Cases of Tamiflu-resistant H1N1 causing new concern

By Steve Sternberg, USA TODAY

The momentum of the H1N1 flu outbreak has fallen off, but flu activity is still high and Tamiflu-resistant virus may have begun to spread. USA TODAY'S Steve Sternberg asks experts for their perspective.

Q: How bad is H1N1 now?
A: Forty-three states are reporting widespread cases, down from 46 last week, says Anne Schuchat, director of the Centers for Disease Control and Prevention's National Center for Immunization and Respiratory Diseases. "We are beginning to see some declines in influenza activity, but there's still a lot of influenza everywhere."

Q: Has the flu peaked?
A: "I wish I knew," Schuchat says. "Influenza is unpredictable, and it's so early in the year to have this much disease."

Q: Is the vaccine supply improving?
A: Yes, she says. As of Friday, 54.1 million doses of H1N1 vaccine were available for states to order, 11 million more than a week ago. By Wednesday, states had ordered 93% of the amount that was available to them. About 94.5 million doses of seasonal flu vaccine also have been distributed nationwide.

Q: What is the latest about Tamiflu-resistant cases?
A: Four patients at Duke University Medical Center in Durham, N.C., and at least five in an unidentified hospital in Wales have become infected with H1N1, or swine flu, viruses that no longer respond to treatment with Tamiflu. Flu viruses swap genes as part of their normal evolution; that means resistant viruses could quickly spread worldwide, says Duke's Daniel Sexton.

Q: Why should I worry about Tamiflu-resistant cases of flu?
A: Tamiflu and Relenza are the most effective antiviral drugs for treating flu. H1N1 is still largely vulnerable to both drugs, unlike many seasonal flu viruses, which are now broadly resistant and more difficult to treat. Most people will get well with rest and fluids. A hard-to-treat virus can be deadly for some patients, such as pregnant women or children with asthma or cerebral palsy, who need effective treatment because they account for a disproportionate number of deaths caused by swine flu.

Q: Does that mean H1N1 will become as deadly as the 1918 virus?
A: There's no evidence to suggest the virus is getting more virulent, Schuchat says. But it may become harder to treat.

Q: Will Thanksgiving have any impact on the epidemic?
A: "We've seen with a lot of respiratory infections that there are increases in January right after the Christmas holiday," Schuchat says. "All the kids get together with their grandparents. There's an exchange of a lot of warmth and love, but there's a little exchange of viruses, too. We think its critical that if you're sick, stay home. And if your child is sick, to keep them away from others."