Quebec man caught drug-resistant swine flu

[wotan]

This one almost seems to be under the radar....

http://www.cbc.ca/canada/montreal/st...resistant.html

Quebec man caught drug-resistant swine flu

Last Updated: Tuesday, July 21, 2009 | 4:22 PM ET Comments0Recommend1

CBC News


A 60-year-old Quebec man is one of a handful of people around the world to catch a strain of swine flu that is resistant to drugs.
Health officials said the man likely contracted the virus from his son and did not require hospital treatment.
Canada's lead researchers are trying to find out more about what this means for the effectiveness of millions of doses of stockpiled antiviral drugs.
Dr. Guy Boivin, Canada Research Chair on emerging viruses and antiviral resistance in Quebec City, said Tuesday the new strains of drug-resistant swine flu raise a red flag but should not scare anyone.
“We know the exact, specific mutation, and this is a mutation that has been reported before in human viruses that were resistant to Tamiflu, so it's not totally unexpected,” said Boivin.
Boivin said he suspects the Quebec father was already infected when he was given a low preventive dose of the antiviral drug Tamiflu. Boivin suspected the father’s virus adapted to the drug at that point, becoming resistant.
Never in hospital

Boivin said the good news is that the father recovered well and was never taken to hospital. He said the next step is to find out how quickly the drug-resistant strain reproduces, and whether it's more potent and dangerous.
“We are using a lot of Tamiflu since [the] beginning of the pandemic, so using more antivirals probably means there is more chance of developing resistances,” Boivin said.
He said he'd also like to see a greater variety of antiviral drugs on the market, in case more people develop or contract a drug-resistant swine flu.
There are only two antiviral drugs currently available, and Tamiflu makes up 80 per cent of the 50 million doses reserved for Canadians.

[Rwilmer]

We suspected that it would be under the rader. Especially since the case in Hong Kong where the girl came from San Francisco. It is not a suprise that they found this case, I expect that we will find many more.

[AlaskaDenise]

...suspects the Quebec father was already infected when he was given a low preventive dose of the antiviral drug Tamiflu. Boivin suspected the father’s virus adapted to the drug at that point, becoming resistant.

If confirmed, this is an important point. Supposedly, he did not acquire the resistance from a circulating resistant strain.

My next question would be - who were his contacts after the resistance mutation? Did it spread? Time for contact testing!

We need to know when there is a circulating resistant stain.

This case appears different from the HK girl who acquired a circulating resistant strain.

.

[Rwilmer]

Excellent points AlaskaDenise

[AlaskaDenise]

This story brings up something I never thought about, i.e., people are taking tamiflu and may not practice good hygiene & social distancing, assuming they're not contagious.

However, if their virus becomes tamiflu resistant, they might be contagious with a resistant version. Huummm.....something to think about.

.

[HenryN]

Originally Posted by AlaskaDenise

This story brings up something I never thought about, i.e., people are taking tamiflu and may not practice good hygiene & social distancing, assuming they're not contagious.

However, if their virus becomes tamiflu resistant, they might be contagious with a resistant version. Huummm.....something to think about.

.

H274Y is on MILD H1N1. This is the second patient who was infected, but did not require hospitalization (although the Hong Kong patient was hospitalized because she was H1N1 positive).

[AlaskaDenise]

Originally Posted by niman

H274Y is on MILD H1N1. This is the second patient who was infected, but did not require hospitalization (although the Hong Kong patient was hospitalized because she was H1N1 positive).

So are these mild 274Y tamiflu-taking patients unknowingly contagious?

.

[HenryN]

Originally Posted by AlaskaDenise

So are these mild 274Y tamiflu-taking patients unknowingly contagious?

.

Mild cases are more likely to spread H1N1 because they don't know or don't think they are infected. Many cases of H1N1 don't produce a fever. Other H1N1 infections only produce a low grade fever. The recent recruits in CT (10% of freshman class) had fevers of about 100 F, and although the infection spread throughout the class, most cases were MILD.

[HenryN]

>>“We know the exact, specific mutation, and this is a mutation that has been reported before in human viruses that were resistant to Tamiflu, so it's not totally unexpected,” said Boivin.<<
Sounds like H274Y again.

[AlaskaDenise]

Originally Posted by niman

>>“We know the exact, specific mutation, and this is a mutation that has been reported before in human viruses that were resistant to Tamiflu, so it's not totally unexpected,” said Boivin.<<
Sounds like H274Y again.

Is he saying only that they know what to look for, or that they have actually found it?

My interpretation was that they are trying to downplay the mutation by saying it's nothing new - they know exactly what to look for.

.

[HenryN]

Originally Posted by AlaskaDenise

Is he saying only that they know what to look for, or that they have actually found it?

My interpretation was that they are trying to downplay the mutation by saying it's nothing new - they know exactly what to look for.

.

They know it is H274Y, but don't specifically say it (just describe it indirectly). They are trying to downplay the significance.

[wotan]

The headline is probably in error, but I will post it here for tracking:

http://www.ctv.ca/servlet/ArticleNew...Health&s_name=

Quebec man dies of Tamiflu-resistant H1N1 flu virus

Updated Tue. Jul. 21 2009 9:04 PM ET
The Canadian Press
TORONTO -- Canada has recorded a case of Tamiflu-resistant H1N1 virus, in a Quebec man who had been given the drug to prevent infection.
The case is the fourth reported globally since the new H1N1 virus was discovered in April.
The man, 60, was given the flu antiviral after his son fell ill with the pandemic virus. It's believed the resistance arose in the man and there is no evidence he transmitted resistant virus to anyone else.
"It appears to be an isolated case," said Jirina Vlk, spokesperson for the Public Health Agency of Canada.
"Although the strain does not appear to have spread beyond the reported individual case we continue to be vigilant on this front."
Use of Tamiflu to prevent infection -- a procedure called prophylaxis -- has been seen on occasion to give rise to resistant viruses.
"We know that it was going to happen and it's not good news that it's happening," said Dr. Allison McGeer, an influenza expert at Toronto's Mount Sinai University.
But she said given the amount of Tamiflu being used in the world right now, such cases are bound to arise.
"It's the problem with influenza, right? Either we're going to see small numbers of these and they're just going to kind of appear periodically and we're all going to worry or it's going to go big," McGeer said.
"There's probably not going to be much in between."
This is the fourth case reported so far of Tamiflu resistance in H1N1 cases; earlier cases were reported from Denmark, Japan and Hong Kong. Three of the four cases arose in people who had been taking the drug.
The other was in a girl from San Francisco who travelled to Hong Kong and was discovered to be ill there. She hadn't taken the drug, suggesting the virus that caused her infection was already resistant. U.S. officials have intensified surveillance for resistant viruses in the San Francisco area but say they have not found other cases.
The Public Health Agency says the man recovered from his bout of swine flu without complications and never needed hospitalization.
Vlk said the agency recommends using Tamiflu for treatment only, adding prudent use of the drug could stave off the development of resistance.

Note that the article is inconsistent with the headline.

[HenryN]

>>This is the fourth case reported so far of Tamiflu resistance in H1N1 cases; earlier cases were reported from Denmark, Japan and Hong Kong. <<

Actually, the Quebec case is the fifth example of H274Y because the Yamaguchi case (second example from Japan) was reported July 17

http://www.flutrackers.com/forum/sho...2&postcount=16

[HenryN]

Quebec finds case of Tamiflu-resistant swine flu, fourth recorded globally
By Helen Branswell Medical Reporter (CP) – 30 minutes ago
TORONTO — Canada has recorded a case of Tamiflu-resistant swine flu virus, in a Quebec man who had been given the drug to prevent infection.
The case is the fourth reported globally since the new H1N1 virus was discovered in April.
The man, 60, was given the flu antiviral after his son fell ill with the pandemic virus. It's believed the resistance arose in the man and there is no evidence he transmitted resistant virus to anyone else.
"It appears to be an isolated case," said Jirina Vlk, spokesperson for the Public Health Agency of Canada.
"Although the strain does not appear to have spread beyond the reported individual case we continue to be vigilant on this front."
Use of Tamiflu to prevent infection - a procedure called prophylaxis - has been seen on occasion to give rise to resistant viruses.
"We know that it was going to happen and it's not good news that it's happening," said Dr. Allison McGeer, an influenza expert at Toronto's Mount Sinai University.
But she said given the amount of Tamiflu being used in the world right now, such cases are bound to arise.
"It's the problem with influenza, right? Either we're going to see small numbers of these and they're just going to kind of appear periodically and we're all going to worry or it's going to go big," McGeer said.
"There's probably not going to be much in between."
This is the fourth case reported so far of Tamiflu resistance in swine flu cases; earlier cases were reported from Denmark, Japan and Hong Kong. Three of the four cases arose in people who had been taking the drug.
The other was in a girl from San Francisco who travelled to Hong Kong and was discovered to be ill there. She hadn't taken the drug, suggesting the virus that caused her infection was already resistant. U.S. officials have intensified surveillance for resistant viruses in the San Francisco area but say they have not found other cases.
The Public Health Agency says the man recovered from his bout of swine flu without complications and never needed hospitalization.
Vlk said the agency recommends using Tamiflu for treatment only, adding prudent use of the drug could stave off the development of resistance.
-Follow Canadian Press Medical Writer Helen Branswell's flu updates on Twitter at CP-Branswell

http://www.google.com/hostednews/can...nwA_JRXyesKjAQ

[HenryN]

Commentary

[AlaskaDenise]

Originally Posted by niman

Commentary

Commentary

Tamiflu Resistant Pandemic H1N1 Spread to Canada and Japan

Recombinomics Commentary 04:15
July 22, 2009

"We know the exact, specific mutation, and this is a mutation that has been reported before in human viruses that were resistant to Tamiflu, so it's not totally unexpected," said Boivin.

Boivin said he suspects the Quebec father was already infected when he was given a low preventive dose of the antiviral drug Tamiflu.

The above comments describe another case of oseltamivir resistance in pandemic H1N1 swine flu. The description indicates the resistance is due to H274Y because all reported oseltamivir resistance since 2007 has been H274Y in H1N1. earlier this month there were three cases described, and two of the three were also on prophylactic oseltamivir. However, since all cases have involved H274Y, the treatment may simply be aiding in the detection of H274Y, rather than selecting for de novo mutations. Sequence data reports consensus sequences, so a low level of H274Y would not be seen unless multiple clones were sequenced or levels increased due to the elimination of wild type H1N1 by oseltamivir treatment.

In addition to the H274Y in Quebec, a sequence released today from Yamaguchi Province in Japan also had H274Y. The characterization sheet provides little detail on the patient, but Yamaguchi Province gives detailed reports on each H1N1 confirmed case, and the reports give no support for the development of H1N1 in contacts under prophylactic treatment. Therefore, it is likely that the Yamguchi isolate is from a sample collected prior to Tamiflu treatment.

The sequence of A/Yamaguchi/22/2009 is distinct for the other two published sequences with H274Y. However, like A/Hong Kong/2369/2009, there are several NA sequences which are exact matches, other than position H274Y. These precursors are widespread, and the earliest isolate is from the United States (Sullivan county in New York), and all subsequent isolates are from other countries (Japan, China, Brazil) once again raising questions about surveillance of mild H1N1 cases in the United States. In Japan there have been no reported pandemic H1N1 deaths and most of the cases in in Yamaguchi province have been mild and patients have recovered without hospitalization.

These two cases of resistance raises the total to five and all involve H274Y, the same polymorphism reported in seasonal H1N1, where the level quickly rose to 100% last season and is reported at 100% in the southern hemisphere this season. The presence of H274Y on seasonal H1N1, which is co-circulating with pandemic H1N1, offers the opportunity of recombination between seasonal and pandemic H1n1 to allow the H274Y to jump from seasonal H1N1 to pandemic H1N1.

The reports of H274Y in five patients this month raises concerns that the frequency will rise in the near term, with recombination and genetic hitchhiking driving the levels to 100%, due in part to widespread use of oseltamivir and in part to the large reservoir of H274Y in seasonal flu.


.

[HenryN]

Tamiflu-resistant strain rare: health officials

Last Updated: Wednesday, July 22, 2009 | 12:52 PM ET Comments0Recommend0

CBC News


There have been five documented cases of Tamiflu-resistant swine flu worldwide. (Michael Probst/Associated Press) Despite the appearance of a case of drug-resistant swine flu in Quebec, the resistant strain remains rare worldwide and there is no need to change Canada's approach to prescribing Tamiflu, health officials said Wednesday.
A 60-year-old Quebec man is one of five people around the world found to have a strain of H1N1 flu resistant to the antiviral drug Tamiflu (oseltamivir). The other cases occurred in Japan, Denmark and Hong Kong.
Dr. Guy Boivin, Canada Research Chair on emerging viruses and antiviral resistance in Quebec City, said he suspected the Quebec man was already infected when he was given a low preventive dose of Tamiflu as a precaution because he had a pulmonary condition. His son fell ill with the pandemic virus.
The man was given Tamiflu as post-exposure prophylaxis — an attempt to prevent illness in someone exposed to the pandemic virus.
Boivin believes the man may have already been infected with the H1N1 virus. There is no evidence the man transmitted the resistant virus to anyone else. The man recovered and was never hospitalized.
Treat symptoms quickly

"In some cases, it's probably better to wait until we have the symptoms," said Boivin, who works at the Infectious Disease Research Centre in Quebec City. "But rapidly after symptom onset, treat with high doses of the anti-viral drug."
The man was never hospitalized and there are few cases of resistance worldwide, which means Canada's approach to swine flu should stay the same, Boivin said.
Health officials are watching for signs that the resistant strain might spread person-to-person or become more or less dangerous.
"Just because he ended up with a drug-resistant strain doesn't necessarily mean that that strain has the 'right stuff' to be able to go person to person to person," said Dr. Michael Gardam of the Ontario Agency for Health Protection and Promotion.
"Usually when you see Tamiflu-resistant strains, they actually aren't very good at spreading person to person. That isn't always the case. There is one strain that's out there that's very good at spreading person to person. But right now, we don't have any evidence that this strain is one of those strains that is able to do that."
Gardam said he and other health officials are watching closely for clusters of Tamiflu-resistant cases among people who hadn't been on the drug, which would indicate the resistant strain is starting to move from person to person.
Health officials also continue to take swabs of people sick enough to go to emergency to check for any mutations in the virus. Anyone who is sick enough to go to emergency should be treated with Tamiflu, Gardam said, adding the drug works best if given with the first 48 hours after showing symptoms.
The Public Health Agency of Canada recommends using Tamiflu for treatment only, to help stave off the development of resistance, said Jirina Vlk, a spokeswoman for the agency.
Stockpile still works

About 80 per cent of Canada's stockpile of antiviral medications consists of 50 million doses of Tamiflu, which remains effective. Boivin said he would like to see companies develop alternative antivirals in case more drug resistance occurs.
The other 20 per cent of Canada's stockpile is the antiviral drug Relenza (zanamivir), which is harder to administer than Tamiflu because it has to be inhaled into the lungs, Gardam said.
The company that manufactures Tamiflu, Roche, said its research shows a small percentage of people will not respond to the drug.
"We know that there are various reasons for the resistance. What we know is that it's not drug-induced, that it's some kind of natural mutation," said Laura Pagnotta, who speaks for Roche Canada.
Pagnotta said the World Health Organization still recommends Tamiflu for the prevention and treatment of swine flu, but says it should be prescribed on a case-by-case basis.
Health officials continue to recommend that people:

• Wash their hands often with warm, soapy water or hand sanitizer.
• Cough and sneeze into your arm, not your hand.
• Keep common surfaces and items clean and disinfected.
• Stay home if you're sick, unless directed to seek medical care.

The worldwide death toll from swine flu is more than 700, according to the World Health Organization, which recently stopped counting the number of cases worldwide.
As of last week, Canada was reporting more than 10,000 swine flu cases, with 45 deaths. Between 4,000 and 8,000 Canadians die of influenza and its complications annually, depending on the severity of the season, the Public Health Agency said.

http://www.cbc.ca/health/story/2009/...esistance.html

[HenryN]

First case of Tamiflu-resistant H1N1 reported in Quebec







By Drew Halfnight, The GazetteJuly 22, 2009 11:52 AMComments (1)

• Story
• Photos ( 2 )

More Images »


MONTREAL, QUE: APRIL 30, 2009 -- Montreal resident Amanda Mussgnug gets checked by triage nurse Sally Yip at the emergency ward of the St Mary's hospital in Montreal. Quebec registered the province's first confirmed case of swine flu in the Montreal area on Thursday, April 30, 2009.

Photograph by: Phil Carpenter, Gazette




A Quebec man became the first person in Canada to contract the H1N1 virus after taking the Tamiflu vaccine, raising concerns about the drug’s reliability.

The man, 60, was given Tamiflu after his son fell ill with H1N1, but contracted the deadly flu anyway. He recovered quickly without going to hospital. It appears that nobody caught the drug-resistant strain from him.

Five instances of immunity to Tamiflu have been reported since a Danish man became the first patient to resist the drug at the end of last month. In four of the five cases, patients had been taking Tamiflu to prevent infection.

Doctors have said taking Tamiflu as a prophylactic or preventative can give rise to resistant strains of the virus.

But in one of the five cases ­ a San Francisco woman diagnosed during a visit to Hong Kong ­ the patient had never taken Tamiflu, suggesting the strain she caught was already resistant. So far, no other cases of Tamiflu-resistant H1N1 have been reported in the U.S.

A spokesperson for the Public Health Agency of Canada told The Canadian Press the Quebec man “appears to be an isolated case,” adding the agency is watching closely for similar cases.

The agency recommends using Tamiflu for treatment only, not prophylaxis.

Friday, the Quebec government confirmed 10 new cases of the virus, bringing the total number of infections in the province since the end of April to 2,294.

http://www.montrealgazette.com/healt...888/story.html

[ironorehopper]

San Francisco, Quebec...!

These resistant variants are quite common, despite the lack of updated surveillance reports.

Backlogs in testing works?

A strange feeling is around: a deafness silence that disquieting a lot.

Transparence and quick release of informations about virological surveillance seem to remain a dream.

[HenryN]

Originally Posted by ironorehopper

San Francisco, Quebec...!

These resistant variants are quite common, despite the lack of updated surveillance reports.

Backlogs in testing works?

A strange feeling is around: a deafness silence that disquieting a lot.

Transparence and quick release of informations about virological surveillance seem to remain a dream.

All isolates were from (early) June infections. Data is lagging as virus spreads.

[Mingus]

http://mediacorus.corusquebec.com/we...dio/218511.mp3

Here is a radio interview with Dr.Guy Boivin of Laval University about his finding and the circumstance surrounding it.

http://mediacorus.corusquebec.com/we...dio/218511.mp3

It's in french.