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Tamiflu-resistant H1N1 cluster in Wales

In Wales, five patients have been identified as victims of the H1N1 mutation, with an additional three infections undergoing investigation

The National Public Health Service for Wales (NPHS) has confirmed that five patients with severe underlying health conditions at the University Hospital of Wales, Cardiff, have been diagnosed with a strain of swine flu resistant to Tamiflu. The announcement follows a recent diagnosis of four patients at Duke University Medical Center in North Carolina with an antiviral-resistant strain of H1N1. Three of the patients at the North Carolina facility have died and while flu seems to have been a factor in each death, Dr Daniel Sexton, professor of medicine and director of the Duke Infection Control Outreach Network, points out that all the patients were very sick and so it was difficult to attribute the mutated H1N1 strain as the primary cause of death. 

Over 50 isolated cases of H1N1 mutation resulting in resistance to antiviral drugs like Tamiflu have been identified globally since the outbreak of H1N1, however none has appeared to spread beyond the original host. The emergence of patient clusters in these two locations now leaves little doubt that the H1N1 variation can be transmitted from patient to patient.

According to Dr Roland Salmon, director of the NPHS Communicable Disease Surveillance Centre, 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 Salmon said.

The patients are being treated with an alternative antiviral and one has made a full recovery. The others continue to be monitored.

23rd November 2009

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