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.
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.
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