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http://www.walesonline.co.uk/news/healt ... -25208853/

A cluster in Wales following a cluster in Scotland is a cluster of clusters.

Scotland

http://www.recombinomics.com/News/11160 ... uster.html

In all, 580 laboratory confirmed cases of swine flu have been reported by the National Public Health Service since the start of the outbreak.

A total of 377 people confirmed with swine flu in Wales have been admitted to hospital since the start of the outbreak. 46 of these cases were still in hospital as of November 17.

Two immunosuppressed patients being treated for H1N1v Influenza virus (swine flu) at an un-named South Wales hospital have been found to have developed resistance to oseltamivir (Tamiflu).

Advice for pregnant women on how to protect themselves and their unborn child from swine flu


The NPHS said the emergence of influenza A viruses that were resistant to Tamiflu was not unexpected in patients with serious underlying conditions and suppressed immune systems, who still tested positive for the virus despite treatment.

"Initial investigations suggest that the resistance developed during treatment and that the resistant virus has not spread from patient to patient. This is in line with findings throughout the world," said a spokesman.

Health information and advice


"The patients have been given alternative antiviral treatment, and one has made a full recovery while the other continues to be monitored."

http://www.thisissouthwales.co.uk/south ... ticle.html

The U.K. Health Protection Agency is investigating a number of cases of possible swine flu infections which are resistent to treatment with Roche Holding AG’s Tamiflu drug.

The cases have been reported among nine patients in a hospital in Wales. Five cases are “known to be resistent to oseltamivir”, the generic name for Tamiflu, the HPA said today in an e-mailed statement.

http://www.bloomberg.com/apps/news?pid= ... T9EV790UEI

To date (as of 18 November 2009) 3,359 viruses have been analysed by the Centre for Infections for the genetic marker commonly associated with resistance to oseltamivir in seasonal H1N1 flu (H274Y). 12 viruses have been found to carry this marker in the UK with three of these, through additional testing, showing evidence of resistance when viral growth is tested in the presence of antivirals. In addition, 293 specimens have been fully tested for susceptibility.

The Agency is continually assessing its advice to government on health protection policies such as antiviral use. Currently there is no requirement to change existing guidance.

There have been no significant changes in the virus.

http://www.hpa.org.uk/webw/HPAweb&HPAwe ... 1252394302

Health officials say a Tamiflu-resistant strain of swine flu has spread between hospital patients.

Five patients on a unit treating patients with severe underlying health conditions at the University Hospital of Wales, Cardiff are infected.

Three appear to have acquired the infection in hospital.

They are thought to be the first confirmed cases of person-to-person transmission of a Tamiflu-resistant strain in the world.

There have been several dozen reports around the world of people developing resistance to Tamiflu while taking the drug.

But there has only been one reported case of person-to-person transmission of a resistant strain - between two people at a US summer camp - and this has never been confirmed.

Two of the University Hospital Wales patients have recovered and have been discharged from hospital, one is in critical care and two are being treated on the ward.

The health officials stressed there was no risk to anyone else.

They said tests were being carried out to confirm exactly what happened.

The UK has bought enough doses of Tamiflu, which can shorten the duration of swine flu and reduce the risk of complications, for half the population.

Serious concern

Any spread of a Tamiflu resistant strain of the illness is a serious public health concern.

Dr Roland Salmon, director of the National Public Health Service for Wale's Communicable Disease Surveillance Centre, said: "The emergence of influenza A viruses that are resistant to Tamiflu is not unexpected in patients with serious underlying conditions and suppressed immune systems, who still test positive for the virus despite treatment.

"In this case, the resistant strain of swine flu does not appear to be any more severe than the swine flu virus that has been circulating since April."

Dr Tony Jewell, Chief Medical Officer for Wales, said: "We know that people with suppressed immune systems are more susceptible to the swine flu virus, which is why they are a priority group under the first phase of the vaccination programme in Wales which is progressing at pace.

"We have stringent processes in place for monitoring for antiviral resistance in the UK so that we can spot resistance early and the causes can be investigated and the cases managed.

"Identifying these cases shows that our systems are working so patients should be reassured.

"Treatment with Tamiflu is still appropriate for swine flu and people should continue to take Tamiflu when they are prescribed it.

"It's also important that good hygiene practices are followed to further prevent the spread of the virus."

Story from BBC NEWS:
http://news.bbc.co.uk/go/pr/fr/-/2/hi/h ... 370859.stm

Commentray

http://www.recombinomics.com/News/11200 ... Wales.html

Tamiflu-resistant strain of swine flu spreadingResistant strain discovered in Cardiff hospital, prompting concern among health officials
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Owen Bowcott guardian.co.uk, Friday 20 November 2009 17.22 GMT Article history
Doctors in Wales have discovered a Tamiflu-resistant strain of swine flu that has been spreading from patient to patient in a Cardiff hospital.

The emergence of an easily transmissible, resistant strain is a worrying development for health officials and appears to be the first documented case in Europe.

Five patients at University Hospital Wales, in Cardiff, were infected and isolated for treatment. All had severe underlying conditions that left them with weakened immune systems. At least three had acquired the infection in hospital.

There have been a handful of reported cases from around the world of Tamiflu-resistant strains of the H1N1 virus. Only one previous case, at a US summer camp, however, involved person-to-person transmission.

The Cardiff patients have been treated with an alternative anti-viral drug. Two have recovered and been discharged and three others remain in hospital, one in intensive care.

Dr Roland Salmon, the director of the communicable disease surveillance centre in Wales, said: "The emergence of [H1N1] viruses that are resistant to Tamiflu is not unexpected in patients with serious underlying conditions and suppressed immune systems, who still test positive for the virus despite treatment.

"In this case, the resistant strain of swine flu does not appear to be any more severe than the swine flu virus that has been circulating since April.

"For the vast majority of people, Tamiflu has proved effective in reducing the severity of illness. Vaccination remains the most effective tool we have in preventing swine flu so I urge people identified as being at risk to look out for their invitation to be vaccinated by their GP surgery."

Any spread of a Tamiflu-resistant strain of the virus into the community would constitute a serious public health concern. The government recently reminded those who caught swine flu to take Tamiflu as a first line of medical defence.

A Department of Health official in London said: "We take this development seriously, but the Health Protection Agency considers that the risk to the general healthy population is low. The Tamiflu-resistant virus has emerged in a group of particularly vulnerable individuals – this type of resistance is well documented.

"Our strategy to offer anti-virals to all patients with swine flu is the right one – to help prevent complications and reduce the severity of the illness. We are keeping the situation under review."

http://www.guardian.co.uk/society/2009/ ... -swine-flu

Here's the official statement from the UK Health Protection Agency.

http://www.hpa.org.uk/webw/HPAweb&HPAwe ... 1252394302

HPA statement on possible transmission

20 November 2009

The HPA is working with colleagues from the Public Health Service of Wales to investigate a number of possible cases of person to person transmission of oseltamivir resistant swine flu.

To date, a total of nine H1N1v confirmed cases have been reported amongst patients on a hospital ward in Wales. Five of these cases are known to be resistant to oseltamivir, one is sensitive and for three resistance status is presently unknown.

The virus has emerged in a group of particularly vulnerable individuals in whom the development of oseltamivir resistance is well documented. At present we believe the risk to the general healthy population is low. There is no evidence that the oseltamivir resistant virus is any more virulent than any other type of flu. The situation is being kept under review.

Further follow-up of cases and their close contacts both on the ward and in the community is underway to ascertain if there is evidence of onward transmission. The virus remains sensitive to the other frontline drug Relenza® which is being used as an alternative antiviral and patients are responding well.

Although further epidemiological investigation is underway, it would seem likely that transmission of oseltamivir-resistant H1N1 virus has taken place.

The current cases of oseltamivir resistance under investigation have all occurred in patients with haematological problems which result in immuno-suppression either because of the disorder or the chemotherapy given to treat the disorder.

Oseltamivir resistance to influenza viruses is well documented in immunosuppressed individuals and can develop quickly. It is likely to be associated with the high viral load which may occur during infection in these patients.

In addition, immunosuppressed people may be more susceptible to infection ie a smaller exposure may result in infection in these patients.

Antiviral resistance monitoring has been in place in the UK for a number of years and this allows us to identify drug resistance early so that cases can be investigated and managed appropriately

It still remains appropriate to use oseltamivir for the treatment and prophylaxis of influenza in the UK. Guidance is being developed to cover the particular instance where modifications to the current antiviral treatment policy may be required.


Background information
As of 20th November, WHO have reported 57 incidences of oseltamivir resistance worldwide.

There have been no documented episodes of person to person transmission of a oseltamivir resistant pandemic influenza virus. A small number of individual cases have been identified, however, in whom drug resistant virus has been isolated with no history of prior use of anti-virals..

In addition, on 19 November, WHO was notified by the US of four patients with infection with oseltamivir-resistant pandemic H1N1 2009 influenza virus among inpatients in the same unit at a hospital during October and November. The possibility that these viruses have been transmitted within this hospital unit is currently under investigation.
Generally, the pandemic H1N1 oseltamivir resistant viruses are not considered "fit" and transmission is poor.

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