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Pandemic H1N1 Locations
"It's a small number. It certainly doesn't change the scale of what we're seeing," Penn said.
The above comments by WHO are curious. WHO is funded by member nations and has a mandate to protect citizens of member nations. The withholding of important information such as the number and location of Tamiflu resistant pandemic H1N1 virus is not consistent with that mission. Tamiflu is widely used and recommended by WHO, so the withholding of information on resistance leads to inappropriate used of the antiviral, and places patient care and health care systems at risk.
This type of risk was easily seen in the two immuno-suppressed patients detailed in the recent MMWR dispatch. WHO has maintained that resistance is rare and due to spontaneous mutations selected in Tamiflu treated patients. However, recent data, including that from the patients in Washington state suggested that the limited number of reports is related to limited and delayed testing, which is compounded by the withholding of information on identified isolated.
The MMWR describe patients who were H1N1 infected in June. The patients were treated with Tamiflu and detectable resistance developed quickly. However, treatment was increased and resistance was not confirmed until August, after one patient developed a Tamiflu resistant recurrence and the other patient continues to be hospitalized in spite of treatment with Tamiflu, Relenza, and ribavirin. The ability of Tamiflu resistant pandemic H1N1 to persistence in such aggressively treated patients increases concerns that the recent worldwide rise in patient deaths and hospitalizations is linked in part to such resistance.
When WHO stated it was withholding the information on resistance, there had already been 8 examples in patients which were supported by sequence data. Another example (in Thailand) had already been described in media reports and shortly after the proclamation by WHO, Hong Kong reported another cases of resistance in a patient being treated prophylatically and the two patients in Washington State were detailed. Moreover, additional information on the American patient in Singapore provided compelling data that H274Y was silently circulating because the vast majority by WHO and consultants involved samples collected prior to Tamiflu treatment, which were failing to detect the H274Y present as a mixture in the H1N1 samples being sequenced.
The WHO should be encouraging countries to promptly report resistance and expand testing to patients who have been briefly treated with Tamiflu. A true accounting of H274Y in pandemic H1N1 is long overdue.