Recombinomics: United States Deploys Tamiflu Stockpile to Asia

Recombinomics Commentary
May 22, 2006

The United States has sent a supply of Tamiflu to Asia to help the region prepare for a human outbreak of avian influenza, U.S. Health and Human Services Secretary Mike Leavitt said on Monday.

"I am not going to specify the amount or the location, but I want to make clear that we are beginning to deploy it," he said

The deployment of Tamiflu treatment courses to Asia is cause for concern. Tamiflu supplies in the United States are below those of most industrialized countries, so deployment from the US signals a potentially serious situation.

The current H5N1 bird flu outbreak in North Sumatra, Indonesia has recently caused concern because the number of fatalities in the cluster rose to seven today and the transmission chains appears to have extended through three of four generations.

Today's fatality was the father of a member of a large cluster. The father had left the hospital and refused Tamiflu treatment prior to being readmitted and dying on Monday. His time at home may have exposed additional family members and contacts. Moreover, earlier reports had described three additional family members who began to show H5N1 bird flu symptoms last week. The latest case was withheld from the WHO update as were the disease onset dates. Witholding of this information creates additional concerns..

Interestingly, today WHO announced that they were approving the use of amantadine for the treatment of H5N1. Although amantadine resistance had been found in the clade 1 cases in Vietnam, Thailand, and Cambodia, the H5N1 human cases in Indonesia and China had been amantadine sensitive and anantadime has been used previously to treat H5N1 patients.

In the past, amantadine resistant H5N1 isolates had been detected in Indonesia and China, but these isolates were rare. The sending of Tamiflu to a secure location in Asia may signal amantadine resistance in Indonesia and the emergence of H5N1 in North Sumatra which does not have the novel cleavage site found in human amantadine sensitive cases in West Java, Jakarta, and Lampung

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