In the UK, at Cardiff’s University Hospital of Wales, person to person transmission of Tamiflu (Oseltamivir) resistant H1N1 infections is confirmed. There were 5 reported cases, all occurring at a unit treating individuals with underlying health conditions. At least ‘three (cases) appear to have been acquired in the hospital’. A sixth case, in a patient linked to the group of five, was confirmed today. Dr Roland Salmon, Director of the National Public Health Service of Wales’ Communicable Disease Surveillance Centre, commented that ‘the resistant strain does not appear to be any more severe’ than non-resistant circulating H1N1 strains.

Two patients have been discharged from the hospital, three patients are still being treated at the unit, one remains in critical care. The sixth patient was reported today; there is currently no update on the patient’s condition. Household contacts for all infected patients are being followed up. Test results for one additional patient who was in contact with the now 6 infected cases are imminent. However, all other patients in the unit have tested negative for H1N1.

In the USA, 4 Tamiflu resistant H1N1 cases have been confirmed at Duke University Medical Hospital. The cases have occurred over the past 6 weeks, and were recently confirmed by the Centers for Disease Control & Prevention (CDC). Like the UK cases, all Tamiflu resistant viruses came from an isolated ward of the hospital, and all patients had underlying chronic conditions. ‘Experts from CDC, State of North Carolina Public Health Department, Durham County Health Department, and the Duke Division of Infectious Diseases are now working to better understand the nature of these cases’.

These UK and US cases have all been treated with alternative antivirals, and it appears the spread of the particular drug resistant H1N1 viruses is contained. These cases emphasize that medical advice should be followed in using H1N1 antiviral medication. Drug resistant organisms can develop and spread rapidly.