What is the situation in the WHO Eastern Mediterranean Region?
To date, WHO has been informed of 364 laboratory-confirmed cases of human infection with pandemic (H1N1) 2009 - influenza A(H1N1) - from 15 countries in the WHO Eastern Mediterranean Region: Bahrain (15 cases), Egypt (67 cases), Iraq (11 cases), Islamic Republic of Iran (1case), Jordan (22 cases) Kuwait (34 cases), Lebanon (47 cases), Morocco (17 cases), Oman(3 cases) Palestine (30 cases) Qatar (10 cases), Saudi Arabia (89 cases) Tunisia (3 cases), United Arab Emirates (8 cases) and Yemen (7cases).
What is the latest information on emergence of antiviral resistance?
The National Influenza Centre (NIC) in Denmark has (today) reported the first detection of an oseltamivir-resistant pandemic H1N1 virus which was confirmed by the WHO Collaborating Centre in London, UK. This resistant virus, which has a H274Y mutation, is however sensitive to zanamivir. The resistance has not been seen in other viruses from the same cluster of 2 other cases.
How did the resistance develop?
The patient in whom the resistant virus was detected had received oseltamivir prophylaxis. The precise mechanism for development of this resistance is still under investigation.
How is antiviral resistance detected?
Antiviral resistance is only detectable by laboratory analysis using molecular based methods and/or phenotypic assays.
Does this mean that oseltamivir-resistant viruses will now spread?
It is too early to predict. It is possible that this will remain an isolated finding and it is possible that additional resistant viruses will be found. WHO is closely monitoring the situation through its Global Influenza Surveillance Network and other networks and will provide updated information when available.
What are the recommendations for clinical treatment of cases now with the discovery of an antiviral-resistant isolate?
WHO treatment recommendations remain unaltered. WHO is working with experts to develop more comprehensive guidance on use of antivirals for both seasonal and pandemic influenza. These guidelines, which are anticipated within the next month, will include recommendations for dealing with viruses with differing susceptibilities to antivirals.
How is WHO monitoring the situation?
The WHO Global Influenza Surveillance Network, comprising 126 national influenza centres in 97 countries, continuously monitor antiviral resistance among other virological characteristics through laboratory surveillance of circulating and emerging influenza viruses globally, including their antiviral susceptibility. Other networks are monitoring from clinical and epidemiological perspectives. WHO and its partners continue to monitor antiviral drug resistance.
Should I take an antiviral now as a preventive measure against the new virus?
No. You should only take an antiviral, such as oseltamivir or zanamivir, if your health care provider advises you to do so. Individuals should not buy medicines to prevent or fight this new influenza without a prescription, and are advised not to buy such antivirals over the internet.
For the latest update go to: www.emro.who.int/csr/H1N1 and www.who.int