Tamiflu wird langsam stumpf.......Die Chance für Biota mit Relenza & Laninamivir - 500 Beiträge pro Seite

[Massel]

Tamiflu wird langsam stumpf....Die Chance für Biota mit Relenza & Laninamivir

----------------------------------------------------------
Tamiflu wird langsam stumpf

(http://www.fr-online.de/in_und_ausland/wissen_und_bildung/ak…

Für Experten überraschend schnell entwickeln Grippeviren Resistenzen gegen das Medikament / Über Kläranlagen gelangt der Wirkstoff in die Umwelt

Von Irene Meichsner

Kein anderes Medikament machte innerhalb so kurzer Zeit eine so steile Karriere. Tausende von Patienten sind im Zuge der Schweinegrippe-Pandemie bereits mit dem Grippemittel Tamiflu behandelt worden. Doch vielen Fachleuten ist inzwischen der freizügige Umgang mit Tamiflu und dessen Wirkstoff "Oseltamivir" nicht mehr ganz geheuer. Rund 30 Fälle wurden seit Ende Juni registriert, in denen Patienten auf Tamiflu nicht mehr reagierten. Bei den meisten verlor das Mittel erst während der Behandlung seine Wirkung - ein seltenes, im Prinzip aber bekanntes Phänomen. Doch es gab auch Fälle, in denen eine Resistenz des Schweinegrippe-Virus H1N1 festgestellt wurde, obwohl zuvor keinerlei Kontakt zu Tamiflu bestand - ein Hinweis darauf, dass sich solche Erreger bereits aus eigener Kraft ausbreiten könnten.
Wie rasend schnell sich ein Grippevirus durch eine kleine Änderung seiner Oberflächenstruktur dem Angriff durch antivirale Medikamente vom Typ Tamiflu zu entziehen vermag, hat sich eben erst gezeigt. Anfang 2008 war zunächst in Norwegen aufgefallen, dass einige Patienten, die mit dem saisonalen Grippeerreger infiziert waren, auf Tamiflu nicht mehr reagierten. Binnen weniger Monate breitete sich dieser resistente Virusstamm erst über Europa und dann die ganze Welt aus. Heute sind in vielen Ländern, darunter Deutschland, die saisonalen Influenzaviren zu nahezu hundert Prozent gegen Tamiflu resistent. Als Ursache stellte man eine Mutation des sogenannten Neuraminidase-Eiweißes "H274Y" fest.

Belastete Flüsse und Seen

Niemand kann ausschließen, dass sich ein solches Drama auch beim Neue-Grippe-Virus H1N1 (Schweinegrippe) wiederholt. Dabei werden Bedenken noch von einer ganz anderen Seite geäußert. Zuerst waren es nur Rechenmodelle. Im Januar 2007 stellte sich der britische Umweltforscher Andrew Singer von der Universität Oxford die Frage, welche Folgen es haben könnte, wenn während einer Influenza-Pandemie Millionen von Menschen auf der ganzen Welt gleichzeitig mit Tamiflu behandelt würden.

Damals gab es noch keine Schweinegrippe. Doch es gab das aggressive Vogelvirus H5N1 und die große Angst, dass dieser Erreger auf Menschen überspringen könnte. Nach Empfehlungen der Weltgesundheitsorganisation WHO hatten sich viele Länder, darunter auch Deutschland, bereits mit größeren Mengen von Tamiflu eingedeckt.

Andrew Singer interessierte sich allerdings weniger für medizinische als für ökologische Probleme. Der Forscher wollte wissen, in welchen Mengen und Konzentrationen die Wirksubstanz von Tamiflu in die Oberflächengewässer gelangt, wenn Millionen von Patienten das Medikament während einer Grippe-Pandemie tatsächlich schlucken.

Höchstens 20 Prozent des eingenommenen Tamiflu werden vom Körper verwertet, die restlichen 80 bis 90 Prozent in ihrer aktiven Form als so genanntes "Oseltamivircarboxylat" (OC) wieder ausgeschieden. Der überwiegende Anteil des Grippemittels würde somit über die Kanalisation zunächst die Klärwerke erreichen.

"Die aktiven Komponenten des Medikaments sind sehr widerstandsfähig. Sie überwinden die verschiedenen Reinigungsstufen von Kläranlagen und wandern im Prinzip direkt in deren Abwässer", sagt Jerker Fick, ein Chemiker an der nordschwedischen Universität Umea, der mit seinen Kollegen den Nachweis führte, dass das Oseltamivircarboxylat von den herkömmlichen Kläranlagen nicht abgebaut wird.

Nahezu unversehrt und in riesigen Mengen gelangt die Wirksubstanz von Tamiflu somit in Flüsse und Seen, an denen Enten und andere Wasservögel leben. Wenn diese Vögel Grippeviren in sich tragen, was sehr häufig der Fall ist, könnten einige Erreger eine Resistenz gegen das Medikament entwickeln. Würden solche Viren von den Vögeln ausgeschieden und auf Menschen überspringen, hätte dies für eine nachfolgende Grippewelle womöglich fatale Konsequenzen: Eine der wenigen halbwegs wirksamen Waffen gegen die Influenza wäre plötzlich stumpf.

------------------------------------------------------------------
Ich möchte hier vorallem die Nachrichten disktuieren, die
in Zusammenhang mit Tamiflu und ggf. Verlustes des Nr.1 Status
im antiviralen Medikamentensektor im Zusammenhamg stehen könnten.

Ich denke, dass dieser Sachverhalt überaus wichtig ist, da dies
zu exorbitanten Kurssprüngen bzw. MEHREINNAHMEN bei Biota führen könnte wenn Tamiflu wirkungslos werden würde.

- zunehmende Tamiflu Resistenz & Tamiflu Nebenwirkungen sind
wohl die Ereignisse die maßgeblich dazu beitragen könnten Tamiflu in der Bedeutungsloskeit verschwinden zu lassen, wenn diese massiv zunehmen sollten...

Also lasst uns hier die Fakten , Nachrichten zusammentragen, damit wir ein besseres Bild darüber bekommen.

Gruß
massel

[Erbse1]

Antwort auf Beitrag Nr.: 38.245.091 von Massel am 23.10.09 23:35:11

Hallo Massel
Hab nur eine kleine Frage. Das ist ja alles ganz logisch und soweit versteh ich das auch. Trifft das dann aber nicht auch auf Relenza & Laninamivir zu.
Du schreibst <<<Für Experten überraschend schnell entwickeln Grippeviren Resistenzen gegen das Medikament / Über Kläranlagen gelangt der Wirkstoff in die Umwelt>>>
Warum soll das nur auf Tamiflu zutreffen und nicht auf Relenza & Laninamivir.
Wäre schön hierauf eine verständliche Antwort zu erhalten.
Grüße
Erbse

[Massel]

Hi Erbse,

kleine aber sehr wichtige Frage;

siehe hier:
http://www.faz.net/s/Rub7F74ED2FDF2B439794CC2D664921E7FF/Doc…

Auszug:

......"Und schließlich können Ärzte, wenn sie nach 24 Stunden Behandlung mit Tamiflu keine Besserung erkennen, auf ein zweites Influenzamedikament umsteigen: Vor dem Medikament Relenza mit dem Wirkstoff Zanamivir bietet die Mutation H274Y den Viren keinen Schutz"....

....."Allerdings passt die Tamiflu-Wirksubstanz nicht optimal, sie muss das Molekül der Neuraminidase ein wenig verbiegen, um ins aktive Zentrum zu passen. Das verhindert nun die Mutation H274Y, die Neuraminidase bleibt steif und Tamiflu außen vor. Relenza hingegen passe besser, erklärt Ruprecht Schmitt-Ott vom Relenza-Hersteller GlaxoSmithKline. „Resistenzbildung lässt sich auch bei diesem Wirkstoff nicht vollständig ausschließen.“ Aber diese setzt genetische Veränderungen der Viren voraus, die in diesem Fall schwieriger im Erbgut zu gestalten sind, ohne die Enzymfunktion der Neuramidase zu beeinträchtigen.".......

-----------------------------------------------------------------
Meine Meinung:

Natürlich würde die Gefahr einer Resistenz immer größer werden,
je mehr Relenza von der Bevölkerung genommen werden würde:
die Zeit liegt aber noch vor uns ...

Deswegen hat die WHO ja auch dringend empfohlen diese Medikamente
nur in wirklich berechtigen Fällen zu verabreichen und nicht direkt bei jeder Erkältung...

Bei Tamiflu scheint es nun schon zu spät zu sein, denn die Resistenz ist bei der normalen Grippe schon voll ausgeprägt und bei der Schweingrippe eindeutig auf dem Vormarsch...

Zusammenfassend kann man wohl sagen, je länger ein Medikament im Markt UND die Anzahl der Benutzung (vorallem die nicht sachgerechte) am größten ist, desto höher ist die Gefahr des es zu Resistenzbildung kommt, denn Viren könne sich sehr gut anpassen.

Laninamivir ist noch nicht erhältlich (voraussichtlich ab 1/2 Q. 2010) und daher absolut "sauber", bei Relenza gibt es bisher keinen einzigen registrierten Resitenz-Fall.


Gruß
massel

[Erbse1]

Also doch dann zeitverzögert das gleiche Problem. Somit doch kein gravierender Vorteil gegenüber Tamiflu. Danke für deine Antwort.

Grüße und schönes Wochenende
Erbse

[Massel]

Antwort auf Beitrag Nr.: 38.245.450 von Erbse1 am 24.10.09 08:49:31

es kann ggf. bei Relenza auch Resistenzen geben, dies kann man
nicht ausschließen (es gibt nirgends eine 100%ig Sicherheit).
Fakt ist momanten gibt es sie nicht.

Bei Tamiflu jedoch nachweislich schon.

Mann kann also sagen Tamiflu wirkt nicht immer, Relenza aber schon.
Weil man im Falle einer Schweinegrippe-Infektion nur ca. 48Std. Zeit hat mit den Medikamenten erfolgreich zu behandeln, nicht unwichtig...

Daher ist das schon ein gravierender Vorteil für Relenza. Ansonsten hätten z.B die USA Ihren Medikamentenstock-Politik nicht vor kurzem von 80:20 Tamiflu-Relenza in 50:50 geändert.

oder hier: Tamiflu hat versagt, Relenza Leben gerettet:

http://www.stern.de/grippe/aktuelles/schweinegrippe-zweiter-…

es gibt mittlerweile etliche News im Internet, einfach mal googleln...

Gruß und schönes Wochenende
massel

[Massel]

Taiwan > National
Foreign Community
National
Local
Foreign Affairs
China-Taiwan Relations
Business
Arts & Leisure
Updated Wednesday, October 28, 2009 9:29 am TWN, The China Post news staff
Elementary, junior high schools seeing H1N1 surge
TAIPEI, Taiwan -- In the last week alone, the number of swine flu infections observed across elementary and junior high school campuses have jumped by 10 to 20 percent, health officials said yesterday.

The resurgence of the A(H1N1) swine flu has been especially perceptible in northern regions of the island, said Deputy Director-General Chou Zhi-hao of the Centers for Disease Control (CDC).

Amid a recent drop in temperatures on the island, the novel virus has wended its way back to communities, with classrooms continuing to present themselves as prime breeding ground.

Of the 14 hospitalized A(H1N1) cases reported yesterday, nine of them involved children nine years or younger, according to the Central Epidemic Command Center (CECC).

Students should not take fever reducers to combat symptoms of the swine flu without consultation with a medical professional, CECC officials warned. Even in the absence of fever, the virus remains active and contagious, officials said.

Department of Health (DOH) Vice Minister Chang Shan-chwen was cited as saying that medical facilities have seen increased traffic in outpatient flu clinics as well as in emergency rooms in the last few weeks.

Meanwhile, reports surfaced of another Oseltamivir-resistant A(H1N1) virus strain.

Oseltamivir is an antiviral drug commonly known by its trade name Tamiflu, made by pharmaceutical company Roche.

The CECC confirmed the discovery of the resistant flu strain in a 44-year-old male and maintained that the infection remained an isolated case.

No signs of further transmission or collective outbreak were detected, said the CECC.

This is the second mutated form of the flu discovered in Taiwan.

According to the World Health Organization (WHO), there have been 39 A(H1N1) flu-resistant strains reported across the globe.

Including the latest flu-resistant strain would bring the tally to 40, said Chang.

There are 960,000 courses of another antiviral drug Relenza in government stockpiles, intended for use when resistance is shown against Tamiflu, Chang remarked.

Health officials are currently discussing the possibility of prescribing Relenza to those with A(H1N1) infections that do not respond to Tamiflu, the vice minister indicated. In related news, A(H1N1) vaccinations are set to roll out beginning this Sunday, said the United Evening News.

Typhoon Morakot victims are to receive vaccine shots Nov. 1 and medical care personnel on Nov. 2, the report noted. Infants between six months and one year of age will be immunized starting Nov. 9 with vaccine manufactured by Swiss pharmaceutical company Novartis, said the report.
Subscribe to The China Post and save 25%

[Massel]

http://www.telegraaf.nl/grieplijn/5240521/__Eerste_resistent…

wo 04 nov 2009, 11:39 | 81 reacties

Eerste resistente geval Mexicaanse griepBILTHOVEN - In Nederland is een eerste geval geconstateerd van een patiënt, besmet met Mexicaanse griep, die niet reageert op de virusremmer Tamiflu. Het Rijksinstituut voor Volksgezondheid en Milieu (RIVM) heeft dat woensdag bekendgemaakt.


Grieppatiënten met Mexicaanse griep die in het ziekenhuis worden opgenomen, worden doorgaans behandeld met Tamiflu. Ze knappen daarvan meestal iets sneller op, en zijn iets minder ziek. Volgens directeur Infectiezieken Roel Coutinho van het RIVM kan de patiënt nog worden behandeld met Relenza, een andere virusremmer. Maar hij zegt ook dat de persoon vooral op eigen kracht zal moeten herstellen.

De resistentie hoeft volgens Coutinho in principe niet veel negatieve consequenties te hebben voor de overlevingskansen van de persoon. De patiënt heeft behalve Mexicaanse griep ook een afweerstoornis. Uit het feit dat de persoon in het ziekenhuis ligt, kan worden afgeleid dat hij of zij er ernstig aan toe is.

Volgens het RIVM wordt de familie van de patiënt onderzocht op besmetting maar zijn er tot nu toe geen aanwijzingen dat het virus zich heeft verspreid.

Wereldwijd zijn er 39 gevallen bekend van resistentie tegen Tamiflu. Volgens Coutinho heeft niet één geval zich verder verspreid. Gezondheidsautoriteiten vinden het heel belangrijk te voorkomen dat resistente virussen kans krijgen zich te verspreiden. Virusremmers zijn zo'n beetje het enige middel dat er is om aan ernstig zieke Mexicaanse grieppatiënten te geven.

Het RIVM hamert erop dat mensen die zich grieperig voelen, thuis moeten blijven. Als ze hoesten of niezen, moeten ze dat in een weggooizakdoek doen of in de binnenkant van hun elleboog. Ook is het raadzaam om vaak de handen te wassen. Op deze manier zou voorkomen kunnen worden dat virussen zich verspreiden.

-----------------

gruß
massel

[Massel]

Wieder ein Fall , wieder aus Hongkong, bei dem "anscheinend" Tamiflu versagt....:



Hong Kong: Critical case of human swine influenza at Tuen Mun Hospital
Submitted by editor on November 11, 2009 - 19:00

The following is issued on behalf of the Hospital Authority:

The spokesperson of Tuen Mun Hospital (TMH) made the following announcement regarding a newly confirmed critical human swine influenza (HSI) case today (November 11):

A five-year-old girl with global developmental delay, epilepsy and asthma developed flu symptoms on November 6.She attended the Accident and Emergency Department of Tuen Mun Hospital on November 9 and was admitted to the intensive care unit for observation and treatment.Positive result for human swine influenza was confirmed on November 10 and she was prescribed with Tamiflu and antibiotics.Her condition deteriorated to critical today (November 11) and she requires ventilation support.The hospital is closely monitoring her condition.
------------------------------

gruß
massel

[Massel]

Und einer aus Canada....:

Tamiflu-Resistant Swine Flu Found in Canadian Father

WEDNESDAY, Nov. 11 (HealthDay News) -- Researchers report that a father in a Canadian family developed a strain of the H1N1 swine flu that was resistant to the antiviral Tamiflu, after being given the drug to prevent the disease.

To date, the World Health Organization has reported some 45 cases of H1N1 swine flu that were resistant to Tamiflu, which is why the U.S. Centers for Disease Control and Prevention and others caution against using Tamiflu to prevent the disease in people who are symptomless.

"We have a person who was taking post-exposure prophylaxis with Tamiflu, probably at the time he was already incubating the virus, but before symptoms developed," said lead researcher Dr. Guy Boivin, of the Centre Hospitalier Universitaire de Quebec, in Quebec.

According to the report, when the father's 13-year-old asthmatic son was hospitalized with H1N1 swine flu, other family members were given a reduced dose of Tamiflu to prevent them from getting the disease. These included the 59-year-old father, who suffered from chronic obstructive pulmonary disease (COPD), his 50-year-old wife and two teenage daughters.

Within a day the father developed flu symptoms, but he did not see a doctor for eight days. A test of his virus showed that it was resistant to Tamiflu. None of the other family members developed flu. The father recovered from the flu, according to the report in the Nov. 11 online edition of the New England Journal of Medicine.

The mutated strain of H1N1 swine flu remained susceptible to another antiviral, Relenza, Boivin added.

The family's experience was a good setting for resistance to emerge, Boivin said. When someone has the H1N1 swine flu, Tamiflu is given twice a day for five days. But when the drug is used to prevent the disease, it is given only once a day for 10 days, he explained.

Since the father was most likely already infected with swine flu, the dose of Tamiflu he received was ineffective at stopping the virus and low enough to allow the virus to develop resistance to the drug, Boivin said.

"In that context, Tamiflu is a risk factor for the emergence of resistance," he explained.

Boivin said that one-third of the known cases of H1N1 virus resistant to Tamiflu have been among people already exposed to the pandemic flu. "Another third emerged in imuno-compromised [weakened immune system] patients who received prolonged therapy with Tamiflu," he said.

The mutation of the H1N1 virus that caused its resistance to Tamiflu was the same one that was found in seasonal flu resistant to the drug. Last year, one strain of the seasonal flu was resistant to Tamiflu, Boivin said.

"You should be careful when you use post-exposure prophylaxis," Boivin said. In most cases, Tamiflu should be reserved for early treatment of flu when symptoms develop, he said.

Dr. Marc Siegel, an internist and associate professor of medicine at New York University Langone Medical Center in New York City, said that "Tamiflu prophylaxis given to the wrong people can increase your risk of a resistant strain developing -- and that's the last thing we need."

Siegel thinks, however, that Tamiflu used correctly can help prevent people from getting the flu, especially when the vaccine is in short supply.

"In the absence of available vaccine, one of the ways you can cut down on the spread of H1N1, to people you feel are at risk, is with the proper use of Tamiflu prophylaxis," he said.

Another expert, Dr. Pascal James Imperato, dean and Distinguished Service Professor of the School of Public Health at SUNY Downstate Medical Center in Brooklyn, N.Y., said that "based on our current knowledge, it appears that resistance of influenza viruses to the anti-influenza drug Tamiflu occurs in a setting of drug overuse."

This reported case from Canada underscores the need to limit the use of Tamiflu in people who aren't displaying flu symptoms, Imperato said.

"It also points out the need for increasing the dose of the drug to therapeutic levels in anyone who develops symptoms of influenza while on lower post-exposure prophylactic doses," he said.

More information

For more on H1N1 swine flu, visit the U.S. Department of Health and Human Services.


SOURCES: Guy Boivin, M.D., Centre Hospitalier Universitaire de Quebec, Quebec, Canada; Marc Siegel, M.D., internist and associate professor, medicine, New York University Langone Medical Center, New York City, and author, Swine Flu: The New Pandemic; Pascal James Imperato, M.D., M.P.H., dean and Distinguished Service Professor, School of Public Health, SUNY Downstate Medical Center, Brooklyn, N.Y.; Nov. 11, 2009, New England Journal of Medicine, online

Copyright © 2009 ScoutNews, LLC. All rights reserved.

[eric949]

http://cbs4.com/local/tamiflu.resistance.prescribing.2.13083…

Nov 12, 2009 1:57 pm US/Eastern

Canadian Docs Warn Of Danger Using Tamiflu On H1N1

QUEBEC CITY, Quebec (CBS4)

As fear and confusion continue to rule the debate on swine flu
vaccines, Canadian officials are warning doctors against overusing Tamiflu, or using it in the wrong manner. In June, a Canadian father was the first case of Tamiflu-resistant swine flu in North America. According to the World Health Organization, 42 cases of Tamiflu-resistant pandemic H1N1 viruses have been found globally since the pandemic began earlier this year.

The case was reported by Dr. Guy Boivin who is based at Laval University in Quebec City. "I have to admit I would have expected more cases, considering…the large volume of Tamiflu that has been used in the last few months, certainly more than in the last five years," Boivin told the Canadian Press.

If swine flu is developing a resistance to Tamiflu, it wouldn't be the first flu to mutate that way. Seasonal flu viruses began to develop resistance to Tamiflu a few years ago. Doctors and researchers still haven't figured out why the resistance developed.

Boivin said part of the problem was doctors are prescribing the drug and giving it at a prophylaxis dose instead of a treatment dose, according to the Canadian Press. One-third of the cases of Tamiflu resistant flu have been in people who had been giving the drug for prophylaxis, which helps stave off infection but doesn't kill off all the viruses in an infected person's body, the Canadian Press reported.

"If I had a highly immunocompromised host (patient) where I knew that they were unlikely to respond to the vaccine and they had a significant risk exposure, I would probably err on the side of giving them full therapeutic doses for that particular exposure," antiviral expert Dr. Frederick Hayden told the Canadian Press. "But I think one needs to individualize."

According to Hayden, if it's necessary to put someone on prophylaxis, it might be better to use Relenza, saying it's been under-utilized for that purpose.

[Massel]

Tamiflu-resistant swine flu cluster reported in NC
By MIKE STOBBE (AP) – 1 hour ago

ATLANTA — Four North Carolina patients at a single hospital tested positive for a type of swine flu that is resistant to Tamiflu, health officials said Friday.

The cases reported at Duke University Medical Center over six weeks make up the biggest cluster seen so far in the U.S.

Tamiflu — made by Switzerland's Roche Group — is one of two flu medicines that help against swine flu, and health officials have been closely watching for signs that the virus is mutating, making the drugs ineffective.

More than 50 resistant cases have been reported in the world since April, including 21 in the U.S. Almost all in the U.S. were isolated, said officials with the U.S. Centers for Disease Control and Prevention.

The BBC reported another cluster of five Tamiflu-resistant cases this week in Wales, in the United Kingdom.

The CDC has sent three disease investigators to North Carolina to help in the investigation there, said Dave Daigle, a CDC spokesman. CDC testing confirmed the Tamiflu-resistant cases.

All four cases at the hospital were very ill patients in an isolated cancer unit on the hospital's ninth floor, and it is believed they all caught the flu while at the hospital, said Dr. Daniel Sexton, professor of medicine and director of the Duke Infection Control Outreach Network.

Three of the four patients died and one is recovering, he said. Flu seems to have been a factor in each death, but they were very sick so it was hard to say that it was the primary cause, he added.

North Carolina health officials did not disclose details about the four patients, other than that three of them — including the survivor — were women and their flu illnesses occurred last month and this month.

The first patient had been given Tamiflu before becoming ill with the virus, as a preventive measure. The three others were given Tamiflu after developing flu symptoms, Sexton said.

The case is under investigation, but hospital officials said they have no evidence the cases represent a hospital-wide concern.

The North Carolina cluster is unusual, but "at this time we don't have any information that should raise concerns for the general population," said Dr. Alicia Frye, epidemiologist in the CDC's flu division, in a prepared statement.

The only other reported U.S. instance of Tamiflu-resistant swine flu spreading from one person to another occurred about four months ago at a summer camp in western North Carolina, where two teenage girls — cabin mates — were diagnosed with the same drug-resistant strain. Health officials said at the time that the virus may have spread from one girl to the other, or it's possible that the girls got it from another camper.

Why did both Tamiflu-resistant clusters occur in North Carolina? It could be coincidence, or perhaps North Carolina's disease surveillance is unusually good, said Megan Davies, the state's epidemiologist.

Overall, CDC officials said Friday that swine flu cases appear to be declining throughout most of the U.S., with reports of swine flu illnesses widespread in 43 states last week, down from 46 the week before.

CDC officials also said reports have been increasing in a few states, including Maine and Hawaii. They said it's hard to know whether the epidemic has peaked or not.

Thanksgiving and the holidays may not help matters, said Dr. Anne Schuchat, who heads the CDC's National Center for Immunization and Respiratory Diseases.

"All the kids get together with their grandparents and there's a lot of exchange of warmth and love, but a little exchange of viruses, too," she said.

Swine flu has sickened an estimated 22 million Americans, hospitalized about 98,000 and killed 4,000 since it was first identified last April. It has proved to be similar to seasonal flu but a much bigger threat to children and young adults.

Also on Friday, CDC officials said they are aware of a new report from Norway of a distinct form of swine flu seen in three patients that seems to have an unusual ability to settle deep into the lungs and therefore could potentially be more dangerous.

The Norway report isn't the first time that particular mutation has been seen: About 15 others have been reported around the world, including four in the United States. Some cases proved fatal, but others caused only mild illnesses, CDC officials said.

The swine flu vaccine and antiviral drugs like Tamiflu and Relenza all seem to work well against it, CDC officials also said.

Copyright © 2009 The Associated Press. All rights reserved.

[Massel]

http://de.euronews.net/2009/11/21/neue-resistenzen-bei-schwe…

In Großbritannien ist eine neue Form des Schweinegrippevirus aufgetaucht, die gegen das Mittel Tamiflu resistent ist. Betroffen sind fünf Patienten in einem Krankenhaus in Wales.

Drei von ihnen haben sich offenbar dort erst angesteckt: Dann wäre es das erste Mal, dass eine resistente Form des Erregers – bei der die Behandlung also nicht mehr wirkt – von Mensch zu Mensch übertragen wurde.

Bei allen fünf Patienten war das Immunsystem angegriffen. Trotz der Tamiflu-Resistenz wirkte bei ihnen eine Behandlung mit Relenza, einem anderen Mittel.

Mediziner zeigen sich von der Veränderung des Virus aber wenig überrascht: In ihren Augen hat sich der Erreger bisher erstaunlich stabil verhalten, seit er im April zum ersten Mal aufgetaucht ist.

Auch Norwegen meldet eine Mutation des Virus. Die neue Form siedelt sich offenbar tiefer in den Atemwegen an. Sie wurde bei drei Patienten entdeckt; zwei von ihnen sind gestorben. Allerdings war das schon vor etwa zwei Monaten; seitdem ist diese Form nicht wieder gefunden worden. Eine Resistenz gegen Medikamente oder Impfstoffe gab es bei diesen Erregern nicht.

Copyright © 2009 euronews

tags: Gesundheit

------------------------------------------

gruß
massel

[Massel]

ORF.athttp://news.orf.at/?href=http%3A%2F%2Fnews.orf.at%2Fticker%2…

Erstmals mutierte Schweinegrippe-Viren entdeckt
zurückIn Norwegen und Großbritannien haben Ärzte verschiedene mutierte Schweinegrippe-Viren nachgewiesen. In beiden Fällen gehen die Mediziner derzeit aber nicht von einem höheren Gefahrenpotenzial aus.

In Großbritannien haben sich Menschen erstmals gegenseitig mit einer Schweinegrippe-Variante angesteckt, gegen die das verbreitete Medikament Tamiflu nicht wirkt. In Norwegen fand sich bei zwei verstorbenen und einem schwer kranken Schweinegrippe-Patienten eine andere Variante des Erregers H1N1, die möglicherweise dazu führt, dass der Erreger tiefer in die Atemwege eindringen kann.

Auf Uniklinik angesteckt
Bei den fünf britischen Patienten eines Krankenhauses in Wales handelt es sich nach Erkenntnissen der Gesundheitsbehörden um die weltweit ersten Fälle einer Übertragung eines solchen resistenten Erregers von Mensch zu Mensch. Mindestens drei der Patienten hatten sich direkt auf der Station der Universitätsklinik in Cardiff angesteckt, wo sie wegen anderer schwerer Krankheiten behandelt worden waren.

Zwar wurden der Weltgesundheitsorganisation (WHO) bisher mehr als 50 Fälle von Grippestämmen gemeldet, die gegen Tamiflu resistent sind. Nach Informationen der nationalen Gesundheitsbehörde gab es bisher aber keine bestätigten Fälle einer Übertragung von Mensch zu Mensch. Die Behörde ging jedoch nicht davon aus, dass sich der Stamm aus Cardiff weit verbreiten wird.

Der Erreger ist den Angaben zufolge nicht aggressiver als andere Grippeviren und könne zudem mit dem Mittel Relenza behandelt werden. Zwei Patienten hätten sich bereits erholt.

--------------------------------------------------------

gruß
massel

[Massel]

http://www.express.co.uk/posts/view/141733/Swine-flu-Tamiflu…

SWINE FLU: TAMIFLU-RESISTANT STRAINS 'INEVITABLE'


SWINE FLU: More outbreaks of Tamiflu-resistant strains are "inevitable"
Sunday November 22,2009
By Daily Express Reporter Have your say(1)
BRITAIN’S leading flu expert yesterday warned that more outbreaks of Tamiflu-resistant strains of swine flu were “inevitable”.

It comes as five patients at a Welsh hospital were diagnosed with a new strain that does not respond to the drugs.

Experts believe the five, at University Hospital of Wales, Cardiff, may be among the first cases of person-to-person transmission of a Tamiflu-resistant strain in the world.

The five were being treated for underlying health problems. One is in intensive care. Two are on the ward and two have been discharged.

Virus expert, Professor John Oxford, of Queen Mary School of Medicine, University of London, said: “As the virus spreads and millions are infected and more and more of the drug is used you would expect drug-resistant strains to come up.”

He said the drug-resistant strains were more likely to affect people who already have problems with their immune system.

Meanwhile, swine flu vaccines are said to be in short supply and are being rationed among GPs in Lincolnshire, according to a leaked email sent to doctors across the county.

-----------------------------

gruß
massel

[Massel]

Auch neue Tamiflu-Resitenzfälle in den USA:

http://www.app.com/article/20091121/NEWS06/91121063/Drug-res…

Drug resistant H1N1 found in U.S. and U.K.By Steve Sternberg • USA TODAY • November 21, 2009

Comments(0)Recommend
Print this page E-mail this article ShareDel.icio.us Facebook Digg Reddit Newsvine
Buzz up!Twitter Epidemic experts say they are investigating the apparent spread of Tamiflu-resistant swine flu virus among four patients at Duke University Medical Center in Durham, N.C., and five in a hospital in Wales.

These clusters appear to be the first in which a virus resistant to the antiviral Tamiflu, a mainstay of flu treat, has spread from person to person, researchers said Friday.

If Tamiflu-resistant virus spreads widely, swine flu will become tougher to treat and may cost more lives, says Duke's Daniel Sexton, who is leading the hospital's investigation.

Doctors say investigations of the two hospital outbreaks are underway, but the preliminary genetic evidence suggests that the virus spread among patients at the hospitals.

"The four patients involved in this situation had the same resistance pattern," says Sexton, adding that researchers at the Centers for Disease Control and Prevention are now testing virus samples from Duke to see whether they're identical.

"The resistance pattern suggests that might be the case," he says.

All of the Duke patients were located in a ward for people with cancer or severe blood disorders. All were severely ill and were highly susceptible to infections, Sexton says.

The patients became ill with flu in October. When they didn't respond to Tamiflu two weeks ago, the hospital sent specimens of their virus to see whether it might be resistant to antiviral treatment. The results came back this week, prompting Duke to launch an investigation.

CDC spokesman Dave Daigle confirmed that three CDC epidemiologists have arrived at Duke to assist in the investigation, alongside infectious disease experts from the hospital and the state health department. The research team is also trying to determine whether Tamiflu-resistant flu is circulating elsewhere in North Carolina.

Three of the four Duke patients have died, Sexton says. The fourth is extremely ill but is being treated with another antiviral called Relenza and appears to be recovering.

In Wales, doctors have confirmed five Tamiflu-resistant swine flu cases in one ward of an unidentified hospital. Three more patients on the ward are being tested for drug-resistant virus; a ninth patient is infected with virus that is still susceptible to Tamiflu.

"At present we believe the risk to the general healthy population is low," Britian's Health Protection Agency said in a statement, noting that there is no evidence that the resistant virus is any more virulent than any other form of flu. A community-wide investigation is ongoing, the agency said.

So far, like the swine flu virus isolated from the Duke patients, the Wales virus remains sensitive to the antiviral drug Relenza.

As of Friday, the World Health Organization has reported 57 cases of Tamiflu-resistant virus worldwide.

---------------------------

gruß
massel

[Massel]

Tamiflu-resistant H1N1 causing some concern
November 22, 2009

The momentum of the H1N1 flu outbreak has fallen off, but flu activity is still high and Tamiflu-resistant virus may have begun to spread. USA TODAY'S Steve Sternberg asks experts for their perspective.

Q: How bad is H1N1 now?


A: Forty-three states are reporting widespread cases, down from 46 last week, says Anne Schuchat, director of the Centers for Disease Control and Prevention's National Center for Immunization and Respiratory Diseases. "We are beginning to see some declines in influenza activity, but there's still a lot of influenza everywhere."


Q: Has the flu peaked?


A: "I wish I knew," Schuchat says. "Influenza is unpredictable, and it's so early in the year to have this much disease."

Q: Is the vaccine supply improving?


A: Yes, she says. As of Friday, 54.1 million doses of H1N1 vaccine were available for states to order, 11 million more than a week ago. By Wednesday, states had ordered 93% of the amount that was available to them. About 94.5 million doses of seasonal flu vaccine also have been distributed nationwide.

Q: What is the latest about Tamiflu-resistant cases?

A: Four patients at Duke University Medical Center in Durham, N.C., and at least five in an unidentified hospital in Wales have become infected with H1N1, or swine flu, viruses that no longer respond to treatment with Tamiflu. Flu viruses swap genes as part of their normal evolution; that means resistant viruses could quickly spread worldwide, says Duke's Daniel Sexton.

Q: Why should I worry about Tamiflu-resistant cases of flu?

A: Tamiflu and Relenza are the most effective antiviral drugs for treating flu. H1N1 is still largely vulnerable to both drugs, unlike many seasonal flu viruses, which are now broadly resistant and more difficult to treat. Most people will get well with rest and fluids. A hard-to-treat virus can be deadly for some patients, such as pregnant women or children with asthma or cerebral palsy, who need effective treatment because they account for a disproportionate number of deaths caused by swine flu.


Q: Does that mean H1N1 will become as deadly as the 1918 virus?


A: There's no evidence to suggest the virus is getting more virulent, Schuchat says. But it may become harder to treat.

Q: Will Thanksgiving have any impact on the epidemic?

A: "We've seen with a lot of respiratory infections that there are increases in January right after the Christmas holiday," Schuchat says. "All the kids get together with their grandparents. There's an exchange of a lot of warmth and love, but there's a little exchange of viruses, too. We think its critical that if you're sick, stay home. And if your child is sick, to keep them away from others."

-------------------------------


Tamiflu´s Zeit läuft definitiv immer schneller ab.
Die Evolution des Virus lässt sich nicht aufhalten.


gruß
massel

[Massel]

http://www.hstoday.us/content/view/11197/149/

Tamiflu-resistant H1N1 Varients Has Experts Worried
by Anthony L. Kimery
Tuesday, 24 November 2009

'Argues for vaccination as the one sure way to combat this disease before it strikes'
Four patients at Duke University Medical Center in Durham, NC, at least five persons in a hospital in Wales, and a father in Quebec, Canada have become infected with an apparently mutated strain of H1N1 that is resistant to Tamiflu (oseltamivir), the leading antiviral of choice to treat influenza in lieu of having a vaccine.

Meanwhile, Norwegian health authorities reported a potentially significant mutation in H1N1 that could be responsible for the severest symptoms in those infected by the strain - especially persons most at risk to the virus - which authorities are monitoring carefully because of concerns that it, too, might become resistant to Tamiflu, and, possibly, other antivirals if they become as widely administered as oseltamivir.

Similar mutations have been reported elsewhere, but haven’t necessarily provoked a more virulent virus or proven to be less resistant to Tamiflu or other antivirals. Nevertheless, authorities are concerned.

There have been growing concerns on the part of virologists for some time that antiviral-resistant influenza could be a serious problem during a pandemic, as antivirals are the primary defense against a pandemic until an effective vaccine is developed and distributed.

The World Health Organization (WHO) reported that it has confirmed more than 40 cases of Tamiflu-resistant pandemic H1N1 viruses globally since it declared a pandemic in June.

The Centers for Disease Control and Prevention (CDC) said there have been 57 US cases of Tamiflu resistance since the pandemic H1N1 virus was identified in April, and “sporadic” reports of mutations similar to those in Norway.

Seasonal H1N1 viruses had already developed resistance to Tamiflu several years ago, and experts are concerned that the same thing could occur with the pandemic strain of H1N1 given that Tamiflu is now in widespread use.

According to the recent study, Morbidity and Mortality Associated With Nosocomial Transmission of Oseltamivir-Resistant Influenza A (H1N1) Virus, published in the March 2 Journal of the American Medical Association (JAMA), and authorities at CDC, a natural genetic mutation in A-H1N1 rather than the virus’s adaptation to survive treatment with antivirals, has made it resistant to Tamiflu. This poses an extraordinarily serious health threat to patients hospitalized with the flu virus who are being treated with the antiviral.

“I think the seminal message [of this study] is a valuable key to our understanding of the presumed efficacy of antiviral treatment, and again argues for vaccination as the one sure way to combat this disease before it strikes,” a top public health official told HSToday.us on background because of the politically sensitive nature of his position.

While Tamiflu-resistant influenza increasingly has been found around the world since January 2008, it had been presumed that strains carrying the mutation were of lower risk and less likely to be transmitted.

"However, current widespread circulation of oseltamivir-resistant influenza A-H1N1 viruses associated with typical influenza illnesses and viral pneumonia suggest that these viruses retain significant transmissibility and pathogenicity," the authors of the JAMA report wrote.

Because flu viruses are among the most mutable viruses, they interchange genes swiftly and routinely, meaning antiviral-resistant viruses could quickly spread worldwide.

CDC officials stated that nearly all cases of the most common seasonal flu strain in the United States are resistant to Tamiflu.
"As of February 19, resistance to oseltamivir had been identified among 264 of 268 :eek98.5 percent):eek: US influenza A-H1N1 viruses tested,” researchers noted.

The problem of antiviral-resistant strains of a pandemic influenza virus has long worried public health authorities. As HSToday.us has reported, resistance to Tamiflu in particular has been growing among some strains, including highly virulent H5N1 strains and seasonal influenza. Authorities say evidence indicates antiviral-resistant influenza occurs in settings of overuse of the medications.

Experts worry that over-prescribing Tamiflu for what remains a relatively mild illness for the majority of people who are infected by A-H1N1 could make antivirals useless over the long term.

Brit Oiulfstad, the pandemic influenza coordinator for the County of Los Angeles, had earlier told HSToday.us that heavy reliance on antivirals is “even more troubling when we are currently dealing with the effects of overuse/misuse of antibiotics.”

Despite these concerns, though, prescriptions for Tamiflu, Relenza, and other antivirals totaled 587,960 for the week ending Oct. 30, a 5.9 percent increase from the week before, according to Wolters Kluwer Pharma Solutions, which provides information on prescriptions for the antivirals to the Food and Drug Administration (FDA), which uses the data to track the treatment of H1N1 and other influenza viruses.

In late September, CDC cautioned that the spread of H1N1 would "likely impact the nation’s pharmacies as a greater number of people than usual seek to fill prescriptions for influenza antiviral drugs."

"I want to stress that people who are not from the at risk group ... need not take antivirals," Dr. Nikki Shindo of WHO’s global influenza program stated. "We are not recommending taking antivirals if otherwise healthy people are experiencing only mild illness, or as a preventive in healthy people."

"Tamiflu prophylaxis given to the wrong people can increase your risk of a resistant strain developing - and that's the last thing we need," Dr. Marc Siegel, an associate professor of medicine at New York University Langone Medical Center, told Health Day News.

Dr. Joel Lexchin, a professor at York University's School of Health Policy and Management in Canada, told Health Canada that "If we prescribe [antivirals] for people with relatively mild flu, and the virus develops resistance, then they wouldn't be of very much use for people with severe cases of H1N1."

"We are encouraging prudent use and warning against abuse of these medications as we want to make sure we have medications that work for these people who really need it," New Brunswick, Canada's chief medical officer of health, Dr. Eilish Cleary, told the Times & Transcript.

Because of the widespread demand for Tamiflu to protect those most at risk to A-H1NI, coupled to some physicians writing prescriptions for the drug to any patient who asks for it, there have been spot shortages of the drug nationwide, especially in the form that is given to children.

Before his untimely death, renowned virologist, Dr. Graeme Laver – who was instrumental in developing Tamiflu and Relenza - told HSToday.us during many lengthy interviews with him that pandemic preparedness authorities needed to begin stockpiling all flu antivirals in the event that one or more strains of influenza – in particular especially virulent strains - began to show marked resistance to the most prescribed antivirals like Tamiflu.

Currently, “we have no evidence as yet of resistance to Relenza - in part this may be due to lesser use of this drug as a first line treatment modality,” said the public official who spoke on background.

Laver warned that widespread use of Tamiflu and other antivirals as a prophylaxis to prevent infection by a pandemic strain of influenza is simply wrongheaded.

Laver, who studied influenza viruses for nearly 40 years and with Dr. Robert Webster (another world-renowned virologist at St. Jude Children’s Research Hospital) discovered the link between human flu and bird flu and in the 1960's received world acclaim when they developed a new and innovative generation of vaccines for flu viruses, told HSToday.us that “prophylaxis with Tamiflu in a pandemic is wrong. Early treatment is the only way to go.”

In Canada, authorities there report that about one-third of the cases of Tamiflu resistance has been found in people who had been given the drug prophylactically.

"Because of that we need to limit as much as possible the use of Tamiflu prophylaxis and instead focus on early treatment," said Dr. Guy Boivin of Laval University in Quebec City.

Responding to the disclosure that a Tamiflu-resistant strain of H1N1 had spread between five patients at the University Hospital of Wales, Cardiff, in a unit treating people with severe underlying health conditions, the public health official who spoke to HSToday.us on background said, “as you know, there have been sporadic reports around the world of isolated cases of Tamiflu resistance, [but] transmission can occur irrespective of whether resistance is present. These two viral functions are separate and unrelated … Given the hundreds of thousands of courses [of antivirals] prescribed it is inevitable that direct transmission of such a mutation would eventually be found. It's true for all infectious agents: viral, bacterial, protozoan, etc. All of us have been on the alert for such occurrences. It is our hope that vaccination, coupled with standard non-pharmaceutical prevention practices, will diminish the need for anitivirals and thus diminish events of this nature.”

“We do not know the effects of long-term antiviral use in a prophylactic setting. Therefore, we always consider that we must do no harm, and until we have some more answers, we proceed on those recommendations for prophylaxis with great caution," Oiulfstad said. "Until the science is in that shows that these drugs prevent illness, this seems to be the only reasonable way to approach the problem.”

Because of the evidence of growing Tamiflu resistance, British researchers have warned that governments need to stockpile other antivirals besides Tamiflu in the event that a mutated pandemic strain resistant to Tamiflu becomes widespread.

"We have been extremely foolish on our policies of stockpiling drugs. We have been stockpiling two varieties of the same drug," stated virologist Robert Webster at St Jude Children's Hospital at a medical conference in Hong Kong.

Discussing with reporters the problem of H5N1 and antivirals, Webster said “the likely scenario is that the [H5N1] virus will become resistant when you start using more and more [of one] drug; you get resistant [H5N1] mutants.”

Because authorities are beginning to see this scenario playing out with varients of H1N1, they are concerned about the widespread use of Tamiflu among people who are not considered to be at risk to complications from the bug. Similarly, they are concerned about generalized prophylactic use of the antiviral among at risk populations whether they've contracted the H1N1 pandemic flu or not.

----------------------------

gruß
massel

[Massel]

21 Fälle von Tamiflu-Resistenz in Polen

http://wiadomosci.gazeta.pl/Wiadomos...azliwe_na.html
Translated http://translate.googleusercontent.c...To_la5CCeajFaw

Prof. Zielinski: Mutations of the virus less sensitive to one drug
jagor, PAP
2009-11-23

In the case of 21 mutations in the influenza virus has been confirmed to reduce their sensitivity to the drug oseltamiwirum (Tamiflu) - admitted today the national epidemiology consultant, Professor. Andrzej Zielinski.

Also pointed out that these mutations are still sensitive to another antiviral drug - zanamivir (Relenza it comes to medicine, available only in hospitals). - There is no information to allow the virus to lose sensitivity to the vaccine - said prof. Zielinski.

- There are many variants of no great importance, but there are some that may be important, especially locally, including in Norway. For the moment there are no data that this mutation is spreading. The situation requires urgent follow-up. If the virus is more rife zajadliwy slower, harder, because people get sick and have no contact with others - emphasized the national epidemiology consultant.

--------------------------

gruß
massel

[Massel]

Home Business Economy
Economy 2009/11/30 13:58 KST


S. Korea reports 1st case of Tamiflu-resistant H1N1 flu

SEOUL, Nov. 30 (Yonhap) -- South Korean health authorities said Monday that they have discovered a H1N1 Influenza-A flu strain resistant to the anti-viral drug Tamiflu in a patient infected with the strain, the first such reported case in South Korea.

According to the Ministry for Health, Welfare and Family Affairs, the Tamiflu-resistant H1M1 virus was found in a five-year-old boy last month.
Data picture

It said a virus enzyme that can make Tamiflu ineffective was detected in samples taken from the boy adding it marks the first time that such a development has been detected in the country.

The discovery is noteworthy because health authorities may need to take additional actions to treat people that catch the flu responsible for 104 deaths in the country since mid-August.

"If the Tamiflu drug does not show any effect after five straight days, people must report to hospitals and clinics immediately," an official said.

Health authorities, however, said the boy did not develop the same kind of tolerance to the Relenza drug also used to treat flu patients.

The World Health Organization said that there have been 75 cases of people developing tolerance for Tamiflu since the outbreak was first reported in North America in April.

[e-mail]
(END)

[Massel]

http://www.examiner.com/x-29228-LA-Health-Technology-Examine…

Oseltamivir-resistant H1N1 H275Y mutations increasing quickly, not confined to immunocompromised December 2, 3:54 PMLA Health Technology ExaminerVictoria NicksPrevious Next Comment Print Email RSS Subscribe Subscribe


Get alerts when there is a new article from the LA Health Technology Examiner. Read Examiner.com's terms of use. Email Address


Include other special offers from Examiner.com
Terms of Use



Swine flu prevention is more effective than Tamiflu treatment due to mutation
AP Photo/Carolyn KasterOseltamivir, or Tamiflu, is an antiviral medication used to treat the swine flu virus. A recent mutation of the H1N1 influenza virus results in resistance to this medication. This H275Y mutation does not affect the effectiveness of Relenza, another antiviral medication. According to the World Health Organization (WHO), the number of cases of swine flu with the H275 mutation that makes it Tamiflu resistant have increased sharply over the past two weeks.

Tamiflu resistant swine flu


The version of the swine flu that emerged initially causes typical flu symptoms, some of which can be severe, particularly in infants and toddlers. Antiviral medications are most effective when given early in the infection, but the H1N1 mutation H275Y causes the antiviral medication known as Tamiflu, or oseltamivir, to be ineffective. Currently, the alternative antiviral medicine, Relenza, also known as zanamivir.

Increases in mutated swine flu


The number of cases of the swine flu virus that have resisted treatment with Tamiflu have increased sharply in recent weeks, according to a December 2 report from the WHO. This report states that the number of Tamiflu-resistant cases have nearly doubled, from 57 to 96 reported cases, in just two weeks. Approximately one-third of these cases have occurred in immunocompromised individuals.

Related Information
-----------------------------------------

Gruß
massel

[Massel]

More cases of resistant swine flu.
""Tamiflu has been our mainstay of therapy. And yes, as we get more and more resistance, we do have some concerns about that," says Dr. Bruce Dixon, of the Allegheny County Health Department."

http://kdka.com/health/drug.resistant.H1N1.2.1351045.html


gruß
massel

[Baam]

Forscher be zweifeln Wirksamkeit von Tamiflu bei Grippe!!!!

http://lifestyle.t-online.de/schweinegrippe-forscher-bezweif…

[Massel]

Antwort auf Beitrag Nr.: 38.537.722 von Baam am 09.12.09 17:42:06

@baam, spiegel online, Rheinische Post sind auch am Thema dran, noch wichtiger:


http://www.winnipegfreepress.com/canada/breakingnews/7890655…

Transmission of Tamiflu-resistant H1N1 on a Vietnamese train 'a concern': WHO

By: Helen Branswell, Medical Reporter, THE CANADIAN PRESS

9/12/2009 7:00 PM | Comments: 0
TORONTO - Seven healthy people on a train from Ho Chi Minh City to Hanoi in Vietnam caught Tamiflu-resistant H1N1 flu, researchers reported Wednesday in a prominent medical journal.
The transmission event, which occurred in July, is one of the largest clusters of cases of resistant H1N1 seen so far and the first time so many linked cases have been seen in previously healthy people who had not been on the drug.

Surveillance since the summer has only turned up three additional drug resistant viruses, the authors note in their letter to the New England Journal of Medicine. But they say they cannot rule out the possibility of ongoing transmission of resistant pandemic H1N1.

The event is a warning that resistant viruses can spread among healthy people and more such events may be in store, an antiviral expert with the World Health Organization said.

"What this looks to be is ... the sort of situation we have been alert for, because it's something that we certainly don't want to see happening but need to know about if it does," Charles Penn said in an interview from Geneva.

Penn said this event is different from two recent clusters, in which severely immunocompromised patients in hospitals in Wales and North Carolina developed and probably transmitted among themselves Tamiflu-resistant H1N1 virus. It's known that resistance develops easily in such patients.

This, however, is a case where healthy people, who weren't taking the drug and who had no known contacts with sick people in the week before they fell ill, were infected with resistant viruses - "which is an apparent transmission of the resistant virus in a more normal community setting," Penn said.

"This is different and it does raise the levels of concern. But it also I think reinforces the message that we do need to be constantly monitoring for this. And reporting it as quickly as it's observed."

The scientists, from Vietnam's National Institute of Hygiene and Epidemiology and Oxford University's clinical research unit in Vietnam, reported that the event first hit the radar in early September when routine screening of H1N1 viruses turned up three with the mutation known to confer resistance to Tamiflu.

The ensuing public health investigation uncovered a tale of a 42-hour train trip in which 10 students who didn't know each other prior to the journey socialized on the train.

Six of the 10 became sick a day or two after arriving at their destination. Two didn't develop symptoms and public health officials were not able to trace two others.

Interestingly, a seventh person who travelled in a different carriage on the same train and who doesn't appear to have been in contact with the students also contracted Tamiflu resistant H1N1 during the trip.

"Ongoing transmission from the cluster was not detected, but the tracing of all contacts was not possible, so ongoing transmission (of resistant virus) cannot be ruled out," the authors wrote, adding that careful use of flu antivirals should be stressed to minimize that risk.

Penn said to date there have been over 100 cases of Tamiflu-resistant H1N1 viruses spotted. About a third have been seen in immunocompromised patients. Of the remaining two-thirds, nearly all have been in people who took the drug to treat or prevent illness, or who had close contact with people who took the drug for one of those purposes.

Prior to this report, he said, there have only been four cases spotted in people who hadn't taken the drug and didn't have traceable exposure to someone who had.

The authors reported they were able to grow viruses from samples from three of the cases.

Penn said the WHO will want to know if the viruses have been checked for other mutations that might account for the seemingly easy spread of resistant viruses. "I think we'll be in touch with the authors."

It used to be thought that flu viruses that developed resistance to Tamiflu would be so weakened by the mutation that confers resistance that they would not be able to spread from person to person. But that belief was shattered in the winter of 2008 when Norway reported a startling rate of Tamiflu resistance in seasonal H1N1 viruses.

Over the next year, the resistant seasonal H1N1 viruses virtually crowded out the Tamiflu-susceptible versions of the virus - a precedent public health authorities don't want to see repeated with the pandemic virus.

"But we are expecting and we've said this, that as the pandemic spreads through this Northern Hemisphere winter and as the medicines continue to be used around the world, the number of sporadic cases is going to rise, as it has been at a steady by small rate," Penn said.

"And then the risk of this sort of event occurring is going to increase with more virus around and those infections being treated."

-----------------------------------------------------------

Ich denke , wir können mittlerweile davon ausgehen, dass es sich
nun um eine "WELTWEITE" Verbreitung der Tamiflu-Resistenz handelt.

Soviele Länder sind betroffen !

Die Meinung, dass hauptsächlich nur kranke Menschen davon besonders betroffen sind wir durch die o.g. Nachricht eindeutig wiederlegt !

Gruß
Massel

[Massel]

Hier könnte die Intialzündung für Biota kommen;

Top NEWS :

Simcere Pharma Gets SFDA Approval To Manufacture And Sell Zanamivir In China - Quick Facts breites Grinsen aufmerksam
2/11/2010 2:57 AM ET

RELATED NEWS


(RTTNews) - Thursday, Simcere Pharmaceutical Group (SCR: News ) announced that one of its units, Nanjing Simcere Dongyuan Pharmaceutical Co. Ltd., has received new drug registration approval from the State Food and Drug Administration or SFDA to manufacture and sell Zanamivir, a neuraminidase inhibitor inhalant used in the prevention and treatment of Influenza A and Influenza B. Zanamivir is marketed globally by GlaxoSmithKline under the trade name Relenza.

Jinsheng Ren, Chairman and Chief Executive Officer of Simcere Pharmaceutical Group, said, "We are delighted to receive SFDA approval to manufacture and sell Zanamivir, which has proved very successful in the fight against the H1N1 strain of Influenza A. With our leading domestic manufacturing facilities, well-known brand and nationwide marketing platform, Simcere is well prepared to bring this exciting drug to China."

Click here to receive FREE breaking news email alerts for Simcere Pharmaceutical Group and others in your portfolio

by RTT Staff Writer

For comments and feedback: contact [e-mail]

-----------------------------------

gruß
massel

[sentence]

Antwort auf Beitrag Nr.: 38.923.617 von Massel am 11.02.10 10:19:16

Leider ist nicht bekannt,was für Biota dabei herausspringt oder
ob es eine Art" Entwicklungshilfe"für einige Länder im asiat.
Raum ist. In Indian gibt es z.B.ein Relenza-Generika mit dem
Namen Virenza.40% preiswerter als Relenza aus den z.B.USA.
Da gehen wir auch leer aus.

[Massel]

Widespread and Common Tamiflu Resistance in Japan
|
Contributed by ontheway (Reporter)
Samstag, 27. Februar 2010 08:08:33
More stories from this contributor
30 people have read this story

Recombinomics has the story.

The Japan NIID released sequences (at GISAID) from 13 recent isolates in Japan which were collected between November, 2009 and January, 2010. Ten of the thirteen were Tamiflu resistant because of H274Y. The geographic locations were diverse and the sequences fell onto multiple branches of a phylogenetic tree indicating they were independently introduced, while those clustered were also transmitting. The independent introductions and transmission were reported previously, but not at this high frequency of 77% (10/13).

Although A/Wakayama-C/1/2010 represents the first reported sequence from a 2010 isolate with H274Y, the large number of such sequences in December collections suggests H274Y is currently widespread in Japan. Earlier sequences created a trend of an increasing frequency of reported sequences with H274Y, but the latest report suggests that the trend is quickly moving toward fixing H274Y in pandemic H1N1, as was seen in seasonal flu.

H274Y produces resistance in Tamiflu as well as Peramivir, which leaves Relenza as the only approved antiviral unaffected by H274Y or S31N in M2. The recent reports of increased H1N1 activity on Region 4, as well as increased absenteeism in schools, raise concerns of a new wave of H1N1. Each of the prior pandemics last century had a winter/spring wave which followed a fall wave, and the emerging pandemic displaced the existing influenza A seasonal flu. The latest week flu report by the CDC (week 7) had no detection of seasonal H1N1 or H3N2, supporting a repeat of patterns seen in the past three pandemics.

The trend of increasing frequencies of H274Y in isolates in Japan, coupled with reports of low reactor recombinants, raises concerns that the winter/spring wave will be more difficult to manage.

------------------------

gruß
massel

------------------------------------------------
http://beforeitsnews.com/story/20663/Widespread_and_Common_T…

[Massel]

Nun nimmt die Tamiflu-Resistenz offiziel Formen an und findet entsprechende Beachtung:

Wöchentliches UPDATE der WHO zur vorhandenen Tamiflu-Resitenz:

http://www.who.int/csr/disease/swineflu/Oseltamivirresistant…

Gruß
massel

[Massel]

http://www.foodconsumer.org/newsite/Non-food/Disease/swine_f…

http://macondaily.com/news.asp?id=27760

Resistance can develop fast
By: Reuters
Sun Mar 28, 2010 6:45am EDT

(Pic)- A thermal scanner shows the heat signature of passengers from an international flight arriving at Incheon airport, west of Seoul April 28, 2009. REUTERS/Jung Yeon-je

WASHINGTON (Reuters) - The H1N1 swine flu virus can develop resistance quickly to antivirals used to treat it, U.S. doctors reported on Friday.

Government researchers reported on the cases of two people with compromised immune systems who developed drug-resistant strains of virus after less than two weeks on therapy.

Bacteria quickly develop resistance to antibiotics, which must be used carefully. Viruses can do the same and doctors worried about resistance had recommended against using antivirals for flu except in patients who really needed them.

"While the emergence of drug-resistant influenza virus is not in itself surprising, these cases demonstrate that resistant strains can emerge after only a brief period of drug therapy," said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases.

"We have a limited number of drugs available for treating influenza and these findings provide additional urgency to efforts to develop antivirals that attack influenza virus in novel ways," he said in a statement.

Swine flu emerged a year ago in the United States and Mexico and spread around the world in just six weeks, killing thousands of people. It hit children and young adults especially hard.

Older antiviral drugs did not work against it -- they do not work against seasonal flu, either -- but Roche AG's Tamiflu, known generically as oseltamivir, did. It was not widely used, however.

Dr. Jeffery Taubenberger and colleagues studied two flu patients who had immune limitations due to past blood stem cell transplants. They were treated with Tamiflu.

Writing in the journal Clinical Infectious Diseases, Taubenberger and colleague Dr. Matthew Memoli said the virus infecting one patient developed a drug-resistant mutation after nine days and the other after 14 days of treatment.

And one of the patients also developed resistance against a second antiviral, Biocryst's peramivir, which is an experimental drug approved for emergency intravenous use in patients who cannot take Tamiflu.

This patient continued getting worse despite 24 days on Tamiflu and was given peramivir for 10 days.

Finally, GlaxoSmithkline's flu drug Relenza, known generically as zanamivir, did work and the patient recovered, the researchers said.

"These cases of rapid appearance of drug-resistant 2009 H1N1 influenza in immune-compromised patients are worrisome and should prompt clinicians to reconsider how they use available flu drugs," Memoli said.

----------------------------------

gruß
massel

[Massel]

http://www3.niaid.nih.gov/news/newsreleases/2010/resistantfl…


National Institute of Allergy and
Infectious Diseases (NIAID)
http://www.niaid.nih.gov

FOR IMMEDIATE RELEASE
Friday, March 26, 2010 Media Contact: Anne A. Oplinger
[phone]
[e-mail]



Rapid Development of Drug-Resistant 2009 H1N1 Influenza Reported in Two Cases Reevaluation of Treatment Strategies for Prolonged Infection Urged


Two people with compromised immune systems who became ill with 2009 H1N1 influenza developed drug-resistant strains of virus after less than two weeks on therapy, report doctors from the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health. Doctors who treat prolonged influenza infection should be aware that even a short course of antiviral treatment may lead to drug-resistant virus, say the authors, and clinicians should consider this possibility as they develop initial treatment strategies for their patients who have impaired immune function.

Both patients in the new report developed resistance to the key influenza drug oseltamivir (Tamiflu), and one also demonstrated clinical resistance to another antiviral agent, now in experimental testing, intravenous peramivir, note senior authors Matthew J. Memoli, M.D., and Jeffery K. Taubenberger, M.D., Ph.D. This is the first reported case of clinically significant peramivir-resistant 2009 H1N1 illness, say the scientists. The report is scheduled to appear in print on May 1 in Clinical Infectious Diseases and is now online.

The people in the current case report had immune limitations due to blood stem cell transplants that occurred several years previously. Both recovered from their influenza infections.

While the emergence of drug-resistant influenza virus is not in itself surprising, these cases demonstrate that resistant strains can emerge after only a brief period of drug therapy, says NIAID Director Anthony S. Fauci, M.D. We have a limited number of drugs available for treating influenza and these findings provide additional urgency to efforts to develop antivirals that attack influenza virus in novel ways.

The 2009 H1N1 influenza virus is susceptible to just one of the two available classes of anti-influenza drugs, the neuraminidase inhibitors. Besides oseltamivir, other neuraminidase inhibitors are zanamivir (Relenza), which is inhaled, and the intravenously administered investigational drug peramivir. As the H1N1 influenza pandemic unfolded, laboratory tests of virus strains isolated from patients showed that some strains contained a genetic mutation (the H275Y mutation) that makes the virus less susceptible to some neuraminidase inhibitors.

The two people in the current case study had pre-existing medical conditions that impaired their immune system function before contracting 2009 H1N1 flu. Strains of 2009 H1N1 influenza containing the H275Y mutation had been reported previously in people with diminished immune function, but in previous cases the mutation arose after more than 24 days of continuous therapy. In the newly described cases, the mutation appeared after 14 days in one individual and after nine days in the second.

Although the recommended length of treatment with oseltamivir is five days, it is common for physicians to continue giving this first-line drug longer if the patient does not improve, says Dr. Memoli.

Both people in the current report received oseltamivir for extended periods but they continued to shed virus in their nasal secretions throughout treatment. When one patients condition worsened despite 24 days of oseltamivir treatment, doctors administered peramivir for 10 days. The drug did not reduce viral shedding and the patient remained ill, demonstrating what the authors described as clinically significant resistance to peramivir. Next, doctors administered the only other available flu drug, zanamivir, for 10 days. The person then fully recovered.

Additional, larger studies are needed to further refine our findings, says Dr. Memoli. But these cases of rapid appearance of drug-resistant 2009 H1N1 influenza in immune-compromised patients are worrisome and should prompt clinicians to reconsider how they use available flu drugs.

The mutation that allows 2009 H1N1 to resist oseltamivir also significantly reduces the viruss susceptibility to peramivir. If a relatively short course of oseltamivir causes a mutant flu strain to emerge in a particular patient, that person may not respond to peramivir. Zanamivir might be a good choice if a patient does not respond within a few days to oseltamivir, Dr. Memoli says. However, because zanamivir must be inhaled, patients who are very ill and whose breathing is mechanically supported cannot be given zanamivir.

As clinicians, we should carefully consider our treatment options and use all the drugs available to us wisely. This is especially important in a patient with prolonged infection or when an antiviral drug fails to cure the patient after the recommended course of treatment, says Dr. Memoli.

NIAID scientist Rachel J. Hrabal contributed to this study along with Arash Hassantoufighi and Maryna C. Eichelberger, Ph.D., of the FDA.

Visit www.Flu.gov for one-stop access to U.S. government information on influenza. Also, visit NIAIDs flu Web portal.

----------------

gruß
massel

[Massel]

Laninamivir much more effective than Tamiflu

in Swine Flu Treatment, Tamiflu

http://www.theswineflureport.com/laninamivir-much-more-effec…

Laninamivir octanoate markedly reduced the median time to illness alleviation in comparison with oseltamivir in patients infected with oseltamivir-resistant influenza A (H1N1), and the difference was -60.9 hours in the 40-mg group and -66.2 hours in the 20-mg group. On the other hand, there were no significant differences in the time to alleviation of illness between the laninamivir groups and oseltamivir group against influenza A (H3N2) or B infection. Laninamivir octanoate was well tolerated. The most common adverse events were gastrointestinal events. Laninamivir octanoate was an effective and well-tolerated treatment for children with oseltamivir-resistant influenza A (H1N1) virus infection. Further study will be needed to confirm clinical efficacy against influenza A (H3N2) or B virus infection. Its ease of administration is noteworthy, because a single inhalation is required during the course of illness.

via Long-Acting Neuraminidase Inhibitor Laninamivir Oc… [Antimicrob Agents Chemother. 2010] – PubMed result.

[Massel]

http://coldflu.about.com/b/2010/04/17/tamiflu-may-not-preven…

Tamiflu May Not Prevent Spread of Flu
Saturday April 17, 2010

A new study conducted in Hong Kong showed that oseltamivir (Tamiflu) may not prevent the spread of the flu even though it does shorten the duration of symptoms. This is important because one of the primary reasons that oseltamivir is prescribed in many cases is to reduce the chance that the flu will be spread to other household contacts that may be at high risk for complications.

The study casts doubt over whether or not the medication is useful to prevent the spread of the virus. However, there are a few things about this study that are important to remember:

* The study was relatively small (only 90 participants actually took the medication)
* It was conducted over the 2007 and 2008 flu seasons - the results may not be the same with the pandemic H1N1 virus (swine flu)
* Results indicate that there may be some protection for others when the oseltamivir is started within the first 24 hours

-------------------------
gruß
massel
gruß
massel