New Flu, Old War

On May 20, several weeks after influenza A virus subtype H1N1 broke out in Mexico City in March this year, Taiwan recorded its first case when the Central Epidemic Command Center (CECC) confirmed the flu had been diagnosed in a 52-year-old Australian man who had just arrived from New York City. The next day, two Taiwanese women—one arriving from New York and one from San Francisco—were also found to have contracted the virus. All three cases of H1N1 were detected at the fever screening station inside Taiwan Taoyuan International Airport, where they showed temperatures exceeding 38 C. After this initial screening, each of the passengers was sent to Taoyuan General Hospital, which is operated by the Department of Health (DOH).
On July 2, the DOH’s Centers for Disease Control (CDC) announced the detection of the H1N1 virus in two specimens collected from residents of communities in Taiwan, showing that local transmission of H1N1 had begun. The first severe case of the flu in Taiwan was reported on July 17 in a 34-year-old man, and the first fatality occurred when a 39-year-old man died on July 31. Vice Premier Eric Li-luan Chu took over from Yaung Chih-liang, minister of the DOH, as CECC chief in early September as students started returning to schools, which are prone to outbreaks. As of mid-October, Taiwan had recorded around 360 cases in which H1N1 patients had been hospitalized. Of those patients, 24 died, but most recovered and are free of complications.
H1N1, commonly known as swine flu in some countries, began its global spread as health authorities were preoccupied with another flu associated with animals, bird flu. The name swine flu is somewhat misleading, however, as H1N1 is a mixture of two influenza strains found in pigs together with one found in humans and one in birds. Pork vendors around the world have complained about the flu’s common name and point out that the virus cannot be contracted by eating cooked pork. In Taiwan, the emerging disease is usually called “H1N1 flu,” or simply the “new flu.”
Despite the heavy media coverage, H1N1 has proven similar to other, more mundane types of flu, as like them, it is spread by coughing, sneezing or touching the nose or mouth with contaminated hands. An H1N1 patient suffers much like one afflicted with normal seasonal flu, which usually causes fever, a sore throat, a headache and muscle pain. Actually, despite the somewhat elevated level of public anxiety over H1N1’s seriousness, the great majority of those who have contracted the disease in Taiwan have recovered fully after developing only mild symptoms.
In June, after the World Health Organization (WHO) declared a global but mild pandemic, the CDC shifted H1N1 from its most severe category of infectious diseases, bumping it down to the fourth most-severe level. Taiwan’s Communicable Disease Control Act designates five levels of epidemics according to standards such as the potential number of fatalities, infection rate and speed of transmission. The CDC’s most serious category of communicable diseases includes smallpox, plague and severe acute respiratory syndrome (SARS), which hit Taiwan hard in 2003. Level one communicable diseases require immediate case reporting and quarantining, while level four diseases such as H1N1 require regular, comprehensive monitoring of factors such as transmission rates within communities, genetic mutation of the virus and resistance to antiviral medicines.
Wu De-lon, president of the Taiwan Hospital Association and a top advisor for the Chang Gung Healthcare System, one of the largest medical institutions in Taiwan, points out that although it is caused by a new virus, H1N1 flu is less deadly than the average seasonal flu, which kills 4,000 to 5,000 people each year in Taiwan, and thus is not a cause for excessive alarm. “Some people are easily panicked by the more sensational, exaggerated views in the media,” Wu says. “But the severe impacts that some academics and health experts warned of haven’t materialized yet.”
DOH Minister Yaung Chih-liang points out that for the government, the principal goals of handling the outbreak are to build a comprehensive picture of the impact of H1N1, including infection rates and locations, as well as give the public access to adequate, transparent information. “The most difficult thing to do is developing well-balanced control measures,” Yaung says. “We cannot afford to underestimate the risks of infection on the one hand, but we don’t have to treat it like a horrible enemy and cause panic for the general public on the other.”
For one thing, Yaung does not think that students should be prevented from attending school on a national scale. Currently, according to guidelines for schools from kindergarten to high school, the government has instituted the “three-two-five” policy, under which a class is suspended for five days, including weekends and holidays, if two or more students in that class are diagnosed with H1N1 within a span of three days. According to the Ministry of Education, in mid-October around 460 classes in about 285 schools were closed, accounting for 0.3 percent of all classes. As for colleges and universities, less than 0.1 percent of classes had been suspended.
Designated Flu Clinics
For his association’s member hospitals, Wu says the most important thing for the screening system to accomplish is to identify H1N1 patients whose illnesses tend to worsen over time instead of improve, as these cases are much more severe. Fortunately, according to the DOH there are around 3,000 designated flu-care clinics around the country, which increases the chances that medical professionals trained in infectious diseases will be able to identify the serious cases. “With these clinics available in neighborhoods, people don’t have to go to big hospitals for initial treatment for flu,” Yaung says.
The minister is also quite confident about the ability of the National Health Insurance (NHI) program to check the spread of H1N1. Taiwan’s universal healthcare system was launched in 1995 and, despite some financial difficulties, currently covers virtually the entire population. “Going to a doctor is not a problem for our people,” Yaung says, “and the [H1N1] medicine is also ready for use.”
In early September, the DOH began to release 250,000 doses of the antiviral drug Tamiflu, which were purchased from Swiss pharmaceutical company Hoffmann–La Roche Ltd. to treat patients in the early stages of H1N1 infection. The Tamiflu was distributed to local governments and clinics designated by health authorities in proportion to local populations. Since coverage for Tamiflu treatment was included in the NHI program in mid-August, there has been an increasing demand for the drug. In order to prevent hoarding, the CDC has directed that clinics must pay for the antiviral in cash within three months and cannot return any unused supplies. Also, the CDC has purchased another 2.68 million doses of Tamiflu from Roche for delivery to Taiwan by the end of this year.
The DOH’s decision to distribute Tamiflu to medical units at the grassroots level was welcomed by Chen Chien-jen, former DOH minister and a distinguished research fellow at Academia Sinica’s Genomic Research Center in Taipei. The epidemiologist points out that when H1N1 is detected early, especially in patients with mild symptoms and weaker contagion, it is much more effective to give them antivirals like Tamiflu than to wait and treat them by other means if their case worsens later. Chen says he hopes that there will be a sufficient amount of antivirals to treat each new flu patient within the initial “golden 48 hours” when the drugs are most effective. “That way we can wait patiently to release a vaccination,” he says.
Domestic Vaccine
In its preparations for H1N1, Taiwan has further matched WHO standards through its newfound ability to produce vaccines. In addition to five million doses of H1N1 vaccine purchased from Swiss pharmaceutical company Novartis International AG, 10 million doses were ordered from Adimmune Corp., a domestic vaccine manufacturer headquartered in Taichung County, central Taiwan. Clinical trials on humans of Adimmune’s vaccine were scheduled to wrap up in November.
H1N1 vaccinations using the Novartis or Adimmune product were scheduled to begin in Taiwan in November this year, with their administration proceeding according to an order established by the DOH that prioritizes certain occupational and age groups. Typhoon Morakot disaster survivors and healthcare and infection control personnel were given top priority, followed by infants from six months to one year old, pregnant women, preschool children, people above the age of 7 with major illnesses or injuries, elementary school students from 7 to 12 years old, junior high school students from 13 to 15 years old, high school students from 16 to 18 years old, people from 19 to 24 years old, people above the age of 25 with certain critical illnesses such as diabetes and cardiovascular, pulmonary, liver and kidney disease, people from 25 to 49 years old, people from 50 to 64 years old, and people above the age of 65.
The vaccinations, which are administered free of charge, are scheduled to run through February 2010. The Taiwan Hospital Association and Taiwan Medical Association have vowed to help promote the government’s vaccination campaign to further slow the spread of the disease. According to a survey released by the CECC in early October this year, 60 percent of the respondents said they were willing to be vaccinated, while 17 percent said they would consider it. DOH Minister Yaung notes that, like the NHI program, all of the government’s measures to contain H1N1 apply not only to Taiwan citizens, but also to all legal residents. Although the number of purchased vaccinations is not sufficient to inoculate all of Taiwan’s 23 million people, some local health authorities believe that the program will produce a collective immunity effect that will help protect those who do not receive them.
At around the same time Tamiflu distribution began in September this year, the CECC directed that 2 million facemasks be sent to convenience stores around Taiwan for sale at the mandated retail price of NT$6 (US$0.18) each, following the first such facemask release in early May. In general, while facemasks may not prove overly effective in preventing wearers from getting H1N1, for those who have already contracted the virus, the masks stop coughs and sneezes from expelling infected droplets into the air, one of the prime vectors of transmission. Yaung says that the CECC’s distribution programs are designed to facilitate circulation of the masks, as is the case for antiviral drugs, through regular market mechanisms so that retailers do not hesitate to make their stock available to consumers. According to a survey conducted by the CECC, about 80 percent of the respondents had purchased facemasks by early October this year, with the other 20 percent mostly from low-income households. Through cooperation with local civil affairs authorities, low-income households were scheduled to receive a box of 50 facemasks free of charge in November.
The CECC survey also showed that people in Taiwan have good knowledge about preventing the spread of H1N1. Among other things, more than 90 percent of those surveyed were aware of the appropriate methods of avoiding infection, including washing their hands frequently, trying not to touch their eyes or nose with their hands and understanding how to seek medical care. More than 90 percent of the people surveyed also knew how to prevent passing H1N1 to others, including staying home if they get sick, taking medications as instructed by doctors and wearing a mask when going out. Yaung says he believes that the knowledge and adaptable attitude of Taiwanese are good weapons against a possible epidemic. “Viruses are a force of nature,” the minister says. “They’re just another of the numerous barriers that humans have to use their intelligence to overcome for a sustainable existence.”

Tamiflu Still Number One Say WHO

The World Health Organisation wants everybody to know that they are standing by the influenza medication Tamiflu and have not changed their recommendations because of the few isolated cases of Tamiflu resistance experienced in the UK, the United States and other countries. The WHO made it clear that Tamiflu was still the most effective defence against the H1N1 swine flu virus and that a change of policy would not be beneficial.
In the UK and the US a number of cases which didn’t respond to Tamiflu have caused concern but this does not necessarily mean that the Tamiflu was not working because it could have been that the individual patients had compromised immune systems due to other illnesses. In fact four Americans who didn’t respond to Tamiflu were actually being treated for cancer and a number of other individuals in the UK were also being treated in hospital for other conditions which could have a bearing on why the Tamiflu didn’t work.
Dr. Keiji Fukuda who heads the influenza section at the World Health Organisation said that they were looking into these individual cases and therefore could not to jump to conclusions at present. There has been plenty of speculation about possible mutations of the H1N1 swine influenza virus but most of it is based on media hype as opposed to logical science.
It is likely that the virus will continue to mutate but just because it changes slightly does not mean that Tamiflu will automatically be rendered ineffective.
Tamiflu even works against the deadly H5N1 bird flu virus which kills about 50 percent of those who get it making it the most deadly influenza virus known to man. On the other hand the swine influenza virus while serious does not kill nearly as many people as some people like to speculate. Nevertheless what makes the swine influenza virus dangerous is that certain sections of the population for example obese individuals are more likely to become seriously ill or even die from it.

Swine flu mutation reported in Italy

The Italian Health Ministry reported the country's first case of a mutant form of swine flu on Monday.
The ministry said the variation of the A(H1N1) virus was identical to one reported in Norway on November 20. On Friday, France reported the death of two people infected by the same mutation.
The A(H1N1) variation was found three or four months ago in a patient in Monza, near Milan, Italian Deputy Health Minister Ferruccio Fazio said in comments reported by ANSA news agency.
"The Higher Institute of Health has examined around 100 strains (of the virus) found in recent months in patients from all over Italy and up to now the mutation has only been found in one patient," the ministry said in a statement.
"Italian data suggest that at the moment the mutation in question is not dominating serious and fatal cases of the virus. Furthermore, the mutation seems to be sporadic and does not appear to be spreading," the ministry said.
Vaccination and anti-viral treatments were still effective against the mutation, the ministry said.
"Only vaccination protects us from the virus, which is likely to become more dangerous with mutations," Fazio said.
The Italian health institute said it had found one case of resistance to the Tamiflu antiviral treatment.
This was an isolated case involving a patient who was already very ill, the institute said, and the resistant strain did not appear to be spreading.

South Korea reports first Tamiflu-resistant flu case

Health authorities on Monday reported South Korea’s first case of swine flu that was resistant to the anti-viral drug Tamiflu, and called for extra precautions against any future cases.
The health ministry said in a statement that it found a Tamiflu-resistant strain of the (A)H1N1 virus in a five-year-old boy, who needed repeated and doubled doses of Tamiflu to recover.
Another anti-viral drug, Relenza, proved effective in specimens taken from the child but he was too young to take the drug, it added.
The ministry urged people to report immediately to hospitals or health authorities if Tamiflu had no effect five straight days after the first dose.
It said the World Health Organization has reported 75 Tamiflu-resistant cases globally since the first such case in North America in April.
South Korea’s swine flu death toll has reached 104 but the spread of the disease is waning, according to the ministry.

Facts about Tamiflu

When the WHO declared H1N1 virus (swine flu ) as a pandemic, Tamiflu became the most known drug. A lot of rumors have arisen regarding Tamiflu ranging from its administration to its side effects.
So what are the facts about Tamiflu ?
Actually Tamiflu contains the active ingredient Oseltamivir which is an antiviral used for treating and preventing the “flu”, it treats any kind of flu and not specifically swine flu. It should be clear that all antivirals are not a cure for swine flu, but will help to reduce the length of time of illness by around one day, relieve some of the symptoms, and reduce the potential for serious complications such as pneumonia
Mechanism of action of Oseltamivir is suppression and decreasing the spread of influenza A and B viruses. It does this by blocking the action of neuraminidase, an enzyme produced by the viruses that enables them to be spread from infected cells to healthy cells. By preventing the spread of virus from cell to cell, the symptoms and duration of influenza infection are reduced.
On average, oseltamivir reduces the duration of symptoms by one and a half days if treatment is started within forty-eight hours of the beginning of symptoms. A huge advantage of Oseltamivir is that it was FDA approved in October 1999 as an antiviral medication.
But it also should be mentioned that Tamiflu is not a substitute for the flu shot; vaccination is still the first line of defense for flu protection. However, as it is known flu strains vary from area to area, so if you are exposed to a strain of the flu that is not the same strain as the one your vaccination protects against, you may still get the flu — and that’s where Tamiflu may be able to help. This means that Tamiflu can be used within 48 hours after the appearance of the symptoms and should not be taken as a prophylactic medication.
Although Tamiflu seems essential nowadays a lot of people are afraid of using it due to its side effects, of course not everyone taking the medication will suffer from side effects. Usually side effect are nausea, vomiting, diarrhea, bronchitis, abdominal pain, headache and dizziness. These side effects mainly occur due to oral administration of the medication and can be significantly reduced by taking the tablets after meals.
Unfortunately more serious side effects have occurred and they should be reported immediately, for example rare but serious skin reactions and allergic reactions have been reported. Some People, particularly children and adolescents, may be at an increased risk of self injury, confusion, seizures, panic attacks, delusions, delirium, depression, loss of consciousness, and even suicide shortly (24-48 hr) after taking Tamiflu. If any of these side effects appear Tamiflu should be stopped and a physician contacted immediately.
A lot of the schools are taking leaves due to the widespread of swine flu through them, so a lot of parents asking what should I do if my child got sick?!!! Should my child take antiviral medication or not??!!!!!
Although Tamiflu is supposed to be safe for children under 12 .The drugs were found to reduce the duration of the flu by a day, yet not to reduce the complications of the flu such as fewer asthma problems in children with existing asthma or the need to use antibiotics to treat secondary ear infections arising as part of the flu illness process. On the other hand, 1 in 20 children develop nausea and vomiting from these drugs which can cause life-threatening dehydration in any child.
It also should be pointed out that the FDA added a warning label to Tamiflu back in November of 2006, based on numerous reports of delirium and suicide in children. The FDA warning states “People with the flu, particularly children, may be at an increased risk of self-injury and confusion shortly after taking Tamiflu and should be closely monitored for signs of unusual behavior”
This data suggests that the benefit to risk ratio should be properly assessed in children on the basis of individual cases and according to the severity of the flu case.
A disturbing revelation nowadays is that the swine flu virus is becoming resistant to Tamiflu which is the most effective antiviral drugs for treatment. Flu viruses normally swap genes as part of their normal evolution; that means resistant viruses could quickly spread worldwide. But it is comforting that pandemic (Swine) flu is still largely vulnerable to the drug, unlike many seasonal flu viruses, which are now broadly resistant and more difficult to treat.
Studies inform us that as of November 2009, only 52 out of over 10,000 samples of 2009 swine flu tested worldwide have shown resistance to oseltamivir and World Health Organization (WHO) reported 57 cases of Tamiflu-resistant swine flu virus and additional cases are being investigated in the U.S. and U.K.
But regarding the seasonal flu, Tamiflu is not very effective in the 2008 seasonal H1N1 virus anymore due to acquired resistance in 99.6% of all 2008 seasonal H1N1 strains, up from 12% in 2007-2008 flu season, as declared by the CDC.
Finally we have to say that most people infected with flu virus 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, generally speaking patients who have weak immunity; these patients will need an effective treatment.
However the hopes are still high that Tamiflu will continue to be effective against the pandemic swine flu virus to prevent a worldwide disaster of further spread of the virus.

Reported in 7 Countries Including the U.S

H1N1 strain has mutated yet again. However, the W.H.O. (World Health H1N1 Swine Flu Mutations Reported in 7 Countries Including the U.S Organization) says that it is nothing to be concerned about. They report that infections were seen in very fewpeople. However, I think that there is something to be concerned about.
The W.H.O. also says that people with normal uncompromised immune systems, will not allow the spread of the mutated virus as easily. Dr. Keiji Fukuda, chief flu adviser of the W.H.O.'s director general, said that the change in the virus did however cause resistance to the medicine used to fight it, Tamiflu. Reassuringly, Dr. Fukuda stated, "We don't know the full answer, but it is more likely that we are not seeing a major shift."
Dr. Fukuda also said that flu's mutate so fast, that it is difficult to keep up with how widespread they are, and their severity. He also stated that W.H.O. scientists are unsure of the threat posed by another mutation that would allow the virus to reach the lungs easier. This mutation has been discovered in various countries including; Ukraine, Norway, China, Japan, Mexico, Brazil, and the United States, in diverse stages of severity. This is why I think we should be concerned. The swine flu strain began as a mutation of the seasonal flu, this mutation led to what is now the modern day pandemic. I believe that scientists should be investigating these mutations more seriously.
The earliest detection of the mutation is from April 2009. Many of the cases that were found in the above countries were fatal; however, many were also mild, therefore, it is correct to say that the mutations are similar to most other mutations in that all cases vary in severity, just like the original H1N1 swine flu, which also is a mutation of influenza. Flu travels inter-species very easily, and can mutate to be very resistant to anything we throw at it, whether it is vaccines or antivirals.

Local pharmacists fight scarcity by mixing Tamiflu

Some Indiana pharmacists are using a couple of the tools apothecaries used centuries ago - the common mortar and pestle - to bring some relief to children suffering the symptoms of H1N1 and the more common seasonal flu.Health officials have been warning that the Americans most at risk from swine flu are the youngest ones, children from 6 months to 24 months old. The flu danger has been complicated for weeks by a national scarcity of prescription liquid Tamiflu, favored by many doctors for patients too young to swallow capsules.
At right, Jim Kodman compounds a batch of liquid Tamiflu at Gatti Compounding Pharmacy in Indiana
Tamiflu is often prescribed to reduce the severity and duration of a flu infection. To get the most out of the medicine, patients need to take it as soon as possible after flu symptoms appear.
According to Jim Kodman, an Indiana pharmacist and owner of Gatti Compounding Pharmacy in Indiana, Tamiflu was never a blockbuster drug until this fall. But it's been in demand this autumn with the presence of swine flu and seasonal flu simultaneously.
Compounding is a process in which a physician and pharmacist work together to develop customized medications for one particular patient, frequently using raw ingredients in the pharmacy.
"The idea of compounding is to meet one individual patient's needs,'' often based on the patient's weight, Kodman said. Compounding usually becomes more common when large medicine manufacturing companies can't meet the demand. And the unsatisfied demand now is for liquid Tamiflu.
"There is no supply of the liquid. That's a national problem,'' Kodman said.
What Kodman and other compounding pharmacists are doing is using Tamiflu capsules, which are readily available, to make a liquid version of the medicine that is easier for small children to swallow.
"It's one of the simpler compounds to make,'' but it takes time, Kodman said.
The compounding pharmacist must open the capsule by hand, pour the powdered medicine into a mortar and grind it with a pestle. The pharmacist then blends the medicine with a syrup and the resulting mixture has a viscosity between water and the syrup that tops an ice cream sundae. A flavoring is also added to make the medicine more palatable to children.
A critical aspect of compounding is knowing how much of the medicine to use.
Tamiflu capsules are manufactured in the 75-mg size, but young children typically need only 30 to 60 mg, depending on their body weight, Kodman said.
"Usually a fraction of the capsule is used,'' he said.
One Web site suggests that parents can crush Tamiflu capsules themselves and mix the medicine with chocolate syrup for their children.
Kodman said he would not recommend that to a parent.
"The last thing you'd want to do is give your child the wrong dose,'' he said.
Most of the prescriptions Kodman has been receiving for compounding liquid Tamiflu are coming from emergency room physicians at Indiana Regional Medical Center.
Adam Kochman, director of pharmacy at IRMC, said the hospital's own compounding pharmacists have been following the recommendations of the Centers for Disease Control and Prevention to make the hospital's liquid form of Tamiflu.
The IRMC pharmacists compound the first dose of liquid Tamiflu for an ill patient to take even before he or she leaves the emergency room, and a prescription is sent out to one of the local retail pharmacies for more doses the patient can take at home, Kochman said.
Vicky Coark, pharmacy manager at the Giant Eagle Pharmacy in Indiana, said her staff has been compounding a few prescriptions each week for Tamiflu liquid, mainly from physicians in the Indiana area.
She said she hasn't received any news about when commercially manufactured Tamiflu liquid will be available again.
And Robert Kasisky, a pharmacist and owner of the Eaglescripts pharmacy in Indiana, also stands ready to compound liquid Tamiflu if needed.
From his vantage point, Kasisky believes the number of local flu cases may have peaked about one month ago.
But based on his observations as a pharmacist for 17 years, he said, "I don't think we're out of the woods yet.''
He anticipates another spike in local flu cases in mid-winter.

Over 1,000 deaths in a week, main increase in Americas

The swine flu epidemic death toll is now officially at 7,826, according to the World Health Organization. Mutated and resistant strains are playing a yet-undefined role in the death toll. Around 1,200 mutated strains have been identified.
Europe recorded 300 deaths in the previous week. Most fatalities were in the Americas, where 554 deaths were recorded over that period, up to 5360 up from 4806. That figure indicates deaths from infections of all forms, and represents over 10% of the whole in the time frame.
WHO is monitoring the mutated strains of the virus but is unable at this stage to identify a definite trend in terms of progression. The nature of flu strains is that while some may become killers, many actually mutate into harmless forms.
There’s a problem with predicting mutation characteristics and their effect on viral populations. In a recent case, a mutant form of virus completely replaced the previous strain. In this case a Tamiflu resistant strain became the primary strain.
Epidemic time frames are another problem. A recent flu outbreak in Mexico created a panic, but was relatively brief, and the reporting of the epidemic left a lot to be desired. The moral is that the first case scenarios tend to produce more rumors than facts.
Basic flu, the common version, is believed responsible for 36,000 deaths in the US every year. Swine Flu isn’t yet in that league, globally. The high mutability of this disease isn’t good news, but if it follows the normal pattern of mutation, only a few strains will be dangerous.
Avian flu was a case in point in terms of assessing the relative dangers of mutation. Only one of several strains was identified as a high probability killer, although all strains were lethal in several cases.
So the educated approach is “Don’t get too concerned… yet.”
The ultra-pandemic scenario to worry about it is a “plague” syndrome with high degrees of human to human transmission and lethality. That isn’t the case at this stage. For a communicable disease with an extremely high level of infections, the death rate for Swine Flu is if anything statistically very low.
The spike in deaths may represent a seasonal peak in terms of normal epidemiological assessment methodologies.

Tamiflu shortages for kids give birth to doses with ice cream

Doctors and pharmacists are racking their brains to work out creative formulas to cope with shortages of Tamiflu influenza treatment for small children who have been principally hit by the ragin H1N1 flu epidemic, with some coming up with doses of adult formula mixed with ice cream.
Tamiflu is administered typically in sweetened dry syrup for small children and in capsules for adults, which are deemed too bitter for small children.
For this flu season, Chugai Pharmaceutical (OOTC:CHGCY) Co., the sole manufacturer and marketer of Tamiflu in Japan, has planned to produce enough of the antiviral drug for 12 million people, around three times more than last season. It includes the dry syrup formula for around 3.6 million, which Chugai started making in September.
According to the Ministry of Health, Labor and Welfare, about 80 percent of flu patients in Japan are underage children chiefly comprising students in primary and lower secondary schools.
In that age bracket, patients have been increasing particularly among those aged 7 or younger, resulting in demand for the Tamiflu dry syrup far outstripping projected supply.
A Chugai spokesman said, ''Since the beginning of November, we haven't been able to catch up in supply. We're producing at full capacity and aren't in a position to boost supply any further.''
Against this backdrop, the health ministry issued information to clinics and hospitals in early November, telling them they ''may re-administer Tamiflu removed from capsules for pediatric formulas and quantities in the event there are no other alternatives.''
Because of its bitter taste, doctors and pharmacists are suggesting doses mixed with ice cream or yogurt, for instance.
Kazutaka Hosoda, a doctor at Navitas Clinic in Tachikawa on the outskirts of Tokyo, points to potential problems with re-administering the adult version for children, saying, ''Redoing preparations takes time and some children may not be able to consume the treatment because it may be too bitter.''
If a child stops taking the drug because of such problems, there may be a risk that the flu virus develops resistance to it, he added.
Hosoda said there are effective drugs other than Tamiflu and he prescribes Chinese medicines.

The doctor's prescription for swine flu: Get a grip

A barrage of media coverage — photographs of people wearing face masks and stories about terrified officials closing schools.
How to avoid it? How many will it kill?
Are we all going to die?
Remove the letters “d,” “e” and “m” from the word “pandemic” and you get America’s response to swine flu. But are the school closings, canceled travel plans and frantic calls to doctors worthy of the threat?
Incredibly, with a fact-gathering tool as powerful as the Internet, people still react without thinking to the hyperbole of a public official and a scary headline on the 5:30 news. In doing so they create problems disproportionate to the hazard and actually impair the official response.
Regarding swine flu, the doctor’s orders would seem to be: Take a deep breath (face masks optional) because a check of the facts reveals swine flu will be no worse than the barnyard varieties of flu we deal with on a regular basis.
But there’s that menacing word: “pandemic.” It sounds so much like “epidemic,” doesn’t it? What most people don’t know is the word “pandemic” refers to the coverage area of a contagion, not its severity. The World Health Organization recently elevated swine flu to a category 6, its highest level of coverage, which means the virus has spread to enough countries to be considered a global phenomenon. But that doesn’t mean it will be Shiva, destroyer of worlds.
In its most recent report, the Centers for Disease Control and Prevention estimates as many as 34 million cases of swine flu have been reported in the United States from April through October, resulting in as many as 153,000 hospitalizations and 6,000 deaths (the high estimates).
Those are frightening numbers — until you consider that in a normal, non-pandemic year as many as 36,000 Americans die of the flu.
Let’s put those numbers into context. Suppose you heard that in your county, 10 people died of swine flu. You might be tempted to keep your children home, load up the rifles and sit down to a meal of MREs and a screening of “28 Days Later.” Yet in a normal year as you shopped at Walmart, dodged sniffles at the office and warmed chicken soup for your flu-addled family, 60 people in your county died of ordinary flu.
What would you do? Probably nothing.
Yet parents demanding that little Abercrombie receive the vaccine are besieging doctors’ offices, creating problems of supply, demand and more importantly, the physicians’ ability to respond to legitimate health issues. And the indiscriminate use of anti-virals such as Tamiflu actually poses the risk of breeding a vaccine-resistant strain of the virus.
More significantly, the very latest WHO report indicates the pandemic may have spiked in North America. The CDC reports new cases and hospitalizations have fallen three weeks in a row in November. Has the biological apocalypse passed us by? That possibility has somehow escaped folks.
And while the virulence of swine flu isn’t known right now, it appears, from most reports, that it’s no more potent than ordinary flu.
It’s entirely possible the swine flu virus could mutate and become a deadly killer. But it’s more likely the virus will simply run its course and you will deal with it the way you dealt with SARS, ebola and West Nile … by living your lives as you always have.
Thirty-six thousand killed by regular flu. Six thousand killed by swine flu?
Pandemic or panic?
Don’t panic.

Costa Rica to invest $18 mln to combat second wave of A/H1N1 flu

Costa Rica announced an investment of 18 million U.S. dollars on Thursday in an effort to fight the second wave of A/H1N1 flu expected to hit the nation in January 2010.
To combat the flu, the country's social security system (CCSS) would purchase 30 X-ray machines, 97 fans, and 18,000 Tamiflu (oseltamivir) treatment dosages for patients who need it.
It would also buy 70 refrigerators to store 300,000 vaccines expected to arrive in the country in the next few days.
CCSS President Eduardo Doryan also said that some 227 new jobs would be created as the country was to strengthen patient supervision and improve patient care for the flu pandemic.
So far this year, Costa Rica has reported 40 deaths due to the A/H1N1 influenza.

Medical personnel report giving many regular and swine flu shots

Local physicians and clinics report administering varying amounts of flu immunizations and many are still receiving doses of the H1N1 vaccination.
Amiee Fulk, public relations coordinator for Banner Churchill Community Hospital, said the hospital staff have given out approximately 850 regular flu immunizations and 100 H1N1 immunizations, specifically to health care providers and first responders. She said fewer than 50 doses of Tamiflu have been given out to patients.
The Churchill County community health nurse gave out 421 H1N1 immunizations, said Ben Kieckhefer, public information officer for the Nevada Department of Human Health Services.
Dr. Lana Narag of the Narag Fallon Family Clinic said her clinic has administered approximately 300 regular flu immunizations and 345 H1N1 immunizations. Narag said she wasn't sure how much Tamiflu has been given out, but it was a lot.
Walgreens spokesman Robert Elfinger said the local Fallon Walgreens received 200 H1N1 doses to administer, and nationwide, the drugstore chain has given out over 5 million regular flu immunizations and offers liquid Tamiflu. Elfinger said a new shipment of H1N1 vaccine will be administered beginning Friday.
Spokesmen for these locations said no one has reported adverse reactions to the H1N1 vaccine.

H1N1 vaccine considered 'safe' by U.S. health officials and WHO states Tamiflu is still effective

Following the latest news this week that the World Health Organization (WHO) had received reports from both the U.K. and the the U.S. on H1N1 swine flu mutations and resistance to drugs, WHO has stated that Tamiflu should still be used in the majority of cases for H1N1 swine flu treatment. In addition, although the recent H1N1 vaccine recall in Canada may make people reconsider having the H1N1 vaccine, U.S. officials have stated that the H1N1 vaccine is still 'safe'.
Using Tamiflu to treat H1N1 swine flu
Tamiflu proved ineffective in treating H1N1 swine flu in cases in both the U.S. and the U.K. but these incidences were with people who all had a “compromised immune system”. WHO officials have now stated that Tamiflu was still an effective drug in treating H1N1 swine flu in “the majority of cases”.
The safety of the H1N1 vaccine
News on the recall of a batch of H1N1 vaccines in Canada earlier in the week may have prompted fears over the safety of the H1N1 vaccine in the U.S. However, U.S. health officials have reported that the H1N1 vaccine is 'safe', and where side effects have been reported, the majority have been 'minor'. Many pregnant women however are still concerned over reported miscarriages and the effect of the ingredient thirmerosal in H1N1 vaccines.

WHO says Tamiflu still works against swine flu

The World Health Organization says isolated cases of drug-resistant swine flu in Britain and the United States have not changed the agency's assessment of the disease.
It says Tamiflu remains highly effective against the vast majority of H1N1 cases.
Four cancer patients in a North Carolina hospital tested positive last week for a type of the flu that was resistant to Tamiflu. Five people at a British hospital also didn't respond to the drug after contracting the flu.
WHO flu chief Dr. Keiji Fukuda said Thursday that investigations were under way, but that the American and British patients for whom Tamiflu did not work had severely weakened immune systems.

Tamiflu still fights H1N1 despite resistant cases

The isolated cases of Tamiflu-resistance in swine flu patients in Britain and the United States likely aren't a sign that the virus is becoming resistant to the antiviral drug, a WHO spokesperson said Thursday.
The UN health agency has not changed its assessment of the disease, WHO flu chief Dr. Keiji Fukuda told reporters.
Clusters of resistance have been discovered at hospitals in Wales and North Carolina and need to be investigated further, he said.
The cases occurred in severely immunocompromised patients, who are at risk of developing drug resistance.
What health officials are on the lookout for are signs that resistant strains of virus are moving from patients to infect those with healthy immune systems, and there is no reason to suggest that has happened, Fukuda said.
"What it points out is there needs to be a lot of vigilance taken with those groups of patients, but it probably does not have big implications for the overall pattern of spread or the overall patterns of illness in the general community," he said from Geneva during the WHO's weekly briefing on the swine flu pandemic.
So far, 75 cases of Tamiflu resistance related to the H1N1 influenza A virus that causes swine flu have been reported to WHO.
On Wednesday, public health officials reported one more patient has tested positive for H1N1 virus resistant to Tamiflu at a hospital in Cardiff, raising the total number of cases in that hospital to six.
It was not unexpected that more patients exposed to the original case would test positive for the resistant strain, said Dr. Roland Salmon, director of the National Public Health Service Communicable Disease Surveillance Centre in Cardiff.
"The emergence of influenza A viruses that are resistant to Tamiflu is not unexpected in patients with serious underlying conditions and suppressed immune systems, who still test positive for the virus despite treatment," Salmon said in a release.
"In this case, the resistant strain of swine flu does not appear to be any more severe than the swine flu virus that has been circulating since April."
Mutation in Norway
Last week in North Carolina, four cancer patients tested positive for a type of flu virus that was resistant to Tamiflu.
More investigation will also be needed into a mutation reported by health authorities in Norway to clarify whether the mutated virus is more likely to trigger severe illness or become more common.
"And the question is whether this mutation … suggests that there is a fundamental change going on in viruses out there or whether there is a turn for the worst in terms of the severity? And I think the answer right now is that we are not sure."
Fukuda also commented on Canada's vaccine surveillance system, which picked up a potential problem in one lot of H1N1 vaccine that was halted from further use. Before then, six people who were vaccinated from the batch developed anaphylaxis, or severe allergic reaction.
On Wednesday, the Public Health Agency of Canada confirmed 24 cases of anaphylaxis among people who have received the H1N1 vaccine.
Flu activity appears to be leveling off in some areas of the northern hemisphere, but Fukuda cautioned against saying activity has peaked until there is a definitive downward turn.

Police raid drug importers for illegally marketing antiviral meds

Police raided the offices of five pharmaceutical importers on Wednesday for illegally advertising the anti-influenza drug Tamiflu online.
Osaka Prefectural Police searched the five drug importers after they advertised the anti-flu drug without government authorization -- a violation of the Pharmaceutical Affairs Law.
It was the first time police have carried out raids in the investigation of the illegal trade of anti-influenza virus medication, which is becoming increasingly common as swine flu spreads rapidly throughout Japan.
Currently, the Ministry of Health, Labor and Welfare restricts sales of Tamiflu to its official Japanese distributor Chugai Pharmaceutical Co., and the advertisement or sale of the drug by other dealers is prohibited by the pharmaceutical law.
Investigators have searched a total of 12 locations in six prefectures, including the branch offices of one Osaka-based company, three Tokyo firms and one individual importer in Okayama.
Police allege the five distributors advertised the product by uploading photographs of Tamiflu 75mg packages to their Web site, in an apparent attempt to sell them for between 8,200 and 16,000 yen per 10 capsules, while claiming to be personal trade facilitators providing import management services.
Police will investigate whether the importers have already sold unapproved anti-flu drugs to customers.

State Asks Pharmacies To Give Free Flu Meds

The state has sent letters asking pharmacies to give the medicine free of charge to those who can't pay.
"We're seeing an outbreak," said pharmacist Phillip Bradley of Bradley Drug Co., who said he's seeing a lot of patients with the flu, both H1N1 and seasonal, but not all of his patients are getting help.
"We're seeing a lot of prescriptions coming through here that are antivirals, but I know that a lot of my customers that are uninsured, I don't see them coming in with prescriptions," said Bradley.
The government sees the problem, too, which is why the state just sent letters to all the pharmacists in Tennessee asking them to dispense antiviral medications -- normally Tamiflu -- to uninsured and under-insured Tennesseans who can't afford it for free.
The pharmacies themselves have to sign up for the program, but Bradley said he thinks it's a good idea
"My initial thought is it's a great thing for Tennesseans," he said. "A lot of the uninsured do not have the ability to get antiviral medications because of the expense, so through the state and through the pharmacy association, we're going to be able to dispense these antiviral medications at no charge."
Tamiflu costs about $100 if it's paid for out of your pocket.
In an unprecedented move, the state will dispense the medicine to the pharmacies from a state stockpile to help prevent the spread of H1N1and perhaps counter the fact that it's been difficult keeping up with vaccination demand.
"We'll be able to hopefully help limit the antiviral activity in this community," said Bradley.
Doctors will let pharmacists know which patients can't afford the antiviral medicine by writing "TDH stockpile" on the prescriptions.
Pharmacies are still in the process of signing up with the state, so you will need to check with your doctor and pharmacy before you can get the free medicine.

WHO probing drug resistant swine flu

The World Health Organization is looking into reports in Britain and the United States that the H1N1 flu may have developed resistance to Tamiflu in people with severely suppressed immune systems, a spokesman said Tuesday.
Britain's Health Protection Agency (HPA) said five cases have been confirmed in Wales of patients infected with H1N1 resistant to oseltamivir -- the generic name of Roche and Gilead Sciences Inc's antiviral drug Tamiflu.
The patients had serious conditions that suppressed their immune systems, which can give the virus a better than usual opportunity to develop resistance, the HPA said. It said the drug-resistant strain had probably spread person to person.
"We have seen the reports, we need to look into them," WHO spokesman Thomas Abraham said in Geneva.
The U.S. Centers for Disease Control and Prevention last week also reported four cases of H1N1 resistant to Tamiflu at Duke University Hospital in North Carolina. All were said to be very ill with underlying severely compromised immune systems and multiple other complex medical conditions.

The WHO spokesman said both the reports involved Tamiflu resistance in people with severely compromised immune systems.
"We'll see if we need to put any additional measures in place to protect this vulnerable group of patients. It might mean that they are at more serious risk than others," Abraham said.
People with suppressed immune systems, such as those undergoing chemotherapy or suffering from HIV are more likely to fall ill from infections.
The WHO has previously reported cases of the pandemic virus being resistant to oseltamivir but says these are rare.

Roche CEO sees group outpacing market in 2009-paper

Swiss drugmaker Roche's (ROG.VX) pharma and diagnostics units will significantly outpace the market this year, the group's head was quoted as saying in an interview on Wednesday.
Roche is also confident it will reach its recently raised sales growth target for its pharma division of at least high-single digit growth, chief executive Severin Schwan told Swiss weekly Handelszeitung in an interview.
Schwan said he was confident the pharma unit would gain market share thanks to its strong drugs pipeline, adding the group would announce 2010 targets for the unit at the start of next year.
Roche, the world's biggest maker of cancer drugs, posted a forecast-beating 10 percent rise in third-quarter sales last month, helped by demand for Tamiflu due to the H1N1 swine flu pandemic. [ID:nLD628052]
Schwan said the group's pharma unit was still growing faster than the market, even when excluding Tamiflu sales -- likely to be above 2.7 billion Swiss francs ($2.67 billion) this year -- and Roche's key cancer drugs were seeing double-digit growth.
Schwan said Avastin, which had annual global sales of 5.2 billion Swiss francs in 2008, still had considerable potential, with over 450 trials running on more than 30 different cancer types.
Separately on Wednesday, Roche said it had filed for European approval to extend the use of Avastin to patients with metastatic breast cancer in combination with a broader range of standard chemotherapies.[ID:nGEE5AO05D]
Roche sealed a $47 billion buyout of U.S. partner Genentech earlier this year. Schwan said the group was now looking for small and mid-sized acquisitions.
The group repaid 7 billion francs of debt from the Genentech buyout in the third quarter and Schwan said the group would be able to get rid of 25 percent of its debt next year and have a positive net-cash position by 2015.
Schwan said Roche was sticking to its dividend policy despite the Genentech deal. Roche paid a dividend of 5 francs this year.
Roche stock was trading up 0.24 percent at 167.80 Swiss francs, slightly underperforming a 0.6 percent rise in the European pharmaceuticals sector .

H1N1 is now a full blown mutated pandemic in many countries

If you thought the H1N1 story was history then you might be mistaken. Reports from the CDC, the WHO and doctors confirm that the "plague" that was and still is in the Ukraine now spread to cities all over the world where the lungs of people fill with blood, their lungs get destroyed within days and then they die.
In the Ukraine currently we see people getting infected, going to hospitals but not coming out again. They remain sick for longer than usual, we also hear of a lot of people where they die and their lungs are filled with blood.
According to the WHO they said earlier this month that the H1N1 in Ukraine was the same as in other countries but afterwards they said it did in fact mutate. In Norway the disease or whatever we may call it mutated as well according to the WHO that said also earlier this month that:
The Norwegian Institute of Public Health has informed WHO of a mutation detected in three H1N1 viruses. The viruses were isolated from the first two fatal cases of pandemic influenza in the country and one patient with severe illness.
Norwegian scientists have analysed samples from more than 70 patients with clinical illness and no further instances of this mutation have been detected. This finding suggests that the mutation is not widespread in the country.
The virus with this mutation remains sensitive to the antiviral drugs, oseltamivir and zanamivir, and studies show that currently available pandemic vaccines confer protection.
Worldwide, laboratory monitoring of influenza viruses has detected a similar mutation in viruses from several other countries, with the earliest detection occurring in April. In addition to Norway, the mutation has been observed in Brazil, China, Japan, Mexico, Ukraine, and the US.
So that means that the h1n1 has mutated in all the above countries according to the World Health Organization.

Analysing Tamiflu on the Fortis C18 column

Fortis Technologies has published an application note showing the successful analysis of Tamiflu (oseltamivir) on its silica-based Fortis C18 column.
The official method approved by the Centre for Disease Control and Prevention (CDC) shows that the best option for the analysis of oseltamivir is by using high-pH mobile phase to neutralise the analyte.
A Fortis C18 column is used in this application due to its ability to work with high-pH mobile phase systems.
Based upon a silica particle template, the bonding process of Fortis C18 allows the full use of the pH range from 1-12 without the need for a hybrid technology.
Being able to operate on a silica particle means no loss of efficiency, loadability or speed of equilibration.
Scalability and ease of method transfer from UHPLC through to preparative chromatography is maintained in the simplest of fashions.

Egypt to make own Tamiflu

Health Minister Hatem el-Gabali said on Tuesday that Egypt will produce the Tamiflu vaccine for both Avian and Swine flu patients, locally, at 75 Egyptian pounds ($14) per packet, explaining that it will import raw materials from different bodies accredited by the World Health Organization. The minister confirmed that the price of the virus testing in Private labs in the country would cost some 800 Egyptian pounds ($145).
Gabali stated during the fourth session of the 6th development of health services conference in Sharm El Sheikh that “strategic stockpiles of Tamiflu available in the ministry , are enough,” pointing out that the epidemic situation of the disease is “stable and the death rate did not exceed three per one thousand, less than a quarter of the death rate in countries the world.”
He also confirmed that the ministry continues to conduct the virus tests for free to selected groups of citizens in need, stressing that “not all the labs are equipped to conduct such tests, especially the provision of reagents used to make the testing possible,” explaining that allowing private labs the ability to make these tests does not mean that the ministry will give up conducting such examinations.
He stressed that the ministry will give the infected Tamiflu for free within and outside the hospitals run by the ministry, meaning that some people will be given Tamiflu without being held in hospital. It is part of the ministry’s efforts to help create a means to treat as many individuals as possible.
The ministry warned laboratories against the public declaration of the results of the tests they give, noting the need to inform the ministry of positive results before going public and to “be approved by a consultant physician or specialist who holds a doctorate degree” from the ministry.
Egypt has seen more than 3,000 H1N1, or Swine flu, cases since it was first discovered in the country last June. At least 10 people have died from the disease, but the ministry says its efforts to curtail the spread of the virus are “having results.” The Avian flu, or bird flu, has been more detrimental to Egypt, with dozens of people dying from the deadly virus since it first arrived in the country in early 2006.
Egypt is a major gateway for air-born diseases as it lies on the cusp of three continents and is a major migratory stop for birds. The ministry, and global health officials, fear a mutated form of Avian and H1N1 into a virus that could ravage the population.

Tamiflu-Resistant H1N1 Flu Strain Shows Up

Could there be a new strain of H1N1? That's what health officials are investigating after several cases seem to be resistant to the treatment drug Tamiflu.
Four patients at Duke University Medical Centers in North Carolina and five in Wales have been diagnosed with a strain of flu too strong for Tamiflu to treat.
Health officials with the U.S. Centers for Disease COntrol and Prevention say this doesn't indicate a health emergency. But there is concern over what appears to be mutations of the virus.
"We are unable to say if their deaths were caused by influenza, they are influenza associated but they had medical issues that were compromising their health," said Megan Davies, a North Carolina state epidemiologist.
The virus is just as severe, but this new mutation of H1N1 has a different characteristic. It might not be treatable with medications currently available.
"This resistance is from a mutation but its doesn't mean H1N1 in general is mutating. It's a mutation that has occurred in a small number of patients," said Dr. Zack Moore, a medical epidemiologist.
Health officials with CDC are investigating the connection - if any - between the Duke and Wales patients.
Doctors at Duke were still treating one patient who appeared to have the mutated H1N1 strain with the drug Relenza. She appeared to be recovering.
"The vast majority of people with influenza do not even receive antivirus treatment. This mutation is a moot point to most of us. However, it's something we have to pay attention to when we see it," said Davies.
Dr. Frank Esper with Rainbow Babies Children's Hospital at University Hospital said over 1,000 H1N1 cases were screened at the hospital for resistance and only 10 were Tamiflu-resistant.
So, Tamiflu is still able to treat the vast majority of H1N1 flu cases. Esper says flu viruses are constantly changing so there was no surprise the H1N1 strain mutated to survive.
Vaccination against H1N1 still appears to be effective.

Swine flu - is a Misinformation?

As one of the two MedPage Today writers on full-time H1N1 duty since the beginning of the outbreak in April, I feel like I know the issues well enough to help clear up misconceptions when they come up in conversation.
The other day, just such a situation presented itself. An acquaintance of mine, who is pregnant, said she was very concerned about H1N1 because "pregnant women can't fight it off."
Although pregnant women have a tougher time fighting off infection from H1N1 and other pathogens, it's certainly not a lost cause. But I let that one go.
This acquaintance's fear was heightened, however, by something she had heard -- that pregnant women who come down with H1N1 flu can't be treated the same way as non-pregnant people because the drugs used to battle the virus will kill the baby. Not might kill the baby. Will kill the baby.
I was shocked when I heard this because presumably she was talking about antivirals, for which pregnancy is not a contraindication.
I was also surprised because this is not a myth surrounding the H1N1 pandemic that I'd heard before.
For the record, oseltamivir (Tamiflu) and zanamivir (Relenza) are "Pregnancy Category C" drugs, which means there haven't been any clinical studies evaluating the safety of these medications for pregnant women.
But they've been used for seasonal flu and according to the CDC, "the available risk-benefit data indicate pregnant women with suspected or confirmed influenza should receive prompt antiviral therapy."
For treatment of pregnant women, the CDC recommends oseltamivir as the drug of choice because of its systemic activity.
The agency is less clear regarding chemoprophylaxis: "Zanamivir may be preferable because of its limited systemic absorption; however, respiratory complications that may be associated with zanamivir because of its inhaled route of administration need to be considered, especially in women at risk for respiratory problems."
I explained to my acquaintance that the CDC recommends antiviral treatment for pregnant women and that there was no evidence that the drugs were killing fetuses.
I hope, in the event that she does develop flu-like symptoms, that she won't hesitate to seek treatment.
The exchange made me wonder, though: What other misconceptions about H1N1 and the vaccine are floating around out there?

Stockpiling Tamiflu Is Not A Healthy Habit

Research shows H1N1 flu activity is down across the city and the country, but that is not stopping some people from stocking up on the most popular anti-viral treatment. NY1's Health reporter Kafi Drexel filed the following report.
For months, the children's version of Tamiflu, or the liquid form of the anti-viral drug, has been in limited supply across the country.
There's still plenty of supply in the city, but with the Swiss drugmaker Roche not expected to make more available in the United States before January, pharmacists like Charles Tabouchirani of Cherry Pharmacy in Manhattan's Upper East Side have been busy converting the adult capsule form to pediatric doses.
"We are seeing more prescriptions for Tamiflu and the initial reaction from a parent, because we are a pediatric pharmacy, is panic when they know the Tamiflu suspension is not available," says Tabouchirani. "But of course we can make it, we can compound it. It's as effective and actually tastes a little better than the manufactured Tamiflu."
While there hasn't been as much flu activity in New York City as there was this spring, health officials say pharmacists are reporting an increase in Tamiflu prescriptions particularly for young children ages zero to four. And they say that activity is out of proportion with the amount of illness currently circulating around the city.
"It is really about people nervous and stockpiling, which is a bad idea for a couple reasons," says Dr. Don Weiss of the city's Department of Health. "One, you put it in your cupboard, you forget about it. Then maybe you need it, it's already expired. Two, although we don't have a shortage of Tamiflu now, if people continue to stockpile, then maybe there will be a shortage and it won't be available to people who really need it."
Cases of a Tamiflu-resistant strain of the virus have been reported in Europe in patients with serious underlying medical conditions, and the Centers for Disease Control has already confirmed a resistant strain of H1N1 flu in a small cluster of patients in North Carolina.
While they continue to investigate, health officials say those small pockets of illness, compared to millions of other cases across the globe, do not mean a sudden shift towards a more dangerous strain of the virus. Another antiviral treatment, Relenza, has still worked in some of those patients.
There's no way of knowing if H1N1 flu activity in New York and across the country will continue to calm down or increase along with seasonal flu in the coming months. So in the meantime, most doctors still say the most important thing people can do is to get vaccinated when they can for both seasonal and H1N1 flu.

Fear of the flu

For a few moments, Austin Torres was afraid he was going to die.
The night before, Austin found out he had the flu strain known as H1N1, the 11-year-old had a sore throat, headache and fever. His mom, Denise Torres, knew what was wrong but didn’t tell him at first. Austin woke up the next day feeling worse, so Torres took him to the doctor’s office, where tests confirmed he had H1N1.
When Torres told Austin he had H1N1, he immediately became upset and started crying.
“I was kind of scared. I had heard of all those deaths from H1N1,” said Austin of Tarboro.
Austin’s reaction wasn’t a complete surprise for Torres, a physician assistant with the Chronic Heart Failure Clinic at Heritage Hospital. She had seen worse reactions from parents who found out their children had or were suspected of having H1N1. It can be terrifying for parents whose only knowledge of the illness comes from news stories about outbreaks or deaths.
H1N1 needs to be taken seriously, as evidenced by the fact that many people in the United States and abroad have died from it, said Carol Schriber, a spokeswoman for the N.C. Department of Health and Human Services. From April through Sept. 26, when health officials stopped differentiating H1N1 from other influenzas, the state reported 13 deaths and 267 hospitalizations from laboratory-confirmed H1N1.
However, much of the fear surrounding H1N1 stems more from its unpredictability than from it actually being worse than other strains of flu, she said.
Until this year, the flu for many people meant vaccinations in October and the possibility of catching it from November to early spring, Schriber said. Older people usually were the most at risk.
Then H1N1 showed up this spring and hung on through summer, fall and now probably into winter, Schriber said. Instead of older people, children and young adults ages 6 months to 24 years are the most at risk.
“When it is something new, and of course nobody knew how bad H1N1 might get, then it becomes scarier. When it hits different populations than we are used to, then it gets scarier for people,” Schriber said.
In reality, the strains share most of the same symptoms: fever, cough, sore throat, runny nose, body aches, headaches and tiredness, Torres said. Some people with H1N1 also might have diarrhea or vomiting.
In most cases, health care officials are telling people suspected of having H1N1 that the virus will have to run its course, Torres said. It lasts an average of three to five days but can linger for weeks depending on the person and his or her immune system.
Because of shortages and fear of developing a resistance, antiviral drugs such as Tamiflu mainly are reserved for children, pregnant women and people already suffering from other conditions that can lower a body’s defenses, including diabetes, asthma and heart disease, Torres said. Tamiflu stops H1N1 from replicating and often cuts its normal run by two days or lessens the symptoms.
Since Austin has asthma, he was considered in the high-risk group and put on Tamiflu, Torres said.
Paula DeLong, 53, wishes she had been given Tamiflu when her first symptoms showed up Oct. 5. She originally was diagnosed with a bad cold and, later in the week, bronchitis.
“I got worse and worse. In fact, that weekend was the weekend I thought I was going to die. All I could think about was that my heart wasn’t getting enough oxygen and that I was going to have a heart attack,” said DeLong, sales and marketing manager at the Rocky Mount Telegram.
When DeLong’s conditioned worsened and she returned to the doctor Oct. 14, she was told she had severe bronchitis most likely as a result of H1N1. She couldn’t be tested for the virus because the limited number of test kits doctors receive are reserved for higher risk patients. DeLong wasn’t able to return to work for 3 1/2 weeks.
While health officials continue to work on the medication shortage problem, they encourage people in high risk groups to get their H1N1 vaccine and for everyone to continue the good practices of washing their hands regularly, coughing into their sleeves and staying home if they are sick, said Karen Ramsey, health education supervisor at Nash County Health Department.

1918 Flu Pandemic Genes Found in Current Swine Flu

Recombinomics has stated that a paper published by the National Institute of Health has reported the presence of similar binding receptors in swine flu samples from Brazil, Ukraine and Norway.
Although WHO stated that this change was "not significant" in the Ukraine samples, it was associated with the fatal cases and is cause for concern. The concern was increased by the announcement from Norway indicating the same change was found in fatal H1N1 lung infections there also.
Some have commented that this change was spontaneous and diid not spread, although this change was found in all four deceased patients in Ukraine from two distinct locations -- meaning they did indeed spread. What is serious, though, is what this means for the spread of the pandemic.
The concept of acquisition via recombination has serious implications for the current pandemic. It was used to predict the D225G change, in part because the change was "in play" and appearing in July/August sequences at increasing frequency, even though the H1N1 sequences represented different genetic backgrounds. Similarly the clusters of Tamiflu resistance in Wales and North Carolina are also driven by recombination, as happened when the identical change was acquired in H1N1 seasonal flu in patients who were not taking Tamiflu (oseltamivir).
These changes to the swine flu virus are making it resistant to Tamiflu, the best medicine to fight this kind of viral infection.
Similarly the clusters of Tamiflu resistance in Wales and North Carolina are also driven by recombination, as happened when the identical change was acquired in H1N1 seasonal flu in patients who were not taking Tamiflu (oseltamivir).

Cox Warns Consumers About Tamiflu Drug Prices

Attorney General Mike Cox today announced the results of an undercover survey that showed significant price variations at pharmacies across the state for the H1N1 drug Tamiflu. Cox’s team of investigators looked into the price of liquid Tamiflu, a form commonly used to treat children, at fifty different pharmacies across five Michigan communities and found that some consumers may be paying more than they need to.
Excluding select pharmacies offering free Tamiflu while their supplies last, the Attorney General discovered that statewide prices ranged from $28.00 at one Lansing pharmacy to $140.00 at a pharmacy in Grand Rapids. Pharmacies in Detroit, Flint, Grand Rapids, Lansing and Traverse City were contacted, and the price range in each community included:
Detroit- $50.00 to $122.00;
Lansing- $28.00 to $119.00;
Grand Rapids- $47.90 to $140.00;
Flint- $48.00 to $94.00; and
Traverse City- $54.90 to $129.99
Cox urges Michigan residents to shop around for the best price on Tamiflu and all their prescription needs. The Attorney General’s office is contacting pharmacies with higher prices to gain more insight into why some have prices that are significantly higher than others.
“The high cost at some pharmacies of a drug that can save lives is disturbing,” said Cox. “These prices show the importance of checking more than one pharmacy, especially residents without insurance.”
Cox also released a consumer alert today, titled “How to Safely Save Money on Prescription Drugs,” including tips to help consumers shop around for the best price on a prescription for Tamiflu and other drugs. The consumer alert, found at www.michigan.gov/tamiflu also warns consumers to stay away from so-called “miracle” H1N1 cures that they may find on the Internet.
Consumers who believe they have been charged an excessive amount for Tamiflu should contact the Attorney General’s Consumer Protection Division at (877) 765-8388. Complaints can also be filed at www.Michigan.gov/ag.
Michigan consumers looking for additional information about the H1N1 or seasonal flu, including tips to help prevent or treat the flu, and examples of fraudulent flu products, are encouraged to visit http://www.flu.gov.

Swine flu type found in North Carolina develops resistance to Tamiflu

The dreaded swine flu is getting smarter and smarter meaning the medical community has to keep working on ways to battle the strand that has sickened thousands from coast to coast.
Federal health officials confirm that four people in North Carolina have tested positive for a strand of swine flu has developed a resistance to the drug Tamiflu.
This new finding makes the NC cluster the first the U.S. has seen of that many cases so close together.
Health officials say the cases came out of Duke University Medical Center in Durham, North Carolina.
Tamiflu has been touted as one of two of the most effective treatments to fight the swine flu, though health officials are now keeping a closer eye on the warning signs that that virus is beginning to mutate again which would make the drug ineffective.
According to the Associated Press, “About 52 resistant cases have been reported in the world since April, including 15 in the U.S. so far. Officials with the U.S. Centers for Disease Control and Prevention say almost all the U.S. cases have been isolated.”

Wales Tamiflu-resistant swine flu responds to Relenza - One antiviral still works on H1N1 mutatio

The H1N1 swine flu virus is mutating, causing more severe illness and resistance to antiviral medications. More severe strains of H1N1 mutation have been identified in Norway and the Ukraine. The Norwegian and Ukraine flu outbreaks cause bleeding in the lungs. Tamiflu-resistant swine flu clusters have been found in North Carolina and Wales, while isolated incidents of antiviral-resistant strains of swine flu have been identified all over the world.
Tamiflu-resistant swine flu mutation
The swine flu mutation that results in a resistance to treatment by the antiviral medication Tamiflu has been found in two clusters. Four patients in a North Carolina hospital were diagnosed with the antiviral-resistant strain of H1N1 within a six-week span. Three of the four patients passed away, although it is unknown if the swine flu was the cause of death. In Wales, five patients have been identified as victims of the H1N1 mutation, with an additional three infections undergoing investigation.
Relenza as alternate antiviral treatment
Relenza is an alternate antiviral treatment to the use of Tamiflu in cases of the swine flu mutation. In addition, this antiviral medication is recommended by the manufacturer for the prevention of H1N1 infection. According to a Stanford Study, Tamiflu and Relenza are equally effective in the prevention of flu symptoms in uninfected people, but safety information for children has not been explored.

Drug-resistant swine flu strain spread between patients at a Welsh hospital

THE first European cases of a strain of swine flu which cannot be treated with the drug Tamiflu have been diagnosed in Wales.
The five patients at the University Hospital of Wales, in Cardiff, could also be the first confirmed cases of person-to- person transmission of Tamiflu-resistant swine flu in the world.
Two of the patients have been treated and discharged, one is in critical care and the remaining two are on a ward receiving treatment.
It is thought that they contracted the virus, which must be treated with an alternative antiviral medicine, while they were in hospital.
Public health officials last night took steps to reassure the public that Tamiflu, which is also known as oseltamivir, is safe.
The Government stockpiled millions of doses of the drug, which can cut the duration and severity of flu infections, before the emergence of the swine flu pandemic in April.
The drug has been used as a first line treatment in those people who become infected and have underlying health problems, putting them at greater risk of complications.
Dr Roland Salmon, director of the National Public Health Service for Wales’ (NPHS) communicable disease surveillance centre, said: “The emergence of influenza A viruses that are resistant to Tamiflu is not unexpected in patients with serious underlying conditions and suppressed immune systems, who still test positive for the virus despite treatment.
“In this case, the resistant strain of swine flu does not appear to be any more severe than the swine flu virus that has been circulating since April.
“For the vast majority of people, Tamiflu has proved effective in reducing the severity of illness.
“Vaccination remains the most effective tool we have in preventing swine flu so I urge people identified as being at risk to look out for their invitation to be vaccinated by their GP surgery.”
The NPHS last night said that all the patients at UHW who have been diagnosed with Tamiflu-resistant swine flu have been treated with an alternative antiviral. They have either been isolated or are being cared for in a designated area for influenza cases. All other patients on the unit have also been tested for swine flu.
The NPHS said that Cardiff and Vale University Health Board has ensured that all appropriate infection control measures are in place on the unit.
Patients and staff at the unit have been offered swine flu vaccines and those patients due to come onto the unit for treatment will be contacted over the weekend and advised to have the swine flu jab before they are admitted.
Household contacts of the patients with swine flu are also being followed up to ensure early and appropriate treatment is offered should they develop flu-like symptoms.
Dr Tony Jewell, Wales’ chief medical officer, said: “We know that people with suppressed immune systems are more susceptible to the swine flu virus, which is why they are a priority group under the first phase of the vaccination programme in Wales which is progressing at pace.
“We have stringent processes in place for monitoring for antiviral resistance in the UK so that we can spot resistance early and the causes can be investigated and the cases managed.
“Identifying these cases shows that our systems are working so patients should be reassured.
“Treatment with Tamiflu is still appropriate for swine flu and people should continue to take Tamiflu when they are prescribed it.
“It’s also important that good hygiene practices are followed to further prevent the spread of the virus.”
The emergence of Tamiflu- resistance swine flu is not unheard of – the World Health Organisation said 28 resistant viruses have been detected and characterised.
The emergence of Tamiflu- resistant swine flu at UHW came a day after the swine flu-related death toll rose to 21 in Wales and it was confirmed that children under five will be offered the swine flu jab.

Tamiflu-resistant swine flu prompts vaccination call

PEOPLE in Wales at risk of contracting swine flu were urged today to get vaccinated against the virus after it emerged five people have been diagnosed with a strain resistant to Tamiflu.
The advice came from Dr Roland Salmon, director of the Communicable Disease Surveillance Centre at the National Public Health Service for Wales (NPHS).
He was speaking after it was announced five patients at University Hospital for Wales in Cardiff have been diagnosed with a strain resistant to the antiviral drug.
Dr Salmon said: “Vaccination is the most effective tool we have in preventing swine flu, so I urge people identified as being at risk to look out for their invitation to be vaccinated by their GP surgery.”
More than three million healthy children under five across the UK are also to be offered the swine flu jab, it was announced earlier this week.
Parents will be invited by their GPs to bring their children into surgeries, with vaccinations expected to start in December.
The Tamiflu-resistant strain will become much more common as the virus mutates, according to a flu expert.
Three out of the five patients diagnosed at the University Hospital for Wales remain in hospital, after it was revealed they could be the world’s first cases of person-to-person transmission of the virus, the NPHS said.
Professor Nigel Dimmock, a virologist at the University of Warwick, said: “This is just the beginning. You have got a lot of viruses and if you use Tamiflu at the level they are using it you get resistance.
“However, they probably aren’t resistant to Relenza, the other anti-viral. You need other mutations to make it resistant to Relenza.
“Also, the vaccine is coming on so people regard Tamiflu as a stop gap and there’s no need to panic.”
He added it was unsurprising person-to-person transmissions had started. “This is the trouble with going into hospitals, where you can get MRSA, C.diff, Norovirus and so on,” he said. “You go in with something and you come out with a virus, it’s a well known problem.”
Wales swine flu
Three of the five people on a unit for those with severe underlying health conditions at the hospital in Cardiff appear to have acquired the infection on the ward, the NPHS said yesterday.
Two of the five have recovered and have been discharged from hospital, one is in critical care and two are being treated on the ward.
Prof Dimmock said the likelihood of the cases in Cardiff causing an outbreak of the resistant strain hinges on how well the virus has been contained.
He said: “It depends how well the people in Cardiff have been able to restrict the spread of the virus. US figures show that one in 80 are diagnosed, meaning for every person that knows they are sick, there are 79 that do not know they have it.
“If it has affected more people and they don’t know, it could spread.”
Cardiff and Vale University Health Board has put appropriate infection control measures in place on the unit, the NPHS said.
Prof Dimmock added: “The fact people have recovered is a good sign, there doesn’t seem to be anything sinister about developing a resistance and it is what everybody expected.
“This is probably the first time an anti-viral has been deployed on a global scale. Everybody knows if you put an anti-viral in front of a virus it will mutate because viruses don’t have DNA, they have RNA.
“DNA can correct itself but RNA can’t, so mutations stick.
“Resistance will become more and more common so we will use Relenza and then it will become resistant to Relenza. These drugs are useful but they are short term.”
The Government last night played down fears that the resistant strain could now become widespread after the Health Protection Agency (HPA) confirmed there had previously been “no documented episodes of person-to-person transmission”.
A Department of Health spokeswoman said: “Examples of Tamiflu resistance are very rare, but when this does occur it has often been among these especially vulnerable patients. In other words, because their immune systems are compromised, it is more likely for resistant viruses to develop.”
On Thursday the World Health Organisation (WHO), which has reported 57 incidents of Tamiflu resistance worldwide, received four reports of possible person-to-person transmission in a US hospital.
An HPA spokesman said the possibility that the American viruses have been transmitted within the hospital was also being investigated.
The Welsh cases occurred in patients with haematological problems who had compromised immune systems because of their disorder or because of chemotherapy, the agency added.
The HPA said in a statement: “To date, a total of nine (swine flu) confirmed cases have been reported amongst patients on a hospital ward in Wales.
“Five of these cases are known to be resistant to oseltamivir (Tamiflu), one is sensitive and for three resistance status is presently unknown.”
The statement said the risk to the general healthy population was “low”.
It added: “There is no evidence that the oseltamivir-resistant virus is any more virulent than any other type of flu. The situation is being kept under review.
“Further follow-up of cases and their close contacts both on the ward and in the community is under way to ascertain if there is evidence of onward transmission.
“The virus remains sensitive to the other frontline drug, Relenza, which is being used as an alternative anti-viral and patients are responding well.
“Although further epidemiological investigation is under way, it would seem likely that transmission of oseltamivir-resistant H1N1 virus has taken place.”
Dr Salmon said the emergence of a resistant strain was “not unexpected” in patients with serious underlying conditions.
He added: “In this case, the resistant strain of swine flu does not appear to be any more severe than the swine flu virus that has been circulating since April.
“For the vast majority of people, Tamiflu has proved effective in reducing the severity of illness.”
Wales’s Chief Medical Officer Dr Tony Jewell said people with suppressed immune systems were designated as a priority group for vaccination because they were known to be more susceptible to the virus.
“Treatment with Tamiflu is still appropriate for swine flu and people should continue to take Tamiflu when they are prescribed it,” he said.
Latest figures show 214 people in the UK with swine flu have died – 21 in Wales, 142 in England, 38 in Scotland and 13 in Northern Ireland. The majority had underlying health conditions.

A Few Things Parents Should Know About Tamiflu

Several weeks ago, I had a "personal experience" with a young teen being diagnosed with H1N1 aka "swine flu" by his pediatrician. The antibiotic Tamiflu was prescribed for treatment of the H1N1 flu.
This writing is to alert parents to educate themselves about Tamiflu in the treatment of the H1N1 flu -- especially as it relates to children and make a competent decision with your pediatrician before filling that prescription -- weighing out what is safe for your child or loved one. The FDA warning on Tamiflu states, “People with the flu, particularly children, may be at an increased risk of self-injury and confusion shortly after taking Tamiflu and should be closely monitored for signs of unusual behavior.”
It was noted that some children were struck with psychosis, delusions, and paranoia – all in formerly normal children. The FDA issued a warning about Tamiflu's potential for producing skin rashes.
It wasn't until reports surfaced of more than 100 new cases of delirium, hallucinations and other abnormal psychiatric behavior in children treated with Tamiflu that the FDA changed course and required Roche, the company that makes the drug, to include a warning label cautioning patients, doctors and parents to look out for strange behavior in anyone taking the drug. The patent for Oseltamivir (Tamiflu) is held by Gilead Sciences and is valid at least until 2016. Gilead licensed the exclusive rights to Roche in 1996. The drug does not enjoy patent protection in Thailand, Philippines, Indonesia and several other countries.
Gilead is politically well connected and is financially very rewarding to many. Donald Rumsfeld served as chairman from 1997 until he became U.S. Secretary of Defense in 2001; former Secretary of State George Shultz and the wife of former California Governor Pete Wilson, Gayle Wilson also had served on the board. By the way, this is the same Donald Rumsfeld who was CEO of Searle -- maker of Aspartame which is an artificial sweetener treated with much skepticism because of medical writings concerned with ties to increased cases of cancers, autism and parkinson's disease as well as a myriad of other physicial disabilities and diseases.
Aspartame is an additive in many diet soft drinks -- as well as other diet foods. When Searle was absorbed by Monsanto in 1985, Rumsfeld reportedly received a $12 million bonus. The "political" ties to what is affecting the American people in drug treatment as well as foods is concerning. Tamiflu and Aspartame tied to a former Secretary of Defense -- Rumsfeld and a Secretary of State -- Shultz.
An Internet TV station reporting to the American people on the dangers of what we put into our bodies and other timely issues -- Former Vice President, Al Gore. (This probably falls under a public service).
Oh and Rudy Giuliani's ties to the maker of OxyContin (Purdue Pharma). More on Rudy later -- especially since he is considering a run for the U.S. Senate. My hope is that he does announce his candidacy because I'm anxious to do that writing. The purpose of this article is to encourage the American people to read information on drugs they are being prescribed -- especially prescribed to their children -- and to read, read, read ingredients contained on labels -- especially what is being ingested by children.
There is a reason for the huge jump in autism in this country. An article I recently read said 1 in 100 children is diagnosed with autism in the U.S. Scary, isn't it? So if a former Secretary of Defense (Rumsfeld) was defending us against our enemies abroad -- who was defending us against Rumsfeld and his financial ties to the pharmaceutical industry?

Don’t give up on swine flu jab

THE five Welsh patients with a Tamiflu-resistant strain of swine flu have increased the need for those at risk to be vaccinated, health officials have said.
Over the weekend, three of the five remained in Cardiff’s University Hospital of Wales. The five are thought to be first confirmed person-to-person cases of a Tamiflu-resistant strain in the world.
Concerns exist that those in need of vaccination will now pass up the offer because they believe the virus is untreatable, but hospital officials warned the opposite was true and that vaccination was more important than ever.
Dr Roland Salmon, director of the National Public Health Service for Wales’ (NPHS) communicable disease surveillance centre, said that the emergence of a Tamiflu-resistant strain was not unexpected where patients had serious underlying conditions and suppressed immune systems.
He said: “I wouldn’t like people to go away with the idea that this is completely untreatable.
“This is a very special set of circumstances, and it remains to be seen whether this would actually happen out in the community, where most of the people you would meet would have perfectly normal immune systems.
“One of the things this does say to us is, if anything, it makes vaccination more important and particularly vaccination of those people who have been top of the priority list, which is those with underlying health conditions of the type which have given rise to the problem here.
“The one medicine, an important medicine that we’ve got a lot of, Tamiflu, these patients have developed resistance to.
“But there is another perfectly good treatment, Relenza or Zanamirvir, still available and to which this virus is not only sensitive but, for various biological reasons, we expect to remain sensitive.”
Two of the five Cardiff patients were treated and discharged while one is spending the weekend in critical care and the other two are on a ward being treated.
It is thought that they contracted the virus in hospital, but health officials have stressed there is no risk to anyone else.
Tests have been carried out to establish what happened and officials have issued reassurances to the public that Tamiflu, also known as oseltamivir, is safe.
The Government stockpiled millions of doses of the drug, which can cut the duration and severity of flu infections, before swine flu first emerged in April.
The drug has been used as a first line treatment in those people who become infected and have underlying health problems, putting them at greater risk of complications.
Despite the latest alert, statistics show that cases of swine flu are falling
Dr Salmon said: “The number of people contacting their GP with flu symptoms has stalled and started to decline slightly over Wales as a whole.
“Nevertheless, flu is still circulating and we therefore continue to emphasise the importance of being aware of the symptoms of swine flu and of the steps that can be taken to prevent its spread.
“The vaccine against swine flu has been tested and approved. It is now being offered to people at most risk of complications from the virus as well as front line health and social care workers.
“Vaccination is the most effective tool we have in preventing swine flu, so I urge people identified as being at risk to look out for their invitation to be vaccinated by their GP surgery.”
In the UK, 214 people with swine flu have died – 21 in Wales. Most had underlying health conditions.

All about the pill that helps you beat the H1N1 virus

Confronted with the mounting casualties of influenza A H1N1, the government introduced major changes in the testing and treatment guidelines for the virus three months ago.
Initially, Tamiflu was only available in government hospitals, now the drug can be obtained from select pharmacies on a doctor's prescription.
Guidelines regarding its administration have also been relaxed. While earlier only those who tested positive for H1N1 were given Tamiflu, now doctors are free to prescribe it to anyone they feel is a high- risk candidate.
"If a patient has high fever, congestion, cough and bodyache, which is incapacitating the patient and who has a history of travelling to high-risk areas, we can put him on the medicine till test results come," says Dr Ellora Nanda of swine flu (H1N1) screening centre, Moolchand Medcity.
Some doctors, however, feel that the drug should be taken only after a laboratory confirmation of the H1N1 virus infection.
"Unnecessary use of Tamiflu can impair the body's ability to fight virus, and even create resistance to the drug in some people," says Dr M.P. Sharma, head internal medicine Rockland Hospital.
Tamiflu is an antiviral drug which works by slowing the reproduction of the virus that causes swine flu in the body and isn't recommended for ordinary seasonal flu. This isn't a sure cure for flu and research has found that it may reduce the amount of time people have symptoms of flu by just about a day.
It's best taken within 48 hours of getting flu symptoms as this is the time the virus is replicating in your body. It may also reduce the risk of people developing complications such as pneumonia, and protect a person from getting symptoms if they have been exposed to the infection.
Tamiflu doesn't work for everyone though.
This comes in capsule as well as liquid form for children and adults who have problems swallowing. People who have kidney problems and pregnant women are usually offered another antiviral drug called Relenza (zanamivir) instead.
The most common side-effects of this drug are nausea and vomiting. Other reported effects are stomach pain, diarrhoea and headache. Some children and teenagers have reported unusual symptoms like vivid nightmares and delirium. Side effects in adults are less common than in children.

Swine flu jab to be offered to healthy under-fives

Healthy children aged between six months and five years old will be vaccinated against swine flu from next month, the Department of Health has confirmed.
The expansion of the government's inoculation programme comes as the latest pandemic bulletin reported a sharp rise in the number of children being admitted to hospital and a further surge in patient deaths.
The overall estimate of swine flu cases, however, showed a second successive weekly fall. Health officials estimate there were 55,000 new cases this week in England compared with 64,000 last week. There was also a dip in cases in Scotland. The decline could still be a temporary consequence of warm weather or half-term: pupils have been one of the main transmission routes.
The number of people who have died from swine flu in the UK has risen to 215, with 18 deaths in England alone last week. The figures since the start of the outbreak in May now stand at 142 fatalities in England, 21 in Wales, 39 in Scotland and 13 in Northern Ireland. Among the latest confirmed deaths was that of a five-year-old schoolgirl from Slough, Berkshire.
The number of people needing hospital care for the virus is 783, down slightly from 785 in the previous week. Of those in hospital, 180 were in intensive care - up from 173 the previous week. 
The decision to include young children in the next phase of the inoculation programme comes as evidence accumulates demonstrating their vulnerability to the H1N1 virus. Around 21% of all H1N1 deaths in the UK have been among the under-14s. More than 80% of the under-fives who ended up in hospital had no previous health problems.
The existing vaccine priority groups include those with pre-existing medical conditions, their carers and pregnant women. Youngsters with asthma or diabetes, for example, are already being vaccinated. The additional categories will raise the target numbers for priority vaccine groups from 14 million to approaching 20 million. GPs are expected to begin offering the vaccine to healthy young children before Christmas even if they have not inoculated all their patients in other priority groups. 
The chief medical officer, Sir Liam Donaldson, said: "Protecting those most at risk from the disease will reduce the levels of serious illness, and deaths. That's why we will shortly offer the vaccine to young children. 
"Vaccination remains a personal choice, but I urge everyone who is offered the vaccine to accept it and protect themselves. While the risks of serious complications from flu may be small, the impact on those affected can be devastating."
Professor Terence Stephenson, president of the Royal College of Paediatrics and Child Health, said: "[We] strongly recommend that parents should get their children vaccinated if they are offered the vaccine. We would like to emphasise the importance of children's doctors and nurses being vaccinated too, not least to prevent passing the infection on to their patients who may be vulnerable children with serious diseases."
Andrew Lansley, the Conservative health spokesman who has urged the government to vaccinate healthy children, said: "This is in line with emerging evidence that they are one of the groups with the highest rates of hospitalisation, which is putting a real strain on the NHS."
Around 715,000 people are estimated to have caught the infection. Nearly two-thirds of those who have died in the UK have been under the age of 44.
The Medicines and Healthcare Regulatory Agency (MHRA) yesterday released further details of reported adverse reactions to vaccines and anti-viral drugs prescribed for swine flu. It said that no safety concerns had emerged. Eight deaths had been reported among patients who took Tamiflu but: "These cases have been fully evaluated and in none of these is there evidence to confirm that Tamiflu was directly responsible for the fatal event. Underlying medical conditions and/or concurrent infection provide a more plausible alternative explanation for the events."