Rhiza Labs FluTracker Forum

SCOTLAND could be facing a drug-resistant strain of swine flu after two patients failed to respond to treatment.
One patient in the Lothians and another believed to be from Fife failed to respond to Tamiflu, one of the only treatments for the H1N1 virus.

Doctors around the world have seen a handful of cases where the virus has mutated to develop resistance to the drug.

NHS Lothian confirmed it has seen one patient with Tamiflu-resistant swine flu.

A spokesman for the Scottish Government said: "We are aware of Tamiflu resistance in two Scottish H1N1 patients.

"We have asked Health Protection Scotland to monitor the situation closely."

http://news.scotsman.com/edinburgh/Drug ... 5826882.jp

I posted this under "discussion" because it appears to represent TWO patients in Scotland who failed to respond to treatment because they were Tamiflu resistant. This would be significant because there were two patients at teh same place and time ands there was no mention of prophylactic treatment, suggeting the resistance, H274Y, was transmitting.

Health Secretary Nicola Sturgeon has said there is no cause for concern after the emergence of drug resistant cases of swine flu.

Two people have been discovered in Scotland with a strain of the bug which is resistant to Tamiflu, she confirmed.

But the Deputy First Minister said that both patients in Scotland have made a full recovery and that another drug is available.

She said: "This is a rare occurrence but it's not of huge concern and it's certainly not a sign that swine flu is mutating into something more serious.

"It's something that can happen when an individual is on anti-virals for a prolonged period of time."

The patients concerned, and others across the UK, developed a resistance only to the Tamiflu drug.

But Ms Sturgeon added: "We have stockpiles of another anti-viral which can be used to treat patients.

"Secondly, there's absolutely no evidence of person to person transmission of a resistant H1N1 strain.

"Health Protection Scotland monitor these things carefully, but at this stage there's no cause for people to be concerned."

Ms Sturgeon also said there is no evidence of serious side effects to the swine flu vaccine, despite recent reports that some NHS staff had fallen ill. Some people, though, may experience symptoms like a sore arm.

Scotland now has about 40% of the supplies it needs to vaccinate the priority groups, including pregnant women and frontline healthcare workers, Ms Sturgeon said.

All GP practices now have some supplies of the vaccine.

She added: "We said at the outset of the programme that we intended to offer vaccination to everybody in the priority groups by Christmas and we remain absolutely on track to do that."

Decisions about the next phase of the programme will be taken after these priority groups have been vaccinated.
http://www.heraldscotland.com/news/heal ... n-1.932706

Map of area

http://flutracker.rhizalabs.com/flu/gma ... 375&zoom=9

Commentary

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

http://www.google.com/hostednews/ukpres ... Q_w1j20rtQ
Drug resistant flu 'no concern'
(UKPA) – 3 hours ago

Health Secretary Nicola Sturgeon has said there is no cause for concern after the emergence of drug resistant cases of swine flu.

Two people have been discovered in Scotland with a strain of the bug which is resistant to Tamiflu, she confirmed.

But the Deputy First Minister said that both patients in Scotland have made a full recovery and that another drug is available.

I'm assuming they might be talking about the newly approved Peramivir or Relenza. I've seen Relenza mentioned as the backup drug they are holding back in the event Tamiflu fails. I thought I remembered seeing massive Relenza resistance stories back when H5N1 was the story de jour. Isn't Relenza resistance, also known as Amantadine already established in many influenza viruses? What are the issues regarding resistance development in those?

No. Relenza (Zanamivir) resistance and Amantadine resistance are two different things. No resistance to Relenza has yet been detected in pandemic H1N1 anywhere yet and I believe molecular analysis shows that it is harder for the virus to develop Relenza resistance than Tamiflu. Relenza isn't newly developed either. Also of note the world's only Relenza production facility is at a GSK plant in Scotland.

http://en.wikipedia.org/wiki/Zanamivir

Zanamivir (INN) (pronounced /zəˈnæmɨvɪr/) is a neuraminidase inhibitor used in the treatment and prophylaxis of Influenzavirus A and Influenzavirus B. Zanamivir was the first neuraminidase inhibitor commercially developed. It is currently marketed by GlaxoSmithKline under the trade name Relenza.

According to the Centers for Disease Control and Prevention (CDC), no flu, seasonal or pandemic, has shown any signs of resistance to zanamivir.[1]

H274Y confers resitance to Tamiflu AND Peramivir. The patients recovered because of Relenza treatment (possibly IV).

I've seen one more option mentioned, but not much.

Antiviral cocktail shows promise against resistant H1N1

Via Medical News Today.com: Triple-combo Drug Shows Promise Against Antiviral Resistant H1N1. Excerpt:

An experimental drug cocktail that includes three prescriptions now widely available offers the best hope in developing a single agent to treat drug-resistant H1N1 swine flu, says a virology researcher in the University of Alabama Birmingham (UAB) Division of Pediatric Infectious Diseases.

In laboratory testing, the triple combination of oseltamivir (Tamiflu), amantadine (Symmetrel) and ribavirin showed a significant capacity to stop flu-virus growth, says Mark Prichard, Ph.D, who serves on the board of directors of the International Society for Antiviral Research.

The combo drug works better in the test tube than currently recommended single or double antiviral therapies used to treat both seasonal and swine flu strains, he says.

Thanks Niman. So this change is going to eventually knock out 2 primary weapons in the fight. Hogweed commented that he thought Relenza was more resistant to developing resistance due to antigenic shift. Is this your position as well? Have we seen any evidence of changes on that front? I don't think we have from what I have seen - but you would probably know better.

PS...Hogweed, thanks for clarifying the Amantadine / Relenza issue. My memory failed me on that one.