- Serious questions are raised today about the ability
to combat an anticipated bird flu pandemic following the deaths of two
people who were being treated with the drug the world is stockpiling as
a safeguard against the virus.
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- To the dismay of medical experts and concern among those
responsible for the worldwide efforts to fight a pandemic, the H5N1 bird
flu virus in the bloodstream of the two patients in Vietnam rapidly developed
resistance to the drug, Tamiflu. One, a 13 year-old girl, appeared to be
stable at first and then rapidly worsened as the virus mutated, became
more aggressive, and eventually killed her.
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- The deaths are reported today in the respected New England
Journal of Medicine by doctors funded by the British Wellcome Trust working
in Vietnam. They urge changes to the global plans for fighting a flu pandemic.
Other antiviral drugs are needed alongside Tamiflu, they say.
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- An eminent professor at Cornell University in New York
calls the report "frightening" in a commentary in the journal.
Anne Moscona, from the department of paediatrics, microbiology and immunology
at Weill medical college, says Tamiflu-resistant H5N1 "is now a reality",
and calls for efforts to prevent individuals stockpiling the drug. Its
misuse, she says - by people who, for instance, take too low a dose - will
breed resistance and further undermine its effectiveness if a pandemic
sweeps the world.
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- The British government has ordered 14.6m courses of Tamiflu,
enough for a quarter of the population. Its maker, Roche, cannot keep up
with demand, however, as most countries attempt to stockpile. So far, 3.5m
doses have been delivered, and the rest is due by next September. At a
conference last month, the chief medical officer, Sir Liam Donaldson, made
it clear that Tamiflu was Britain's first line of defence. But he acknowledged
that nobody knew for sure how the drug would work in a pandemic against
a strain of flu yet to be encountered."It doesn't cure flu, it simply
reduces the severity of the attack," he said.
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- Last night, a spokeswoman for the department of health
said Tamiflu was selected on the strength of independent advice. "Internationally,
this is agreed as the product of choice," she said. But she added
that the research would be carefully considered as part of the government's
constant review of its antiviral strategy.
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- Alan Hay, head of the WHO Influenza Centre of the MRC
National Institute of Medical Research, said it was important to remember
that four of the eight Vietnamese patients in the study survived after
their treatment with Tamiflu. But, he said, the report was of "very
significant concern in regard to how we use these drugs to treat people".
It had already been recognised that resistance could build against Tamiflu.
In Japan, one in six children treated with the drug for ordinary forms
of flu developed resistance. It appeared, he said, that resistance was
more likely in children because they had not been exposed to the prevailing
strains of flu. In the case of bird flu, however, nobody has been exposed.
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- The report in the NEJM by Jeremy Farrar and colleagues
from the Oxford University Clinical Research Unit at the hospital for tropical
diseases in Ho Chi Minh City, Vietnam, reveals that they confirmed a resistant
form of bird flu in two out of eight patients who were being treated with
oseltamivir, of which Tamiflu is the brand name. One was treated at an
early stage of infection, when Tamiflu is supposed to be most effective.
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