WHO Recommends Only High-Risk H1N1 Flu Patients Use Antivirals as Concern Over Supply, Drug Resistance Grows
"[T]o ensure adequate supplies in case the virus should mutate and become more dangerous," the WHO on Tuesday cautioned that antivirals should only be used to treat high-risk patients, such as pregnant women and people with underlying health conditions, infected with the H1N1 (swine) virus, the AP/Washington Post reports.
The AP/Washington Post writes that WHO's "comments appeared aimed at European countries, which have been using antiviral drugs such as Tamiflu and Relenza much more aggressively than the U.S. and Mexico, administering them whenever possible in an attempt to contain the virus before it spreads more widely" (Kilpatrick/Stevenson, AP/Washington Post, 5/13). "As part of pandemic preparedness plans we urge countries to plan for prioritization," said Nikki Shindo, a medical officer with the WHO's global flu program "a decision that also must take into account how many antivirals are available in each country," AP/Washington Post writes (Castillo, AP/Washington Post, 5/12).
While studies have found the H1N1 flu to be more contagious than the seasonal flu (Kaiser Global Health Policy Report, 5/12), a growing body of evidence suggests that most patients can recover from H1N1 flu without the antivirals. However, based on the availability of antivirals, the WHO continues to recommend that antivirals be administered to patients with already weakened immune systems (Nebehay, Reuters, 5/12). The WHO plans to publish new guidelines about how to treat patients who present with mild symptoms of H1N1 flu soon, AFP/Yahoo! News reports (AFP/Yahoo! News, 5/12).
The CDC announced on Tuesday that all pregnant women with H1N1 flu should be treated with Tamiflu or Relenza to protect against complications of the virus, the Wall Street Journal reports (Dooren, Wall Street Journal, 5/13) after studies of evidence out of Mexico and the U.S. suggest "pregnancy was emerging as a risk factor rivaling asthma, diabetes, immunosuppression and cardiovascular disease," the New York Times writes.
Because pregnancy weakens a woman's immune system, the H1N1 virus is more likely to cause pneumonia, dehydration and premature labor. The New York Times writes, "Because a positive test for the new H1N1 flu can take days, the [CDC] said, Tamiflu should be given to any pregnant patient with flu symptoms and a history of likely contact with someone else with swine flu," however, "Tamiflu is not normally recommended for use by pregnant women because the effects on the unborn child are unknown, according to its maker, Roche" (McNeil, New York Times, 5/13).
Still, the AP/Google.com writes, the "risks from the virus are greater than the unknown risks to the fetus from the drugs Tamiflu and Relenza," Anne Schuchat, the interim director of CDC's science and public-health program, said Tuesday. Historical flu pandemics have shown that flu infection raised the rate of premature birth (Stobbe, AP/Google.com, 5/12). The Wall Street Journal writes, "The CDC is also recommending that doctors consider antiviral treatment for young children and babies though antiviral drugs aren't approved for use in children who are younger than one" (Wall Street Journal, 5/13).
The WHO on Wednesday reported 33 countries have officially reported 5,728 cases of swine flu. Laboratory tests have confirmed: 2,059 cases of swine flu, including 56 deaths in Mexico; 3,009 cases, including three deaths in the U.S.; 358 cases, including one death in Canada; and eight cases, including one death in Costa Rica. The WHO writes, "The following countries have reported laboratory confirmed cases with no deaths - Argentina (1), Australia (1), Austria (1), Brazil (8), China (3, comprising 1 in China, Hong Kong Special Administrative Region, and 2 in mainland China), Colombia (6), Cuba (1), Denmark (1), El Salvador (4), Finland (2), France (13), Germany (12), Guatemala (3), Ireland (1), Israel (7), Italy (9), Japan (4), Netherlands (3), New Zealand (7), Norway (2), Panama (29), Poland (1), Portugal (1), Republic of Korea (3), Spain (98), Sweden (2), Switzerland (1), Thailand (2), and the United Kingdom (68)" (WHO Influenza A(H1N1) - update 27, 5/13).
As the H1N1 virus continues to spread, Roche announced on Tuesday it was ramping up production of Tamiflu, Reuters reports (MacInnis/Nebehay, Reuters, 5/12). Shindo said the possibility remains that the H1N1 virus, while appearing mild now, could mutate and become more lethal, and it was unclear how effective Relenza and Tamiflu would be against a mutated form of the virus, the AP/Washington Post writes.
As the southern hemisphere approaches its flu season, Shindo added, "We are also facing the risk of having resistant viruses." Just last year, there was "widespread evidence of oseltamivir (generic form of Tamiflu) resistance in seasonal influenza," Shindo said (AFP/Yahoo! News, 5/12).This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.