[Discussion] Tamiflu could boost drug-resistant flu in wild birds

[JJackson]

http://www.flutrackers.com/forum/showthread.php?t=11760

A couple to things to consider before you loose to much sleep over this.

Tamiflu resistance develops fairly readily in both seasonal and H5N1 flu.

You would not get the kind of concentrations they are concerned about unless a pandemic had started and national stockpiles had been distributed (unless there was so much Tamiflu available it was being used as a widespread prophylactic).

In the event of a pandemic starting and there being thousands of infected patients taking Tamiflu it is almost inevitable a resistant strain would develop early on and be selected for. Why? There have been only slightly over 250 confirmed human cases, not all of whom have been given Tamiflu, and of those that have been sequenced - and released - there have already been 5 confirmed Tamiflu resistant sequences (Vietnam & Indonesia), in the event of efficient h2h spread this rate would equate to new resistant mutations daily.

All of the above would lead to a Tamiflu resistant pandemic from the get go and so there would be no need to invoke this route to generate Tamiflu resistant sequences for recombination; there will already be enough to go around.

Of the four Anti-virals Relenza is the only one which has not been shown to be susceptible to resistance but has its own problems due to its method of application.

Discuss.

 

[christian]

Re: [Discussion] Tamiflu could boost drug-resistant flu in wild birds

It seems tamiflu is used as a prophylactic on quite a large scale around infected areas. Considering the hygienic circumstances, the virus in some hosts (ducks, chickens, pigs) thus would have ample opportunity to 'get acquainted' with the molecule - doesn't this constitute a possible route to resistance?

 

[sharon sanders]

Re: [Discussion] Tamiflu could boost drug-resistant flu in wild birds

Thanks JJ for moving the discussion here.

I find the premise very interesting. There are other sections of the paper that re-confirm what many know:

"....The World Health Organization (WHO) confirmed 41 human deaths from avian influenza A (AIA)/(H5N1) in 2005, and 64 people have already died in 2006, more than twice the pace of the previous year. The current state of alert provides an unprecedented opportunity for the global community to devise strategies to decrease mortality rates in the event of pandemic influenza. An integral component of these strategies is the manufacture
of an effective vaccine. However, this cannot be produced until the emergence and identification of the pandemic influenza strain (McKimm-Breschkin et al. 2003). During the time it will take to prepare a vaccine the WHO recommends Tamiflu (oseltamivir phosphate (OP); Figure 1) for the treatment and prevention of pandemic influenza (WHO
2006)...."

Direct link to the paper: http://www.ehponline.org/members/2006/9574/9574.pdf

This underscores the situation. There are vaccine efforts underway, however, there needs to be alternative methods and strategies to help lessen morbidity and mortality in a pandemic. Some are:

social distancing,
http://www.flutrackers.com/forum/showthread.php?t=11542&highlight=social+distancing

preparations,
http://www.flutrackers.com/forum/forumdisplay.php?f=6

possible use of statins,
http://www.flutrackers.com/forum/showthread.php?t=11141

possible use of a "polypill",
http://www.flutrackers.com/forum/showthread.php?t=7652&highlight=polypill

traditional and natural methods,
http://www.flutrackers.com/forum/forumdisplay.php?f=164

Neighborhood and local support groups,
http://www.flutrackers.com/forum/forumdisplay.php?f=594

Faith based support groups,
http://www.flutrackers.com/forum/forumdisplay.php?f=441

 

[JJackson]

Re: [Discussion] Tamiflu could boost drug-resistant flu in wild birds

Christian you are quite right it is possible that in very small georaphical area (i.e. the village stream) there could be quite high levels but numbers of potential efected wild life is also very low and I would rate the risk low. However it might be worth explaining it to those given Tamiflu with a request to contain urine for the duration of thier treatment for disposal in a large enough water course to dilute it to biologically inactive levels.

 

[wetDirt]

Re: [Discussion] Tamiflu could boost drug-resistant flu in wild birds

Christian you are quite right it is possible that in very small georaphical area (i.e. the village stream) there could be quite high levels but numbers of potential efected wild life is also very low and I would rate the risk low. However it might be worth explaining it to those given Tamiflu with a request to contain urine for the duration of thier treatment for disposal in a large enough water course to dilute it to biologically inactive levels.

It would be better to dig a hole greater than 50 feet from any watercourse and bury it. There's nothing really wrong with latrines, anyway. Rural sanitation is abysmal, and the waterborne disease rates, also infant mortality, reflect this.

 

[Shannon Bennett]

Re: [Discussion] Tamiflu could boost drug-resistant flu in wild birds

I'd like to reiterate the alternative response route. It really isn't all that radical as all of the compounds studied here on the alt. med forum have scientific studies backing up their efficacy. There are very few viable alternatives, especially in the short run and in countries with a vast number of poor who cannot afford any but the cheapest medicines. The article I imported above is taken for the 'Science' article recently published. It suggests the best way to confront the disease is from the immunomodulatary route. We have identified several key substances that have that ability. It also recognizes high rates of replication, an overwhelming viral lode, and a lowering of leucocyte numbers. All of which may be moderated by substances we have researched.

 

[JJackson]

Re: [Discussion] Tamiflu could boost drug-resistant flu in wild birds

Andrew Singer, author of the paper this thread is discussing, has been posting in the comments on his paper at Effect Measure. Here is an interesting alternative treatment he had heard of, can you help him?

On a separate note, is anyone aware of published (or not) evidence that in China people dose a rag with vinegar and put it on a radiator, effectively volatilising the acid into the home which kills the virus (as the influenza virus is sensitive to pH above 9 and below 5). I heard this from a colleague but she couldn't remember where she heard this. it would be cheap, easy, and environmentally friendly with no side effects except a smelly home. It beats getting pandemic influenza! Of course you need to practice 'social distancing' to avoid getting the virus from your neighbor who is taking Tamiflu!

 

[gsgs]

Re: [Discussion] Tamiflu could boost drug-resistant flu in wild birds

jjackson, but the resistant Tamiflu mutation which occured so far
is said to be poorly transmittable.
There was a paper by Moscona in late 2005 and one in sciencemag.org
in April.
Countries are still stockpiling Tamiflu as pandemic preparation.

 

[JJackson]

Re: [Discussion] Tamiflu could boost drug-resistant flu in wild birds

gsgs

That is true of all H5N1 in mammals - as far as I know.

Of all know human H5N1 cases about 2% have had known Tamiflu resistant mutations, even if this was reduced by two or three orders of magnitude they would still be cropping up regularly once a pandemic was underway. If you then screen out many of the others with effective Tamiflu treatment it should not take long to find one which is both Tamiflu resistant and well adapted.
This is just a numbers game, 6.6 x 10^9 people * .25 (conservative CAR) * .01 (1% resistance) would still leave > 16 million cases with a resistant mutation, any one of which could seed a resistant wave.