (Pro453Ser) seemed to fit the bill. They looked at all published PB2 sequences to see if this was a common mutation and were able to find only three instances collected since 1918: one each in 1933, 1976 and 1988.



The bottom line here is that these two genetic changes -- H274Y in NA and Pro453Ser -- are associated and seem to be related to the unexpected fitness of Tamiflu resistant seasonal H1N1.


Science is a slow process and fitting all the pieces together takes even more time. There are false starts and backtracks and sometimes things that seem significant are only side tracks or misinterpretations. Whether this finding is indeed true, and if true, how it works mechanistically we don't know. But it's a clue that might tell us something important about viral fitness and Tamiflu resistance. Could it affect the pandemic? Possibly, if the existence of Pro453Ser could be used as a marker or early warning of developing Tamiflu resistance. Another possibility, that it might provide information about a new therapeutic target, is probably too distant to have any application in the next year or two.


Science marches to its own rhythm.

 

[HenryN]

Re: EM - Tamiflu resistance puzzle

Re: EM - Tamiflu resistance puzzle

P453S was among many polymorphisms in clade 2B that had been acquired from clade 2C via recombination

http://precedings.nature.com/documents/2832/version/1

 

[HenryN]

Re: Tamiflu-resistant swine flu found on US-Mexico border

Re: Tamiflu-resistant swine flu found on US-Mexico border

Commentary

Spread of Tamiflu Resistant Pandemic H1N1 in Texas
Recombinomics Commentary 13:46
August 4, 2009

We have seen some cases, few of which we are confident, El Paso and around McAllen, Texas," said Dr. Maria Teresa Cerqueira, responsible local office of PAHO, at a conference on influenza A. The persons concerned cross the border regularly and were autom?dicament?es, says the doctor.

The above translation adds to the uncertainty associated with the oseltamivir resistance report on the Texas / Mexico border (see map). Since the report cites self-treatment of Tamiflu, it is unclear if and when the resistant cases were treated. In previously announced cases worldwide, five were on prophylactic treatment because of exposure , and at least two developed symptoms on the fifth day of Tamiflu treatment, raising concerns that H274Y was present at reduced levels in these patients and the treatment allowed for the detection of the H274Y, which may be the case for some of the patients on the Texas border.

However a traveler from San Francisco was tested in Hong Kong and had H274Y in the absence of Tamiflu treatment, which may also be the case for some of the patients along the Texas border. More aggressive testing and release of these sequences would be useful.

However, these sequences should be tested more thoroughly for the presence of H274Y as a mixture. A recent report on Relenza resistance (Q136K) indicated the polymorphism was only detected after culture on MDCK cells, indicating the levels in the clinical sample were below detection. In addition to the nine examples in southeast Asia / Australia, which were in the report, a sequence from Nicaragua has been published (see list here) and a mixture from Pennsylvania was published a year ago, although agency reports claim no Relenza resistance in the US in the 2007/2008 season. The Q136K was in patients who were not being treated with Relenza, and more widespread treatment of swine flu patients will likely lead to more detected cases, which is the likely situation for H274Y also.

The failure to provide more concrete information and sequences from the resistant patients along the Texas border increases concerns that resistant pandemic H1N1 is widespread, but grossly under-represented in the limited number of public sequences released at Genbank or GISAID.


====

My Bolding - not Dr Niman's. The obvious question is what other polymorphisms might be gaining ground below the radar.

PB1 E627K. It was in the original and first clone from Shanghai, but was absent in the second clone. This is another important change which may be flying below the radar, especially at this time in the northern hemisphere.

In the fall, the story will be quite different.

 

[HenryN]

Re: Tamiflu-resistant swine flu found on US-Mexico border

Re: Tamiflu-resistant swine flu found on US-Mexico border

Dr. Niman,

Do you have any sort of rough outline as to what you think will happen in the fall and when things will start to become noticeable as far as severe sickness/death?

Gennie

The CDC has said they expect outbreaks like NYC to be widespread in the US in the fall. I think this is an optimistic projection. In the northern hemisphere the fall will signal the start of flu season and cases increase simply because the cooler temperature allows the virus to remain viable longer. Thus there is more transmission just because there is more virus laying around.

However, the species jump is significant, and major changes are possible with minor changes. I expect H274Y to be widespread as well as PB2 E627K. These two changes alone could have a significant impact because the virus will be able to grow faster at lower temperatures and will be resistant to Tamiflu (and Relenza resistance may follow).

Some signals will come out of sequences from the southern hemisphere, although those sequences lag. There is at least one marker for Argentina, and the Sao Paulo change may be significant. There may be more sequences released this week, which could make these initial onservations on fatal cases easier to evaluate.

In addition, there are more people living in the northern hemisphere, so issues in the southern hemisphere could be magnified in the north. I suspect some time in September the picture will be clearer and I expect results to indicate that the CDC projection is VERY optimistic.

 

[Commonground]

Tamiflu resistance in pandemic influenza - historical compilation of news

Tamiflu resistance in pandemic influenza - historical compilation of news

Patient that died was not treated in time. Onset: 7/25

Deaths due to the first influenza A/H1N1 in Vietnam
TPHCM 9 doctors, nurses of the Thong Nhat hospital with positive influenza A/H1N1. 4-8 To date, Vietnam has recorded 995 cases of influenza A/H1N1 infection
4-8 days, the Ministry of Health issued new guidelines diagnosis, treatment and infection influenza A/H1N1 replaced Decision 1440/QD-BYT 29 - 4-2009 guide diagnosis, treatment and infectious influenza A/H1N1 in pigs.

Deaths are not treated in time

4-8 days, Dr. Nguyen Huy Nga, Director Department of Department of Health and Environment (Ministry of Health), said the report of Health Department of Khanh Hoa, a female patient Tran Thi Kim L., 29 years old (in the Th?nh Gia, Vinh Nguyen Ward, Nha Trang City, Khanh Hoa), infected on 25-7, with mild symptoms of fever, cough and sore throat.

30-7 days, patients entered Military Health Institute 87, tested positive influenza A/H1N1 virus. then, 2-8 days, patients transferred to the Hospital Khanh Hoa and death 3-8 days by severe respiratory failure. Causes initially identified: After detecting the symptoms of influenza, the patient did not go to hospital to be treated timely.

According to Trinh Quan Huan, Deputy Minister of Health, to assert that to make sure patients have died due to influenza A/H1N1 health departments will conduct some tests, and to study the disease profile This view has infected chronic or not. The agencies are conducting investigations to study epidemiology determine exactly causes death of this patient.

Huan also by his ability to patient deaths due to influenza A/H5N1 virus infection was removed by the test results have confirmed patients negative for the virus this flu.

24 more cases of influenza infection

In 4-8 days, Vietnam has recorded 24 more cases of influenza A/H1N1 infection in the South: 10 CA, Northern: 11 ca, Central: 3 ca. Thus, up to this time, Vietnam has recorded 995 cases of influenza A/H1N1 infection.

4-8 pm, Director of the Department of Health Quang Tri Tran Van Thanh confirmed patients first influenza A/H1N1 infection is Tran Thi Phuong Tan, 39 years old, indicated Quarter 4, Ward 5, Dong Ha (Quang Tri). Earlier, on 24-7, Ms. Q. TPHCM go on 26-7, in the Quang Tri.

On 28-7, Ms. Q. see the hot and uncomfortable fever hospital treatment. After sending samples tested, the 4-8, Medical Center for Quang Tri province received her results Q. have been influenza A/H1N1 infection.

According to new guidelines by the Ministry of Health, at present, the diagnosis and treatment is difficult by the place clinical diversity, there are many serious cases, evolve quickly, easily lead to death due to influenza virus A/H1N1.

When patients acute events will have some manifestation as fever and symptoms of respiratory tract: inflammation on respiratory, sore throat, or khan or spotting, headache, and pain, fatigue, non, diarrhea. Many cases are manifestations of severe pneumonia, even respiratory failure and failure has increased.

Cases have been identified as infected with clinical manifestations of influenza and tests positive for influenza A/H1N1 virus ... In this text, the Ministry of Health treatment guidelines for the slow response or resistance to drug Tamiflu, because the last time, Vietnam has a number of slow response patients with drugs of this specification.

According to Ministry of Health, the patient is in hospital after the 3-day fever, clinical status is stable, testing A/H1N1 influenza virus on the fourth negative. In the case of the test on the fourth is still positive, the test again on Friday.

Cases of patients infected with influenza A/H1N1 death shroud must be as prescribed preventive, must khử micro-organism with the micro-organism and khử. Move the corpse to burial or cremation with private vehicles, ensuring regulations and infection. Carcass must be buried away or cremation within 24 hours.

Flu but have no clinical symptoms

4-8 pm, Dr. Nguyen Duc Cong, Director of Hospital Thong Nhat (HCMC), confirmation has 9 doctors, nurses Hospital Thong Nhat positive for influenza A/H1N1. In particular, 4 doctors get flu from the outside community, and 5 nurses, nursing influenza A/H1N1 infected by close contact with patients being treated isolation flu here. The flu cases has no clinical symptoms.

In addition, in the isolation of the Thong Nhat Hospital are 4 patients infected with influenza A/H1N1 treatment. "Health of the patients infected with influenza A/H1N1 here are stable, the suspect has spread process, so no worries" - the Doctor said.

The same day, hospital treatment for influenza A/H1N1 in private secondary schools Nguyen Extension (Ward 13, Tan Binh, HCMC) was clearance.

 

[sharon sanders]

Tamiflu resistance in pandemic influenza - historical compilation of news

Tamiflu resistance in pandemic influenza - historical compilation of news

Tamiflu Resistant Flu Cases Found



# 3581


Without providing much in the way of details, tonight officials at PAHO (Pan-American Health Organization) have announced the discovery of some small number of Tamiflu (oseltamivir) resistant swine flu cases near the Mexican border.

First the press report, and then some commentary.

UPDATE: Tamiflu-Resistant Swine Flu Found Near US-Mexico Border (Roche AG)
(Updates with details, background)

LA JOLLA, Calif. (AFP)--A strain of swine flu that is resistant to treatment with the drug Tamiflu has been discovered near the U.S.-Mexico border, the Pan-American Health Organization said on Monday.

"We have found resistance to Tamiflu on the border. We have observed some cases, few to be sure, in El Paso and close to McAllen, Texas," said Maria Teresa Cerqueira, head of the local PAHO office.

(Continue . . . )
​

A certain amount of `spontaneous? resistance to Tamiflu, according to Roche laboratories, is to be expected. They estimate that happens about .5% of the time, or about 1 in every 200 people that take the drug.

Up until now, only a handful of cases have been reported around the world, and no ongoing transmission of a resistant strain has been detected.

The great concern is that this novel H1N1 virus will acquire the same level of resistance to Tamiflu that seasonal H1N1 has over the past year. That would effectively eliminate our massive stockpiles of antivirals as a weapon against this pandemic and could drive the CFR (case fatality ratio) higher.

Right now, we have scant information available.

Until we know how many cases have been found, and whether there appears to be ongoing transmission of this strain, it is hard to gauge the seriousness of this report.

It is worrisome, however.

No doubt, officials at the CDC and the WHO will be watching this story closely, as shall we.

 

[HenryN]

Re: Denmark Tamiflu Resistant Sequence Released

Re: Denmark Tamiflu Resistant Sequence Released

The two companion sequences were collected Jun 4 (11F and 24M). The patient (21F) with resistance developed symptoms 5 days after the start of prophylactic Tamifu. The sample from her was collected 5 days after (Jun 9) the companion samples.

 

[Zac]

Re: Denmark Tamiflu Resistant Sequence Released

Re: Denmark Tamiflu Resistant Sequence Released

With the tamiflu resistance now becoming evident in swine flu, would it be better to keep relenza on hand rather than tamiflu? (in terms of which is more likely to remain effective around October)

 

[HenryN]

Re: Denmark Tamiflu Resistant Sequence Released

Re: Denmark Tamiflu Resistant Sequence Released

With the tamiflu resistance now becoming evident in swine flu, would it be better to keep relenza on hand rather than tamiflu? (in terms of which is more likely to remain effective around October)

Both would be best (Relenza resistance may also be silently circulating and may appear as Relenza use increases).

 

[HenryN]

Re: Tamiflu-resistant swine flu found on US-Mexico border

Re: Tamiflu-resistant swine flu found on US-Mexico border

Health official clarifies 'swine flu' remarks regarding El Paso

Posted:<SCRIPT language=JavaScript>var wn_last_ed_date = getLEDate("Aug4, 2009 7:37 PM EST"); document.write(wn_last_ed_date);</SCRIPT> Aug 4, 2009 07:37 PM EDT
Updated:<SCRIPT language=JavaScript>var wn_last_ed_date = getLEDate("Aug4, 2009 8:42 PM EST"); document.write(wn_last_ed_date);</SCRIPT> Aug 4, 2009 08:42 PM EDT
By ABC-7 Reporter Darren Hunt
EL PASO -- A Pan-American Health Organization official was quoted during a seminar in California Monday as saying there have been Tamiflu-resistant cases of the H1N1 virus in El Paso.
Tuesday that same official, Border Chief Maria Cerqueira, was pressed by ABC-7 and she clarified her remarks. She said tougher strains of the Swine Flu virus are a concern but there have been no documented cases in El Paso or anywhere else along the border.
"There are lots of questions about vaccines, about the actual virus," said Cerqueira. "There's things we really don't know because it's so new, there is very little evidence and there's also very limited resources to research everything."
Officials with Cerqueira's organization responded via a statement. They said their border chief's comments, which were publicized in an article in the Armed Forces Press, were "inadvertent."
In the article, Cerqueira said, "We have found resistance to Tamiflu on the border. We have observed some cases, few to be sure, in El Paso and close to McAllen, Texas."
The article went on to state the resistant strains were likely emerging because of the overuse of Tamiflu along the border with Mexico. "In the United States, Tamiflu is sold with a prescription, but in Mexico and Canada it is sold freely and taken at the first sneeze. Then, when it is really needed, it doesn't work," Cerqueira added.
She went on to say the best way to avoid the possibility of getting a Tamiflu-resistant version of the virus is to avoid self-medicating with the drug.
A spokeswoman for the City Health Department said there have been no such documented cases but added there no labs in the Borderland to test for anti-viral resistance.

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