Recenlty , we saw reports about a Tamiflu resistant strain circulating in Europe.
This morning on Dutch radio:
2 young people died in 2 different hospitals from a Tamiflu resistant strain.
Dr Ab Osterhaus warns doctors not to put their trust on Tamiflu only, but also look at other anti-virals, like Relenza.
I think that oseltamivir treatment in severely ill patient like those above described was established for only ethical consideration, for compasionate purpose. As the drug label states that no data about safety and effectiveness of treatment are available for this patients.
Perhaps, it may be more useful to use a parenteral drug or a combination with the aim to reduce probability of treatment failure in a setting with widespread circulation of H1N1 oseltamivir resistant virus.
you speculate that Tamiflu treatment _caused_ the deaths ?
[Automatic translation by Google - Eurosurveillance has not to date report any death of patient with influenza virus strain resistant to oseltamivir. IOH]
-
Two young deaths from flu virus
Publication: Journal. May 21 to 23, 2008
Column: NieuwsReflex
Source (s): 886
Both in Utrecht and Rotterdam is a deceased patient with flu, by resistance to oseltamivir (Tamiflu). The victims were young patients with a weakened immune system strong.
The Rotterdam virology professor Charles Boucher reported victims of the flu virus resistant to the Congress pharmacology'100 years' on May 16 in Utrecht. 'Yearly death thousand people to the flu, but that his elderly. It was hard to lose these young patients to flu, "Boucher light to
"Until recently we thought that there were no resistant griepvirussen against oseltamivir. This is incorrect. For clinical practice, it is important to take into account the possibility of resistance. "
On January 31, 2008 reported the journal Eurosurveillance for the first resistance of oseltamivir against the H1N1 influenza virus. Those viruses were still sensitive to zanamivir (Relenza) and amantadine or rimantadine. In the Netherlands was 6 percent of the measured H1N1 viruses resistant.
Oseltamivir has a clear place in the prevention of influenza in immunocompromised patients, for example after a transplant. A 'normal' flu virus can be lethal for these patients. In general, in the Netherlands far too little attention given to flu, according to virologists Boucher. HC
-
http://medischcontact.artsennet.nl/content/dossiers/609054878/728332751/AMGATE_6059_138_TICH_R209922754455751/
-----
you speculate that Tamiflu treatment _caused_ the deaths ?
Please.
Commentary
http://www.recombinomics.com/News/05230801/H274Y_Fatal.html
even Osterhaus can not exclude that the young patients were
hit by a flu virus that is immune to Tamiflu.
And I give it ~70% at this moment.
But can we exclude the opposite ?
According to the medical journal the strain was resistant for tamiflu:
it was presented on a congres recently.
http://medischcontact.artsennet.nl/content/dossiers/609054878/728332751/AMGATE_6059_138_TICH_R209922754455751/
even Osterhaus can not exclude that the young patients were
hit by a flu virus that is immune to Tamiflu.
And I give it ~70% at this moment.
But can we exclude the opposite ?
The Rabbit Hole: Tamiflu Now Useless::
This year 99% of flu cases in the U.S. are the Tamiflu-resistant strain. In response, the C.D.C. issued new guidelines two weeks ago.
http://rabbitholenews.blogspot.com/2009/01/tamiflu-now-useless.htmlHOME |
WHO Outbreak Communication WHO Outbreak Communication::
File Format: PDF/Adobe Acrobat - View as HTMLOnce cases begin to be identified as a new influenza strain, . all of the H5N1 human isolates from Asia: oseltamivir, also known as Tamiflu, and
http://www.who.int/csr/don/Handbook_influenza_pandemic_dec05.pdfHOME |
The H1N1 likely has H274Y but it did NOT develop in the patients.
To add some perspective a snip from the warning of ECDC, posted before :
Resistance to oseltamivir (Tamiflu) found in some European influenza virus samples
Updated 7th May 2008
- snip -
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.
- snip -
http://ecdc.europa.eu/Health_topics/influenza/antivirals.html
Commentary
http://www.recombinomics.com/News/05230801/H274Y_Fatal.htmlCommentary
Fatal Tamiflu Resistant H1N1 Cases in The Netherlands
Recombinomics Commentary 12:58
May 23, 2008
Both in Utrecht and Rotterdam is a deceased patient with flu, by resistance to oseltamivir (Tamiflu). The victims were young patients with a weakened immune system strong.
The above translation describes two patients in the Netherlands who died from infection with Tamiflu resistant (http://www.recombinomics.com/News/04200804/H274Y_Brisbane.html)H1N1. Their immune system was compromised, and the H1N1 was not susceptible to Tamiflu (oseltamivir) treatment.
The report highlights the limitations of using Tamiflu to treat seasonal flu when the H274Y status is unknown. H274Y is common in many European countries. In Norway, more H1N1 infections are Tamiflu resistant than wild type. High levels (http://www.recombinomics.com/News/04170803/H274Y_Turkey.html) have also been reported in France and Russia, while many countries have frequencies between 10-20% of H1N1 cases.
Although these isolates are susceptible to Relenza, and some are still sensitive to amantadines, the reliance on Tamiflu can have deadly consequences.
Moreover, the widespread distribution of H274Y in H1N1 can (http://www.recombinomics.com/News/01300804/H1N1_H274Y_H5N1.html) impact H5N1 treatment (http://www.recombinomics.com/News/02150801/H274Y_Concurrent.html) if the polymorphism is acquired by recombination.
Recent mild H5N1 cases (http://www.recombinomics.com/News/05220806/H5N1_Dhaka_Mild.html) raise concerns that the level of H5N1 in human populations is significantly higher than the confirmed cases reported by the WHO.
.
I would like to make clear the 2 flu victims had an already weakened immune system.
No details available, they were patients already, after a transplant for instance.
So: no "killer flu" roaming around here in Holland, but this makes clear, flu is something to pay more attention to.
...and because this takes quite some time, we have to speculate.
We had seen resistance in immunocomprimized childs before,
I remember one flu-case, which developed resistance to several
drugs over several months with persistant flu.
http://www.flutrackers.com/forum/showthread.php?t=13292
But resistance seems to be easier to develope with current
circulating strains, so I speculate they had indeed H274Y - resistance.
Hmm, they are not ready yet for publication, but couldn't keep
it longer secret ?
I speculate the cases are from the season-peak , which was week 7 at
the German-Dutch border
...and because this takes quite some time, we have to speculate.
We had seen resistance in immunocomprimized childs before,
I remember one flu-case, which developed resistance to several
drugs over several months with persistant flu.
But resistance seems to be easier to develope with current
circulating strains, so I speculate they had indeed H274Y - resistance.
Hmm, they are not ready yet for publication, but couldn't keep
it longer secret ?
I speculate the cases are from the season-peak , which was week 7 at
the German-Dutch border
Please.
H274Y has nothing to do with DEVELOPING resistance. H1N1 with H274Y is quite fit and in wide circulation. It does NOT develop in these patients.
You are again posting nonsense.
Not good.
Additionaly, looking at the last web releases of Eurosurveillance:
Eurosurveillance, Volume 13, Issue 21, 22 May 2008
and the date of the professor reported it - 16 May
"The Rotterdam virology professor Charles Boucher reported victims of the flu virus resistant to the Congress pharmacology'100 years' on May 16 in Utrecht."
Maybe this web site could be connected more quickly with inf. of death flu reports from the field (by e-mails), if it want's to aware EU citizens on Internet more quickly.
There isn't a clear link between the death of one or two immunocompromised patients with underlying diseases and oseltamivir resistant H1N1 seasonal human influenza virus emergence at this point.
Be careful to avoid speculation when there is a lack of data.
Eurosurveillance will update its weekly review when researchers' work will be ready for publication.
[Google Automatic Translation]
-
Influenza viruse requires young lives
By RONALD OF GEENEN
ROTTERDAM -
An influenza virus strain that is the most commonly used anti viral, the lives of two young patients demanded.
One patient was in a Rotterdam hospital, the other in Utrecht.
They had a strong immune system weakened and were treated with the anti viral Tamiflu.
But the flu virus appeared insensitive to the drug.
That requires the Medical Journal Medical Contact today.
The news is a significant damper for doctors and virusfighters. Until recently, Tamiflu was seen as a last resort. The plea is our country's millions of doses stored to cope with large, life-influenza preparedness.
,, Until recently we thought that there was no flu strains were resistant to Tamiflu. This is incorrect. It is important that hospitals consider them,''says Charles Boucher Rotterdam virologists in Medical Contact.
Boucher:,, Each year thousand people die to the flu, but that his elderly. It was hard to lose these young people with flu.''
According to virologists Ab Osterhaus is still not entirely clear why the anti viral to the young patients offered no relief. ,, The virus goes very quickly around them in people with a weak immune system. Sometimes we see that Tamiflu than no control over the disease.''
Osterhaus can not exclude that the young patients were hit by a flu virus that is immune to Tamiflu. He urges doctors in hospitals, therefore, to be extra vigilant. ,, Now it is clear that Tamiflu is not helped, I recommend them to other virusremmers to deploy, as Relenza.''
Early this year it became known that a flu virus that is insensitive to Tamiflu is circulating in our country. Information provided by the Dutch Influenza Center proved to be the fourth of the surveyed flu samples.
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http://www.ad.nl/binnenland/2312068/Griepvirus_eist_jonge_levens.html
------
machinetranslated
'Two young deceased to flu'
Released: May 23, 2008
UTRECHT - Two Dutch youngsters are deceased to flu strain which appeared to be resistant for the prevailing anti-viral tamiflu. The magazine Medical Contact has published.
The young people came from Utrecht and Rotterdam. They were in a very weak condition.
The Rotterdam virologists Charles Boucher urges doctors to be alert to the dangerous flustrains that are resistant to tamiflu.
Remedy
The government has large quantities of the antiviral saved as the first remedy for a pandemic. This is a global outbreak of a new influenza virus against which no drugs still are available.
A few years ago showed that in Asia already tamiflu not always worked as an inhibitor of influenza virus.
http://www.nu.nl/news/1579984/10/%27Twee_jongeren_overleden_aan_griep%27.html
Two deaths from tamiflu resistant griepvariant
Friday, May 23, 2008 11:15
(Novum) - Two patients from Rotterdam and Utrecht are deceased this year as a result of an griepvariant proved resistant against conventional medicine tamiflu.
That indicates the journal Medical Contact Friday.
The victims were relatively young: they fell outside the risk of the elderly. But they had a significantly weakened immune system.
In the Netherlands, according to death virology professor Charles Boucher of the UMC Utrecht some thousand people annually to flu. "But these are elderly. It was hard to lose these young patients to flu. " The age of the victims and where exactly they are deceased is not known in the trade press.
In January docks in Norway griepvariant one that is resistant to tamiflu.
These variant came under Roel Coutinho Director of the Centre Infectieziektebestrijding of the National Institute of Health and Environment (RIVM), Netherlands barely. It is unclear whether the two Dutch deaths is connected with the flu virus that appeared in Norway. 'In the RIVM is not known what the virus is two deceased "explains a spokesman.
In the Netherlands, the antigriepmiddel tamiflu mainly used in old people's homes. When an occupant gets flu, the preventive medicine for other residents administered.
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http://www.elsevier.nl/nieuws/laatste_24_uur/artikel/asp/artnr/206827/
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Resistant influenza virus evaluates two patients
From our correspondent Marjolein den Dekker
published on May 23, 2008 15:50, updated at 15:50
She had the flu virus known as H1N1 among members.
This virus appeared spontaneously insensitive to withstand the prevailing virusremmer oseltamivir, better known under the brand name Tamiflu.
The Rotterdam virologists Charles Boucher spent this last week (Friday, May 16) at the scientific symposium 100 years of Pharmacology outwards.
Boucher also warned that the flu virus HIV alongside one of the main dangers for the world population. In so doing he was referring to the H5N1 avian flu virus, which feared that it makes the transition from the bird to humans.
According collegaviroloog Ab Osterhaus is the H1N1-flu virus, last winter the dominant virus, a relatively harmless variety.
"Studies of early this year shows that on average 25 percent of Europeans infected with the virus that is insensitive to antivirals such as Tamiflu," says Osterhaus, 'in the Netherlands is only 6 percent. "He stressed that this resistance only dangerous for certain risk groups such as transplant patients and the elderly in nursing homes.
The two deceased patients were relatively young according Osterhaus because transplants under a immuunbehandeling. 'In this way rejection of the transplant, but it means also an inhibition of the immune system. It is not uncommon for such patients receive a respiratory infection but which would still have little to do. "
Osterhaus know that it is the first time that a resitentie against a antiviraalmiddel has occurred spontaneously.
"Therefore we must be extra vigilant on that risk. If an antiviral treatment appears to have paid off is a multiple or triplebehandeling advised by other virusremmers as zanamivir (Relenza) and amantadine or rimantadine administration.
The Dutch government has a large stock tamiflu as the first remedy for a pandemic. Ostenhaus sees no reason for concern that the virusremmer would not work.
-
http://www.volkskrant.nl/binnenland/article540711.ece/Resistent_griepvirus_velt_twee_patienten
------
[Automatic translation by Google - Eurosurveillance has not to date report any death of patient with influenza virus strain resistant to oseltamivir. IOH]
-
Two young deaths from flu virus
Publication: Journal. May 21 to 23, 2008
Column: NieuwsReflex
Source (s): 886
Both in Utrecht and Rotterdam is a deceased patient with flu, by resistance to oseltamivir (Tamiflu). The victims were young patients with a weakened immune system strong.
The Rotterdam virology professor Charles Boucher reported victims of the flu virus resistant to the Congress pharmacology'100 years' on May 16 in Utrecht. 'Yearly death thousand people to the flu, but that his elderly. It was hard to lose these young patients to flu, "Boucher light to
"Until recently we thought that there were no resistant griepvirussen against oseltamivir. This is incorrect. For clinical practice, it is important to take into account the possibility of resistance. "
On January 31, 2008 reported the journal Eurosurveillance for the first resistance of oseltamivir against the H1N1 influenza virus. Those viruses were still sensitive to zanamivir (Relenza) and amantadine or rimantadine. In the Netherlands was 6 percent of the measured H1N1 viruses resistant.
Oseltamivir has a clear place in the prevention of influenza in immunocompromised patients, for example after a transplant. A 'normal' flu virus can be lethal for these patients. In general, in the Netherlands far too little attention given to flu, according to virologists Boucher. HC
-
http://medischcontact.artsennet.nl/content/dossiers/609054878/728332751/AMGATE_6059_138_TICH_R209922754455751/
-----
Not good.
Additionaly, looking at the last web releases of Eurosurveillance:
Eurosurveillance, Volume 13, Issue 21, 22 May 2008
and the date of the professor reported it - 16 May
"The Rotterdam virology professor Charles Boucher reported victims of the flu virus resistant to the Congress pharmacology'100 years' on May 16 in Utrecht."
Maybe this web site could be connected more quickly with inf. of death flu reports from the field (by e-mails), if it want's to aware EU citizens on Internet more quickly.
1) They had a strong immune system weakened and were treated with the anti viral Tamiflu.
2) Osterhaus can not exclude that the young patients were hit by a flu virus that is immune to Tamiflu.
Thus, the patients were immuno-compromised and influenza virus MAY be resistant but it isn't certain at this time.
Here's a brief background which may keep this thread on track. In the past H274Y was thought to impose a fitness penalty. Thus, H274Y could develop in Tamiflu treated patients because wild type (normal) H1N1 would be inhibited by the anti-viral drug, while the H274Y strain would not. However, the fitness penalty would prevent H274Y from spreading into untreated hosts (because wild type would dominate or the host immune system would quickly clear the crippled H1N1 with H274Y).
However, the spread of H274Y in Europe and worldwide clearly shows that the circulating virus with H274Y doesn't have much of a fitness penalty, and can successfully compete with wild type (which is also true of H274Y in H5N1 in wild birds), so these patients are being infected with H1N1 that already has H274Y. Thus, there is no DEVELOPMENT in these patients (and no requirement for Tamiflu treatment for development).
As a result, treating immuno-compromised patients with Tamiflu will not be effective, since the Tamiflu doesn't inhibit H1N1 with H274Y. These patients could be treated with Relenza or possibly one of the amantadines, but not Tamiflu.
The data for the two fatal cases would appear to involve unsuccessful treatment of these two patients with Tamiflu. The failure was not due to an excessive virulence in the H1N1 or the DEVELOPMENT of resistance, but the resistance did influence the outcome because H274Y was in the H1N1 BEFORE these patients were infected.
There isn't a clear link between the death of one or two immunocompromised patients with underlying diseases and oseltamivir resistant H1N1 seasonal human influenza virus emergence at this point.
Be careful to avoid speculation when there is a lack of data.
Eurosurveillance will update its weekly review when researchers' work will be ready for publication.
I think the link is the treatement, not the virus. No one has said the virus is more lethal. If the patients were treated with Tamiflu, and the H1N1 is resistant, then there is a problem (and the problem is H274Y awareness and consequences).
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Netherlands: Tamiflu resistant flu strain kills two