By Susan Brinkmann, OCDS
Getting a flu shot is more important than ever this year as experts say virtually all the flu strains occurring in the United States this season are resistant to the leading antiviral drug Tamiflu. Scientists and health officials are trying to figure out why.
The situation is not yet considered to be a public health crisis only because this year’s flu season is below average and the main strain circulating can still be treated with other drugs, but infectious disease experts are still worried.
Last year, the Centers for Disease Control (CDC) reported that 11 percent of throat swabs taken from infected patients showed a Tamiflu-resistant strain. This year, 99 percent do.
“It’s quite shocking,” said Dr. Kent Sepkowitz, director of infection control at Memorial Sloan-Kettering Cancer Center in New York told the International Herald Tribune. “We’ve never lost an antimicrobial this fast. It blew me away.”
The CDC responded by issuing new guidelines urging doctors to test suspected flu cases as quickly as possible to see if they are influenza A or influenza B, and if they are A, whether they are H1 or H3 viruses. Right now, the Tamiflu-resistant strain, H1N1 is causing almost all the flu cases in the country except in a few mountain states where H3N2 is more prevalent.
Quick testing is crucial because antiviral drugs work only if they are taken within the first 48 hours. A patient with severe flu could be given the wrong drug and die of pneumonia before test results come in. So the new guidelines suggest that doctors check with their state health departments to see which strains are most common locally and treat their patients accordingly.
“We’re a fancy hospital, and we can’t even do the A versus B test in a timely fashion,” Sepkowitz said. “I have no idea what a doctor in an unfancy office without that lab backup can do.”
New York City has tested only two flu samples as of Jan. 6, and both were Tamiflu-resistant, said Dr. Annie Fine, an epidemiologist at the city’s health department. Flu cases in the city are only “here and there,” she said, and there have been no outbreaks in nursing homes. Elderly patients, and those with the AIDS virus or on cancer therapy are most at risk.
But, she added, because of the resistance problem, the city is speeding up its laboratory procedures so it can do both crucial tests in one day.
“And we strongly suggest that people get a flu shot,” she said. “There’s plenty of time and plenty of vaccine.”
The flu typically kills about 36,000 Americans a year, the CDC estimates, most of them the elderly or the very young, or people with problems like asthma or heart disease; pneumonia is usually the fatal complication.
Experts are unable to say exactly how the Tamiflu-resistant strain emerged.
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