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Emergence of seasonal influenza viruses type A/H1N1 with oseltamivir resistance in some European Countries at the start of the 2007-8 influenza

Re: :::Emergence of seasonal influenza viruses type A/H1N1 with:::

Re: :::Emergence of seasonal influenza viruses type A/H1N1 with:::

http://www.faz.net/s/Rub7F74ED2FDF2...AA9F0344C5D20B8754~ATpl~Ecommon~Scontent.html

Nicoll, ECDC said:

> Norway is a country, which in relation to Germany much less traveler visits. "if at the beginning
> of one flu season coincidentally a few resistant viruses enter there, become generally accepted
> they in much larger measure." But Nicoll assumes still "something", which helps these resistant
> viruses during the spreading. Perhaps the close resistance mutation H274Y the virale hereditary
> property could be additionally changed and strengthen the exciters. This unknown mutation
> would spread ruggedness at the same time with each virus. Thus it could be also explained
> why for a long time well-known virus trunks with H274Y-Mutation not already spread years ago -
> evenly because the Fitnessmutation was missing to them. "always the use of a medicine
> does not promote the resistance", says Nicoll. But one cannot exclude that the active
> substance completely played a role with the emergence of this resistance at the beginning.


----------------------------------------
Der au?ergew?hnlich hohe Anteil resistenter Viren in Norwegen ist laut Nicoll ohnehin Zufall. Norwegen sei ein Land, das im Verh?ltnis zu Deutschland viel weniger Reisende besuchen. ?Wenn zu Beginn einer Grippesaison dort zuf?llig ein paar resistente Viren einreisen, setzen sie sich in viel gr??erem Ma?e durch.? Aber Nicoll vermutet noch ?irgendetwas?, das diesen resistenten Viren bei der Verbreitung hilft. Nahe der Resistenz- mutation H274Y k?nnte das virale Erbgut zus?tzlich ver?ndert sein und vielleicht die Erreger st?rken. Diese unbekannte Mutation w?rde mit jedem Virus zugleich Widerstandsf?higkeit verbreiten. Damit lie?e sich auch erkl?ren, warum seit langem bekannte Virenst?mme mit H274Y-Mutation sich nicht schon vor Jahren verbreitet haben - eben weil ihnen die Fitnessmutation fehlte. ?Nicht immer f?rdert der Gebrauch eines Medikaments die Resistenz?, sagt Nicoll. Aber man k?nne nicht ausschlie?en, dass der Wirkstoff bei der Entstehung dieser Resistenz ganz am Anfang eine Rolle gespielt habe.
 
::VIRAL ISOLATES OR H1N1 RESISTANT TO OSELTAMIVIR::UPDATE::

::VIRAL ISOLATES OR H1N1 RESISTANT TO OSELTAMIVIR::UPDATE::

From WHO Website:
-
(1) [SEASONAL INFLUENZA, ANTIVIRALS, WHO, UPDATES] Influenza A(H1N1) virus resistance to oseltamivir - Last quarter 2007 to 14 February 2008


The detection of an increased number of A(H1N1) viruses with resistance to oseltamivir was initially reported to WHO from Norway on 25th January (see WHO website ).

Before recent detection of a high prevalence of oseltamivir resistance in influenza A (H1N1) viruses with a specific neuraminidase mutation (H274Y) in Norway, such resistance was rarely observed in community isolates.

During the previous northern hemisphere winter season (2006/07), surveillance through GISN laboratories found no oseltamivir - resistant H1N1 viruses in isolates from Japan and Europe, and less than 1% prevalence in H1N1 isolates from the USA.


In addition to Norway, several other countries in Europe and North America have found elevated prevalence of oseltamivir-resistant viruses this season (Table).

However, insufficient data are available at present to determine the full geographic scope, origins, or patterns of transmission of these oseltamivir resistant H1N1 viruses.


WHO is collecting global data about this phenomenon from multiple laboratories participating in GISN.

Data for European countries in the table below were provided by the EISS and ViRgil project.


This summary table will be updated regularly as new data and reports become available.


Oseltamivir resistance results were obtained with using phenotypic and/or genotypic analysis

-
http://www.who.int/csr/disease/influenza/H1N1ResistanceWeb20080214.pdf
-




-----
 
.:EUROPEAN INFLUENZA SURVEILLANCE SCHEME, UPDATE:.

.:EUROPEAN INFLUENZA SURVEILLANCE SCHEME, UPDATE:.

14/02/2008
Update A(H1N1) viruses resistant to oseltamivir

The update on 13 February 2008 showed that out of 986 influenza A(H1N1) virus isolates tested, 202 (20.5%) were resistant to oseltamivir in Europe.

Resistant A(H1N1) viruses were found in 13 countries: Austria, Belgium, Denmark, Finland, France, Germany, Greece, Luxembourg, the Netherlands, Norway, Portugal, Sweden, and the United Kingdom.
The proportion resistant A(H1N1) viruses ranged from 4.3% in Denmark to 66.3% in Norway. (AM)
-
http://www.eiss.org/news.cgi
-----
eiss1apu8.jpg

Shot at 2008-02-15
eiss1bic3.jpg

Shot at 2008-02-15
------
 
Re: :::Emergence of seasonal influenza viruses type A/H1N1 with:::

Re: :::Emergence of seasonal influenza viruses type A/H1N1 with:::

CDC Questions and Answers on Anti-viral resistance:

"Questions & Answers
Influenza Antiviral Drug Resistance

NOTE: The information in this document is based on flu activity as of February 9, 2008. This document will be updated as needed as the flu season progresses."

http://www.cdc.gov/flu/about/qa/antiviralresistance.htm
 
Re: :::Emergence of seasonal influenza viruses type A/H1N1 with:::

Re: :::Emergence of seasonal influenza viruses type A/H1N1 with:::

CHICAGO -- The Illinois Department of Public Health has issued a health alert to doctors and hospitals because ten Chicago-area patients have tested positive for an unusual type of drug-resistant influenza.
Authorities say the strain of flu can be successfully treated with some drugs, but it does not respond to Tamiflu, which is the most common antiviral medication for flu.
The alert suggests that flu patients who are in intensive care be given a combination of drugs.
Authorities say eight of the ten Tamiflu-resistant infections came from an outbreak at a single Chicago health care facility. They did not release the name of that facility.

http://abclocal.go.com/wls/story?section=news/local&id=5961641
 
Re: :::Emergence of seasonal influenza viruses type A/H1N1 with:::

Re: :::Emergence of seasonal influenza viruses type A/H1N1 with:::

niman said:
Commentary

http://www.recombinomics.com/News/02160803/Tamiflu_Chicago.html
Click to expand...
Commentary http://www.recombinomics.com/feed.xml http://www.newsnow.co.uk/nn/Recombinomics

Tamiflu Resistance Explodes in Chicago

Recombinomics Commentary 18:59
February 16, 2008

Authorities say eight of the ten Tamiflu-resistant infections came from an outbreak at a single Chicago health care facility

The above comments on ten oseltamivir resistant cases in Chicago, including eight from one health care facility, suggest the incidence of Tamiflu resistance is on the rise in the United States. To date the US has reported 16 cases for the entire season, so if the 10 cited above are in the infleunza surveillance network, the number of positives will be markedly higher in the near term. It is likely that the 10 will be H1N1 and resistant because of H274Y, which is true for all isolates reported this season in the United States.

The high concentration at one facility suggests the H274Y is evolutionarily fit, although there is a possibility that these patients were being treated with Tamiflu. However, reports from Europe, where Tamiflu resistance is high, indicate such cases were not treated with Tamiflu.

These cases could pose a serious health problem in at risk populations because Tamiflu is rendered useless by H274Y, and the recent H1N1 isolates in the US and Europe have been the Brisbane strain, which is not well recognized by the current trivalent vaccine. The match failures for H3N2 and influenza B, coupled with the poor match for Brisbane H1N1 has been associated with rapid spread of influenza in the United States, which has generated an MMWR report this week, and the second CDC news conference in a week.

This latest explosion in Tamiflu resistance suggests the frequency will continue to grow. The Tamiflu status of these 10 patients would be useful.


.
 
Re: :::Emergence of seasonal influenza viruses type A/H1N1 with:::

Re: :::Emergence of seasonal influenza viruses type A/H1N1 with:::

MSNBC had a segemnt on seasonal flu. I just caught the tail-end. Sounds like 48-49 states now have widespread activity. Speaker (Dr Lamb?) said to get a flu shot, even though the match is'n't good.

He also mentioned Tamiflu but did say that the resistance been detected was "disturbing".
 
Re: :::Emergence of seasonal influenza viruses type A/H1N1 with:::

Re: :::Emergence of seasonal influenza viruses type A/H1N1 with:::

http://www.cdc.gov/eid/content/14/1/173.htm
...Still, we cannot explain why children were preferentially infected with adamantine-resistant
strains in 2004–05.
There may have been multiple introductions of adamantane-resistant influenza viruses from other geographic areas during the 2004–05 season. This phenomenon was described in a recent phylogenetic analysis of influenza A (H3N2) isolates from New York state over a 9-year period (14). The analysis suggested that viral evolution within epidemic seasons is dominated by random importation of distinct viral strains from other geographic areas...

http://www.ncbi.nlm.nih.gov/pubmed/16198766?dopt=Abstract
...During the decade of surveillance a significant increase in drug resistance was noted, from 0.4% in 1994-1995 to 12.3% in 2003-2004. This increase in the proportion of resistant viruses was weighted heavily by those obtained from Asia with 61% of resistant viruses isolated since 2003 being from people in Asia

link
...significant increase in adamantane resistance in circulating H3N2 viruses in Alberta from 2005 and 2006 when compared with those from 2004 (p<0.001). Adamantane resistance peaked at 74% in 2006 and then decreased (to 38%) in 2007...
 
:.WHO SITUATION UPDATE.:

:.WHO SITUATION UPDATE.:

From WHO website:
-
Influenza A(H1N1) virus resistance to oseltamivir - Last quarter 2007 to 21 February 2008
The detection of an increased number of A(H1N1) viruses with resistance to oseltamivir was initially reported to WHO from Norway on 25th January (see WHO website:
http://www.who.int/csr/disease/influenza/oseltamivir_faqs/en/index.html ).
Before recent detection of a high prevalence of oseltamivir resistance in influenza A (H1N1) viruses with a specific neuraminidase mutation (H274Y) in Norway, such resistance was rarely observed in community isolates.
During the previous northern hemisphere winter season (2006/07), surveillance through GISN laboratories found no oseltamivir - resistant H1N1 viruses in isolates from Japan and Europe, and less than 1% prevalence in H1N1 isolates from the USA.

In addition to Norway, several other countries in Europe and North America have found an elevated prevalence of oseltamivir-resistant viruses this season (Table).
However, insufficient data are available at present to determine the full
geographic scope, origins, or patterns of transmission of these oseltamivir resistant H1N1 viruses.

WHO is collecting global data about this phenomenon from multiple laboratories participating in GISN. Data for European countries participating in EISS were provided by the EISS and VirGil project.
WHO would like to thank all countries, virologists, clinicians and others for contributing data.

This summary table will be updated regularly as new data and reports become available.
Oseltamivir resistance results were obtained with using phenotypic and/or genotypic analysis.

-
http://www.who.int/csr/disease/influenza/H1N1ResistanceWeb20080221.pdf
---


[FROM ECDC]
------
 
Re: :::Emergence of seasonal influenza viruses type A/H1N1 with:::

Re: :::Emergence of seasonal influenza viruses type A/H1N1 with:::

Thank you Ironorehopper. Interesting. This chart is showing that oseltamivir resistance is also occurring in Japan.
 
Re: :::Emergence of seasonal influenza viruses type A/H1N1 with:::

Re: :::Emergence of seasonal influenza viruses type A/H1N1 with:::

are they saying whether the mutation just happens isolated
so viruses with and without that single mutation coexist,

or whether it's part of a new strain which is trying to replace
other strains ,
so the mutation only happens together with other mutations ?
 
Re: :::Emergence of seasonal influenza viruses type A/H1N1 with:::

Re: :::Emergence of seasonal influenza viruses type A/H1N1 with:::

gsgs said:
are they saying whether the mutation just happens isolated
so viruses with and without that single mutation coexist,

or whether it's part of a new strain which is trying to replace
other strains ,
so the mutation only happens together with other mutations ?
Click to expand...
In biology, things don't "just happen" (and don't just happen in 2008!).
Influenza has been around. It KNOWS how to evolve, even if the sequencers don't.
"Random mutations" are nonsense, and dead as a doornail.
 
Re: :::Emergence of seasonal influenza viruses type A/H1N1 with:::

Re: :::Emergence of seasonal influenza viruses type A/H1N1 with:::

Florida1 said:
Thank you Ironorehopper. Interesting. This chart is showing that oseltamivir resistance is also occurring in Japan.
Click to expand...

Thanks to you.
I posted other tables from both WHO and ViRGIL during past weeks and all are in this thread. If viewing is difficult please contact me for updating image size.
 
Re: :::Emergence of seasonal influenza viruses type A/H1N1 with:::

Re: :::Emergence of seasonal influenza viruses type A/H1N1 with:::

2007-2008 Influenza Season Week 7, ending February 16, 2008
(All data are preliminary and may change as more reports are received.)
Synopsis

During week 7 (February 10 - 16, 2008), influenza activity continued to increase in the United States.
  • Two thousand three hundred forty (34.0%) specimens tested by U.S. World Health Organization (WHO) and National Respiratory and Enteric Virus Surveillance System (NREVSS) collaborating laboratories were positive for influenza.
  • The proportion of deaths attributed to pneumonia and influenza was above the epidemic threshold for the sixth consecutive week.
  • The proportion of outpatient visits for influenza-like illness (ILI) and acute respiratory illness (ARI) was above national baseline levels. ILI increased in six of the nine regions compared to week 6, and was above region-specific baselines in all nine regions. All nine regions reported ARI at or above their region specific baselines.
  • Forty-nine states reported widespread influenza activity; one state reported regional influenza activity; and the District of Columbia reported local influenza activity.
<TABLE class=table cellSpacing=0 cellPadding=3 align=center border=0><CAPTION>National and Regional Summary of Select Surveillance Components

</CAPTION><TBODY><TR vAlign=top><TH vAlign=bottom width=85 rowSpan=2>
Region​
</TH><TH noWrap align=middle width=300 colSpan=4>Data for current week</STRONG></TH><TH noWrap align=middle width=276 colSpan=5>Data cumulative for the season</TH></TR><TR vAlign=top><TH align=middle width=72>Sentinel Provider ILI*</TH><TH align=middle width=72>DoD and VA ARI*</TH><TH align=middle width=60>% pos. for flu?</TH><TH align=middle width=96># jurisdictions reporting regional or widespread activity? </TH><TH noWrap align=middle width=48>A (H1)</TH><TH noWrap align=middle width=48>A (H3)</TH><TH align=middle width=60>A Unsub-typed</TH><TH noWrap align=middle width=48>B</TH><TH align=middle width=72>Pediatric Deaths</TH></TR><TR><TD align=left width=85>Nation</TD><TD noWrap align=middle width=72>Elevated</TD><TD noWrap align=middle width=72>Elevated</TD><TD noWrap align=middle width=60>34.0 % </TD><TD noWrap align=middle width=96>50 of 51 </TD><TD noWrap align=middle width=48>1266</TD><TD noWrap align=middle width=48>2156</TD><TD noWrap align=middle width=60>8956</TD><TD noWrap align=middle width=48>2457</TD><TD noWrap align=middle width=72>22</TD></TR><TR><TD align=left width=85>New England</TD><TD noWrap align=middle width=72>Elevated</TD><TD noWrap align=middle width=72>Elevated</TD><TD noWrap align=middle width=60>22.4 % </TD><TD noWrap align=middle width=96>6 of 6</TD><TD noWrap align=middle width=48>34</TD><TD noWrap align=middle width=48>17</TD><TD noWrap align=middle width=60>293</TD><TD noWrap align=middle width=48>235</TD><TD noWrap align=middle width=72>0</TD></TR><TR><TD align=left width=85>Mid-Atlantic</TD><TD noWrap align=middle width=72>Elevated</TD><TD noWrap align=middle width=72>Elevated</TD><TD noWrap align=middle width=60>21.7 % </TD><TD noWrap align=middle width=96>3 of 3</TD><TD noWrap align=middle width=48>57</TD><TD noWrap align=middle width=48>20</TD><TD noWrap align=middle width=60>339</TD><TD noWrap align=middle width=48>379</TD><TD noWrap align=middle width=72>3</TD></TR><TR><TD align=left width=85>East North Central</TD><TD noWrap align=middle width=72>Elevated</TD><TD noWrap align=middle width=72>Elevated</TD><TD noWrap align=middle width=60>50.1 % </TD><TD noWrap align=middle width=96>5 of 5</TD><TD noWrap align=middle width=48>119</TD><TD noWrap align=middle width=48>532</TD><TD noWrap align=middle width=60>347</TD><TD noWrap align=middle width=48>223</TD><TD noWrap align=middle width=72>3</TD></TR><TR><TD align=left width=85>West North Central</TD><TD noWrap align=middle width=72>Elevated</TD><TD noWrap align=middle width=72>Elevated</TD><TD noWrap align=middle width=60>26.3 % </TD><TD noWrap align=middle width=96>7 of 7</TD><TD noWrap align=middle width=48>62</TD><TD noWrap align=middle width=48>65</TD><TD noWrap align=middle width=60>851</TD><TD noWrap align=middle width=48>182</TD><TD noWrap align=middle width=72>0</TD></TR><TR><TD align=left width=85>South Atlantic</TD><TD noWrap align=middle width=72>Elevated</TD><TD noWrap align=middle width=72>Elevated</TD><TD noWrap align=middle width=60>31.8 % </TD><TD noWrap align=middle width=96>8 of 9</TD><TD noWrap align=middle width=48>191</TD><TD noWrap align=middle width=48>676</TD><TD noWrap align=middle width=60>2119</TD><TD noWrap align=middle width=48>424</TD><TD noWrap align=middle width=72>1</TD></TR><TR><TD align=left width=85>East South Central</TD><TD noWrap align=middle width=72>Elevated</TD><TD noWrap align=middle width=72>Elevated</TD><TD noWrap align=middle width=60>42.9 % </TD><TD noWrap align=middle width=96>4 of 4</TD><TD noWrap align=middle width=48>21</TD><TD noWrap align=middle width=48>301</TD><TD noWrap align=middle width=60>22</TD><TD noWrap align=middle width=48>14</TD><TD noWrap align=middle width=72>4</TD></TR><TR><TD align=left width=85>West South Central</TD><TD noWrap align=middle width=72>Elevated</TD><TD noWrap align=middle width=72>Elevated</TD><TD noWrap align=middle width=60>34.9 % </TD><TD noWrap align=middle width=96>4 of 4</TD><TD noWrap align=middle width=48>86</TD><TD noWrap align=middle width=48>304</TD><TD noWrap align=middle width=60>3999</TD><TD noWrap align=middle width=48>472</TD><TD noWrap align=middle width=72>7</TD></TR><TR><TD align=left width=85>Mountain</TD><TD noWrap align=middle width=72>Elevated</TD><TD noWrap align=middle width=72>Elevated</TD><TD noWrap align=middle width=60>27.7 % </TD><TD noWrap align=middle width=96>8 of 8</TD><TD noWrap align=middle width=48>325</TD><TD noWrap align=middle width=48>172</TD><TD noWrap align=middle width=60>567</TD><TD noWrap align=middle width=48>346</TD><TD noWrap align=middle width=72>2</TD></TR><TR><TD align=left width=85>Pacific</TD><TD noWrap align=middle width=72>Elevated</TD><TD noWrap align=middle width=72>Elevated</TD><TD noWrap align=middle width=60>17.5 % </TD><TD noWrap align=middle width=96>5 of 5</TD><TD noWrap align=middle width=48>371</TD><TD noWrap align=middle width=48>69</TD><TD noWrap align=middle width=60>419</TD><TD noWrap align=middle width=48>182</TD><TD noWrap align=middle width=72>2</TD></TR></TBODY></TABLE>

* Elevated means the % of visits for ILI or ARI is at or above the national or region-specific baseline
? National data is for current week; regional data is for the most recent 3 weeks.
? Includes all 50 states and the District of Columbia
Laboratory Surveillance

During week 7, WHO and NREVSS laboratories reported 6,889 specimens tested for influenza viruses, 2,340 (34.0%) of which were positive, including 47 influenza A (H1) viruses, 379 influenza A (H3) viruses, 1,432 influenza A viruses that were not subtyped, and 482 influenza B viruses.
Since September 30, 2007, WHO and NREVSS laboratories have tested a total of 109,089 specimens for influenza viruses and 14,835 (13.6%) were positive. Among the 14,835 influenza viruses, 12,378 (83.4%) were influenza A viruses and 2,457 (16.6%) were influenza B viruses. Three thousand four hundred twenty-two (27.6%) of the 12,378 influenza A viruses have been subtyped: 1,266 (37.0%) were influenza A (H1) viruses and 2,156 (63.0%) were influenza A (H3) viruses.
Although influenza A (H1) viruses predominated through mid-January, an increasing proportion of subtyped influenza A viruses are influenza A (H3) viruses. Influenza A (H3) viruses were reported more frequently than influenza A (H1) viruses during January 20?February 9. During week 6, influenza A (H3) became the predominant virus for the season overall. This season influenza A (H3) viruses have been reported more frequently than A (H1) viruses nationally, as well as in five of the nine surveillance regions (East North Central, East South Central, South Atlantic, West North Central, and West South Central). Influenza A (H1) viruses have predominated circulation this season in the remaining four regions (Mid-Atlantic, Mountain, New England, and Pacific).
<CENTER>
image071.gif

http://www.cdc.gov/flu/weekly/weeklyarchives2007-2008/data/whoAllregt07.htmView WHO-NREVSS Regional Bar Charts | View Chart Data | View Full Screen </CENTER>Antigenic Characterization:


CDC has antigenically characterized 280 influenza viruses [141 influenza A (H1N1), 70 influenza A (H3N2), and 69 influenza B viruses] collected by U.S. laboratories since September 30, 2007.
Influenza A (H1) [141]
  • One hundred twenty-four (88%) of the 141 viruses were characterized as A/Solomon Islands/3/2006, the influenza A (H1N1) component of the 2007-08 influenza vaccine for the Northern Hemisphere and the 2008 influenza A (H1N1) component for the Southern Hemisphere.
  • Seventeen (12%) of the 141 viruses showed somewhat reduced titers with antisera produced against A/Solomon Islands/3/2006.
Influenza A (H3) [70]
  • Twelve (17%) of the 70 viruses were characterized as A/Wisconsin/67/2005-like, the influenza A (H3N2) component of the 2007-08 influenza vaccine for the Northern Hemisphere.
  • Fifty-five (79%) of the 70 viruses were characterized as A/Brisbane/10/2007-like. A/Brisbane/10/2007-like viruses are a recent antigenic variant which evolved from, but are antigenically distinct from, A/Wisconsin/67/2005-like. A/Brisbane/10/2007-like virus is the recommended influenza A (H3N2) component for the 2008 Southern Hemisphere vaccine.
  • Three (4%) of the 70 viruses showed somewhat reduced titers with antisera produced against A/Wisconsin/67/2005 and A/Brisbane/10/2007.
Influenza B (B/Victoria/02/87 and B/Yamagata/16/88 lineages) [69]
  • Victoria lineage [4]
  • Four (6%) of the 69 influenza B viruses characterized belong to the B/Victoria lineage of viruses.
    • o Two (50%) of these 4 viruses were characterized as B/Ohio/01/2005-like. The recommended influenza B component for the 2007-08 influenza vaccine is a B/Malaysia/2506/2004-like virus, belonging to the B/Victoria lineage. B/Ohio/01/2005 is a recent B/Malaysia/2506/2004-like reference strain.
      o Two (50%) of these 4 viruses showed somewhat reduced titers with antisera produced against B/Ohio/01/2005 and B/Malaysia/2506/2004.
  • Yamagata lineage [65]
  • Sixty-five (94%) of the 69 viruses were identified as belonging to the B/Yamagata lineage of viruses.
Antiviral Resistance:

In the United States, two groups of antiviral drugs have been approved by FDA for use in treating or preventing influenza infections. These two groups of antiviral drugs are: neuraminidase inhibitors (oseltamivir and zanamivir) and adamantanes (amantadine and rimantidine). A description of these drugs can be found at: http://www.cdc.gov/flu/protect/antiviral/index.htm.
  • Neuraminidase Inhibitor Antiviral Drugs: Small numbers of influenza viruses resistant to the neuraminidase inhibitor oseltamivir have been detected in the United States. Of the 471 influenza A and B viruses tested for antiviral resistance so far this season, 27 (5.7%) have been found to be resistant to oseltamivir. Currently all of the resistant viruses are H1N1 viruses, with 27 (8.7%) of all H1N1 viruses exhibiting a genetic mutation that confers oseltamivir resistance. All tested viruses retain their sensitivity to zanamivir. Additional information on antiviral resistance can be found at: http://www.cdc.gov/flu/about/qa/antiviralresistance.htm
    Adamantane Antiviral Drugs: Resistance to the adamantanes continues to be high. Among 282 influenza A viruses tested, 88 (31.2%) are resistant to adamantanes, including 98.6% of H3N2 viruses and 7.2% of H1N1 viruses. The adamantanes are not effective against influenza B viruses: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5606a1.htm
    Based on the level of oseltamivir resistance observed in only one influenza subtype, H1N1, and persisting high levels of resistance to the adamantanes in both H3N2 and H1N1 viruses, CDC continues to recommend the use of oseltamivir and zanamivir for the treatment or prevention of influenza. Use of amantadine or rimantadine is not recommended. Guidance on influenza antiviral use can be found at: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5606a1.htm
Pneumonia and Influenza (P&I) Mortality Surveillance

During week 7, 8.2% of all deaths reported through the 122 Cities Mortality Reporting System were reported as due to P&I. This percentage is above the epidemic threshold of 7.2% for week 7. Including week 7, P&I mortality has been above threshold for six consecutive weeks.
<CENTER>
picurve07.gif

View Full Screen</CENTER>Influenza-Associated Pediatric Mortality

Twelve influenza-associated pediatric deaths were reported to CDC during week 7 from ten states [AR, CA, CO(2), FL, IL, IN, MS, NYC, TX(2), and WI]. Since September 30, 2007, CDC has received a total of 22 reports of influenza-associated pediatric deaths that occurred during the current season.
<CENTER>
IPD07_small.gif

View Full Screen</CENTER>Influenza-Associated Pediatric Hospitalizations

Laboratory-confirmed influenza-associated pediatric hospitalizations are monitored in two population-based surveillance networks: the New Vaccine Surveillance Network (NVSN) and the Emerging Infections Program (EIP).
During November 4, 2007-February 9, 2008, the preliminary laboratory-confirmed influenza-associated hospitalization rate reported by the NVSN for children 0-4 years old was 1.83 per 10,000.
<CENTER>
NVSN07_small.gif
</CENTER>
<CENTER>View Full Screen </CENTER>
During September 30 ? February 2, 2008, the preliminary laboratory-confirmed influenza-associated hospitalization rate reported by the EIP for children 0?17 years old was 0.36 per 10,000. For children aged 0-4 years and 5-17 years, the rate was 1.0 per 10,000 and 0.1 per 10,000, respectively.
<CENTER>
EIP07_small.gif

View Full Screen </CENTER>Outpatient Illness Surveillance

Nationwide during week 7, 6.4% of outpatient visits reported through the U.S. Influenza Sentinel Provider Surveillance Network were due to influenza-like illness (ILI), which is above the national baseline of 2.2%. On a regional level, the percentage of visits for ILI increased in six of the nine regions compared to last week and ranged from 4.1% to 10.1%. All nine regions reported ILI above their region-specific baselines.
Starting in week 5, New York City began reporting ILI data collected electronically from emergency departments city-wide, adding approximately 60,000 additional patient visits per week to the U.S. Influenza Sentinel Provider Surveillance Network. Retrospective reports were submitted for all earlier weeks this season. While this change increases the total patient visits per week by approximately 15%, it is not expected to influence the national ILI outpatient visit percentage after population weighting, but may have a larger impact on the Mid-Atlantic regional ILI percentage.
During week 7, 3.7% of patient visits to Department of Veteran?s Affairs (VA) and Department of Defense (DoD) outpatient treatment facilities were for acute respiratory illness (ARI), which was above the national baseline of 3.2%. On a regional level, the percentage of visits for ARI ranged from 1.8% to 4.3%, and was at or above the region-specific baselines in all nine regions. The percentage of visits reported for ARI was at or above age-specific baselines in the 5-17 years, 18-49 years, 50-64 years, and >64 years age groups.
<CENTER>
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View Sentinel Providers Regional Charts | View Chart Data |View Full Screen
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View Full Screen </CENTER>Geographic Spread of Influenza as Assessed by State and Territorial Epidemiologists


During week 7 the following influenza activity was reported:
  • Widespread activity was reported by 49 states (Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, Wisconsin, West Virginia, and Wyoming).
  • Regional activity was reported by 1 state (Florida).
  • The District of Columbia reported local influenza activity.
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A description of surveillance methods is available at: http://www.cdc.gov/flu/weekly/fluactivity.htm
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Re: :::Emergence of seasonal influenza viruses type A/H1N1 with:::

Re: :::Emergence of seasonal influenza viruses type A/H1N1 with:::

http://www.usatoday.com/news/health/2008-02-22-flu-vaccine_N.htm?csp=34


Flu epidemic rises as expected

Posted 1h 13m ago (Feb. 22, 2008)




By Steve Sternberg, USA TODAY
The USA's flu epidemic continued to grow last week, with cases mounting in every state and a dozen new deaths among children, the government's leading flu expert said Friday.

Altogether 22 children have died of flu so far, with widespread flu activity reported in 49 states, up from 44 last week, says Nancy Cox, director of the Centers for Disease Control and Prevention influenza division. Only Florida is reporting regional flu activity for the week ending Feb. 16th, according to the CDC.

"Influenza activity has continued to increase, but not quite as dramatically as over the previous two weeks," she said in her weekly flu update. "We're within the normal parameters of what we'd expect for an influenza season."


Cox blamed much of the flu's recent influx on a switch in dominant viruses. The virus circulating in December and January had spread widely enough in previous years for people to build up immunity through infection or vaccination. More people in the USA were susceptible to the newer virus, she said. Another reason for the rise in cases is a mismatch in the make-up of the current flu vaccine. Only one of the three strains in the current vaccine matches those causing most of this year's cases, leaving people with less protection against two of the circulating strains.

As a result of the mismatch, a Food and Drug Administration advisory panel recommended on Thursday that all three flu viruses in this year's vaccine be replaced with three others for next year's flu season, citing a major change in the mix of circulating flu bugs. Vaccine manufacturers have had a "head start" in growing viruses that will be used in next year's vaccine, Cox says, because flu officials in September recommended a similar switch for the upcoming flu season in the Southern Hemisphere.
 
Re: :::Emergence of seasonal influenza viruses type A/H1N1 with:::

Re: :::Emergence of seasonal influenza viruses type A/H1N1 with:::

Situation in Hong Kong​
​
(week ending 9 February 2008)​

Increasing​
​
​
influenza activity has been observed over the previous weeks although a mild holiday effect was noted during
the week of Lunar New Year holiday causing a mild drop in consultation rates and influenza viruses detection. The average
consultation rates for ILI among sentinel private doctors (Figure 1) and general outpatient clinics (Figure 2) were 28.6 and
5.4 respectively in the week ending 9 February 2008. In the same week, fever surveillance at sentinel chid care centres was
suspended due to Lunar New Year holiday (Figure 3) and 0.10% of residents in the sentinel residential care homes for the
elderly (Figure 4) had fever. The consultation rate for ILI among chinese medicine practitioners (Figure 5) was 4.6 per 1,000
consultations. The laboratory surveillance system detected 16 influenza A (H1N1) viruses, 7 influenza A (H3N2) viruses and​

22 influenza B viruses (Figure 6). There were no confirmed influenza outbreaks reported (Figure 7).

http://www.chp.gov.hk/files/pdf/FLU_EXPRESS_Wk_6_2008.pdf
 
!WEEKLY UPDATE-WHO / ECDC!

!WEEKLY UPDATE-WHO / ECDC!

[In this post: (1) Antivirals Resistance, Seasonal Human Influenza A/H1N1, WHO / ECDC Update. See original texts at the source sites. EDITED.]

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(1a) [ANTIVIRALS, SEASONAL INFLUENZA, ECDC, UPDATES] Resistance to oseltamivir (Tamiflu) found in some European influenza virus samples
[http://www.ecdc.europa.eu/Health_topics/influenza/antivirals.html]

Updated 28th February 2008



Preliminary results from surveillance of antiviral drug susceptibility among seasonal influenza viruses circulating in Europe (the EU-EEA-EFTA countries) has revealed that some of the A (H1N1) viruses in circulation this winter are resistant to the antiviral drug, oseltamivir (also know by the brand name Tamiflu).

So far, 1497 samples of influenza A(H1N1) viruses isolated between November 2007 and February 2008 in 22 European countries have been tested by the EU-funded VIRGIL network and National Influenza Centres.

Surveillance in previous years by the same Virgil Project found minimal numbers of resistant findings so this is a new finding this season.

Of the 1497 samples, 294 from 15 countries showed evidence of resistance to oseltamivir, another 7 countries have had specimens tested and not yet shown any sign of resistance. The data are shown as a figure with a linked table.

It should be noted that for a number of countries the numbers tested are low and therefore these proportions are likely to changes as more testing is undertaken.

This year the predominant type of influenza A viruses in Europe are of the A/H1N1 type and these conform well to the types of influenza viruses used for this seasons influenza vaccine in the Northern Hemisphere.

Hence that vaccine is expected to give good protection against the resistant and non-resistant viruses.

There are also increasing numbers of B viruses as the season progresses but few other A viruses circulating in Europe.

Further details on the virus distribution this season (which varies from country to country) are available on the European Influenza Surveillance Scheme (EISS) weekly update which is also summarised in ECDC?s Influenza News

The proportion of A/H1N1 viruses that are resistant varies across Europe.

The highest proportion of resistant viruses to date have been in Norway where 82 (66%) of the 124 samples tested positive for resistance to oseltamivir.

Given the initial indication of a high level of resistance to oseltamivir in the A H1N1 viruses circulating in Norway, once the information came to their attention, the Norwegian authorities notified their EU partners and the World Health Organization (WHO) of this situation when the information cam to light at the end of January.

The Norwegian Public Health Institute also published an advisory to doctors and the public on its website that evening.

The country with the second highest proportion is France with 80 (39%) of 207 specimens showing the mark for oseltamivir resistance.

Experts from the European Centre for Disease Prevention and Control (ECDC), the European Commission, the European Influenza Surveillance Scheme and the World Health Organization (WHO) are currently assessing the significance of the data from the EISS VIRGIL network.

An interim European risk assessment has been published by ECDC and comments on this are welcomed to influenza@ecdc.europa.eu.

Global surveillance has started coordinated by WHO and has this has found evidence of similarly resistant viruses in North America and the Far East.

All data including that on the WHO web-site are refreshed every Thursday at present.

These are the first human influenza viruses resistant to oseltamivir found transmitting in the community anywhere in the world.

Similar viruses have been seen before but usually following treatment and those viruses have not been able to transmit and infect and have rapidly disappeared.

From the experience in Norway it seems that people who become ill with the oseltamivir resistant strain of A(H1N1) do not appear to become any more or less sick than people infected with ?normal? seasonal influenza.

That said, it should be remembered that any influenza A can cause severe disease or death in vulnerable people (older people, those with debilitating illnesses and the very young).

There is no evidence that the appearance of these new viruses are related to use of oseltamivir which is currently thought not to be widely prescribed in most European countries.

ECDC is now working to gather more information on routine oseltamivir use in Europe.

At this stage it is difficult to comment fully on the significance of these finding and impossible to predict whether these viruses will become more or less common as the season progresses.

ECDC, WHO, EISS, VIRGIL and authorities in the member states are investigating the new findings intensely and progress will be reported through this and other relevant web-pages.

For information on seasonal influenza and how to protect yourself against it.

Data were provided by the European Influenza Surveillance Scheme and the VIRGIL Project

ECDC would like to thank all countries, virologists, clinicians and others for contributing data.

Funding for the VIRGIL project comes from the European Union FP6 Research Programme and EISS is supported by ECDC. Laboratories in EISS contribute to the Global Influenza Surveillance Network managed by WHO.

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(1b) [ANTIVIRALS, SEASONAL INFLUENZA, ECDC, UPDATES] Oseltamivir resistance in human seasonal influenza type A/H1N1 isolates in Europe (EU, EEA, EFTA countries)
[http://ecdc.europa.eu/Health_topics/influenza/antivirals_graph.html]

Data were provided by the European Influenza Surveillance Scheme http://www.eiss.org/index.cgi and the VIRGIL Project http://www.virgil-net.org/ ECDC would like to thank all countries, virologists, clinicians and others for contributing data.
Funding for the VIRGIL project comes from the European Union FP6 Research Programme http://ec.europa.eu/research/health/influenza/proj13_en.html and EISS is supported by ECDC.
Laboratories in EISS contribute to the Global Influenza Surveillance Network managed by WHO.




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(1c) [ANTIVIRALS, SEASONAL INFLUENZA, ECDC, UPDATES] Oseltamivir resistance in human seasonal influenza Type A/H1N1 isolates in Europe (EU, EEA, EFTA Countries) - Season 2007/2008 Period 1/10/07 to 28/02/08
[http://ecdc.europa.eu/Health_topics/influenza/antivirals_table.html]

This season influenza virus type A (H1N1) has been the predominant virus among those reported 6 EISS to date.

As of January 27, where typing has been done to give an A/H Type or B virus, around 64% has been A/H1, under 2% A/H3 and 34% Type B.

Data were provided by the European Influenza Surveillance System http://www.eiss.org/index.cgi and the VIRGIL Project http://ec.europa.eu/research/health/influenza/proj13_en.html

ECDC would like to thank all countries for contributing data. Funding for the VIRGIL project comes from the European Union FP6 Research Programme and EISS is supported by ECDC.




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(1d) [ANTIVIRALS, SEASONAL INFLUENZA, WHO, UPDATES] Influenza A(H1N1) virus resistance to oseltamivir - Last quarter 2007 to 28 February 2008
[http://www.who.int/csr/disease/influenza/H1N1ResistanceWeb20080228.pdf]

The detection of an increased number of A(H1N1) viruses with resistance to oseltamivir was initially reported to WHO from Norway on 25th January (see WHO website:
http://www.who.int/csr/disease/influenza/oseltamivir_faqs/en/index.html ).

Before recent detection of a high prevalence of oseltamivir resistance in influenza A (H1N1) viruses with a specific neuraminidase mutation (H274Y) in Norway, such resistance was rarely observed in community isolates.

During the previous northern hemisphere winter season (2006/07), surveillance through GISN laboratories found no oseltamivir - resistant H1N1 viruses in isolates from Japan and Europe, and less than 1% prevalence in H1N1 isolates from the USA.

In addition to Norway, several other countries in Europe and North America have found an elevated prevalence of oseltamivir-resistant viruses this season (Table).

However, insufficient data are available at present to determine the full geographic scope, origins, or patterns of transmission of these oseltamivir resistant H1N1 viruses.

WHO is collecting global data about this phenomenon from multiple laboratories participating in GISN.

Data for European countries participating in EISS were provided by the EISS and VirGil project.

WHO would like to thank all countries, virologists, clinicians and others for contributing data.

This summary table will be updated regularly as new data and reports become available.

Oseltamivir resistance results were obtained with using phenotypic and/or genotypic analysis.







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Re: :::Emergence of seasonal influenza viruses type A/H1N1 with:::

Re: :::Emergence of seasonal influenza viruses type A/H1N1 with:::

Five cases resistant to Tamiflu seen aided by Relenza

Kyodo News


A strain of the influenza virus resistant to the antiviral drug Tamiflu was found in five flu patients in Yokohama, with three of them believed to comprise a group infection, health officials of the city said Thursday.
Relenza, another antiviral drug, was effective for the patients, who were all infected with the type A Soviet Union flu. Yokohama City Institute of Health advised caution in selecting a drug for that type of influenza.
The five, residents aged 8 to 13 of the same ward in Yokohama, saw doctors on Jan. 28. Three attend the same elementary school; the other two were diagnosed at the same health-care institution.
All were found to have a virus resistant to Tamiflu in a test before they were prescribed treatment.
Given that the resistant strain has not been found since then, they were isolated cases of infection, the institute said.
A similar Tamiflu-resistant type A Soviet Union strain was also found this winter in Europe and North America.
Tamiflu is known to be effective at containing flu symptoms, if taken early. Japan is building a stockpile of the drug to prepare for a new type of influenza epidemic. It has enough Tamiflu for 28 million people and enough Relenza for 1.35 million.

The Japan Times: Friday, Feb. 29, 2008

http://search.japantimes.co.jp/cgi-bin/nn20080229a7.html
 
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