WHO's advice: Just assume it's swine flu

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WHO's advice: Just assume it's swine flu

The World Health Organization will recommend that nations curtail efforts to

confirm swine flu cases and assume the H1N1 virus is the culprit. Meanwhile,

resistance to antiviral drug Tamiflu is seen.

By H. Maugh II July 8, 2009.

As the World Health Organization prepares to recommend that most countries

assume that their flu cases are the result of the novel H1N1 swine flu virus,

officials are seeing the first signs of resistance to the commonly used

antiviral drug Tamiflu -- though so far none that are particularly disturbing.

Meanwhile, the virus is continuing to spread through the Northern Hemisphere

this summer -- even though flu normally doesn't spread well in hot weather --

and its effect is growing in the southern half of the globe, which has begun its

traditional winter flu season.

Within the next few days, the WHO will suggest that countries with major

outbreaks of swine flu move away from laboratory confirmation of cases and

toward larger, national indicators of disease, such as the number of people with

flu-like symptoms and cases of pneumonia, Dr. Keiji Fukuda, WHO assistant

director-general, said Tuesday in a telephone news conference.

The large number of cases in such countries is overwhelming labs and making it

" very hard to keep up " with testing, he said. The new guidelines will " ease the

burden on laboratories, " he said. In most countries with major outbreaks of the

virus, 95% or more of total flu cases are being caused by H1N1.

" In countries with no cases, we will continue to recommend that people be tested

so the presence of the new virus can be confirmed, " Fukuda said. " In all

countries, we will continue to stress testing for unusual cases, clusters,

unusually severe cases and new symptoms. "

But the number of swine-flu-free countries is likely to be small soon. The most

recent figures reported to the WHO indicate that more than 98,000 cases have

been confirmed in 120 countries, with 440 deaths, though officials estimate the

number of actual infections at 10 to 100 times that.

The most recent figures for the United States indicate 33,902 lab-confirmed

cases and 170 deaths, but officials at the national Centers for Disease Control

and Prevention have estimated that more than 1 million Americans have contracted

the virus.

In the last two weeks, health officials have identified three patients -- one

each in Denmark, Japan and Hong Kong -- with a virus resistant to Tamiflu, known

generically as oseltamivir.

The cases in Denmark and Japan occurred in patients who had been taking the drug

prophylactically; the Hong Kong case involved a girl who had traveled from San

Francisco and never been given oseltamivir, suggesting that she contracted a

resistant virus.

Viruses from all three patients displayed the same mutation producing the

resistance, and officials believe it is a spontaneous mutation, not a

recombination with seasonal viruses, many of which are resistant to the drug.

All three viruses were susceptible to the antiviral drug Relenza, known

generically as zanamivir.

The WHO is not particularly concerned about the mutations, Fukuda said, because

there is no evidence that the resistant virus is spreading.

" The single most important point, at this time, is that we are not recommending

any clinical changes to . . . treating patients, " he said.

The health agency continues to recommend prophylactic treatment for those

exposed to people with a known case of H1N1.

Unlike seasonal flu viruses, the H1N1 virus is continuing to spread largely

unabated during the Northern Hemisphere summer.

Outside the United States and Mexico, the greatest spread has been in Britain.

Last week, that country's health minister said he expected 100,000 new cases

every day for the foreseeable future.

The virus is also spreading throughout the Southern Hemisphere, where the flu

season is just beginning. Hardest hit is Argentina, with 2,800 confirmed cases

and a death toll that doubled in the last week to 60, the third-highest toll

after the United States and Mexico. Chile has had more than 8,000 confirmed

cases and 18 deaths. Australia has had more than 6,300 confirmed cases and 13

deaths.

So far, however, the virus does not appear to be changing, and the number of

deaths is apparently a reflection of the widespread nature of the disease.

Africa has been the last continent to see an outbreak, and the virus' presence

has now been confirmed in 12 countries there, Fukuda said.

The continued spread of the virus to developing countries will severely tax the

United Nations, which will need more than $1 billion this year alone to combat

the pandemic, Secretary-General Ban Ki-moon said Monday.

He said the agency has not been receiving as much money for the pandemic as it

had hoped.

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