Tuesday, July 7, 2009

Tamiflu resistant H1N1 reported



From ProMED-mail, a program of the International Society for Infectious Diseases http://www.promedmail.org

Public health authorities in Hong Kong announced Friday [3 Jul 2009] they have found a case of Tamiflu resistance in a woman who hadn't taken the drug. That means she was infected with swine flu viruses that were already resistant to Tamiflu, the main weapon in most countries' and companies' pandemic drug arsenals.

Two earlier cases, reported from Denmark and Japan, involved people who had been taking the medication. While always unwelcome, that type of resistance is known to occur with seasonal [influenza virus] strains and may be less of a threat to the long-term viability of this key flu drug. "It was not at all surprising to see resistance in patients on treatment, but seeing it in someone who was not treated, it certainly is more concerning," says Dr. Malik Peiris, a flu expert at the University of Hong Kong.

There is currently no evidence Tamiflu-resistant viruses are spreading widely. Still, some experts see the Hong Kong case as a warning that Tamiflu's role in this pandemic may not be as long-lived as pandemic planners would like. "I think it's too early to judge," says Dr. Frederick Hayden, an expert on influenza antivirals who teaches at the University of Virginia. "But I think that possibility has existed from the beginning, and it's something that needs to be certainly considered in making determinations about things like antiviral stockpiling, management of patients with more serious illness in hospital and how the available drugs will be used."

Japan's Osaka Prefectural Government sent a research paper to a U.S. medical journal on the 1st case in Japan of a genetic mutation of swine flu [virus] resistant to Tamiflu about a week before making the finding public, officials said Sunday [5 Jul 2009]. "It's not that we intentionally placed priority on the manuscript and delayed the announcement," said Tatsuya Oshita, an official in the prefectural government's health and medical care department. "As it turned out, we dealt with the matter in a way that could be criticized, and we are sorry."

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We have a malady that may now be human-human transmissible that, apparently, has mutated to be resistant to one of the two medicines of choice.

How it became Tamiflu resistant is of interest for the future.

What has changed, to my mind at least, is the need for stronger mitigation measures and a better understanding of what works and what doesn't.

Organizations that are able to perform critical functions in isolation are well-advised to establish, now, means to allow personnel to work in physical - but not virtual - isolation. Such options include use of public and private networks, applications such as Netmeeting/Live Meeting, teleconferences, Instant Messenger, and greater use of email.

As with most things, there are two sides to the "work-in-isolation" coin.

When people work in clusters, highways and byways are crowded with cars and delays in arriving are commonplace. Weather can further delay the commute.

Working in isolation and "commuting" via the Internet likewise will show as the pipe becomes congested with digital traffic, particularly when large files are transferred or video applications are involved.

A partial solution may, operative word is "may," be to stagger Internet access much as most business days are staggered, e.g., when it's 8 a.m. in Miami, it's only 4 a.m. in San Francisco, but 3 p.m. in Jerusalem, Israel. Staggering access puts a greater burden on email and telephone use and slows communication exchanges to what now seems a snail's pace. (Does anyone still communicate via mail and courier? Compared to the Internet, which spoils us, that IS slow.) Fax may make a comeback.

But more than working in isolation, and for those who must be clustered - call centers, classrooms, military maneuvers, etc. - we need to find out exactly what we can do to prevent person-to-person contact in a face-to-face environment.

What, for example, type mask is suitable?

Should we frequently wash hands with anti-bacterial soap or use anti-bacterial wipes? There is the very real probability that the bacteria we kill with the anti-bac applications will simply make the bacteria resistant to the soap. Would it be effective against influenza, anyway? Is simple hand soap - the likes of Ivory or Lava - sufficient?

We can try to teach people to be pro-active; to sneeze into a sleeve or elbow rather than into a hand or, worse, into the air, but no one will succeed in teaching a toddler to do these things.

Likewise, while adults may know to wash hands after a sneeze, will they do so when they are involved in an activity - from working a production line to playing a game? Even watching a movie or tv program ... will we actually get up and wash, missing part of the plot?

A cultural shift may be in order. Many societies are hand-shakers. Perhaps a non-touch salutation is in order, although how the saluting hand is raised could be considered either a greeting or insult, depending on the culture of all involved. The same applies to cheek-to-cheek physical contact.

There is no single answer, and there is no "solution" without its own peril.

Now - actually "yesterday" - is the time to consider all the options that are reasonable for our organizations and for ourselves at a personal level.

John Glenn, MBCI
Enterprise Risk Management/Business Continuity practitioner
Ft. Lauderdale FL
JohnGlennMBCI @ gmail dot com





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