Wednesday, December 21, 2005

December 21 Flu Update--New England Journal of Medicine reports Tamiflu resistant flu is costing lives.

Today's big story...New England Journal of Medicine says two people died in Vietnam recently of flu because the disease resisted the Tamiflu. Note that this reflects statements from a local physician we ran a few weeks ago. It goes without saying that, if it continues to be true, this blows a major hole in containment strategies.

"Improper use of personal stockpiles of oseltamivir [the medical name for Tamiflu] may promote resistance, thereby lessening the usefulness of our frontline defense against influenza, and should be strongly discouraged," wrote Moscona, a medical professor at Weill Medical College of Cornell University in New York who specializes in pediatrics, microbiology and immunology.

Roche disputes the report:

Earlier today, Roche held a news briefing to respond to the findings on Tamiflu-resistant avian flu. Dr. David Reddy, influenza pandemic task force leader for Roche, said the case reports confirmed that Tamiflu is effective against the virus, because four of the eight treated patients experienced a drop in their viral levels in response to Tamiflu, and they survived. The virus progressed in the other four patients who received Tamiflu, and they later died.
Finally, here's the prescription:

"We need to work on a variety of countermeasures — not just Tamiflu — in the hope that some, and ideally many, will indeed be effective," said Bittner, chief of infectious diseases at the VA Medical Center in Omaha, Neb.

For a broader approach, he suggested widespread dispensing of pneumonia vaccines to prevent a common complication of the flu; urging smokers to quit to help them have the healthiest possible lungs and hearts; developing new ways to manufacture the flu vaccine; testing new theories to slow the spread of infection; and formulating plans to keep essential services, such as emergency medical care, running.

The Journal reports indicated that a similar drug, Relenza, might not be prone to the same problems, although there is little evidence to confirm that at this point.

Recombinomics agrees on the combination approach, and also says that the Tamiflu resistant H5N1 seems quite "fit," a bad development.

Helen Branswell has her usual outstanding piece on this situation. Two key pieces:

Research studies are currently being set up in Southeast Asia to try to determine whether higher doses, for longer periods, are needed to treat H5N1 infections.

Should that prove to be the case, governments would face the unwelcome realization that national stockpiles of oseltamivir, or Tamiflu, will not protect as many people as they had anticipated.


Dr. Keiji Fukuda, an influenza expert with the World Health Organization, listed some of the questions posed by the findings, published Thursday in the New England Journal of Medicine.

“How frequently will we see resistance arise? What is going to be the full impact of that? Is that just going to be on individual patients who are under treatment or is it going to escalate and become a larger problem for other people who may get infected by antiviral-resistant viruses?” asked Dr. Fukuda, who was not involved in the research.

“I think these are all open questions.”

Reuters says Turkey sales actually down for Christmas in Britain.

The Ag Secretary (AgSec) is asking Congress to approve bird flu funding.

A journey of a million miles....they've started human trials on a bird flu vaccine in China, with six volunteers.

North Korea, of all places, says it has developed a way to detect bird flu.

New Zealand details potential cost to the nation in a pandemic.

Romania finds bird flu East of Bucharest, in the 22nd village since October.

Effect Measure says that WHO has a handbook for journalists in covering the bird flu, but in his view is misleads them on the question of a vaccine.

ProMed has reports on surveys of migratory birds in Denmark.

Sussex County, NJ has been declared ready for a pandemic.

The UN says that Indonesia needs to be better prepared for a pandemic.


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