# 6086
In Indonesia the antiviral Tamiflu ® (Oseltamivir) has been distributed fairly liberally over the past 6 years whenever there has been a suspected case of H5N1.
Households, whole neighborhoods - sometimes entire villages - have been placed on prophylactic antivirals in what is commonly called a `Tamiflu Blanket’. The idea is to stop or prevent household or community transmission of the virus.
And the fact that we’ve seen only a few clusters of the H5N1 virus over the years is suggestive that this policy may have been at least partially successful.
But the fear when you use antivirals is that over time, the targeted virus will develop resistance.
That happened in 2008 with the old seasonal H1N1 virus (which was supplanted by pandemic H1N1 in 2009), and in recent months we’ve seen small indications that it may be occurring in some strains of the new H1N1 virus (see NEJM: Oseltamivir Resistant H1N1 in Australia).
So far, most of the H5N1 cases we’ve seen have appeared to be sensitive to oseltamivir, although a few resistant cases have been documented in Indonesia and Egypt.
See CIDRAP’s 2007 article Tamiflu-resistant H5N1 strain surfaces in Egypt and 2005 article Tamiflu resistance in avian flu victims sparks concern.
One of the striking features about Indonesia’s H5N1 cases is the high CFR (Case fatality rate) of 82% – even with antiviral treatment – which is more than double that seen in Egypt (35%).
Today, Indonesia’s Health Minister Endang Rahayu Sedyaningsi is quoted in the media as worrying that oseltamivir may be losing effectiveness against the Indonesian strains of bird flu.
A hat tip to Diane Morin on FluTrackers for finding the following article which appears in Media Indonesia. The original link to the Indonesia (Bahasa) language version is HERE.
The following is a machine translation.
Indonesia Health Minister Suspected Bird Flu Immune Drug
Authors: Cornelius Eko SusantoFriday, January 20, 2012 22:47 pm
JAKARTA - MICOM: Health Minister Endang Rahayu Sedyaningsih suspect in Indonesia has occurred the possibility of resistance (drug resistance) to the drug oseltamivir.
The hypothesis was made based on the presence of some positive victims of bird flu in Indonesia are still died despite oseltamivir have been given early on.
"I suspect resistance to oseltamivir has been happening in Indonesia. That is why the death rate of bird flu patients here reaches more than 80% when oseltamivir was given, "said Minister of Health at a press conference after the ministerial coordination meeting to discuss bird flu on Friday (20 / 1), in Jakarta.
Himself said, there may exist specific genes in the H5N1 virus in Indonesia that caused the H5N1 virus in Indonesia is more virulent than the H5N1 viruses that exist in other countries.
"Honestly, I was curious as a former researcher with the possibility of the existence of this gene," he said.
If there is resistance to oseltamivir, Indonesia no longer has a drug to counteract the spread of the H5N1 virus. Because, oseltamivir is the only drug that can kill the flu virus, although with certain prerequisites and conditions.
In the market, oseltamivir sold under the brand Tamiflu. (Tlc/OL-5)
Based on this article, this theory appears predicated on anecdotal observations; mostly the high CFR. What is needed now is genetic sequencing of these isolates to look for known resistance markers.
One of the big concerns over Indonesia’s prolonged refusal to share samples of the H5N1 virus was that the virus would mutate or change without the world being aware what was happening.
With new virus sharing agreements put into place last year, hopefully the world will get a good look at the viral evolution in Indonesia and be able to document if any serious changes have occurred.
Stay tuned.
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