SWINE FLU

Children Dying of Swine Flu-Personal Update on experiences with this year's flu.

Letters to Dr. Lacombe, local vaccine promoter

Read Thursday,October 29 Editorial to Kennebec Journal. Thank them for including information on Naturopathic Doctors!

Listen to October 7th radio show: Healthy Options with me and Cynthia Swan.

SWINE FLU OCTOBER 2009 UPDATE

FLU VACCINE SIDE EFFECTS

Why I and my family will not be getting the swine flu influenza vaccination.

A response to a very heated conversation with an M.D. in which the words “children are dying of the swine flu!” was used as the reason for getting vaccinated. The hindsight response (always 20/20) is that children are dying of vaccinations and the vaccine is no better than placebo for preventing the flu.

In an update of our dinner conversation, I revisited my previous statements. The information I was using was based on the Cochrane meta-analysis of 2004, which has been updated.

Currently, based on two meta-analyses, the flu vaccine is no better than placebo for children under two. In comparison, my search of the VAERS database over the last ten years yielded the fact that every year between 89 and 137 deaths are directly attributable to vaccination, half of those consistently occurring in children under two.

For children over two, the flu vaccine shows 59% efficacy and a 33% effectiveness rate. Combining these would give me roughly a one in five chance of improving my older son’s chances of not getting the flu, with no evidence that it would prevent complications. Last year there were 387 serious complications from the flu vaccine and eighteen deaths directly attributed to the vaccinations (VAERS data compiled by me.)

For myself and my wife the effectiveness of the flu vaccination is around 15% with little effect on time lost from work and no effect on complications. The previous Cochrane analysis yielded only a 6% difference. Since the primary concern is to prevent complications, and since I clinically believe my entire family has already been exposed to this viral strain, I respectfully decline the vaccine at this time.

Thank you for caring so much about us.

Cochrane Database Syst Rev. 2008 Apr 16;(2):CD004879. Links

Update of:

Cochrane Database Syst Rev. 2006;(1):CD004879.

Vaccines for preventing influenza in healthy children.Jefferson T, Rivetti A, Harnden A, Di Pietrantonj C, Demicheli V.

Vaccines Field, Cochrane Collaboration, Via Adige 28a, Anguillara Sabazia, Roma, Italy, 00061.

BACKGROUND: The consequences of influenza in children and adults are mainly absenteeism from school and work. However, the risk of complications is greatest in children and people over 65 years old. OBJECTIVES: To appraise all comparative studies evaluating the effects of influenza vaccines in healthy children; assess vaccine efficacy (prevention of confirmed influenza) and effectiveness (prevention of influenza-like illness) and document adverse events associated with influenza vaccines. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2007, issue 3); OLD MEDLINE (1950 to 1965); MEDLINE (1966 to September 2007); EMBASE (1974 to September 2007); Biological Abstracts (1969 to September 2007); and Science Citation Index (1974 to September 2007). SELECTION CRITERIA: Randomised controlled trials (RCTs), cohort and case-control studies of any influenza vaccine in healthy children under 16 years of age. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trial quality and extracted data. MAIN RESULTS: Fifty-one studies with 294,159 observations were included. Sixteen RCTs and 18 cohort studies were included in the analysis of vaccine efficacy and effectiveness. From RCTs, live vaccines showed an efficacy of 82% (95% confidence interval (CI) 71% to 89%) and an effectiveness of 33% (95% CI 28% to 38%) in children older than two compared with placebo or no intervention. Inactivated vaccines had a lower efficacy of 59% (95% CI 41% to 71%) than live vaccines but similar effectiveness: 36% (95% CI 24% to 46%). In children under two, the efficacy of inactivated vaccine was similar to placebo. Variability in study design and presentation of data was such that a meta-analysis of safety outcome data was not feasible. Extensive evidence of reporting bias of safety outcomes from trials of live attenuated vaccines impeded meaningful analysis. AUTHORS' CONCLUSIONS: Influenza vaccines are efficacious in children older than two but little evidence is available for children under two. There was a marked difference between vaccine efficacy and effectiveness. No safety comparisons could be carried out, emphasizing the need for standardisation of methods and presentation of vaccine safety data in future studies. It was surprising to find only one study of inactivated vaccine in children under two years, given current recommendations to vaccinate healthy children from six months old in the USA and Canada. If immunisation in children is to be recommended as a public health policy, large-scale studies assessing important outcomes and directly comparing vaccine types are urgently required.

PMID: 18425905

Cochrane Database Syst Rev. 2006 Jan 25;(1):CD004879. Links

Comment in:

Evid Based Med. 2006 Oct;11(5):140.

Evid Based Nurs. 2006 Oct;9(4):107.

Update in:

Cochrane Database Syst Rev. 2008;(2):CD004879.

Vaccines for preventing influenza in healthy children.Smith S, Demicheli V, Di Pietrantonj C, Harnden AR, Jefferson T, Matheson NJ, Rivetti A.

Oxford University, Institute of Health Sciences, Old Road Headington, Oxford, UK, OX3 7LF. sue.smith@public-health.oxford.ac.uk

BACKGROUND: In children and adults the consequences of influenza are mainly absences from school and work, however the risk of complications is greatest in children and people over 65 years old. OBJECTIVES: To appraise all comparative studies evaluating the effects of influenza vaccines in healthy children; assess vaccine efficacy (prevention of confirmed influenza) and effectiveness (prevention of influenza-like illness) and document adverse events associated with receiving influenza vaccines. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 1, 2005); OLD MEDLINE (1966 to 1969); MEDLINE (1969 to December 2004); EMBASE (1974 to December 2004); Biological Abstracts (1969 to December 2004); and Science Citation Index (1974 to December 2004). We wrote to vaccine manufacturers and a number of corresponding authors of studies in the review. SELECTION CRITERIA: Any randomised controlled trials (RCTs), cohort and case-control studies of any influenza vaccine in healthy children under 16 years old. DATA COLLECTION AND ANALYSIS: Two authors independently assessed trial quality and extracted data. MAIN RESULTS: Fifty-one studies involving 263,987 children were included. Seventeen papers were translated from Russian. Fourteen RCTs and 11 cohort studies were included in the analysis of vaccine efficacy and effectiveness. From RCTs, live vaccines showed an efficacy of 79% (95% confidence interval (CI) 48% to 92%) and an effectiveness of 33% (95% CI 28% to 38%) in children older than two years compared with placebo or no intervention. Inactivated vaccines had a lower efficacy of 59% (95% CI 41% to 71%) than live vaccines but similar effectiveness: 36% (95% CI 24% to 46%). In children under two, the efficacy of inactivated vaccine was similar to placebo. Thirty-four reports containing safety outcomes were included, 22 including live vaccines, 8 inactivated vaccines and 4 both types. The most commonly presented short-term outcomes were temperature and local reactions. The variability in design of studies and presentation of data was such that meta-analysis of safety outcome data was not feasible. AUTHORS' CONCLUSIONS: Influenza vaccines are efficacious in children older than two years but little evidence is available for children under two. There was a marked difference between vaccine efficacy and effectiveness. That no safety comparisons could be carried out emphasizes the need for standardisation of methods and presentation of vaccine safety data in future studies. It was surprising to find only one study of inactivated vaccine in children under two years, given recent recommendations to vaccinate healthy children from six months old in the USA and Canada. If immunisation in children is to be recommended as public-health policy, large-scale studies assessing important outcomes and directly comparing vaccine types are urgently required.

PMID: 16437500

Cochrane Database Syst Rev. 2007 Apr 18;(2):CD001269. Links

Update of:

Cochrane Database Syst Rev. 2004;(3):CD001269.

Vaccines for preventing influenza in healthy adults.Jefferson TO, Rivetti D, Di Pietrantonj C, Rivetti A, Demicheli V.

BACKGROUND: Different types of influenza vaccines are currently produced world-wide. Healthy adults are at present targeted only in North America. Despite the publication of a large number of clinical trials, there is still substantial uncertainty about the clinical effectiveness of influenza vaccines and this has a negative impact on their acceptance and uptake. OBJECTIVES: To identify, retrieve and assess all studies evaluating the effects (efficacy, effectiveness and harms) of vaccines against influenza in healthy adults. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 4, 2005) which contains the Cochrane Acute Respiratory Infections Group trials register; MEDLINE (January 1966 to January 2006); and EMBASE (1990 to January 2006). We wrote to vaccine manufacturers and first or corresponding authors of studies in the review. SELECTION CRITERIA: Any randomised or quasi-randomised studies comparing influenza vaccines in humans with placebo, no intervention. Live, attenuated, or killed vaccines or fractions of them administered by any route, irrespective of antigenic configuration were assessed. Only studies assessing protection from exposure to naturally occurring influenza in healthy individuals aged 16 to 65 years were considered. Comparative non-randomised studies were included if they assessed evidence of the possible association between influenza vaccines and serious harms. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trial quality and extracted data. MAIN RESULTS: Forty-eight reports were included: 38 (57 sub-studies) were clinical trials providing data about effectiveness, efficacy and harms of influenza vaccines and involved 66,248 people; 8 were comparative non-randomised studies and tested the association of the vaccines with serious harms; 2 were reports of harms which could not be introduced in the data analysis.Inactivated parenteral vaccines were 30% effective (95% CI 17% to 41%) against influenza-like illness, and 80% (95% CI 56% to 91%) efficacious against influenza when the vaccine matched the circulating strain and circulation was high, but decreased to 50% (95% CI 27% to 65%) when it did not. Excluding the studies of the 1968 to 1969 pandemic, effectiveness was 15% (95% CI 9% to 22%) and efficacy was 73% (95% CI 53% to 84%). Vaccination had a modest effect on time off work, but there was insufficient evidence to draw conclusions on hospital admissions or complication rates. Inactivated vaccines caused local tenderness and soreness and erythema. Spray vaccines had more modest performance. Monovalent whole-virion vaccines matching circulating viruses had high efficacy (VE 93%, 95% CI 69% to 98%) and effectiveness (VE 66%, 95% CI 51% to 77%) against the 1968 to 1969 pandemic. AUTHORS' CONCLUSIONS: Influenza vaccines are effective in reducing cases of influenza, especially when the content predicts accurately circulating types and circulation is high. However, they are less effective in reducing cases of influenza-like illness and have a modest impact on working days lost. There is insufficient evidence to assess their impact on complications. Whole-virion monovalent vaccines may perform best in a pandemic.

PMID: 17443504

Cochrane Database Syst Rev. 2004;(3):CD001269. Links

Comment in:

ACP J Club. 2005 May-Jun;142(3):70.

Evid Based Nurs. 2005 Apr;8(2):47.

Update in:

Cochrane Database Syst Rev. 2007;(2):CD001269.

Update of:

Cochrane Database Syst Rev. 2001;(4):CD001269.

Vaccines for preventing influenza in healthy adults.Demicheli V, Rivetti D, Deeks JJ, Jefferson TO.

Servizo Sovrazonale di Epidemiologia, ASL 20, Via Venezia 6, Alessandria, Piemonte, Italy, 15100. demichelivittorio@asl20.piemonte.it

BACKGROUND: Three different types of influenza vaccines are currently produced worldwide. None is traditionally targeted to healthy adults. Despite the publication of a large number of clinical trials, there is still substantial uncertainty about the clinical effectiveness of influenza vaccines and this has negative impact on the vaccines acceptance and uptake. OBJECTIVES: To assess the effects of vaccines on influenza in healthy adults. To assess the effectiveness of vaccines in preventing cases of influenza in healthy adults. To estimate the frequency of adverse effects associated with influenza vaccination in healthy adults. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 1, 2004) which contains the Cochrane Acute Respiratory Infections Group trials register; MEDLINE (January 1966 to December 2003); and EMBASE (1990 to December 2003). We wrote to vaccine manufacturers and first or corresponding authors of studies in the review. SELECTION CRITERIA: Any randomised or quasi-randomised studies comparing influenza vaccines in humans with placebo, control vaccines or no intervention, or comparing types, doses or schedules of influenza vaccine. Live, attenuated or killed vaccines or fractions thereof administered by any route, irrespective of antigenic configuration were considered. Only studies assessing protection from exposure to naturally occurring influenza in healthy individuals aged 14 to 60 (irrespective of influenza immune status) were considered. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed trial quality and extracted data. MAIN RESULTS: Twenty five reports of studies involving 59,566 people were included. The recommended live aerosol vaccines reduced the number of cases of serologically confirmed influenza by 48% (95% confidence interval (CI) 24% to 64%), whilst recommended inactivated parenteral vaccines had a vaccine efficacy of 70% (95% CI 56% to 80%). The yearly recommended vaccines had low effectiveness against clinical influenza cases: 15%(95% CI 8% to 21%) and 25% (95% CI 13% to 35%) respectively. Overall the percentage of participants experiencing clinical influenza decreased by 6%. Use of the vaccine significantly reduced time off work but only by 0.16 days for each influenza episode (95% CI 0.04 to 0.29 days); Analysis of vaccines matching the circulating strain gave higher estimates of efficacy, whilst inclusion of all other vaccines reduced the efficacy. REVIEWERS' CONCLUSIONS: Influenza vaccines are effective in reducing serologically confirmed cases of influenza. However, they are not as effective in reducing cases of clinical influenza and number of working days lost. Universal immunisation of healthy adults is not supported by the results of this review.

PMID: 15266445

May 11 update

At this point the CDC has declared an arbitrary 2600 cases of novel H1N1 flu and declared that they will stop monitoring the outbreak. On the CDC site, at the bottom in the small print, it is clear that complete genetic testing is not being done. The CDC is assuming any H1N1 that cannot be subtyped is the novel Mexican virus. “Regular” H1N1 still makes up the majority of the cases in the U.S.

The majority of cases of “novel” H1N1 are similar to a normal flu season. Deaths are occurring among people who are already ill. The original Mexican outbreak went from a hundred plus down to sixteen and now stands at forty-eight.

Previously the genetic analysis of confirmed cases was available, but it has been removed. Without being a geneticist, it seemed pretty clear we were seeing a wide variety of genetic subtypes rather than a single subtype.

Here is a direct quote from the current CDC site (http://www.cdc.gov/ncidod/eid/vol8no4/01-0311.htm): “Influenza epidemics occur in most parts of the world and typically arise every 2 to 3 years, causing approximately 20,000 deaths above the yearly mortality baseline (1). The incidence of recurring epidemics is primarily attributed to the high frequency of mutational changes in the hemagglutinin (HA) and neuraminidase (NA) major surface glycoproteins.” The year reported on is 1999, the year a another “novel” form of H1N1 was discovered.

So, now we have an epidemic without oversight, determined by incomplete genetic testing. If no one is actually monitoring the outbreak, how are we to determine if we are indeed dying of the “novel” form or the “regular” form? Isn’t some high level official going to say the words: “false alarm, it’s just the regular flu season?”

Summary: Swine flu is the most recent pandemic scare. Specifically, this pandemic is supposed to occur as a result of a mutation in the common H1N1 flu type. Since H1N1 has predominated in the U.S. in the last two flu seasons, there will be deaths involved with that type. Every year there are deaths due to influenza, predominantly in the elderly and in very young children.

But the distinction necessary here is whether the Mexican variation is spreading to the U.S. and infecting healthy individuals with a potentially lethal strain? At this point, because the CDC of Maine is announcing confirmed cases before genetic confirmation can be obtained, we must assume that somewhere someone has jumped from scientific evidence to hysteria.

The purchase of millions of dollars worth of Tamiflu (oseltamivir) is also somewhat suspicious as a protective tactic. Already a large percentage of H1N1 cases are resistant to Tamiflu and we have no information on medline showing that Tamiflu is effective against this outbreak. So we are purchasing a false insurance policy.

Given the current hysteria, we should all stockpile our garlic and elderberry again. Both are as likely to be as effective as Tamiflu. Elderberry has been specifically shown to be effective against the H1N1 strains. But a far more effective route to prevention would be to follow the flu and cold prevention guidelines (found on the What Do I Treat? Page).

I trust the hysteria will pass, and we will know if this is indeed a threat. If you are overly concerned, please read about the avian flu threat, which was more credible and did not result in a pandemic. The real problem here is how often the CDC can cry wolf before we stop listening. Someone needs to stop shouting pandemic every time we have a mutation, because they happen every year.

MMWR Morb Mortal Wkly Rep. 2009 Apr 24;58(15):400-2. Links

Swine Influenza A (H1N1) infection in two children--Southern California, March-April 2009.Centers for Disease Control and Prevention (CDC).

On April 17, 2009, CDC determined that two cases of febrile respiratory illness occurring in children who resided in adjacent counties in southern California were caused by infection with a swine influenza A (H1N1) virus. The viruses from the two cases are closely related genetically, resistant to amantadine and rimantadine, and contain a unique combination of gene segments that previously has not been reported among swine or human influenza viruses in the United States or elsewhere. Neither child had contact with pigs; the source of the infection is unknown. Investigations to identify the source of infection and to determine whether additional persons have been ill from infection with similar swine influenza viruses are ongoing. This report briefly describes the two cases and the investigations currently under way. Although this is not a new subtype of influenza A in humans, concern exists that this new strain of swine influenza A (H1N1) is substantially different from human influenza A (H1N1) viruses, that a large proportion of the population might be susceptible to infection, and that the seasonal influenza vaccine H1N1 strain might not provide protection. The lack of known exposure to pigs in the two cases increases the possibility that human-to-human transmission of this new influenza virus has occurred. Clinicians should consider animal as well as seasonal influenza virus infections in their differential diagnosis of patients who have febrile respiratory illness and who 1) live in San Diego and Imperial counties or 2) traveled to these counties or were in contact with ill persons from these counties in the 7 days preceding their illness onset, or 3) had recent exposure to pigs. Clinicians who suspect swine influenza virus infections in a patient should obtain a respiratory specimen and contact their state or local health department to facilitate testing at a state public health laboratory.

PMID: 19390508

JAMA. 2009 Mar 11;301(10):1034-41. Epub 2009 Mar 2. Links

Comment in:

JAMA. 2009 Mar 11;301(10):1066-9.

Infections with oseltamivir-resistant influenza A(H1N1) virus in the United States.Dharan NJ, Gubareva LV, Meyer JJ, Okomo-Adhiambo M, McClinton RC, Marshall SA, St George K, Epperson S, Brammer L, Klimov AI, Bresee JS, Fry AM; Oseltamivir-Resistance Working Group.

Collaborators (44)

Ahmed F, Nalluswami K, Bascom SD, Berisha V, Boulton RB, Cohen J, Corkren E, Crockett M, Dao C, Deyde VM, Hall H, Patton M, Sheu TG, Wallis TR, Hales C, Sunenshine R, Erhart LM, Komatsu K, Sunenshine R, Goodin K, Hanson M, Koepsell J, Rietberg K, Haupt T, Laplante JM, Mingle L, Linchangco P, Louie J, Moore A, McHugh L, Moore Z, Najera R, Park S, Rajan R, Person CJ, Yousey-Hindes K, Powell RJ, Reisdorf E, Shult PA, Van TT, Richards SM, Siston A, Stoute A, Van Houten C Jr.

Epidemic Intelligence Service, Office of Workforce and Career Development Assigned to Influenza Division, Centers for Disease Control and Prevention, 1600 Clifton Rd, MS A-32, Atlanta, GA 30333, USA. nfd6@cdc.gov

CONTEXT: During the 2007-2008 influenza season, oseltamivir resistance among influenza A(H1N1) viruses increased significantly for the first time worldwide. Early surveillance data suggest that the prevalence of oseltamivir resistance among A(H1N1) viruses will most likely be higher during the 2008-2009 season. OBJECTIVES: To describe patients infected with oseltamivir-resistant influenza A(H1N1) virus and to determine whether there were any differences between these patients and patients infected with oseltamivir-susceptible A(H1N1) virus in demographic or epidemiological characteristics, clinical symptoms, severity of illness, or clinical outcomes. DESIGN, SETTING, AND PATIENTS: Influenza A(H1N1) viruses that were identified and submitted to the Centers for Disease Control and Prevention by US public health laboratories between September 30, 2007, and May 17, 2008, and between September 28, 2008, and February 19, 2009, were tested as part of ongoing surveillance. Oseltamivir resistance was determined by neuraminidase inhibition assay and pyrosequencing analysis. Information was collected using a standardized case form from patients with oseltamivir-resistant A(H1N1) infections and a comparison group of patients with oseltamivir-susceptible A(H1N1) infections during 2007-2008. MAIN OUTCOME MEASURES: Demographic and epidemiological information as well as clinical information, including symptoms, severity of illness, and clinical outcomes. RESULTS: During the 2007-2008 season, influenza A(H1N1) accounted for an estimated 19% of circulating influenza viruses in the United States. Among 1155 influenza A(H1N1) viruses tested from 45 states, 142 (12.3%) from 24 states were resistant to oseltamivir. Data were available for 99 oseltamivir-resistant cases and 182 oseltamivir-susceptible cases from this period. Among resistant cases, median age was 19 years (range, 1 month to 62 years), 5 patients (5%) were hospitalized, and 4 patients (4%) died. None reported oseltamivir exposure before influenza diagnostic sample collection. No significant differences were found between cases of oseltamivir-resistant and oseltamivir-susceptible influenza in demographic characteristics, underlying medical illness, or clinical symptoms. Preliminary data from the 2008-2009 influenza season identified resistance to oseltamivir among 264 of 268 influenza A(H1N1) viruses (98.5%) tested. CONCLUSIONS: Oseltamivir-resistant A(H1N1) viruses circulated widely in the United States during the 2007-2008 influenza season, appeared to be unrelated to oseltamivir use, and appeared to cause illness similar to oseltamivir-susceptible A(H1N1) viruses. Circulation of oseltamivir-resistant A(H1N1) viruses will continue, with a higher prevalence of resistance, during the 2008-2009 season.

PMID: 19255110

MMWR Morb Mortal Wkly Rep. 2009 Apr 17;58(14):369-74. Links

Update: influenza activity--United States, September 28, 2008-April 4, 2009, and composition of the 2009-10 influenza vaccine.Centers for Disease Control and Prevention (CDC).

This report summarizes U.S. influenza activity from September 28, 2008, the start of the 2008-09 influenza season, through April 4, 2009, and reports on the 2009-10 influenza vaccine strain selection. Low levels of influenza activity were reported from October through early January. Activity increased from mid-January and peaked in mid-February. Influenza A (H1N1) viruses have predominated overall this season, but influenza B viruses have been isolated more frequently than influenza A viruses since mid-March. Widespread oseltamivir resistance was detected among circulating influenza A (H1N1) viruses and a high level of adamantane resistance was identified among influenza A (H3N2) viruses.

PMID: 19373198

MMWR Morb Mortal Wkly Rep. 2008 Jun 27;57(25):692-7. Links

Influenza activity--United States and worldwide, 2007-08 season.Centers for Disease Control and Prevention (CDC).

During the 2007-08 influenza season, influenza activity peaked in mid-February in the United States and was associated with greater mortality and higher rates of hospitalization of children aged 0-4 years, compared with each of the previous three seasons. In the United States, influenza A (H1N1) was the predominant strain early in the season; influenza A (H3N2) viruses increased in circulation in January and predominated overall. While influenza A (H1N1), A (H3N2), and B viruses cocirculated worldwide, influenza A (H1N1) viruses were most commonly reported in Canada, Europe, and Africa, and influenza B viruses were predominant in most Asian countries. This report summarizes influenza activity in the United States and worldwide during the 2007-08 influenza season (September 30, 2007-May 17, 2008).

PMID: 18583957

Emerg Infect Dis. 2009 Apr;15(4):552-60. Links

Oseltamivir-resistant influenza virus A (H1N1), Europe, 2007-08 Season.Meijer A, Lackenby A, Hungnes O, Lina B, van-der-Werf S, Schweiger B, Opp M, Paget J, van-de-Kassteele J, Hay A, Zambon M; European Influenza Surveillance Scheme.

Collaborators (117)

Lachner P, Popow-Kraupp T, Strauss R, Brochier B, Sabbe M, Thomas I, Casteren V, Yane F, Georgieva T, Kojouharova M, Kotseva R, Kurchatova A, Aleraj B, Drazenovic V, Bagatzouni-Pieridou D, Elia A, Havlickova M, Kyncl J, Glismann S, Mazick A, Nielsen L, Fleming DM, Lackenby A, Watson J, Zambon M, Sadikova O, Sarv I, Ziegler T, Cohen JM, Enouf V, Lina B, Mosnier A, Valette M, van der Werf S, Buchholz U, Haas W, Schweiger B, Kossivakis AG, Kyriazopoulou-Dalaina V, Mentis A, Spala G, Berencsi G, Csohán A, Jankovics I, Coughlan S, Domegan L, Duffy M, Joyce M, O'Donnell J, O'Flanagan D, Ansaldi F, Crovari P, Donatelli I, Pregliasco F, Nikiforova R, Van Velicko I, Zamjatina N, Griskevicius A, Kupreviciene N, Rimseliene G, Mossong J, Opp M, Barbara C, Melillo T, Arkema A, Meerhoff T, Paget WJ, van der Velden K, Dijkstra F, Donker G, de Jong JC, Meijer A, Rimmelzwaan G, van der Sande M, Wilbrink B, Coyle P, Kennedy H, O'Neill H, Hungnes O, Iversen B, Brydak L, Romanowska M, Falcão IM, Falcão JM, Rebelo de Andrade H, Alexandrescu V, Lupulescu E, Carman W, Gunson R, Kean J, McMenamin J, Milic N, Nedeljkovic J, Blaskovicova H, Kristufkova Z, Sláciková M, Prosenc K, Socan M, Casas I, Larrrauri A, de Mateo S, Ortiz de Lejarazu R, Pérez-Breña P, Pumarola Suñé T, Vega Alonso T, Brytting M, Linde A, Penttinen P, Rubinova S, Thomas Y, Witschi M, Yilmaz N, Aranova M, Mironenko A, Hay A, Jones R, Thomas D.

Netherlands Institute for Health Services Research, Utrecht, the Netherlands.

In Europe, the 2007-08 winter season was dominated by influenza virus A (H1N1) circulation through week 7, followed by influenza B virus from week 8 onward. Oseltamivir-resistant influenza viruses A (H1N1) (ORVs) with H275Y mutation in the neuraminidase emerged independently of drug use. By country, the proportion of ORVs ranged from 0% to 68%, with the highest proportion in Norway. The average weighted prevalence of ORVs across Europe increased gradually over time, from near 0 in week 40 of 2007 to 56% in week 19 of 2008 (mean 20%). Neuraminidase genes of ORVs possessing the H275Y substitution formed a homogeneous subgroup closely related to, but distinguishable from, those of oseltamivir-sensitive influenza viruses A (H1N1). Minor variants of ORVs emerged independently, indicating multiclonal ORVs. Overall, the clinical effect of ORVs in Europe, measured by influenza-like illness or acute respiratory infection, was unremarkable and consistent with normal seasonal activity.

PMID: 19331731

Clin Infect Dis. 2009 May 1;48(9):1254-6. Links

Influenza virus resistance to antiviral agents: a plea for rational use.Poland GA, Jacobson RM, Ovsyannikova IG.

Mayo Vaccine Research Group, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.

Although influenza vaccine can prevent influenza virus infection, the only therapeutic options to treat influenza virus infection are antiviral agents. At the current time, nearly all influenza A/H3N2 viruses and a percentage of influenza A/H1N1 viruses are adamantane resistant, which leaves only neuraminidase inhibitors available for treatment of infection with these viruses. In December 2008, the Centers for Disease Control and Prevention released new data demonstrating that a high percentage of circulating influenza A/H1N1 viruses are now resistant to oseltamivir. In addition, oseltamivir-resistant influenza B and A/H5N1 viruses have been identified. Thus, use of monotherapy for influenza virus infection is irrational and may contribute to mutational pressure for further selection of antiviral-resistant strains. History has demonstrated that monotherapy for influenza virus infection leads to resistance, resulting in the use of a new monotherapy agent followed by resistance to that new agent and thus resulting in a background of viruses resistant to both drugs. We argue that combination antiviral therapy, new guidelines for indications for treatment, point-of-care diagnostic testing, and a universal influenza vaccination recommendation are critical to protecting the population against influenza virus and to preserving the benefits of antiviral agents.

PMID: 19323631

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