6.8.13

 

H7N9 Bird Flu Drug Resistance a Concern


Drug resistance has been detected in patients infected with the new bird flu that has emerged in China, say doctors.  The H7N9 virus became resistant to Tamiflu in three out of 14 patients treated with antiviral drugs at Shanghai Public Health Clinical Centre.

The researchers said resistance emerged with "apparent ease" and was "concerning".  There have been no new cases of the infection for more than two weeks. Resistance.  Doctors analysed the virus in 14 patients. All had pneumonia and half needed ventilation to keep them alive.

Treatment with antivirals reduced levels of H7N9 in most patients and led to an improvement in symptoms.  Yet the treatment failed in three patients. Genetic testing of the virus in these patients showed it had acquired the mutations needed to resist the drugs.  The doctors believe that in at least one patient the emergence of resistance was a direct consequence of treatment with Tamiflu.
Such antiviral drugs are the only way of treating the infection.

The researchers said: "The apparent ease with which antiviral resistance emerges in H7N9 viruses is concerning, it needs to be closely monitored and considered in future pandemic response plans."
There have been 131 confirmed cases and 36 deaths since the virus was first reported early this year.
However, the most recent case reported was on 8 May. Efforts to close poultry markets are thought to have significantly reduced the spread of the virus.



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Researchers have reported the first case of human-to-human transmission of the new strain of bird flu that has emerged in China.

The British Medical Journal said a 32-year-old woman was infected after caring for her father. Both later died.  Until now there had been no evidence of anyone catching the H7N9 virus other than after direct contact with birds.  But experts stressed it does not mean the virus has developed the ability to spread easily between humans.

By 30 June there had been 133 cases of H7N9 bird flu reported in eastern China and 43 deaths.
Most people had visited live poultry markets or had close contact with live poultry in the week or two before they became ill.

Intensive care
Yet researchers found that the 32-year-old woman had become infected in March after caring for her 60-year-old father in hospital.  Unlike her father - who had visited a poultry market in the week before falling ill - she had no known exposure to live poultry but fell ill six days after her last contact with him.
Both died in intensive care of multiple organ failure.

Tests on the virus taken from both patients showed the strains were almost genetically identical, which supports the theory that the daughter was infected directly from her father rather than another source.
Public health officials tested 43 close contacts of the patients but all tested negative for H7N9, suggesting the ability of the virus to spread was limited.

The researchers said that while there was no evidence to suggest the virus had gained the ability to spread from person to person efficiently, this was the first case of a "probable transmission" from human to human.

Strong warning sign
 
"Our findings reinforce that the novel virus possesses the potential for pandemic spread," they concluded.  Dr James Rudge, of the London School of Hygiene and Tropical Medicine, said that limited transmission between humans is not surprising and has been seen before in other bird flu viruses, such as H5N1.  He added: "It would be a worry if we start to see longer chains of transmission between people, when one person infects someone else, who in turn infects more people, and so on.  "And particularly if each infected case goes on to infect, on average, more than one other person, this would be a strong warning sign that we might be in the early stages of an epidemic".

An accompanying editorial in the BMJ, co-authored by Dr Rudge, concluded that while this study might not suggest that H7N9 is any closer to delivering the next pandemic, "it does provide a timely reminder of the need to remain extremely vigilant".

Sourced from www.bbc.com
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