Denmark - Dane with novel H1N1 found resistant to Tamiflu

[Dutchy]

caution - google translated

The first case in the world of resistance to influenza drug Tamiflu in people with influenza H1N1 has been found in Denmark.


Dane resistant to Tamiflu

29. June 2009

The first case in the world of resistance to influenza drug Tamiflu in people with influenza H1N1 has been found in Denmark.

The person is now healthy, and there is no further evidence of infection with resistant virus, according to Statens Serum Institut.

http://www.dr.dk/Nyheder/Indland/200...1.htm?rss=true

[tropical]

Hi Dutchy,

could you please confirm that this is an "swine" flu pandemic AH1N1 Tamiflu resistance?

[Dutchy]

Original in Danish:

Det første tilfælde i verden af resistens over for influenza-medicinen Tamiflu hos folk med influenza H1N1 er fundet i Danmark.


Dansker resistent over for Tamiflu

29. jun. 2009 15.20 Indland Opdat.: 29. jun. 2009 15.32

Det første tilfælde i verden af resistens over for influenza-medicinen Tamiflu hos folk med influenza H1N1 er fundet i Danmark.

Personen er nu rask, og der er ikke påvist yderligere smitte med det resistente virus, oplyser Statens Serum Institut.

It says "the first in the world' ; if it was "normal" of seasonal H1N1 the man would not be the first one in the world.

[Dutchy]

Update:

Dane resistant to Tamiflu

29. June 2009 15.20 Inland update.: 29 June 2009 15.38

The first case in the world of resistance to influenza drug Tamiflu in people with influenza H1N1 has been found in Denmark.

The person is now healthy, and there is no further evidence of infection with resistant virus, according to Statens Serum Institut.

The infection had been in close contact with another infected person, and was therefore prevented treatment with Tamiflu. Yet the person had flu symptoms and are instead treated with another type of flu drugs, Relenza.

Mutated virus in Denmark

World Health Organization Calls for the Danish case for more attention to the possibility of development of resistance in the virus.

It is not unusual for a flu virus mutating spontaneously and in a press release calls the Statens Serum Institut is "well known and expected."

They also emphasized that it does not pose a threat to public health.

http://translate.google.com/translat...ue&sl=da&tl=en

[HenryN]

Originally Posted by tropical

Hi Dutchy,

could you please confirm that this is an "swine" flu pandemic AH1N1 Tamiflu resistance?

Tamiflu resistance is fixed in seasonal H1N1 and has been for some time. Resistance in SWINE H1N1 would be a first (and news).

[HenryN]

Originally Posted by Dutchy

Update:

Dane resistant to Tamiflu

29. June 2009 15.20 Inland update.: 29 June 2009 15.38

It is not unusual for a flu virus mutating spontaneously and in a press release calls the Statens Serum Institut is "well known and expected."

They also emphasized that it does not pose a threat to public health.

http://translate.google.com/translat...ue&sl=da&tl=en

Well beyond head pats.

"Spontaneous mutation" indicates this was not due to reassortment with seasonal H1N1 (and is likely due to acquisition of H274Y by recombination with seasonal flu, although precise polymorphisms is not stated).

[Dutchy]

Dane resistant to pandemic medicine

/ Ritzau /

Last updated on Monday 29th June 2009, 15:30

The first case in the world of resistance to influenza drug Tamiflu in people with influenza H1N1 has been found in Denmark. The person is now healthy, and there is no further evidence of infection with resistant virus, according to Statens Serum Institut.

The infection had been in close contact with another infected person, and was therefore prevented treatment with Tamiflu. Yet the person had flu symptoms and are instead treated with another type of flu drugs, Relenza. World Health Organization Calls for the Danish case for more attention to the possibility of development of resistance in the virus.

It is not unusual for a flu virus mutating spontaneously and in a press release calls the Statens Serum Institut is "well known and expected." They also emphasized that it does not pose a threat to public health. /

http://www.horsens-folkeblad.dk/?rar...N-7TGHD8201175

[sharon sanders]

Yes! Huge news. Thanks Dutchy.

Is there any chance that the writer or editor of this article does not understand the issues and is mis-stating the situation?

[Dutchy]

May be someone who knows more about these things than me can contact them:

CONTACT SSI


Statens Serum Institut
5, Artillerivej
DK-2300 Copenhagen S
Denmark

Phone: +45 3268 3268
Fax: +45 3268 3868
VAT No. 46 83 74 28
EAN: 5798000362192
serum@ssi.dk

[Dutchy]

Dane resistant to pandemic medicines

29. June 2009 15:30

pandemic flu virus H1N1 has been found in Denmark in a mutated version that is resistant to Tamiflu, which is usually used in the treatment of flu .

The first case in the world of resistance to influenza drug Tamiflu in people with influenza H1N1 has been found in Denmark. The person is now healthy, and there is no further evidence of infection with resistant virus, according to Statens Serum Institut.

The infection had been in close contact with another infected person, and was therefore prevented treatment with Tamiflu. Yet the person had flu symptoms and are instead treated with another type of flu drugs, Relenza.

World Health Organization Calls for the Danish case for more attention to the possibility of development of resistance in the virus.

It is not unusual for a flu virus mutating spontaneously and in a press release calls the Statens Serum Institut is "well known and expected."

They also emphasized that it does not pose a threat to public health.

http://www.kristeligt-dagblad.dk/art...pandemimedicin

[HenryN]

Originally Posted by Dutchy

May be someone who knows more about these things than me can contact them:

CONTACT SSI


Statens Serum Institut
5, Artillerivej
DK-2300 Copenhagen S
Denmark

Phone: +45 3268 3268
Fax: +45 3268 3868
VAT No. 46 83 74 28
EAN: 5798000362192
serum@ssi.dk

I didn't see anything on their website. However, if the patients was NOT treated with Tamiflu, then the polymorphism (likely H274Y) was NOT selected and the virus with the change is fit.

[Dutchy]

Dane first with H1N1-mutation

29. June 2009 15:58 A Dane has developed a mutated version of H1N1 that are resistant to influenza agent Tamiflu. This is the first identified mutation of H1N1 in the world

The first case in the world of resistance to influenza drug Tamiflu in people with influenza H1N1 has been found in Denmark. The person is now healthy, and there is no further evidence of infection with resistant virus, according to Statens Serum Institut.

- We do not expect that it exists long, says Nils Strandberg Pedersen, Managing Director, Statens Serum Institut, and refers to the mutated form of H1N1.

The infected Dane had been in close contact with another infected person, and was therefore prevented treatment with Tamiflu. Yet the person had flu symptoms and are instead treated with another type of flu drugs, Relenza.

According to Niels Strandberg Pedersen, it is not significant that the first mutated version is found in Denmark.

- We see it as an expression of our monitoring work, he said.

World Health Organization Calls for the Danish case for more attention to the possibility of development of resistance in the virus.

It is not unusual for a flu virus mutating spontaneously and in a press release calls the Statens Serum Institut is "well known and expected." At the same time, Niels Strandberg Pedersen not exclude that there will be new forms of mutation.

For the treatment of H1N1, Denmark has large stockpiles of Tamiflu, and in late April were purchased 40,000 doses of Relenza for additional security in cases of resistant mutations.

http://www.kristeligt-dagblad.dk/art...-H1N1-mutation

Dansker den første med H1N1-mutation
29. jun 2009 15:58 En dansker har udviklet en muteret udgave af H1N1, der er resistent over for influenzamidlet Tamiflu. Det er den første konstaterede mutation af H1N1 i verden
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Ritzau
Det første tilfælde i verden af resistens over for influenzamedicinen Tamiflu hos folk med influenza H1N1 er fundet i Danmark. Personen er nu rask, og der er ikke påvist yderligere smitte med det resistente virus, oplyser Statens Serum Institut.

- Vi regner ikke med, at det eksisterer længere, siger Nils Strandberg Pedersen, der er administrerende direktør ved Statens Serum Institut, og henviser til den muterede form af H1N1.

Den smittede dansker havde været i tæt kontakt med en anden smittet person og var derfor i forebyggede behandling med Tamiflu. Alligevel fik personen influenzasymptomer og er i stedet behandlet med en anden type influenzamedicin, Relenza.

Ifølge Niels Strandberg Pedersen er det ikke af betydning, at den første muterede version er fundet i Danmark.

- Vi opfatter det som et udtryk for, at vores overvågninger fungerer, siger han.

Verdens sundhedsorganisationen WHO opfordrer efter det danske tilfælde til mere opmærksomhed på mulighed for udvikling af resistens hos viruset.

Det er ikke usædvanligt, at en influenzavirus muterer spontant, og i en pressemeddelelse kalder Statens Serum Institut det "Velkendt og forventeligt." Samtidig kan Niels Strandberg Pedersen ikke udelukke, at der vil komme nye former for mutation.

Til behandling af H1N1 har Danmark store lagre af Tamiflu, og i slutningen af april blev der indkøbt 40.000 doser Relenza som en ekstra sikkerhed i tilfælde af resistente mutationer.

[wotan]

Originally Posted by niman

I didn't see anything on their website. However, if the patients was NOT treated with Tamiflu, then the polymorphism (likely H274Y) was NOT selected and the virus with the change is fit.

I'm reading it as treatment with Tamiflu was begun but was not effective, and therefore they started Relenza.

We need the sequence to be published.

[Dutchy]

Dane first with H1N1-mutation

/ Ritzau /

Last updated on Monday 29th June 2009, 15:58

The first case in the world of resistance to influenza drug Tamiflu in people with influenza H1N1 has been found in Denmark. The person is now healthy, and there is no further evidence of infection with resistant virus, according to Statens Serum Institut.

- We do not expect that the longer exist, says Nils Strandberg Pedersen, Managing Director, Statens Serum Institut, and refers to the mutated form of H1N1. The infected Dane had been in close contact with another infected person, and was therefore prevented treatment with Tamiflu.

Yet the person had flu symptoms and are instead treated with another type of flu drugs, Relenza.

According to Niels Strandberg Pedersen, it is not significant that the first mutated version is found in Denmark. - We see it as an expression of our monitoring work, he said. World Health Organization Calls for the Danish case for more attention to the possibility of development of resistance in the virus.

It is not unusual for a flu virus mutating spontaneously and in a press release calls the Statens Serum Institut is "well known and expected." At the same time, Niels Strandberg Pedersen not exclude that there will be new forms of mutation. For the treatment of H1N1, Denmark has large stockpiles of Tamiflu, and in late April were purchased 40,000 doses of Relenza for additional security in cases of resistant mutations.

http://www.horsens-folkeblad.dk/?rar...N-7TGHD8201175

[Dutchy]

Articles say no spreading of this resistant strain was found.

Articles also say the man was treated with Tamiflu first, but kept displaying symptoms, than he was treated with Relenza. And was cured.

[tsspar]

I was wondering if it is still possible to be treated with Tamilu after exposure and still develop th flu, I mean it is not 100 percent effedctive at stopping it right? So this may not be resisance per say developed in the flu but just a time when using tamiflu to stop getting it did not work. Is this correct? Thanks

[sharon sanders]

This resistant strain will spread. Just like all flu does.

This is the truth. Period.

[sharon sanders]

Originally Posted by tsspar

I was wondering if it is still possible to be treated with Tamilu after exposure and still develop th flu, I mean it is not 100 percent effedctive at stopping it right? So this may not be resisance per say developed in the flu but just a time when using tamiflu to stop getting it did not work. Is this correct? Thanks

It is possible for different individuals to respond differently to the same treatment, however, they are saying that novel H1N1 has mutated in this case.

Apparently.

[wotan]

Originally Posted by tsspar

I was wondering if it is still possible to be treated with Tamilu after exposure and still develop th flu, I mean it is not 100 percent effedctive at stopping it right? So this may not be resisance per say developed in the flu but just a time when using tamiflu to stop getting it did not work. Is this correct? Thanks

As I understand it Tamiflu (and Relenza) do not stop getting the infection. They are neuraminidase inhibitors, neuraminidase being the protein N in the subtype H1N1, that allows the reproduced virus to exit (kill) the host cell. So the virus still infects cells in the body and replicates, but they don't successfully leave the cell (or at least in large numbers) to propogate the infection.

[HenryN]

Originally Posted by Dutchy

Articles say no spreading of this resistant strain was found.

Articles also say the man was treated with Tamiflu first, but kept displaying symptoms, than he was treated with Relenza. And was cured.

It was not found in the treated patient.

Doesn't statement of contact with another patient and prevented Tamiflu treatment mean that the second person was treated with Relenza becasue tamiflu resistance was found in H1N1 in first person?

[Dutchy]

Originally Posted by niman

It was not found in the treated patient.

Doesn't statement of contact with another patient and prevented Tamiflu treatment mean that the second person was treated with Relenza becasue tamiflu resistance was found in H1N1 in first person?

The articles are not a 100% clear. The way I understand it is this:

a man who was in contact with an infected person was treated with Tamiflu, but still kept having symptoms. Apparently a sample was taken and tested.
Relenza did the job Tamiflu supposed to do.

No mentioning of testresults of the first person.

[Aruna]

Reading the original danish news (It's very similar to swedish) they say that the person which the mutation had been found in had been in close contact with another infected person and was therefore put on preventive tamiflu but still developed symptoms, so he was instead treated with relenza and recovered. Doesn't mention much details beyond that.

[HenryN]

Originally Posted by Dutchy

The articles are not a 100% clear. The way I understand it is this:

a man who was in contact with an infected person was treated with Tamiflu, but still kept having symptoms. Apparently a sample was taken and tested.
Relenza did the job Tamiflu supposed to do.

No mentioning of testresults of the first person.

I read the statement of

"The infected Dane had been in close contact with another infected person, and was therefore prevented treatment with Tamiflu."

to mean that the first person was found to have Tamiflu resistant H1N1, so when the second person was infected, he (the second person) was treated with Relenza instead of Tamiflu and was cured.

[Aruna]

Originally Posted by niman

I read the statement of

"The infected Dane had been in close contact with another infected person, and was therefore prevented treatment with Tamiflu."

to mean that the first person was found to have Tamiflu resistant H1N1, so when the second person was infected, he (the second person) was treated with Relenza instead of Tamiflu and was cured.

No, to original press release says that the person which they found the mutation in first had been treated by preventive tamiflu and when he still developed symptoms they switched to relenza.

"Den smittede dansker havde været i tæt kontakt med en anden smittet person og var derfor i forebyggede behandling med Tamiflu. Alligevel fik personen influenzasymptomer og er i stedet behandlet med en anden type influenzamedicin, Relenza"

[sharon sanders]

Originally Posted by Aruna

Reading the original danish news (It's very similar to swedish) they say that the person which the mutation had been found in had been in close contact with another infected person and was therefore put on preventive tamiflu but still developed symptoms, so he was instead treated with relenza and recovered. Doesn't mention much details beyond that.

Thanks Aruna!

[Dutchy]

Thanks Aruna and welcome to Flutrackers !

[HenryN]

Originally Posted by Aruna

No, to original press release says that the person which they found the mutation in first had been treated by preventive tamiflu and when he still developed symptoms they switched to relenza.

"Den smittede dansker havde været i tæt kontakt med en anden smittet person og var derfor i forebyggede behandling med Tamiflu. Alligevel fik personen influenzasymptomer og er i stedet behandlet med en anden type influenzamedicin, Relenza"

Thanks, then this sounds like the first case of resisatnce in H5N1 in Vietnam (sister of infected patient was given prophylactic dose, which led to resistance and she recovered when dose was increased to treatment dose). This would not demonstrate that resistant H1N1 was fit (but would indicate that Tamiflu blankets, as well as widespread use of Tamiflu WILL be a problem).

[Aruna]

http://www.ssi.dk/sw174.asp?PAGE=1&ArtNo=3651423

That is the original press release from the danish version of cdc, it's a bit more detailed.

Says as before, person was in close contacted with another dane who had tested positive and was given tamiflu, got sick and tested positive for h1n1, was treated with relenza and has now fully recovered. Further analyze found that the virus had mutated and was resistant to tamiflu but not relenza. Says their evaluation of mutation shows no difference in terms virulence or severity. Says it's common knowledge that flu viruses can spontaneously mutate but there are no sign of further spread of the mutated virus and no reason to change the treatment guidelines for the flu. The head of cdc says in another article they don't expect that the mutation "exists anymore" but doesn't rule out there will be other mutations in the future.

[Dutchy]

Official press release, credits theforeigner for the link.

caution google translated, please correct if translation is wrong.

29. June 2009 -

Resistance of pandemic influenza A H1N1v detected in Denmark

The first case of resistance to oseltamivir (Tamiflu ®) in the pandemic influenza A H1N1v found in Denmark. This is the first identified cases worldwide.

It is well known and expected that influenza virus can mutate spontaneously. Resistance has not changed the virus' ability to infect or cause disease, the assessment is that they are a relatively mild flu.

The person is now healthy, and there is no further evidence of infection with resistant virus. The infection was in preventative treatment with oseltamivir (Tamiflu ®) because of close contact with a case that was infected abroad.

Yet he had flu symptoms. A test showed that the person was infected with influenza A H1N1v. Further studies at Statens Serum Institut has now shown that the virus has mutated. It is resistant to the antiviral agent oseltamivir (Tamiflu ®), while zanamivir (Relenza ®) can continue to be used for treatment.

World Health Organization Calls on the basis of the Danish case for increased attention to the possibility of development of resistance in the pandemic influenza A H1N1v.

A similar development of resistance to oseltamivir (Tamiflu ®) is also seen in the winter influenza A H1N1, which has circulated the past two winter seasons.

Each fund in Denmark is mentioned not unexpected. It does not constitute a risk to public health and does not need to change the recommendations for the use of oseltamivir (Tamiflu ®).

In Denmark the situation continues to follow closely in the monitoring of disease incidence and investigation of all isolated influenza A H1N1v.

http://www.ssi.dk/sw174.asp?PAGE=1&ArtNo=3651423

[tropical]

Thanks Aruna!

I have a pause, and didn't saw all the already present answers, before I posted my previous questions.

Wow folks, you screen, drag, answer and type posts warp-speed! Thanks and bravo'.
(how many stunts you have )

So the last wide bulet "faked".
Tamiflu bye, bye.

Interesting would be how many "close infected patients" have the new mutation now.