Seasonal Influenza Outbreaks 2008 (excluding Hong Kong)

[Shiloh]

Source: http://www.stuff.co.nz/timaruherald/4489833a6010.html


Bird flu pandemic risk remains
The Timaru Herald | Monday, 21 April 2008


The hysteria surrounding bird flu may have flown the coop but the risk of a pandemic remains.

Timaru pharmacies have noted a distinct decline in the amount of antiviral medication Tamiflu being sold.

Timaru Hospital remains prepared for a pandemic with the medical officer of health Dr Daniel Williams saying the worst case scenario, based on information from the 1918 pandemic, would see 22,000 people in South Canterbury infected and 440 deaths over a few months.

Timaru pharmacies have noticed few sales of Tamiflu, following the initial sell-out.

Faulks and Jordan pharmacist Neil Savage said his pharmacy had not sold any for the past 12 months.

"At the start we could not get enough supplies.

"That said, we are only just moving into the season now."

Moyles Pharmacy pharmacist Vivien Macintosh said the pharmacy still had stocks and a prescription was required in most cases to get it.

Timaru Hospital business support manager Nathan Taylor said the hospital held a supply of Tamiflu which was updated continuously and dispensed to hospital patients with influenza like-illnesses.

"We are now entering the influenza season and are focusing on prevention (vaccination) strategies both in the hospital as well as through GPs.

"Should indications demonstrate an influenza pandemic is likely, a large stockpile for the South Island region is held in Christchurch, and would be available to the South Canterbury DHB, and other South Island DHBs. Regional stockpiles also exist for antibiotics used to treat the complications of influenza.

"Over the past four years we have work closely with our health providers and partner agencies, such as our three Civil Defence Emergency Management (CDEM) authorities, ambulance, police and fire service, to plan for the possibility of a pandemic.

"The concept of community-based assessment centres (CBACs) in every town in the district is now a realisation to ensure that we can effectively assess and treat patients with influenza-like illnesses in their own community."

Timaru Hospital held a bird flu pandemic presentation for 150 healthworkers on March 11, conducted by Dr Williams.

"A virus named H5N1 is causing concern at present. If it mutated into a form that was easily transmitted between humans, it would only take a few days to circumnavigate the globe.

"By week three of a pandemic, the number of sick patients would be about 10 times higher than the number of beds available at Timaru Hospital, and this figure would continue to rise over several weeks.

Hospital staff would also fall ill, or would need to stay home and care for sick family members, making the situation more urgent."

 

[sharon sanders]

Seasonal Influenza 2008

Seasonal Influenza 2008

This is a thread for seasonal influenza outbreaks and related information.

 

[Commonground]

Re: Seasonal Influenza 2008

Re: Seasonal Influenza 2008

Canada

Flu still spreading across N.B.
Last Updated: Tuesday, April 22, 2008 | 3:46 PM AT
CBC News
Flu season hasn't yet peaked in New Brunswick, according to provincial health officials.

A second strain of the flu virus is working its way across the province and many more people will likely fall ill over the next two weeks, said Dr. Wayne MacDonald, New Brunswick's chief medical officer of health.

"In the past three to four weeks, the activity has increased noticeably ? and probably even perhaps a little higher than expected," MacDonald said.

Flu season in New Brunswick typically peaks in late February to March but it hasn't yet this year, he said, and it isn't expected to for another week or more.

Getting a flu shot won't likely help because the vaccine was targeted at a different type of illness, he said. "So even if you had the vaccine you may be affected by it."

Flu sufferers may be able to find relief of some of the symptoms with over-the-counter medication, said pharmacist Jennifer Flower.

"Mostly just rest would be the main thing," Flower said. "Stay home and treat your fever and your aches, if you need to, with some painkillers out there."

http://www.cbc.ca/canada/new-brunswick/story/2008/04/22/flu-season.html?ref=rss

 

[Commonground]

Re: Seasonal Influenza 2008

Re: Seasonal Influenza 2008

hat-tip Helblindi

CDC Media Briefing: Influenza Vaccine Effectiveness
April 17, 2008, 12:00 p.m. ET

(...)

DAN JERNIGAN, DEPUTY DIRECTOR, CDC INFLUENZA DIVISION, NCIRD: (...) I'd like to next take a few minutes to discuss what we've been finding throughout the year in the laboratory. Most of the circulating influenza viruses this season have been less than optimally matched to the viruses in the vaccine. Influenza A H3N2, one of the two types of Influenza A, and Influenza A H1N1, the other type of Influenza A and Influenza B viruses have been co-circulating in the United States this year. H3N2 viruses, however, are the predominant virus that we have seen this year.

Of the viruses tested, about three quarters were Influenza A and most of those, around another three quarters, were the H3N2 subtype and up those about 70 percent were a string known as A-Brisbane10/ 2007. This particular strain is the one that is the predominant strain this year and is drifted, but it is still somewhat related to the A-Wisconsin strain, which in the 2007 - 2008 vaccine. The majority of the influenza B viruses, and 94 percent were characterized as B Florida, which is belonging to what we call the Yamagada lineage. This is a very different lineage of Influenza B than the Victoria lineage that's in the vaccine this year. No resistance to all Inhibitor has been observe in the other type of influenza AH3N2 or the influenza B viruses. CDC is continuing to monitor the situation closely. Finally, let me now spend a few minutes discussing the vaccine effect of this year's vaccine. Despite a less and optimum match in two of the three vaccine components this year, interim data indicates that the vaccine provided substantial protection against the predominant influenza viruses this season the H3N2 influenza A virus. Interim results of the vaccine effectiveness study carried out at the Marshfield clinic in Wisconsin appeared in this week's MMWR.

These results are from patients enrolled in the Marshfield studies in January 21st to February 8th of 2008. The article summarizes initial vaccine effect in this result for the trivalent inactivated vaccine, flu shot, in preventing medically attended laboratory confirmed influenza among patients living in a 14 zip code areas surrounding Marshfield, Wisconsin during this past influenza season. The study found in overall vaccine effectiveness are 44 percent against all types of influenza both A and B circulating in a community in Wisconsin. However, when you look at the effectiveness of the vaccine at preventing influenza A infections, they found a vaccine effectiveness of 58 percent against circulating influenza A H3N2 viruses, that's the predominant strain this year. There was no vaccine effectiveness against influenza B viruses found. There were no influenza A H1N1 viruses detected, so no vaccine effectiveness is available for the type of influenza A H1N1. While the vaccine effectiveness against the H3N2 viruses is less than might be expected during the season when the viruses and the vaccine, and circulating viruses are well matched, this interim result suggest that vaccination provided substantial protection against H3N2 influenza assorted, associated medically attended illness in the study population. This means that people in the study who are vaccinated were 44 percent less likely to have laboratory diagnosed influenza than those in the study that were not vaccinated. In regarding prevention of the influenza A H3N2, the predominant strain this year, those in the study that were vaccinated were 58 percent less likely to have laboratory diagnosed H3N2 infections than those that were not vaccinated.

(...)

JEANNE SANTOLI, DEPUTY DIRECTOR, CDC IMMUNIZATION SERVICES DIVISION, NCIRD: Hello, there. So, as Curtis told you, I wanted to provide you with an end of season look at the vaccines supply and distribution, and also to speak very briefly about what we're thinking about for the upcoming 2008/2009 season. So, for the 2007/2008 season, as you know there were six manufacturers who are licensed to produce vaccine for the U.S., and these manufacturers together produced a record amount of influenza vaccine approximately 140 million doses. This is about 20 million doses more than were produced in the prior season. Now, based on data that were reported to CDC by influenza vaccine manufacturers and distributors throughout last season, we know that approximately a 113 million doses of that vaccine were distributed. And, this is more vaccine that has been distributed in the U.S. in a single season before and it is about 10 million more doses than were distributed in the last season.

Now, looking ahead, we anticipate that next season's vaccine supply will be similar or somewhat increased to what we had available this season. But, we'll be receiving projections to understand that better from influenza vaccine manufacturers some time in the next month. Another thing to keep in mind, of course, about next season is that in February of this year, CDC's advisory committee on immunization practices voted to expand the annual influenza recommendations to include healthy children and adolescents 5 to 18 years of age. This recommendation is to be implemented during the upcoming 2008/2009 season as feasible and no later than the 2009/2010 season.

Now, you probably are well aware, prior recommendations for the vaccination of children and adolescents included all children 6 months through the fifth birthday, children 5 to 18 years of age with high risk medical conditions like asthma, diabetes or heart disease and children 5 to 18 years, who were the household contacts of high risk children and adults. Now this expanded recommendation for next season increases the number of children recommended for vaccination by about 30 million children although we know from experience with other vaccine recommendations that not all of these newly recommended children and adolescents will be vaccinated during the first season following this recommendation. Thank you very much.

(...)

HELEN BRANSWELL, CANADIAN PRESS: Hi. Thanks very much for taking my question. This efficacy study was done in week 6 which was kind of that around the time when H3 and H3N2 is making its surge and before the late season B surged. With that sort of paint ? because the picture was taken at that point, would it paint a nicer picture than actually might have been the case?

DAN JERNIGAN: The study was initiated when they first started seeing circulation in that community. And so, while compared to the overall U.S. population, it target at a relatively earlier point of that ? for that community. If that's your ? if your concern is that the initiation of the study tended to provide better results to the initiation of the study was done at the time when circulation began in that community.

(...)

CDC Transcript

Plenty more at the source

 

[gsgs]

Re: Seasonal Influenza 2008

Re: Seasonal Influenza 2008

effectiveness is meant as against lab-confirmed influenza here.
Ususally this is called "efficacy", I think. They should make this clear.

Whether and how much the vaccine reduced Influenza-symptoms
is not considered. This depends on the vaccination-coverage
of the participating population. This is not talked about (why ?).

Assuming average Wisconsin-coverage, I see no reduction
in influenza-like-symptoms for vaccinated people.
Arising the question whether the vaccine might reduce the
flu but at the same time increase other flu-like-illness ???

 

[Commonground]

Re: Seasonal Influenza Outbreaks 2008 (excluding Hong Kong)

hat-tip Aurora:

Rash of illness at Marion County Courthouse

Associated Press - April 24, 2008 9:35 AM ET

SALEM, Ore. (AP) - Workers are getting sick at the Marion County Courthouse in downtown Salem.

The court manager's office had to close yesterday when a security guard became sick and had to be taken to the hospital by ambulance.

Three other employees from the office became ill over the last week. A 40-year-old administrative assistant was hospitalized last week and she remains in intensive care.

Health official say she has a serious case of the flu, even though the peak of the flu season has passed.

Workers are cleaning the court manager's office wearing masks and gloves, along with a nearby courtroom.

http://www.ktvz.com/Global/story.asp?S=8220111

Flu breaks out in Oregon assisted living facility
4/24/2008, 8:58 a.m. PDT
The Associated Press

CORVALLIS, Ore. (AP) ? Health officials are monitoring a flu outbreak at a Corvallis assisted living center.

Officials say they confirmed 14 cases of an upper respiratory illness in residents and staff members at Stoneybrook Assisted Living by Wednesday.

Patients came down with symptoms that health officials first assumed were linked to pneumonia. But tests later revealed they had instead contracted influenza types A and B. [snip]

http://tinyurl.com/4325jf

hat-tip Tomo:

FYI-
Corvallis and Albany where the Marion Co. courthouse is (from the above article) are only 15-20 mi apart and a lot of people commute back and forth..

 

[Commonground]

Re: Seasonal Influenza Outbreaks 2008 (excluding Hong Kong)

Flu warning
Updated: 22:04, Thursday April 24, 2008
Scientists are warning Australians they are in for one of the worst flu seasons in recent years.

They're urging everyone to get their jabs as soon as possible, while they work on a more effective vaccine.

This year's flu virus has already cause unprecedented sickness in the northern hemisphere.

'The death rate and number of hospitalisations has been over double what they would see in a normal flu year, so this year we're in for a particularly bad flu season,' said Professor Nikolai Petrovsky of Flinders Medical Centre in Adelaide.

The health department says while it's too early to confirm how bad the flu season will be, it's best to be prepared.

Scientists from Flinders Medical Centre are developing a natural booster which Professor Petrovsky says is at least 10 times more effective than the current vaccine and could also be used to guard against bird flu.

Flinders wants to recruit 1,000 volunteers aged over 60 or with chronic illness to test the drug on people with lower immunity.

The new vaccine should be available within the next two years.

http://www.skynews.com.au/news/article.aspx?id=229908

 

[Giuseppe]

Re: Seasonal Influenza Outbreaks 2008 (excluding Hong Kong)

[From Weekly Epidemiological Record, http://www.who.int/wer - IOH]

Influenza(1)

This summary provides an updated report of seasonal influenza activity for weeks 14–15.

It does not include reports of avian influenza in humans, which are available at http://www.who.int/csr/disease/avian_infl uenza/fr/index.html
During weeks 14–15, the level of overall influenza activity in the world decreased.

Countries in northern hemisphere (except for Canada) reported reduced activity.

In Europe, although influenza B viruses predominated, influenza A (predominantly H1N1) viruses were also detected.

* Canada. The level of overall infl uenza activity increased in week 14 with the majority of the provinces reporting localized or widespread activity in at least one of their regions of surveillance. Widespread influenza activity was reported by 2 provinces (British Columbia and Quebec) and localized influenza activity by 25 regions (to date, the highest number reported this season).
Six regions reported no activity and 20 reported sporadic activity. Influenza A (mostly H1) viruses and influenza B viruses were detected in approximately same proportion.

* Croatia. Influenza activity declined from regional to sporadic. Influenza B viruses were detected.

* Luxembourg. Influenza activity decreased from local to sporadic, with B viruses predominating.

* Netherlands. Influenza activity remained widespread. Influenza B predominated over circulation of influenza A viruses.

* Norway. Regional outbreak was reported. Mostly influenza B viruses were detected.

* Russian Federation. Influenza activity declined from widespread to regional, with influenza A (H1 and H3) and influenza B viruses circulating.

* Slovakia. Local outbreak was reported with influenza B detected.

* United States of America. Local outbreaks were reported in week 14. Six states reported widespread influenza activity, 11 states reported regional influenza activity, 23 states reported local influenza activity; and 10 states plus the District of Columbia reported sporadic influenza activity. Influenza A (H3) viruses and infl uenza B viruses cocirculated.

* Other reports. Between weeks 14 and 15, sporadic influenza activity was detected in Belgium (A, B), Cameroon (H1),2 China (B, H3, H1), the Czech Republic (B), Denmark (B), Estonia (B), France (B), Germany (B), Greece (B), Hungary (A), Hong Kong SAR China (B, H1, H3), Ireland (B), the Islamic Republic of Iran (B), Italy (B), Japan (H3), Latvia (B, H3, H1), Mexico (B), Poland (A, B), Portugal (B, H1), Romania (B), Serbia (B), Spain (B), Sri Lanka (A, B), Sweden (B), Switzerland (B), Ukraine (B, H1) and the United Kingdom (B). Austria, Bulgaria, Lithuania, Mongolia, New Caledonia, Slovenia and South Africa reported no influenza activity.
-
1 See No. 13, 2008, pp. 115–116.
2 See No. 9, 2008, pp. 87–88.
-
Weekly epidemiological record - No. 17, 2008, 83, 145–156
http://www.who.int/wer
-
http://www.who.int/wer/2008/wer8317.pdf
------

 

[Giuseppe]

Re: Seasonal Influenza Outbreaks 2008 (excluding Hong Kong)

This week WHO update about antivirals resistance among seasonal human influenza A/H1N1 (http://www.who.int/csr/disease/influenza/H1N1ResistanceWeb20080425.pdf). Among this week's isolates, 23% are resistant.
See also, http://www.flutrackers.com/forum/showpost.php?p=151683&postcount=14 (with updated tables).

 

[Giuseppe]

Re: Seasonal Influenza Outbreaks 2008 (excluding Hong Kong)

World Health organization Update on Antiviral Resistance among seasonal human influenzavirus isolates.
http://www.who.int/entity/csr/disease/influenza/H1N1ResistanceWeb20080505.pdf

FT thread, updated: http://www.flutrackers.com/forum/showpost.php?p=154047&postcount=17 -
http://www.flutrackers.com/forum/showpost.php?p=154048&postcount=18

Among new isolates (191) 47% were resistant to oseltamivir (91). In the previous WHO report, resistant ratio was 23%.

 

[Commonground]

Re: Seasonal Influenza Outbreaks 2008 (excluding Hong Kong)

Chart from Post #10:

 

[Commonground]

Re: Seasonal Influenza Outbreaks 2008 (excluding Hong Kong)

(continued)

 

[Commonground]

Re: Seasonal Influenza Outbreaks 2008 (excluding Hong Kong)

(continued)

 

[Giuseppe]

Re: Seasonal Influenza Outbreaks 2008 (excluding Hong Kong)

[ANTIVIRALS, SEASONAL INFLUENZA, ECDC, UPDATES] Seasonal Influenza – European Status - Oseltamivir Resistance
[See also updated post with graphs in FT thread http://www.flutrackers.com/forum/showpost.php?p=155019&postcount=20 ]

Resistance to oseltamivir (Tamiflu) in some European influenza virus samples
As the influenza season is over all data including that on the WHO web-site this ECDC website and the EISS web-site will now be updated only monthly with the next update at the end of May.

§ Updated 7th May 2008
In late January 2008 antiviral drug susceptibility surveillance of seasonal influenza viruses in Europe (the EU-EEA-EFTA countries) by the EU-funded VIRGIL network and National Influenza Centres revealed that some of the A (H1N1) viruses circulating this season (winter 2007-8) were resistant to the antiviral drug, oseltamivir through mutation at position 274 in the viral neuraminidase gene.

Analysis of 2680 A(H1N1) viruses from 24 European (European Union, EEA/EFTA) countries isolated between November 2007 and April (data archived on May 7th) showed that 660 were resistant to oseltamivir, but retained sensitivity to zanamivir and amantadine.
The data are shown as a figure with a linked table.

This week’s totals include a report of the first resistant A/H1N1 viruses having been detected in Romania.

It should be noted that the influenza season has now finished in Europe so that new detections like this and other changes in the totals are the result of testing of specimens from during the season and checking of data for example to eliminate duplicates.

The proportion of A(H1N1) viruses that are oseltamivir resistant varied significantly across Europe. The highest proportion of resistant viruses to date have been in Norway where 168 (67%) of the 252 samples are resistant to oseltamivir, whereas no resistant viruses have been detected in five of the 24 countries.

Surveillance in previous years by the Virgil Project found <1% of circulating viruses to be resistant The predominant influenza A viruses in Europe in winter 07/08 were A(H1N1) viruses, antigenically similar to the A/Solomon Islands/3/2006 virus included in the 2007/08 N Hemisphere vaccine.

As the season progressed influenza B viruses started to circulate and then predominated. There were only limited circulation of other influenza A in Europe.

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

Following the observation of a high level of resistance to oseltamivir in the A H1N1 viruses circulating in Norway, the Norwegian authorities notified their EU partners and the World Health Organization (WHO) of this situation at the end of January. The Norwegian Public Health Institute also published an advisory to doctors and the public.

The country with the second highest proportion has been France with 231 (47%) of 496 specimens showing the marker for oseltamivir resistance. This was followed by the Netherlands and Luxembourg with proportions of 30% and 26% respectively.

There is no evidence that the appearance of these new viruses are related to use of oseltamivir which is currently seemingly not widely prescribed in most European countries. ECDC is now working with the manufacturer and national authorities to gather more information on routine oseltamivir use in Europe.

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 Russia, North America and the Far East.

Although sporadic low level transmission of drug resistant viruses may have taken place since 1999 when the Neuraminidase Inhibitor drugs first were licensed, the 07/08 winter season is the first time there has been widespread and sustained transmission of such viruses in the community.
Similar viruses have been seen before, but usually following treatment .

Such viruses previously have not been able to readily transmit and have rapidly disappeared. Clinical experience in Norway suggests that people who become ill with an oseltamivir resistant strain of A(H1N1) have a similar spectrum of illness to those infected with “normal” seasonal influenza A which can cause severe disease or death in vulnerable people (older people, those with debilitating illnesses and the very young). This is now being investigated in national and international studies coordinated by ECDC.

At this stage the significance of these findings remains uncertain. The emergence of drug resistance in the context of limited drug use is unexpected, and the extent of future circulation is difficult to predict. ECDC, WHO, EISS, VIRGIL and authorities in the member states are undertaking intensive surveillance and progress will be reported through this and other relevant web-pages. A summary of the arrangements for the EU EEA & EFTA Countries is available.

Briefing for policy makers in the EU and EEA/EFTA Member States

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

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://ecdc.europa.eu/Health_topics/influenza/antivirals.html
-
http://ecdc.europa.eu/Health_topics/influenza/antivirals_table.html
http://ecdc.europa.eu/Health_topics/influenza/antivirals_graph.html
--------

 

[Giuseppe]

Re: Seasonal Influenza Outbreaks 2008 (excluding Hong Kong)

[Update from ECDC]

[ANTIVIRALS, SEASONAL INFLUENZA, ECDC, UPDATES] Resistance to oseltamivir (Tamiflu) in some European influenza virus samples

As the influenza season is over, all data on the WHO, ECDC and EISS web-sites will now be updated only monthly with the next update at the end of June. Data can be expected to change because of testing of specimens taken earlier in the season
​

Updated 28th May 2008
In late January 2008, antiviral drug susceptibility surveillance of seasonal influenza viruses in Europe (the EU-EEA-EFTA countries) by the EU-funded VIRGIL network and National Influenza Centres revealed that some of the A (H1N1) viruses circulating this season (winter 2007-8) were resistant to the antiviral drug, oseltamivir through mutation at position 274 in the viral neuraminidase gene.

Analysis of 2748 A(H1N1) viruses from 24 European (European Union, EEA/EFTA) countries isolated between November 2007 and late May (data archived on May 28th) showed that 680 were resistant to oseltamivir, but retained sensitivity to zanamivir and amantadine.

The data are shown as a figure with a linked table.

It should be noted that the influenza season has now finished in Europe so that new detections like this and other changes in the totals are the result of testing of specimens from during the season and checking of data for example to eliminate duplicates.

The proportion of A(H1N1) viruses that are oseltamivir resistant varied significantly across Europe.

The highest proportion of resistant viruses to date have been in Norway where 182 (67%) of the 270 samples are resistant to oseltamivir, whereas no resistant viruses have been detected in five of the 24 countries.

Surveillance in previous years by the Virgil Project found <1% of circulating viruses to be resistant The predominant influenza A viruses in Europe in winter 07/08 were A(H1N1) viruses, antigenically similar to the A/Solomon Islands/3/2006 virus included in the 2007/08 N Hemisphere vaccine.

As the season progressed influenza B viruses started to circulate and then predominated.

There were only limited circulation of other influenza A in Europe.

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

Following the observation of a high level of resistance to oseltamivir in the A(H1N1) viruses circulating in Norway, the Norwegian authorities notified their EU partners and the World Health Organization (WHO) of this situation at the end of January.

The Norwegian Public Health Institute also published an advisory to doctors and the public.

The country with the second highest proportion has been France with 231 (47%) of 496 specimens showing the marker for oseltamivir resistance.

This was followed by the Netherlands and Luxembourg with proportions of 30% and 26% respectively. There is no evidence that the appearance of these new viruses are related to use of oseltamivir which is currently seemingly not widely prescribed in most European countries. ECDC is now working with the manufacturer and national authorities to gather more information on routine oseltamivir use in Europe.

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 updated every Thursday at present.

Although sporadic low level transmission of drug resistant viruses may have taken place since 1999 when the Neuraminidase Inhibitor drugs first were licensed, the 07/08 winter season is the first time there has been widespread and sustained transmission of such viruses in the community.

Similar viruses have been seen before, but usually following treatment.

Such viruses previously have not been able to readily transmit and have rapidly disappeared.

Clinical experience in Norway suggests that people who become ill with an oseltamivir resistant strain of A(H1N1) have a similar spectrum of illness to those infected with ?normal? seasonal influenza A which can cause severe disease or death in vulnerable people (older people, those with debilitating illnesses and the very young). This is now being investigated in national and international studies coordinated by ECDC.

At this stage the significance of these findings remains uncertain.

The emergence of drug resistance in the context of limited drug use is unexpected, and the extent of future circulation is difficult to predict.

ECDC, WHO, EISS, VIRGIL and authorities in the member states are undertaking intensive surveillance and progress will be reported through this and other relevant web-pages.

A summary of the arrangements for the EU EEA & EFTA Countries is on the ECDC web-site this is also available in a pdf version as a briefing for policy makers in the EU and EEA/EFTA Member States

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

Information on Antivirals and Antiviral Resistance
-
-----

 

[Giuseppe]

Re: Seasonal Influenza Outbreaks 2008 (excluding Hong Kong)

From the latest two ECDC reports there are:

- 7th May: 2680 H1N1 isolates and 660 total resistant to oseltamivir (24%)

- 28th May: 2748 H1N1 isolates and 680 total resistant to oseltamvir (24%)

- New isolates: 68 H1N1, 20 resistant to oseltamivir (29%).

 

[Giuseppe]

Re: Seasonal Influenza Outbreaks 2008 (excluding Hong Kong)

[FROM ECDC INFLUENZA NEWS: http://www.ecdc.europa.eu/ - IOH, EXCERPTS]

(...)
Crystal structures of oseltamivir-resistant influenza virus neuraminidase mutants.
Collins P.J. et al - Nature (2008) May 14. [Epub ahead of print]

In a complex laboratory study, a group from the WHO Influenza Collaborating Centre in Europe first studied the ability of the two commercially available antiviral neuraminidase inhibitors (oseltamivir and zanamivir) to bind to, and so potentially block the essential surface protein neuraminidase in wild type and three types of resistant influenza A viruses.

The resistant viruses were oseltamivir resistant influenza A(H1N1) with the H274T mutation (responsible for the recent emergence of antiviral resistance) (1), viruses with an A294S mutation isolated from patients receiving oseltamivir and an unusual A294S mutation seen in a naturally occurring (wild type) influenza A(H5N1) isolates from patients in Cambodia and Vietnam.

All three of the resistant viruses showed poor binding for oseltamivir but normal binding for zanamivir.

Meaning they would be resistant to oseltamivir but probably sensitive to zanamivir.

The group then went on to use crystallographic techniques to determine the structural basis of their observation, and showed how these mutations alter the binding site on the neuraminidase, making it have much less affinity for oseltamivir but unchanged affinity for zanamivir.

Finally the group makes some remarks about the need in their view to diversify the approach to antiviral strategies for a pandemic and not rely on one drug (oseltamivir) alone and even for the need to combined therapies.

ECDC Comment (29/05/2008):
This is an important and impressive study linking function with structure.

The emergence of oseltamivir resistance was a surprise to some who had hoped that influenza viruses would not easily develop resistance to oseltamivir which binds to a wide range of types of neuraminidase. (2)

The two A(H5N1) viruses studied here are not that worrying alone as almost all oseltamivir resistant influenza viruses that have emerged seemingly as a result of drug treatment have proved to transmit poorly onto other humans.

Similarly the naturally occurring oseltamivir resistant A(H5N1) viruses remain rare.

It is the emergence of viable and ?fit? human A(H1N1) viruses that has changed the landscape this year as they are the first oseltamivir viruses that are readily capable of competing with other susceptible viruses, even in the absence of oseltamivir use.(1,3)

This has been a timely reminder that no-one can predict the antiviral susceptibility of any novel influenza virus, including the next pandemic strain.

However it is hard to entirely support the speculation of the authors of the need to immediately add zanamivir to stockpile or to adopt combination therapies.

The intention of many stockpiles is that they can be applied speedily at a mass level.

However zanamivir is an inhaled drug which requires a certain amount of training before patients can use the drug successfully.

Logistical issues will need to be considered before adding this drug to stockpiles intended for mass use.

Also bivalent antimicrobial combination therapies are not combination therapies in the presence of high-levels of resistance to one drug.

They are sometimes adopted to avoid the emergence of drug-resistance due to drug pressure. However in the case of the emergence of human influenza viruses resistant to both the adamantanes and oseltamivir, this seems to be due to natural mutations rather than having anything to do with treatment pressure.

1) Lackenby A, Hungnes O, Dudman SG, Meijer A, Paget WJ, Hay A, Zambon MC Emergence of resistance to oseltamivir among influenza A(H1N1) viruses in Europe. Eurosurveillance 2008; 13 (5) Jan 31st 2008 http://www.eurosurveillance.org/edition/v13n05/080131_2.asp

2) Moscona A. Oseltamivir resistance--disabling our influenza defences. N Engl J Med. 2005a; 353: 2667-72.

3) Nicoll A, Ciancio B, Kramarz A. Observed oseltamivir resistance in seasonal influenza viruses in Europe interpretation and potential implications. Eurosurveillance 2008 13 (5) Jan 31st 2008 http://www.eurosurveillance.org/edition/v13n05/080131_1.asp
(...)
-
----

 

[gsgs]

Re: Seasonal Influenza Outbreaks 2008 (excluding Hong Kong)

which site updates reports of Tamiflu-resistance from
the tropes or the Southern Hemisphere ?

including Hongkong (don't understand why it should be excluded in this thread)


we have the WHO table here:
http://www.who.int/csr/disease/influenza/h1n1_table/en/index.html

updated about once per month, last update 5.May,2008


human H1N1-samples from flunet.org

week,Country,samples
------------------------------
20,China,3
21,China,7
19,Russia,16



time again for H3N2 after 2 seasons with H1N1 ?!

 

[Giuseppe]

Re: Seasonal Influenza Outbreaks 2008 (excluding Hong Kong)

which site updates reports of Tamiflu-resistance from
the tropes or the Southern Hemisphere ?

including Hongkong (don't understand why it should be excluded in this thread)


we have the WHO table here:
http://www.who.int/csr/disease/influenza/h1n1_table/en/index.html

updated about once per month, last update 5.May,2008


human H1N1-samples from flunet.org

week,Country,samples
------------------------------
20,China,3
21,China,7
19,Russia,16



time again for H3N2 after 2 seasons with H1N1 ?!

This thread is probably devoted to updates about influenza epidemic activity outside HK SAR. For antivirals resistance another thread exists you know.

WHO web site http://www.who.int/csr/disease/influenza/h1n1_table/en/index.html will be updated with new isolates perhaps in the next few days.

For HK SAR influenza activity see FT thread in this section (HK SAR Govt Updates).

 

[gsgs]

Re: Seasonal Influenza Outbreaks 2008 (excluding Hong Kong)

this one:
http://www.flutrackers.com/forum/showthread.php?t=51648

(BTW. what's the complete headline ?, I only get : ...with::
--edit1--- ahh, it's in the first post:
Emergence of seasonal influenza viruses type A/H1N1 with oseltamivir resistance in some
European Countries at the start of the 2007-8 influenza season
(thread is outdated now)


and one thread about resistance in England AFAIR


there should be an Australian site tracking H274Y now