The Power of III
August 15, 2009
August 15, 2009
The presence of H274Y in a minor species would explain the failure to find H274Y in the above locations, but its presence just below the detection level in untreated patient may explain the recent increases in fatalities. Agencies have repeatedly cited the lack of H274Y detection, leading to the widespread use of Tamiflu in H1N1 in positive cases, including the two immuno-suppressed patents in the state of Washington, where H274Y was detected for the first time in the United States. In those two patients H274Y was not detected until the patients either had a reoccurrence of symptoms or a failure to respond to treatment. The resistance was found in August, even though both patients developed resistance weeks or months earlier. These detection delays and recent reports of patients, who were resistant in May and June, raise concern that the number of samples with H274Y is significantly higher that the 11 confirmed cases thus far. Media reports have described in at least one patient in Thailand, and earlier media reports described multiple cases in Texas along the Mexican border.
However, the detection of H274Y in the sample collected a few days after the start of treatment in the patient in Singapore suggests the actual incidence is much higher than the reported or withheld cases described by WHO, and a more intense screening program is critical, especially of samples collected after the start of osletamivir treatment and the increasingly common fatal cases.