Person-to-person spread of Tamiflu-resistant strain investigated
I am indebted to a loyal follower of this blog for tipping me off about a breaking news story in Wales.
Health officials in Cardiff are investigating the spread of a Tamiflu-resistant strain of swine flu at University Hospital Wales. The strain has infected a small number of patients, all of whom have serious underlying health conditions.
Roche, the maker of Tamiflu, tells me that there have been 57 cases worldwide of people developing resistance to Tamiflu while taking the drug (seven of these in the UK).
But what happened at University Hospital Wales may be quite different. Here, someone developed resistance - and then, I understand, this strain appears to have been passed from person to person in the hospital.
There's been only one other similar case in the United States between two people at a summer camp, but the resistant strain did not spread any further. The CDC reported on this in September.
Health officials in Wales tell me that more tests are being carried out to confirm exactly what happened, and they are not yet confirming person-to-person spread.
All the patients are said to be recovering and being cared for in controlled environments, so there is no risk to anyone else.
Tamiflu is an antiviral and can reduce the risk of the complications of flu, as well as shortening the duration of the illness. The UK has enough doses for half the population. Any spread of a Tamiflu-resistant strain of swine flu would be a serious public health concern - but there is no evidence to suggest that this has happened.
Obviously this is a developing story, and I'll bring you more when I get it.
~RS~q~RS~~RS~z~RS~53~RS~)
I'm 
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That's worrying!
How many doses of Relenza do we have?
I read the other day about other antivirals under development. Seems to be a race against the clock, just when things are seeming to get better. The worst case scenario would be if a strain developed that was immune to the vaccine. Perhaps it is just as well we have the adjuvanted type here in the UK!
Fergus - you say these people had serious underlying conditions in hospital. Wouldn't they have had the vaccine a few weeks ago? Hospital patients were first on the list weren't they? I'm wondering if these are results of something that happened a few weeks backl & the results only just known?
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is this not because of the overuse of Tamiflu?
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In my not very expert opinion it's the vaccine that matters most. My own GP has stopped giving tamiflu to children because it was making them vomit so much. Most people get better without it. Unless this is a sign that sf is becoming more virulent/dangerous then I'm not panicking.
And I do think we overused tamiflu earlier, although I would hesitate to say that is the cause here.
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If the development of such a new strain happened in the UK, it would be no surprise given that we have been handing out the drug as if they were Smarties.
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I agree, Alay. The flu line was a shocking waste of resources, both in terms of risking resistant strains forming and hard cash. It now appears that 'the fight against flu' (which included handing out the stuff for free to anyone who claimed to have a temp) has meant cutbacks in cancer care etc.
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If everybody wouldn't have panicked so much, then it wouldn't have been handed out!
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I agree with you all; this must have something to do with the indiscriminate handing out of the drug in the early days. I think I read on here of the importance of finishing a course of antibiotics otherwise the bacteria becomes resistant; I am guessing this is what has happened here. I am sure when people were experiencing really bad side effects from taking Tamiflu that they didn't finish the course; especially when they didn't have SF. I have no medical knowledge about this, just thoughts!
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Sadly, this was entirely predictable. If Tamiflu is widely used, then sooner or later, the flu virus will find a way to develop resistance. That's just basic Darwinism at work. Even if this case doesn't turn out to represent widespread infection with a new resistant strain, I can't help thinking that such a strain won't be far away.
I have to agree with earlier posters: it was probably a mistake to prescribe Tamiflu quite so widely from the start of the epidemic.
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Genuine question here: DisgustedofMitcham, maybe you will know the answer. If it's obvious that a virus will mutate to get around something like Tamiflu, why won't it mutate to get around a vaccination? Is that entirely different, and if so, why? Just wondering, and I haven't a clue about the answer!
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Did smallpox find a way around a vaccination......... I dont think so.
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Were all these patients in the same room? Were they being treated by the same care staff who cleaned their hands before moving on to the next patient? I know tamiflu was handed out willy nilly but does anyone believe all these patients just happened to be the ones to take tamiflu and their virus became resistent to it? Call me cynical but I personally think the hospital may need to look at its cleanlyness policy!
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But TB has, yorkshiresalutations!
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As I understand it, flu viruses mutate all the time so when we vaccinate or catch them and gain immunity we are really just running to keep still. Even so, each time each of us gets one sort of flu we get immune to that one which gives us a degree of immunity to the next related one that comes along. That's why the experts reckon that even if sf does mutate if we have had the vaccine or the illness we will still have some although not full immunity to it: the difference to mild and serious disease, maybe. AS for chicken pox or small pox, they're more stable for some reason I don't understand and don't mutate - different things.
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9, Enlightened:
That's a very good question. The short answer is that the virus will mutate to get round the vaccination, but possibly not as quickly.
In fact the virus mutates all the time. That's why if you are recommended to have flu vaccine, you need a new jab each year. Different strains circulate in different years, and last year's vaccine may not protect you against this year's strain. However, vaccines protect against a reasonably broad range of different mutants, so any flu virus that is basically H1N1 will probably be put off by the current vaccines.
This is actually a phenomenally complicated subject, and that's about the limit of my knowledge. If any virologists are reading, perhaps they could tell us more.
It's worth noting that the flu virus is particularly good at mutating, so this is a particular problem with flu. As yorkshiresalutations pointed out, smallpox wasn't as good, so the vaccines got it in the end. In fact most vaccines that we have are very effective in protecting against pathogens over the long term. Flu vaccine is a bit of an exception.
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Thank you to Joan, and Disgustedofmitcham. I do find it very interesting.
I didn't realise that some viruses are better at mutating than others are. As you say, that must explain why the smallpox virus didn't come back.
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# 11 Osteo exactly that's exactly what I thought how could one patient get it from another? What were the circumstances of person to person transmission? The hospital should defintely explain how this happened.
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I say so what? first if we look carefully at the facts, far more people die of seasonal flue, and the WHO I believe, says swine flue is less or equally as serious as ordinary flue.
secondly, surely it makes sense to get this swine flue, so long as the body is healthy, and let the natural immune responses take effect.
If this flue is mild, why inject what are poisons, into the body? tamiflu itself is a poison and has some nasty side effects according to some sources. Most drugs are by nature poisons.
the vaccine contains squaline, and ethyl mercury as thiomersol, and aluminium hydroxide!!
My next most important point is this. By increasing ones vitamin D3 to at least 2000 iu's a day, NOT vitamin d2, but D3, and increasing ones vitamin C levels as well, then the magic bullet is to take 5ml of colloidal silver , swill it around the mouth then swallow, and most vital, spray the nose and inhale deeply. colloidal silver is a powerful antibiotic and enhances the immune system.
all my research tells me these measures should more than see of swine flue and any other influenza. I would always say to people do your own research, use google. Don't let others do your thinking for you.
some links that may be very helpful here, I hope,
http://swineflu.mercola.com/sites/swineflu/home.aspx
http://www.fluscam.com/HOME.html
http://www.naturalnews.com/010038_silver_colloidal_silver_antibiotic.html
http://www.uk-cs.co.uk/
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I have read Mercola, and have examples of his misuse of the facts/data on my blog. I am familiar with the research into Vitamin D, and while it is a most promising line of research, it is still preliminary. Also, Dr. John Cannell, the main Vit D guy and the one Mercola cites, himself (a) plans to get the H1N1 jab; (b) says Vit D is important, but no panacea against SF, and (c) says that the risks of GBS post-vaccine have been overstated. Quite interesting that Mercola only picks the bits of Cannell's work he likes out for his website, eh?
http://www.vitamindcouncil.org/newsletter/h1n1-flu-and-vitamin-d.shtml
I also know of a recent study showing Vitamin D had no protective effect on respiratory illnesses:
http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=6103912
Lastly, while it is true that SF has so far killed fewer than expected, there are a few things to note:
1 - stats for seasonal flu deaths are based on estimates, not lab-confirmed cases. These estimates, at least in my country of Canada, and I believe elsewhere, are based on mathematical modelling. Deaths increase in fall/winter, and thru this modelling scientists estimate how much of the swell in fall/winter deaths was due to flu or complications of it. We are comparing apples to oranges. I also have done quite a bit of research into the stats comparing SF and seasonal flu for my own province of Alberta, and have found solid evidence to say anything from "SF has killed more than 4 times as many as we sometimes see with seasonal flu" to "SF has caused by a small fraction of the deaths of seasonal flu". See here (and my added comments); note that AB's death total now stands at 45, not 25 as it did when I wrote this entry:
http://www.kawchukkovacs.com/archive/2009/11/09/correct-the-typo-or-change-the-storymdashalberta-and-h1n1.aspx
2 - The distribution of deaths from SF is very different than what we see with seasonal flu. For some groups, such as children, the risk from SF are higher than from seasonal flu. The US lab-confirmed pediatric death total from SF is already far higher than from seasonal flu, and don't be mislead by those, like Mercola, who point to "last year's child flu deaths" which were well over 100 to claim that SF is nothing to worry about for kids. "Last year's flu season" in the US counts stats from Sept 2008 til the end of August 2009, so the 43 pediatric deaths from H1N1 from April-August 2009 are in fact included in the totals from "last year's flu season" which is why the number is so high compared to previous years. Yes, you read that right, he and others like him are conflating deaths from "last years flu season vs. this years flu season" with deaths from "H1N1 vs seasonal flu". These are NOT the same, and in fact, he is using pediatric deaths from H1N1 itself (from Apr-Aug) to argue against the risks of H1N1 to children!
I completely disagree with you that "you might as well get SF if you are perfectly healthy, and let your natural defences take over." There have been many cases, in many countries, of folks with no underlying health conditions dying of SF, and sometimes quite quickly. Evan Frustaglio (13 year old) is one well-known case in my country; Keith Fagnou (38 year old prof) is another. Google away.
I could go on, but see little point. By all means, put your links out there, and others (such as myself) will add other info, and folks can read and decide for themselves.
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at the risk of becoming repetitive, I have found a couple of very valuable links that may help people not only decide on this extremely important issue of vaccinations and tamiflue, but may be invaluable in making them even healthier, we may be seeing only the early stages in this so called pandemic, and the worst may be coming these next few months if the virus has mutated as reports from Ukraine suggest it has done . Then the vaccine is worthless.
there is so much uncertainty about all this, being objective is extremely difficult, but maybe the links below will give pause for deeper thought
I remain perfectly happy to get this mild disease and let my body cope, and have no qualms at all, about it. Please read the literature on the web. We all react differently but it is wrong to use the data from a few cases to decide on how the rest will react. Someone who has underlying health problems will always suffer more than one who s healthy.
again, there are always cases that prove the exception and boost our own point of view, one must accept that. My concern is why is a mild influenza made such a fuss of, when seasonal flue is taken for granted? It is so inconsistent.
I place my links merely so others can have the broadest spectrum of views, and though many these views I myself am skeptical about, it does very greatly broaden ones focus on this important issue. Again, we must MAKE OUR OWN JUDGEMENT as it is our welfare that matters. That is my only concern.
http://preventdisease.com/news/09/111509_WHO_press_conference_contradictory_evidence.shtml
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one last point, I will look into what you have said, RisainCanada
and study the things you talk about, no one is infallible on all this I'm certainly not.
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Nick,
You might find this piece interesting as it explains a bit about how the estimated death totals for seasonal flu are arrived at, and why comparisons between lab-confirmed deaths and estimated deaths are so problematic (apples and oranges):
http://www.google.com/hostednews/canadianpress/article/ALeqM5iyqqXAU5kW1MBBCoSaz2nHQYREog
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