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

Re: 1,000 Members!!!

Re: 1,000 Members!!!

machinetranslated, edited

Swine flu patient resistant to Tamiflu

GRONINGEN - In the University Hospital Groningen a swine flu patient was found to be resistant to the virus inhibitor Tamiflu. This is the first case in the Netherlands. Worldwide, only 32 cases of Tamiflu resistance were found.

The patient was hosptitalised last week in the UMCG. Despite treatment with Tamiflu the swine flu did not disappear, after research the resistance
could be confirmed.

The UMCG with National Institute of Mental Health and Public Health and Environment (RIVM) research to anyone in contact with the patient.
This to avoid spread f the resistant variant .

Tuesday, 03/11/2009

http://www.oogtv.nl/ontwikkelen/php/home.php?subaction=showfull&id=13715
 
Re: 1,000 Members!!!

Re: 1,000 Members!!!

Grippe H1N1 : premier cas de r?sistance au Tamiflu aux Pays-Bas
(AFP) ?
LA HAYE ? Un premier cas de r?sistance au Tamiflu, principal antiviral utilis? contre la grippe H1N1, a ?t? constat? aux Pays-Bas, a annonc? mercredi l'Institut n?erlandais pour la sant? et l'environnement (RIVM).
"Un patient pr?sentant de graves sympt?mes de la grippe a ?t? infect? par un virus H1N1 r?sistant ? l'oseltamivir", commercialis? sous le nom de Tamiflu, a pr?cis? le RIVM dans un communiqu?.
"C'est la premi?re fois aux Pays-Bas qu'un virus H1N1 r?siste ? l'oseltamivir", a-t-il ajout?.
Le virus r?sistant de la grippe "se transmet moins rapidement", a expliqu? ? l'AFP une porte-parole du RIVM, Jessica Grootenboer. "Il n'y a absolument aucune raison de paniquer", a-t-elle insist?.
L'Organisation mondiale de la sant? (OMS) a recens? ? ce jour 39 cas de r?sistance dans le monde, selon le RIVM.
Dix personnes sont mortes des suites d'une infection au virus H1N1 aux Pays-Bas, qui sont confront?s ? une "petite ?pid?mie", d'apr?s le RIVM. Un millier de personnes meurent chaque ann?e de la grippe saisonni?re dans le pays.
La grippe pand?mique H1N1 a fait "au moins 5.700 morts" depuis l'apparition de la maladie en mars-avril, selon un bilan de l'OMS rendu public le 30 octobre
 
Re: Netherlands: First case of swine flu resistance to Tamiflu

Re: Netherlands: First case of swine flu resistance to Tamiflu

google translated

Tamiflu-resistant flu virus did not spread

GRONINGEN - The Tamiflu resistant swine flu virus did not spread , says Jan Wilschut virologist at the University Medical Center Groningen.

Wednesday it was announced that the variant was detected in one patient in the UMCG. The man is in isolation in the intensive care unit of the hospital. He is in stable condition. The man suffers from an immune disorder, so the virus could easily mutate and multiply. By Tamiflu treatment the resistant strain of the virus prevailed. Wilschut expects that the new variant is milder.

The resistance has nothing to do with the vaccination against the Mexican flu. Wilschut press people at heart when they take the vaccine within the target designated by the government fall.

http://www.rtvnoord.nl/nieuws/indexwm.asp?actie=totaalbericht&pid=86328
 
Tamiflu resistance in A/H1N1 flu - historical compilation of news

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

"...China news agency, Hong Kong, November 6 (Reporter Xiao Ping) - Found in pigs in Hong Kong on the 5th for the first time just because "people pass pig" infected with a stream, and also confirmed the fifth case occurred in Hong Kong A flow of drug-resistant cases of influenza A H1N1 influenza re-emergence of concern changes, indicating a flow of the epidemic in Hong Kong can not be ignored..."


http://www.chinanews.com.cn/ga/news/2009/11-06/1952030.shtml
 
Re: Tamiflu resistance in A/H1N1 flu - historical compilation of news

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

according to latest WER from WHO -

"....cases associated with oseltamivir prophylaxis, 5 were isolated in Japan, 2 from the United States and 1 each from Canada, China and the Special Administrative Region (SAR) of Hong Kong..."

http://www.flutrackers.com/forum/showthread.php?p=311967
 
Re: Tamiflu resistance in A/H1N1 flu - historical compilation of news

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

hat tip Makoto -

<table border="0" cellpadding="10" cellspacing="0" width="100%"><tbody><tr><td class="j25" bgcolor="#ffffff">Tami Shiga full immunity from the 6-year-old girl
国内13例目
13 cases of domestic </td></tr><tr valign="top"><td class="j14">
滋賀県は5日、新型インフルエンザを発症した県内の女児(6)から採取したウイルスに、治療薬タミフルへの耐性を示す遺伝子変異が確認されたと発表した。​



Shiga Prefecture, the prefecture girls who develop pandemic influenza (6) taken from the virus, and its mutation was found to be resistant to Tamiflu treatment.
厚生労働省によると、タミフル耐性ウイルスの確認は国内13例目。​



According to the Ministry of Health, confirmed in 13 of 13 domestic cases of Tamiflu-resistant virus.


県は「タミフル服用後に体内でウイルスが変異した」とみている。​
County, "the mutant virus in the body after taking Tamiflu," the official said.
県によると、女児は10月14日に入院しタミフルを処方したが、19日に再び高熱となり、治療薬をリレンザに切り替えた。​

According to the county on Oct. 14 girls were admitted to prescribe Tamiflu, 19 and again on Wednesday with high fever, switched to the drug Relenza.
既に回復し、周囲への感染拡大は確認されていない。​

The recovery has already spread to the environment has not been confirmed.
(共同通信)​
(Kyodo News)

http://translate.google.com/transla...4&area=S00&sl=ja&tl=fr&history_state0=&swap=1

</td></tr></tbody></table>
 
Tamiflu resistance in A/H1N1 flu - historical compilation of news

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

http://health.usnews.com/articles/h...lu-resistant-swine-flu-found-in-canadian.html

Tamiflu-Resistant Swine Flu Found in Canadian Father
Latest case underscores need to use the antiviral properly, experts say
Posted November 11, 2009
By Steven Reinberg
HealthDay Reporter

WEDNESDAY, Nov. 11 (HealthDay News) -- Researchers report that a father in a Canadian family developed a strain of the H1N1 swine flu that was resistant to the antiviral Tamiflu, after being given the drug to prevent the disease.

To date, the World Health Organization has reported some 45 cases of H1N1 swine flu that were resistant to Tamiflu, which is why the U.S. Centers for Disease Control and Prevention and others caution against using Tamiflu to prevent the disease in people who are symptomless.

"We have a person who was taking post-exposure prophylaxis with Tamiflu, probably at the time he was already incubating the virus, but before symptoms developed," said lead researcher Dr. Guy Boivin, of the Centre Hospitalier Universitaire de Quebec, in Quebec.

According to the report, when the father's 13-year-old asthmatic son was hospitalized with H1N1 swine flu, other family members were given a reduced dose of Tamiflu to prevent them from getting the disease. These included the 59-year-old father, who suffered from chronic obstructive pulmonary disease (COPD), his 50-year-old wife and two teenage daughters.

Within a day the father developed flu symptoms, but he did not see a doctor for eight days. A test of his virus showed that it was resistant to Tamiflu. None of the other family members developed flu. The father recovered from the flu, according to the report in the Nov. 11 online edition of the New England Journal of Medicine.

The mutated strain of H1N1 swine flu remained susceptible to another antiviral, Relenza, Boivin added.

The family's experience was a good setting for resistance to emerge, Boivin said. When someone has the H1N1 swine flu, Tamiflu is given twice a day for five days. But when the drug is used to prevent the disease, it is given only once a day for 10 days, he explained.

Since the father was most likely already infected with swine flu, the dose of Tamiflu he received was ineffective at stopping the virus and low enough to allow the virus to develop resistance to the drug, Boivin said.

"In that context, Tamiflu is a risk factor for the emergence of resistance," he explained.

Boivin said that one-third of the known cases of H1N1 virus resistant to Tamiflu have been among people already exposed to the pandemic flu. "Another third emerged in imuno-compromised [weakened immune system] patients who received prolonged therapy with Tamiflu," he said.

The mutation of the H1N1 virus that caused its resistance to Tamiflu was the same one that was found in seasonal flu resistant to the drug. Last year, one strain of the seasonal flu was resistant to Tamiflu, Boivin said.

"You should be careful when you use post-exposure prophylaxis," Boivin said. In most cases, Tamiflu should be reserved for early treatment of flu when symptoms develop, he said.

Dr. Marc Siegel, an internist and associate professor of medicine at New York University Langone Medical Center in New York City, said that "Tamiflu prophylaxis given to the wrong people can increase your risk of a resistant strain developing -- and that's the last thing we need."

Siegel thinks, however, that Tamiflu used correctly can help prevent people from getting the flu, especially when the vaccine is in short supply.

"In the absence of available vaccine, one of the ways you can cut down on the spread of H1N1, to people you feel are at risk, is with the proper use of Tamiflu prophylaxis," he said.

Another expert, Dr. Pascal James Imperato, dean and Distinguished Service Professor of the School of Public Health at SUNY Downstate Medical Center in Brooklyn, N.Y., said that "based on our current knowledge, it appears that resistance of influenza viruses to the anti-influenza drug Tamiflu occurs in a setting of drug overuse."

This reported case from Canada underscores the need to limit the use of Tamiflu in people who aren't displaying flu symptoms, Imperato said.

"It also points out the need for increasing the dose of the drug to therapeutic levels in anyone who develops symptoms of influenza while on lower post-exposure prophylactic doses," he said
 
Tamiflu resistance in A/H1N1 flu - historical compilation of news

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

Mueren por gripe A dos ni?as de cuatro y 13 a?os en Catalu?a
Las menores no ten?an patolog?as previas que pudieran haber agravado la enfermedad, por lo que se trata de los dos primeros casos en Espa?a de pacientes sanos que pierdan la vida a causa del virus H1N1

COLPISA - 14/11/2009 17:36

La peque?a de cuatro a?os resid?a en el Prat de Llobregat y falleci? el jueves de forma repentina, igual que la otra menor, de 13 a?os, que viv?a en Barcelona. El Departamento catal?n de la Salud confirm? que ninguna de las dos ni?as padec?a "aparentemente problemas respiratorios, ni tampoco ten?an malformaciones cardiovasculares, ni siquiera obesidad", como casi todos los fallecidos por gripe A hasta la fecha.

Salud se?al? este s?bado que los m?dicos de los dos centros sanitarios donde perdieron la vida las ni?as investigan las causas de la muerte y sobre todo por qu? ninguna de las dos hab?a respondido a los antivirales que se les suministraron durante toda la semana.

Ante la gravedad del asunto, Salud y el departamento de Educaci?n han puesto en marcha de forma urgente los protocolos de informaci?n y seguimiento entre los padres de los alumnos de los centros donde estudiaban las menores fallecidas. Los centros escolares, no obstante, se han mantenido en el anonimato para no generar m?s alarma.

A estos dos casos se une el fallecimiento, tambi?n el jueves, de la primera menor en Catalu?a, en este caso una ni?a de 12 a?os de Castelldefels. Los profesores y m?dicos de los tres centros donde estaban escolarizadas las ni?as se esfuerzan desde el jueves en tranquilizar a los padres, seg?n inform? este s?bado el diario 'Avui'.

La incidencia de la gripe A en Catalu?a se ha disparado con la llegada del fr?o, la pasada semana. Al margen de las v?ctimas mortales, el n?mero de afectados se ha duplicado. Por ello, la consejera de Salud, Marina Geli, insiste constantemente en que "no hay que confiarse, ya que detecto una cierta relajaci?n entre la poblaci?n". Las muertes sin factores de riesgo previos ten?an que llegar, seg?n aseguraban tambi?n con cierta asiduidad los expertos. Y lo han hecho entre los ni?os no porque sean m?s vulnerables, sino porque la gripe est? masivamente extendida en esta franja de edad.

En Catalu?a han muerto por gripe A 14 personas, todas ellas con problemas y patolog?as previas y la mayor?a de edad avanzada, salvo las tres ?ltimas ni?as.

La campa?a de vacunaci?n comienza el lunes. Todo el personal sanitario ha sido convocado para que se vacunen no s?lo para su propia protecci?n, sino para evitar contagios a sus pacientes. Tambi?n estar? disponible para quien tenga dolencias cr?nicas y para mujeres embarazadas. Salud no ha incluido a los menores entre los grupos de riesgo a quienes recomienda vacunarse.

Fuente: Diari de Tarragona
http://www.diaridetarragona.com/panorama/036432/mueren/gripe/ninas/cuatro/13/anos/barcelona



Die from influenza A two children of four and 13 years in Catalonia
The minors had previous pathologies that could have aggravated the disease, so this is the first two cases of healthy patients in Spain who lose their lives because of the H1N1 virus

COLPISA - 14/11/2009 17:36

The small four-year resident in El Prat de Llobregat and died suddenly on Thursday, as the other minor, aged 13, who lived in Barcelona. The Catalan Health Department has confirmed that none of the two girls suffered from "apparent respiratory problems, nor had cardiovascular malformations, even obesity," as almost all deaths from influenza to date.

Health said Saturday that doctors in the two health centers where girls lost their lives researching the causes of death and especially why none of them had responded to antivirals that were provided throughout the week.

Given the seriousness of the case, Health and Education Department have launched an urgent information protocols and monitoring among parents of students in schools where the children studied who died. Schools, however, have remained anonymous to generate no more alarm.

These two cases are compounded by the death, also on Thursday, the first child in Catalonia, in this case a girl of 12 years of Castelldefels. The professors and doctors from the three schools where girls were struggling in school since Thursday to reassure parents, according to the newspaper reported Saturday 'Avui'.

The incidence of influenza A in Catalonia has been triggered by the arrival of the cold last week. Besides the fatalities, the number of affected children has doubled. Therefore, the Minister of Health, Marina Geli, constantly insists that "there must be trusted, and I detect a certain relaxation in the population. The deaths without previous risk factors had to come as well with some regularity claimed experts. They have done among children not because they are most vulnerable, but because flu is massively extended at this age.

In Catalonia has died of bird 14 people, all with problems and previous pathologies and most elderly, except the last three girls.

The vaccination campaign starts Monday. All healthcare staff have been subpoenaed to vaccinate not only for their own protection, but to avoid infecting their patients. It will also be available for anyone with chronic conditions and for pregnant women. Health has not included children between the risk groups who get immunized.

Source: Diari de Tarragona
http://translate.google.es/translat...2/mueren/gripe/ninas/cuatro/13/anos/barcelona
 
Re: Tamiflu resistance in A/H1N1 flu - historical compilation of news

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

Drug-resistant swine flu found

Published Date: 16 November 2009

SCOTLAND could be facing a drug-resistant strain of swine flu after two patients failed to respond to treatment.

One patient in the Lothians and another believed to be from Fife failed to respond to Tamiflu, one of the only treatments for the H1N1 virus.

Doctors around the world have seen a handful of cases where the virus has mutated to develop resistance to the drug.

NHS Lothian confirmed it has seen one patient with Tamiflu-resistant swine flu.

A spokesman for the Scottish Government said: "We are aware of Tamiflu resistance in two Scottish H1N1 patients.

"We have asked Health Protection Scotland to monitor the situation closely."

http://news.scotsman.com/health/Drugresistant-swine-flu-found.5826882.jp
 
Re: Tamiflu resistance in A/H1N1 flu - historical compilation of news

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

Update 74 Nov. 13, 2009

The WHO: To date, 52 oseltamivir resistant pandemic H1N1 influenza viruses have been detected and characterized worldwide. All of these viruses show the same H275Y mutation. All these viruses remain sensitive to zanamivir. Worldwide, more than 10,000 clinical specimens (samples and isolates) of the pandemic H1N1 virus have been tested and found to be sensitive to oseltamivir.

http://www.who.int/csr/disease/swineflu/laboratory13_11_2009/en/index.html
 
Re: Tamiflu resistance in A/H1N1 flu - historical compilation of news

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

Hong Kong press release from November 5, 2009 refers to fifth individual first noted in post #262 above.


Tamiflu-resistant human swine influenza virus detected
******************************************************

The Department of Health's Public Health Laboratory Services Branch (PHLSB) today (November 5) detected a strain of human swine influenza (HSI) virus which was resistant to oseltamivir (Tamiflu).

A department spokesman said the virus was identified during PHLSB's routine sensitivity tests of the HSI virus to oseltamivir and zanamivir.

"This is the fifth time Tamiflu resistance in HSI virus has been found in Hong Kong and is the fourth local case.

"Tests showed that this strain is sensitive to zanamivir (Relenza)," he said.

The virus was isolated from the specimen taken from a 74-year-old man who developed flu-like symptoms on October 4. He was admitted to United Christian Hospital on October 7 for acute exacerbation of his chronic lung condition. He has already recovered and was discharged from hospital on October 13.

His nasopharyngeal aspirate specimen tested positive for HSI.

Further test results today showed that the virus was resistant to Tamiflu. The man had a previous history of taking a full course of Tamiflu in late September during another admission for acute exacerbation of his chronic lung condition. His family member was asymptomatic.

The spokesman said there was no evidence of further transmission of Tamiflu-resistant HSI from the patient.

The PHLSB conducts routine sensitivity tests on specimens taken from confirmed HSI patients.

So far more than 5,500 HSI samples have been tested for antiviral sensitivity in Hong Kong.

The case will be reported to the World Health Organisation (WHO), the spokesman said.

Hong Kong has an intensive surveillance system for antiviral resistant influenza viruses.

"We will closely liaise with the WHO and overseas health authorities to monitor the global development of antiviral-resistant HSI virus," he said.

Ends/Thursday, November 5, 2009
Issued at HKT 19:46

http://www.info.gov.hk/gia/general/200911/05/P200911050238.htm
 
Re: Tamiflu resistance in A/H1N1 flu - historical compilation of news

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

Wales
Nov 20 2009 by Gregory Tindle, Western Mail

Excerpt:

And it emerged last night that two patients being treated in hospital have developed resistance to the antiviral Tamiflu, which has been used to treat the H1N1 virus.
Both received an alternative drug and one has recovered. The other patient, who has not been named, is being closely monitored.


http://www.walesonline.co.uk/news/h...-as-number-of-deaths-increase-91466-25211302/
 
Re: Tamiflu resistance in A/H1N1 flu - historical compilation of news

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

hat tip Lisa Schnirring
News: Person to person spread of swine flu resistant to Tamiflu

20 November 2009, National Public Health Service for Wales (NPHS)

The National Public Health Service for Wales (NPHS) has found person-to-person spread of a strain of swine flu resistant to Tamiflu within a South Wales hospital.

Five patients on a unit treating patients with severe underlying health conditions at the University Hospital of Wales, Cardiff, have been diagnosed with swine flu resistant to Oseltamivir (Tamiflu).

Three appear to have acquired the infection in hospital.

Dr Roland Salmon, Director of the NPHS Communicable Disease Surveillance Centre, said: ?The emergence of influenza A viruses that are resistant to Tamiflu is not unexpected in patients with serious underlying conditions and suppressed immune systems, who still test positive for the virus despite treatment.

?In this case, the resistant strain of swine flu does not appear to be any more severe than the swine flu virus that has been circulating since April.

?For the vast majority of people, Tamiflu has proved effective in reducing the severity of illness. Vaccination remains the most effective tool we have in preventing swine flu so I urge people identified as being at risk to look out for their invitation to be vaccinated by their GP surgery.?

Chief Medical Officer, Dr Tony Jewell, said: ?We know that people with suppressed immune systems are more susceptible to the swine flu virus, which is why they are a priority group under the first phase of the vaccination programme in Wales which is progressing at pace.

?We have stringent processes in place for monitoring for antiviral resistance in the UK so that we can spot resistance early and the causes can be investigated and the cases managed. Identifying these cases shows that our systems are working so patients should be reassured.

?Treatment with Tamiflu is still appropriate for swine flu and people should continue to take Tamiflu when they are prescribed it.

?It?s also important that good hygiene practices are followed to further prevent the spread of the virus.?

All patients diagnosed with Tamiflu-resistant swine flu on the unit have been treated with an alternative antiviral.

All other patients on the unit have been tested for swine flu.

Patients have been isolated or are being cared for in a designated area for influenza cases and Cardiff and Vale University Health Board has ensured that all appropriate infection control measures are in place on the unit.

Patients and staff at the unit have been offered swine flu vaccination. Patients due to come into the unit for treatment are being advised to have the vaccination from their GP in advance of coming to the hospital.

Household contacts of the patients with swine flu are being followed up to ensure early and appropriate treatment is offered should symptoms of influenza develop.

Two patients with Tamiflu-resistant swine flu have recovered and have been discharged from hospital. One patient remains in critical care and two others continue to be treated on the ward.


http://www.wales.nhs.uk/newsitem.cfm?contentid=13713
 
Re: Tamiflu resistance in A/H1N1 flu - historical compilation of news

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

USA: North Carolina

Drug resistant swine flu found in N.C. hospital

Posted <script type="text/javascript">document.write(niceDate('11/20/2009 3:05 PM'));</script>29m ago
By Steve Sternberg, USA TODAY
Epidemic experts have launched an investigation of four Tamiflu-resistant swine flu cases at Duke University Medical Center to see whether the resistant virus has begun spreading person-to-person at the Durham, N.C. hospital and beyond.


If so, the cluster appears to be the first instance in which Tamiflu-resistant virus has been transmitted from person to person.



"The four patients involved in this situation had the same resistance pattern," says Daniel Sexton, the hospital epidemiologist leading the investigation, adding that the Centers for Disease Control and Prevention are now testing virus samples to see whether they're identical.



"The resistance pattern suggests that might be the case," he says.
All of the patients were located in a ward for people with cancer or severe blood disorders. All were severely ill and were highly susceptible to infections, Sexton says.


The patients became ill with flu in October. When they didn't respond to Tamiflu, the hospital sent specimens of their virus to see whether the virus might be resistant to antiviral treatment. The results didn't come back until two weeks ago, prompting Duke to launch an investigation.

Sexton says three epidemiologists from the CDC as well as experts from the state health department are now at Duke assisting in the investigation. The investigation has now been extended outside Duke to determine whether Tamiflu-resistant flu is circulating elsewhere in North Carolina.
CDC spokesman Dave Daige says the agency did confirm the cases and has sent three Epidemic Intelligence Service "disease detectives" to assist in the investigation.


Three of the four Duke patients have died; the fourth is extremely ill but is being treated with another antiviral called Relenza and appears to be recovering.

-snip-

http://www.flutrackers.com/forum/showthread.php?t=133970
 
Tamiflu resistance in A/H1N1 flu - historical compilation of news

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

November 20, 2009, 1 submitted by Fondazione IRCCS Policlinico San Matteo, Italy:
<table border="0" cellpadding="2"> <thead> <tr> <td>
</td> <th>PB2</th> <th>PB1</th> <th>PA</th> <th>HA</th> <th>NP</th> <th>NA</th> <th>MP</th> <th>NS</th> </tr> </thead> <tbody><tr valign="top"> <th align="left">Influenza A virus
(A/Pavia/21/2009(H1N1))</th> <td>
</td> <td>
</td> <td>
</td> <td>
</td> <td>
</td> <td>GU216651*</td> <td>
</td> <td>
</td> </tr> </tbody><tbody> </tbody></table> * This sequence has the H274Y mutation that confers resistance to Oseltamivir.


http://www.ncbi.nlm.nih.gov/genomes/FLU/SwineFlu.html


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

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

2009-11-22

TamiFlu Resistance #13 from Italy: Novel with Swine Inclusion plus 4 Rare PF11 Amendments

The thirteenth TamiFlu Resistant specimen with a publicly available sequence, A/Pavia/21, was deposited Friday at GenBank with only Segment 6 (NA). The sample is contemporary and was taken 2009-11-16 on a nasal swab from a host with no gender or age identification in Pavia, a city of 71,000 in the Lombardy region of north central Italy. This Neuraminidase is remarkable due to the number and range of polymorphisms though the sequence is truncated 35 bases from the end.

The NA of Pavia21 is novel at the protein and the nucleotide level with no peer within ΣPF11, nor in the TamiFlu Resistant subset. The 5 polymorphisms on this sequence, if acquired via recombination, require a wide set of donors or more likely coincident recombination and adaptation events. Inclusions are noted that previously appear on Swine H1N1 (recent and 1931), Avian H1N1, Seasonal H1N1, Avian H5N1, Avian H6N1, Avian H10N1, Avian H11N1 and on very small and diverse sets of European PF11 sequences.

Three of the polymorphisms are silent. No combination of any 2 of the 5 signals seems to appear on documented public sequences. None of the signals other than 275Y appear on any previous PF11 TamiFlu-Resistant sequence.

NA Protein Codings to 1 Novel Polymorphism and 4 Rare Signals

  • syn70S
  • 275Y
  • 332K
  • syn360G
  • syn398E

syn70S
encoded from C210T, AGc->AGt
A/Catalonia/NS675 (2009-06-08) is the singular ΣPF11 peer.

332K
Novel to ΣPF11.
Progenitors may include:
H5N1 Avian Asia 2005, 2006, 2007, 2008
H6N1 Avian Europe 2005
H1N1 Swine 1977, 2002
H1N1 Seasonal 2007 (230I)
NCsw36883 (212E)
HKswNS1659
Iowa human swine worker 2005 H1N1 (IA/CEID23/2005)

syn360G
encoded from G1080A, GGg->GGa
Rare to ΣPF11 with 4 French instances in early pandemic.
Paris2590
Paris2591 (HA:225E)
Paris2592
Paris2604
Progenitors may include:
H1N1 Human North America 2007, Middle East 2006, 2007
H1N1 Avian North America 2006, 2007, 2008
H1N1 Avian Asia 2006
H1N1 Swine North America 1931, 2003, 2004, 2005, 2006
H1N1 Swine US 1931
H1N1 Swine Asia 1993, 2001, Europe 2001
H5N1 Avian North America 2005
H6N1 Avian North America 2007, Asia 2006
H10N1 Avian North America 2007
H11N1 Avian North America 2002

syn398E
encoded from G1194A, GAg->GAa
Rare to ΣPF11 with 7 instances.
Italy160 (July from Veneto)
Spain with 5 sequences as recently as 2009-10-28
Canada (May)
Progenitors unknown; however, a 12 residue span in this area, including protein 398, revises for WSN33 and H5N1 Human.

On Pavia21 TamiFlu Resistance is indicated in typical PF11 fashion via a Single Nucleotide Polymorphism coding for 275Y on the Neuraminidase. The sequence displays the following NA Quadruple Combination:

106I, 248D, 275Y, 286S

The following permutations are now represented on the thirteen PF11 anti-viral resistant sequences:

106V, 248N, 275Y, 286S = WA28, WA29, TX47
106I, 248N, 275Y, 286S = Osaka180
106I, 248D, 275Y, 286S = HK2369, Yamaguchi22, Denmark528, Hunan SWL3, Singapore57, Tokushima2, Iwate3, Quebec147365, Pavia21

Until the 2009-08-21 deposit of the two Washington sequences, all 275Y TamiFlu-Resistant specimens on PF11 backgrounds were paired with 106I. We continue to see only 3 of the 13 with 106V. The addition of Pavia21 heavily leverages position 248 toward Aspartate (D) with 9 specimens versus 4 with Asparagine (N). No TamiFlu Resistant specimen on file displays 286G as yet.

Pavia21 is the most hypermorphic TamiFlu-Resistant PF11 strain seen since the oddities from the immuno-compromised patients in Washington. Four changes other than H275Y is unusual in a single sequence.

We are quite impressed with the Influenza reservoir's ability to recycle data between serotypes without reassortment. Unless this sample were exposed to low level radiation during incubation, a series of accumulative recombinations have occurred over a very short time period or a triple co-infection enlisted all variants to build Pavia21 within a single host using an adaptation event to smooth the topping.

The most probable explanation is an accumulation of recombinations across the hypermorphic Catalonia region then exporting data to Italy via wild birds with a single co-incident adaptation event within the eventual host. Additionally, our team would not be at all surprised to find 225E on the HA of this patient's virus if the data is eventually published.

At any measure, another new background is now carrying TamiFlu Resistance in a central flyway for Influenza's primary transportation vector, wild birds.
 
Re: Tamiflu resistance in A/H1N1 flu - historical compilation of news

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

2009-11-22

TamiFlu Resistant Cluster of 4 at Duke Medical Center, North Carolina, US

As the thirteenth TamiFlu Resistant sequence was released publicly by Italy demonstrating a hypermorphic progression to another novel strain, the Duke University Medical Center contemporaneously described a group of patients acquiring PF11 Influenza in an isolated ward of their hospital. Four of the patients from this isolated ward were found to be infected with a TamiFlu Resistant strain. Transmission is suspected and may be verified by publication of all sequences from that ward over a time period covering two weeks prior, during and two weeks after the event. Three of the four patients had fatal outcomes (75%).

Antiviral resistance has now been documented in 50 instances, when investigated, including North America, Europe and widely across Asian countries. The 13 sequences that are available are, for the most part, incomplete for research into cross-segment linking of Hemagglutinin (HA) polymorphisms correlative to the antiviral-resistance conferring H275Y Neuraminidase (NA). Investigators are left at bare benches staring into empty beakers waiting for catalyst.

The resistance marker is now found on numerous backgrounds potentially demonstrating an ability to travel as a silent sub-species. Up to this current stage of the pandemic virus progression, this resistance trait, in several cases, appears to arise in an individual as the prominent super-infection (co-infecting silent H275Y PF11 strain) based on some unidentified characteristic of the individual's host-pathogen meshing, including immune dysregulation or other existing Cytokinic Dysregulation morbidities.

Publication of the remaining 37 sequences, including the Duke University Medical Center clinicals from this prestigious research institution, may benefit worldwide understanding of the efficacy and longevity of currently promulgated mediation measures for PF11.

For additional background on the clinical and epidemiological observational facts concerning Pandemic Influenza H1N1, please refer to the Table of Contents for PF11 Trends & Issues, Mid-Term.
 
Re: Tamiflu resistance in A/H1N1 flu - historical compilation of news

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

S.Korea reports first Tamiflu-resistant flu case

SEOUL ? Health authorities Monday reported South Korea's first case of swine flu that was resistant to the anti-viral drug Tamiflu, and called for extra precautions against any future cases.


The health ministry said in a statement that it found a Tamiflu-resistant strain of the (A)H1N1 virus in a five-year-old boy, who needed repeated and doubled doses of Tamiflu to recover.


Another anti-viral drug, Relenza, proved effective in specimens taken from the child but he was too young to take the drug, it added.


The ministry urged people to report immediately to hospitals or health authorities if Tamiflu had no effect five straight days after the first dose.
It said the World Health Organization has reported 75 Tamiflu-resistant cases globally since the first such case in North America in April.
South Korea's swine flu death toll has reached 104 but the spread of the disease is waning, according to the ministry.


http://www.google.com/hostednews/afp/article/ALeqM5jt6Hkp1giK9B-AiGiXzpgFsROPMg
 
Re: Tamiflu resistance in A/H1N1 flu - historical compilation of news

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

http://www.laverdad.es/murcia/20091129/region/esta-haciendo-virus-resistente-20091129.html

Spanish to English translation

What is being done about the virus resistant to Tamiflu?

29.11.09 - 03:23 - J. P. PARRA | MURCIA

A possible mutation of H1N1 has been from the outset a major concern of the World Health Organization (WHO). When in summer the epidemic began attacking South America, and demonstrated that the virus was particularly virulent, some voices warned that it was too early to declare victory. They recalled the case of Spanish flu, which appeared as a mild disease and ended up causing pneumonia in the fall of 1918 extreme virulence and thus, thousands of deaths.
Fortunately this has not happened, and many scientists have denounced the excessive alarmism with which health authorities themselves have been addressed from the outset this pandemic. However, that does not mean that vigilance has relaxed. Virology Unit The Arrixaca analyzed hundreds of samples for any alteration. "Many viruses are capable of spontaneous mutations," recalls Antonio Moreno, head of this unit.
The A H1N1, are no exception. Indeed, Norway, Denmark and France have in recent days detected an altered virus that makes it much more aggressive in at least five patients who died completed. Also in Pavia in Italy, has discovered a mutation that could be resistant to osetalmivir (active ingredient of the antiviral Tamiflu, used in severe cases of influenza A). "It happens also with the bacteria, which try to adapt to antibiotics, "explains Dr. Moreno.
In any case, French authorities made it clear yesterday that "there are elements that do not fear the spread of a mutant strain" and insisted that the cases detected are still isolated. Neither the region nor in the rest of Spain has now detected alteration.
What they have made it clear the analysis of over 500 samples analyzed in the Arrixaca in the last week is that the seasonal flu has been wiped off the map. 99% of the cases have tested positive for the new H1N1 virus. The rest, an insignificant amount corresponded to strains that have circulated in previous years.
 
Re: Tamiflu resistance in A/H1N1 flu - historical compilation of news

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

In GISAID database -

A/Tennessee/17/2009

1 year old, female

submitted by the CDC on November 25, 2009


oseltamivir resistant
 
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