Third case of Tamiflu-resistant swine flu in Japan

[Chuck]

http://www.wsbt.com/health/51872857.html

Third case of Tamiflu-resistant swine flu in Japan


By WSBT News1

Story Created: Jul 28, 2009 at 11:29 AM EDT

Story Updated: Jul 28, 2009 at 11:29 AM EDT

TOKYO (AP) ? Japan has found a third case of Tamiflu-resistant swine flu in a man who had taken the drug to prevent infection, the Tokushima prefectural office said Tuesday.

Just six cases of Tamiflu-resistant swine flu have been reported worldwide.

In a statement, the prefectural health department said the man in his 30s was given Tamiflu after his colleague was infected with the virus this month.

The Tamiflu-resistant strain does not appear to have spread beyond the man, who has recovered, the prefectural health department said.

Preventive use of Tamiflu has occasionally given rise to resistant viruses, including those of seasonal flu.

Denmark, Hong Kong and Canada also have reported one case each of Tamiflu-resistant swine flu.

 

[oldman]

Re: Third case of Tamiflu-resistant swine flu in Japan

This report seems to be either a bad case of a reporter getting the facts wrong or there is a huge misconception concerning the use of Tamiflu. Exactly when did he take drug? Did he really think he could prevent infection? Was Tamiflu administered by a physician? Are they reporting this Tamiflu-resistant case because he was infected after taking it?

oldman

 

[Rwilmer]

Re: Third case of Tamiflu-resistant swine flu in Japan

H274Y is likely in this case..

 

[HenryN]

Re: Third case of Tamiflu-resistant swine flu in Japan

This report seems to be either a bad case of a reporter getting the facts wrong or there is a huge misconception concerning the use of Tamiflu. Exactly when did he take drug? Did he really think he could prevent infection? Was Tamiflu administered by a physician? Are they reporting this Tamiflu-resistant case because he was infected after taking it?

oldman

Although the sequence is not yet available, I think it is safe to assume that the patient was prescribed Tamiflu because of exposure and developed flu while taking a prophylatic dose of 1 pill per day of Tamiflu. The virus was then isolated and sequenced and had H274Y, which what happened in the two ealrier cases in Japan, as well as cases in Denmark and Canada.

 

[oldman]

Re: Third case of Tamiflu-resistant swine flu in Japan

Rwilmer, do you have more info concerning this case than what is posted here? If so, could you post it? Thanks

oldman

 

[HenryN]

Re: Third case of Tamiflu-resistant swine flu in Japan

WHO mulls ways of using antivirals in flu fight
(AFP) ? 3 hours ago
GENEVA ? The World Health Organisation said Tuesday that it will consult experts on the way anti-viral drugs such as Tamiflu are used to tackle the swine flu pandemic, and possible drug resistance.
"In the coming days we're having technical consultations by teleconference regarding antivirals," said spokeswoman Aphaluck Bhatiasevi.
"But as of now WHO's recommendations for use of antivirals has not changed," she added.
"They will be looking at specifics related to antiviral resistance and use of oseltamivir. WHO's recommendation for use of oseltamivir is for treatment," she underlined.
Oseltamivir is the active ingredient of Tamiflu, one of two drugs the WHO recommends to treat influenza A(H1N1).
Different countries have gradually evolved different approaches on the use of Tamiflu -- normally a prescription drug -- and some have been distributing it more widely to fearful populations than others.
But some doctors have expressed fears that excessive use, especially for preventive purposes or to tackle mild symptoms, could lead to the development of wider drug resistance and reduce the effectiveness of Tamiflu.
Health officials in Canada recently identified a case of drug resistance, adding to cases in Denmark, Hong Kong and Japan.
Roche, the manufacturers of Tamiflu, has said it expects a 0.5 percent rate of case resistance based on clinical trials.

http://www.google.com/hostednews/afp/article/ALeqM5i4PkYvVctDRLbXKxVKgQpCD7tysg

 

[Rwilmer]

Re: Third case of Tamiflu-resistant swine flu in Japan

No, I don't have any more info, I am thinking like Niman.

 

[HenryN]

Re: Third case of Tamiflu-resistant swine flu in Japan

Rwilmer, do you have more info concerning this case than what is posted here? If so, could you post it? Thanks

oldman

The evidence is circumstantial, but Japan is the world's biggest user of Tamiflu, and this is the third reported case from Japan of a patient who developed resistance while on prophylatic Tamiflu. These patients are the most likely candidates for the discovery of H274Y because they are at risk due to contact and are being monitored, so when they develop symptoms while taking Tamiflu, they are tested and the resistant strain is isolated and sequenced.
The chance that this is not another example of H274Y is close to zero.

 

[somebodyoutthere]

Re: Third case of Tamiflu-resistant swine flu in Japan

Is it completely false to say that taking Tamiflu could be a causal factor in the development of Tamiflu-resistant strains? Or is it possible there is some truth to it?

 

[oldman]

Re: Third case of Tamiflu-resistant swine flu in Japan

Thanks for the info, Henry. I get so frustrated with the media, and I cannot understand why at this crucial time we are still dealing with how to prescribe drugs to the masses for a virus that has been around for perhaps thousands of years. But my frustrations cannot compare for what you have been through. Thanks again.

oldman

 

[HenryN]

Re: Third case of Tamiflu-resistant swine flu in Japan

Is it completely false to say that taking Tamiflu could be a causal factor in the development of Tamiflu-resistant strains? Or is it possible there is some truth to it?

Those who think "random mutations" are a major driver of antigenic drift think that the virus makes copy errors at a high frequency, and these errors include H274Y, which is selected in patients taking prophylatic Tamiflu. However, this mechanism doesn't explain why all resisatnce has been H274Y and not N294S, another resistance mutation that has been identified previously in N1.

The "random mutations' also do noy explain the emergence and spread of H274Y in H1N1 seasonal flu, because not anly was all H1N1 resisatnce due to H274Y, but there was no resistance detected in H3N2, even in counttries where the vast majority of influenza A was H3N2.

The resistance is most easily explained by recombination and the Tamiflu treatment just allows the minor population, which has already has acquired H274Y, to be identified.

 

[HenryN]

Re: Third case of Tamiflu-resistant swine flu in Japan

Tokushima Prefecture on April 28, in the prefecture were infected with avian flu virus samples taken from 30 men in their forties, and its gene mutation was found to be resistant TAMI full treatment. Three cases in the country, to spread around, he said.

According to the prefecture, and Tamiflu-resistant virus season has not been cross, believed to have mutations in the body.

The man who was infected in the workplace, the drug was administered to prevent the start of dosing on day 5 of fever. Send samples to the National Institute of Infectious Diseases, 24 had contact with the provincial results.

He increased the dose of Tamiflu after onset, and now that they are recovering.

http://www.hokkaido-np.co.jp/news/influenza/179668.html

 

[HenryN]

Re: Third case of Tamiflu-resistant swine flu in Japan

2009 Tuesday, July 28 20:03
TOKUSHIMA 28 new patients from 30 man flu, anti-flu drug "Tamiflu" has been found to be resistant virus. Resistant virus is confirmed, Osaka, Yamaguchi, Japan continued to the third example. According to the County Department of Health Promotion, the patient has already recovered, to spread around, he said.

According to police, the man in July, for avian flu patients were at work, given Tamiflu as a preventive dense contacts. However, after five days because of fever, the ministry reported to the prefecture, the analysis of virus samples from the National Institute of Infectious Diseases.

http://news.goo.ne.jp/article/jiji/nation/jiji-090728X604.html

 

[wotan]

Re: Third case of Tamiflu-resistant swine flu in Japan

2009 Tuesday, July 28 20:03
TOKUSHIMA 28 new patients from 30 man flu, anti-flu drug "Tamiflu" has been found to be resistant virus. Resistant virus is confirmed, Osaka, Yamaguchi, Japan continued to the third example. According to the County Department of Health Promotion, the patient has already recovered, to spread around, he said.

According to police, the man in July, for avian flu patients were at work, given Tamiflu as a preventive dense contacts. However, after five days because of fever, the ministry reported to the prefecture, the analysis of virus samples from the National Institute of Infectious Diseases.

http://news.goo.ne.jp/article/jiji/nation/jiji-090728X604.html

OK, I'm lost in the translation. This is saying 28 people had cases of Tamiflu resistant some type of flu? I'm assuming even though they say avian flu they are not talking H5N1.

 

[Rwilmer]

Re: Third case of Tamiflu-resistant swine flu in Japan

Here is babylon translation of post #13:

Tokushima-resistant even = new virus-in full, domestic 3 second
July 28 , 2009 (Tue) 20:03
Tokushima prefecture is in 28 th ,the new flu patients from 30 man in his 20s, anti-Flu medicine" "KCDC said resistance against the virus was detected in. resistance virus check, Osaka, and Yamaguchi following domestic 3 second. Prefecture Health Promotion Div., the patients have recovered the surrounding the infection to expand.

The Preservation Division, Acquisitions Department men are July, at work, at the new flu patients, as a thick contact preventive administered KCDC said. However, after the 5 th fever because the prefectureto the Ministry of Health, Labor and Welfare reported that the National Institute of Infectious Diseasesis virus samples analyzed.

 

[HenryN]

Re: Third case of Tamiflu-resistant swine flu in Japan

OK, I'm lost in the translation. This is saying 28 people had cases of Tamiflu resistant some type of flu? I'm assuming even though they say avian flu they are not talking H5N1.

I added the translations for detail. I believe they indicate that 40 employees were given prophylatic Tamiflu because someone in the worlkplace was H1N1 positive. One worker developed symptoms on the 5th day of treatment. The sample was sent to NIID where they sequenced the isolate and found resistance (I assune H274Y). The infection was mild and the patient has recovered.

 

[HenryN]

Re: Third case of Tamiflu-resistant swine flu in Japan

This case is virtually IDENTICAL to the Osaka case, down to the FIFTH day. The patient is started on a 10 day course of Tamiflu. However, the patient gets infected because the H1N1 with H274Y is at a relatively high level, but just below detection by the sequencers (unless they look closley). The published sequences are just "consensus" sequences and represent the dominant strain. If the strain with H274Y is 20% or less, it won't won't show up in the sequence (if it is 20-50% the sequence will have mixed signals).

The fact that the patient become symptomatic five days after the start of treatment, means the level of H274Y is relatively high (normally it takes 2-4 days to develop symptoms), because the delay in disease onset date is small.

The H1N1 at day 5 is exclusively virus with H274Y, so the sequnecers are stuck with H274Y and announce the "discovery".

H274Y is WIDESPREAD and below the sequencer's radar becasue they are not looking very hard.

Japan has a high level of H1N1 and frequently uses Tamiflu, so 3 of the 5 isolates from treated patients are in Japan.

 

[wotan]

Re: Third case of Tamiflu-resistant swine flu in Japan

This case is virtually IDENTICAL to the Osaka case, down to the FIFTH day. The patient is strtaed on a 10 day course of Tamiflu. However, the patient gets infected because the H1N1 with H274Y is at a relatively high level, but just below detection by the sequencers (unless they look closley). The published sequences are just "consensus" sequences and reporesent the dominant strain. If the strain with H274Y is 20% or less, it won't won't show up in the sequence (if it is 20-50% the sequence will have mixed signals).

The fact that teh patient become symptomatic five days after the start of treatment, means the level of H274Y is relatively high (normally it takes 2-4 days to develop symtoms), because the delay in disease onset date is small.

The H1N1 at day 5 is exclusley virus with H274Y, so the sequnecers are stick with H274Y and announce the "discovery".

H274Y is WIDESPREAD and below the sequencer's radar becasue they are not looking very hard.

Japan has a high level of H1N1 and frequently uses Tamiflu, so 3 of the 5 isolates from treated patients are in Japan.

Eagerly awaiting the commentary on this.

 

[HenryN]

Re: Third case of Tamiflu-resistant swine flu in Japan

Tokushima Prefecture was confirmed in patients (30 man) for the avian flu was detected, indicating it H275Y Tamiflu resistance was reported from the National Institute of Infectious Diseases and the separation of the avian flu that mutated gene, the information provides an overview.

However, according to the ministry, with the mutant gene are resistant to Tamiflu, the severity of the virus (pathogenic) is a direct influence is not.


Profile of virus detection>

Contents of a genetic analysis by the National Institute of Infectious Diseases

H275Y oseltamivir resistance marker was detected.
The hybridization of seasonal influenza A/H1N1 virus with the genes that have
Was confirmed.

In the future, the National Institute of Infectious Diseases, drug susceptibility tests are being judged.


2 after the patient
Patients, the incidence of Tamiflu for prevention in the administration, immediately after weighting for the antipyretic treatment, a cure.
Then, to spread around, including a family is not approved.
The travel history of patients.

http://anshin.pref.tokushima.jp/inf...influenza_id=2009_124877425121&news_year=2009

 

[HenryN]

Re: Third case of Tamiflu-resistant swine flu in Japan

Description of confirmed cases in Tokushima linked to this page

http://anshin.pref.tokushima.jp/inf...influenza_id=2009_124877425121&news_year=2009